Friday February 23, 2018

Obamacare: Lessons Indian healthcare can imbibe

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health-621353_640By Dr. J.K. Bhutani

The healthcare system of any country, be it US or India essentially has three key players, viz. Providers, Payers and the Public Health. The successive governments have had many successes inter playing these keys and such actions have led to many improvements in the US healthcare delivery systems. But much work still remains to be done. The private and public insurance reforms and other interventions apart, one in six Americans still does not have insurance cover and thus, cannot access the best health care.

The infant mortality, the life expectancy, other health parameters and quality of healthcare have improved over the years but the cost escalation has increased to disturbing levels too. The US health care costs are disturbingly high, so much so that the providers are sometimes labeled as ‘Working just for commerce and profits unlike the forefathers who worked for serving the humanity’.

From Harry Truman shortly after World War II, to Barack Obama now, many presidents have tried to reform the US healthcare system. The most laudable and controversial has been ‘The Patient Protection and Affordable Care Act of 2010’ or ACA, which has attempted to recognize and support the key role of Public Health in the healthcare system. The US Supreme Court recently upheld the nationwide availability of tax subsidies for the implementation of President Barack Obama’s signature healthcare law… Obamacare (Affordable Care Act – 2010).

Of the four components of any health delivery system (Patients, providers, payers, and public health), The Affordable Care Act attempts for more funding and key role of Public Health. The ACA shall reduce ‘out of pocket’ expenses and bring all preventative care under insurance… subsides by the Federal Government. All developing economies including India, need to learn and strengthen the Public Health institutions from the greedy corporates and their ‘Target-business’ models of health delivery for hospitals and service providers.

Other issues which need attention in US and India are –

1. The American health system with a provision of ‘cutting edge technology’, ‘micro-specialization’ and the ‘best evidence-based practice state of the art medicine’, is the role model for the whole world. The costs are more essentially because of the excessive reliance on the investigative ‘work up’ for fear of litigation. The bulk of the common diseases which have self-limiting course are also worked up unnecessarily.

The primary care strengthening should address this and some strategy can be evolved and legislated to keep common day-to-diseases out of the ambit of litigation. This single step can reduce the cost of nearly 80 percent of the diseases which have an insignificant or self-limiting course.

2. The onus of responsibility exclusively on the Federal Government though sounds responsible but is more of a populist measure for winning the elections in democratic set ups. The onus of the physical and mental health of the family and children should be the responsibility of the parents and the role of the governments should be to improve the social component of health like providing good civil conditions and good environment including water, housing etc.

3. The Insurance concept makes us all reckless with our health and should not be owned completely by the governments and should be shared by the people especially for the Metabolic disorders and Lifestyle diseases like Obesity, Hypertension, Diabetes, Trauma, Alcoholism, Drug Abuse, etc. for which the person himself should pay and Federal Government should only have affirmative role in such diseases. These should be out of ambit of Medicare or Medicaid and insurance subsidies….!

JK1

Dr J.K.Bhutani MD is a protagonist of preventive and promotive health care based on austere biology and facilitating self-healing powers of human organism.
You can follow him at https://twitter.com/drjkbhutani

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Air Pollution And Its Effects On Our Heath

Man is not just affected physically but his mental peace takes a toll too due to the increasing air pollution

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Stubble burning is one of the main reason behind heavy pollution in the Delhi and NCR region. Wikimedia Commons
  • Air pollution is a major concern nowadays and has major effects on one’s health
  • There are many toxic air pollutants in our environment which can cause severe health hazards
  • Health-related problems like asthma, headaches, nausea, etc. can be caused as an effect of air pollution

Air Pollution and their dreadful consequences are not some newly found phenomena of the new-found world. There have been instances of hazardous effects even in the past. The three major historic documentation, dating back to the middle of the 20th century, happened at Meuse Valley in Belgium, Donora in Pennsylvania, and London. The most gruesome of the three is the well-known London mishap that claimed over 4000 lives during the episode, due to temperature inversion and associated elevated levels of Air Pollution, and over 8000 lives in the subsequent period.

Air pollution can have severe effects on one's health.
Air pollution can have severe effects on one’s health.

Mankind is in a fast-paced race, always in the process of trying to outwit each other. The numerous developments born out of this race have brought along with them dreadful health consequences. Air Pollution is one such inadvertent yet a disregardful act by humans. The pollution does not begin only when you step out of your homes but is present within your safety havens itself.

According to the World Health Organization report in 2014, 92% of the world population was living in places where the air quality guidelines levels were not met. Outdoor Air Pollution was cited to be the cause of  3.7 million premature deaths in both cities and rural areas. Around 80% of those deaths were due to heart diseases and stroke, and the rest were due to respiratory illnesses and cancers due to exposure to fine particulate matter.

Air pollution can even cause risk of life.
Air pollution can even cause risk of life.
Air pollutants categories:

Air pollutants are categorized into two groups based on their impact, Criteria pollutants and Toxic air pollutants. Criteria pollutants include particulate matter (PM), ozone (O3), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and lead (Pb). (defined by the United States Environmental Protection Agency in the Clean Air Act). These pollutants are present everywhere and cause health issues when present at significant ambient levels. In general, the criteria pollutants are regarded as the cause of most respiratory and cardiac issues.

Also Read: How exposure to air pollution in womb may shorten lifespan

Toxic air pollutants are also known as “hazardous air pollutants,” are substances that cause cancer or lead to other potential non-cancerous effects on the reproductive and neurological systems and have disastrous consequences in the development process. It is also assumed that there is no threshold level of exposure required to cause cancer. Meaning any amount of exposure to these toxic pollutants can lead to cancer.

At risk Populations:

In any geography, the already ailing and sick (pre-existing medical condition) population is more at risk for suffering from the ill effects of air pollution. Apart from this category, young children are the next at risk.

The reason for children being affected more is that they have higher breathing rates than adults. Therefore, they unknowingly inhale a lot more pollutants than an average adult. The potential for exposure is also increased with increased amount of time spent outdoors. The developing lungs of the young people have a limited metabolic capacity to placate toxicity.

Exposure to air pollutants can case cancer as well.
Exposure to air pollutants can cause cancer as well.

 

Air Pollution Respiratory Diseases:

The small particulate matter of the criteria pollutants has the capacity to reach the lowest portion of the lungs, where the gaseous exchange occurs. The larger particles get trapped in the nose and the medium- sized ones settle in the tracheobronchial region.

The effects of the settlement of these particles are upper and lower respiratory symptoms, asthma attacks, loss of quality living days, and restricted activities. Chronic exposure to particulate matter has also been associated with the development of chronic bronchitis- inflammation of the lining of the bronchial tubes. This condition presents as a cough with mucus.

Also Read: Neurologists say rising air pollution can cause stroke among adults

Lung Cancer:

It is a commonly known fact and an “ought to be stressed upon” fact that chronic exposure to polluted air can also lead to the cancer of the lungs.

Ozone’s effect:

Ozone, an oxidant gas that is poorly water-soluble, travels throughout the respiratory tract due to its nature of solubility. It reacts with the molecules on the surface of the lung and leads to pulmonary oedema, inflammation, and the destruction of epithelial cells that line the respiratory tract. Children who stay outdoors in high Ozone areas develop asthma. Some of the disastrous effects are permanent in nature.

Air pollution can harm you even when you are inside your own houses.
Air pollution can harm you even when you are inside your own houses.
Some more Criteria air pollutants:

When Carbon monoxide reacts with blood haemoglobin, it reduces the oxygen-carrying capacity of blood and hence can cause damage to the nervous system. It causes a headache, fatigue, dizziness, coma, respiratory failure, and eventually death.

Nitrogen dioxide is mostly an indoor air pollutant released due to the increasing use of gas stoves. Exposure to high levels of nitrogen dioxide can lead to respiratory distress with symptoms such as cough, shortness of breath, and tightness in the chest.

Air Pollution Cardiovascular Effects:

The above-mentioned actions of air pollutants in the respiratory tract can also affect the cardiovascular system. The inflammation in the breathing tract induces transient hypercoagulability (abnormal blood clotting), the progression of atherosclerosis, and propensity to plaque rupture, especially in people with coronary atheroma. Long-term exposure to Air Pollution can also speed up the atherogenesis process, heart rate invariability, and arrhythmia (irregular heartbeat). Some recent studies have also found a significant relationship between heart attack (Myocardial infarction) and exposure to polluted air.

Air Pollution in Reproductive and Child Health:

Long-term exposure to the air pollutants poses risks even to an unborn child. It causes Intrauterine growth restriction -low birth weight at term, intrauterine growth retardation, smaller fetus for gestational age etc.

Indoor Air Pollution :

Some of the major causes of indoor air pollution are indoor smoking and burning of fuels for cooking purposes, especially in the second and third world countries. The people in these countries cook and heat their homes with biomass fuels and coal. Thus the main noxious gas released is sulfur dioxide, that causes respiratory issues and eye irritation

 

In Delhi, air pollution is a major concern.
In Delhi, air pollution is a major concern.
Quality of life:

Man is not just affected physically but his mental peace takes a toll too when the feelings of insecurity and the perception of having to live in a hazardous environment take over. Severe annoyance, sleep disturbances, reduced the ability to concentrate, communicate or perform normal daily tasks also accompany the psychological stress issues.

Some of the issues are too massive to be controlled at an individual level but a resolution to change can, of course, make a significant impact. Individually we are just one drop of water but together we can make a big ocean.

Simple steps involve following the government regulations in your state regarding the upkeep of your vehicles, carpooling, avoiding the burning of coal, adequate ventilation of your homes to dilute the effect of indoor air pollutants among others.

Wish for a change? Be the change! Same Condition

Air Pollution Health Effects