What we really need: A feminist health policy

This week in health: bridging the gender gap in healthcare, the myth of miracle drugs and Karnataka’s ban on harmful colouring agents.

Updated - March 13, 2024 09:54 am IST

Published - March 12, 2024 02:12 pm IST

Image for representational purpose only.

Image for representational purpose only. | Photo Credit: Getty Images/iStockphoto

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The International Day for Women is not something we ignore at the health desk. No doubt, over the years, the rampant capitalism that surrounds the event, with freebies and offers and discounts galore, has queered the pitch enough for one to be cynical about March 8. But none of that takes away from the fact that it is a day that comes with the entire heft of the feminist movement behind it. It is also significant for us to push for more equitable systems in health care, for equal opportunities for men and women employed in the health sector and addressing women-related health issues in a more sustainable way. This past week, we had all of that, to commemorate Women’s Day in a meaningful way for these columns, addressing several issues across the gender-health spectrum. In a specially curated Op-Ed page,  Dr. Preetha Reddy writes a very important article on bridging the gender gap in health research. The head honcho of the Apollo group of hospitals, starts with the facts, mixed with an opinion formed from years of working within the health sector: With about four billion women in the world, accounting for approximately 49.75% of the population, it is unfortunate that our approach to health and well-being has been shadowed by a deep-seated gender bias. For far too long, women’s health has been confined to gynaecological and reproductive issues.

Quoting the recently- released World Economic Forum’s report, ‘Closing the Women’s Health Gap’, she underscores the profound disparity between men’s and women’s health worldwide. The report elucidated historical neglect in women’s health research, funding, and policymaking, and highlighted the need for a global effort to address the women’s health gap by urging governments, the private sector, and civil society to realign their strategies with a gender-sensitive approach. A definitive, oft-reiterated point is that by prioritising women’s health, we can create a future where health equity is a reality, the author says. For more insights on the subject, hit up the link above. 

Meanwhile, globally, researchers called for a policy that promotes an equitable global health environment on March 8. Advancing the idea of evolving a Feminist Global Health Policy (FGHP, a group of researchers from across various countries came together to reinforce the importance of this. The world should have a policy that addresses the inequality in the existing power structures hindering health equity, according to the researchers Hannah Eger from the School of Public Health at Bielefeld University, Germany, recently led a study in which researchers and activists, including those from The George Institute for Global Health, India, and across the world collaborated. They highlighted the transformative potential of the intersectional feminist approaches in reshaping health policies. The researchers said the policy they envisaged would encompass holistic and inclusive principles that would reshape health policies and make them responsive to the most marginalised communities and individuals. No doubt, such an approach would promote genuine health equity and reproductive justice for all individuals, the researchers said. The framework will have a set of fundamental and globally applicable guiding principles that encompass human rights, equality, democracy, and decoloniality. That’s the advantage of employing a feminist approach - it scarcely will look only at a segment, but is more likely to be all encompassing.

Last week, Saumya Kalia brought together gender and Tuberculosis - two of the world’s pressing issues in need of attention. For India’s homeless women, TB care is shaped by gender norms and economic precarity, she reported. While it is widely acknowledged that a woman is doubly burdened, the weight of being a woman without shelter presses hard against the economic and clinical challenges of managing TB, leaving no recognition or room for the individual. She quotes a new study, supported by the Dr. Amit Sengupta Fellowship on Health Rights (ASFHR) that captures the gendered lens of a clinical disease and challenges rigid mortality numbers. In addition to economic precarity, patriarchal norms decided if the condition was accurately diagnosed, when the woman reached a health facility, how often she followed the six-month drug regimen, and if she would go on to develop drug-resistant TB infections. Experts suggest that stigma and isolation further wrinkle women’s access to care in a system — that without rehabilitation and support — becomes hostile to people lacking institutional agency or autonomy. 

Here’s a look at another serious issue related to women’s health with a deep impact on their overall well-being: anaemia. The southern State of Tamil Nadu recently acknowledged that anaemia and poor weight gain among pregnant women in rural areas remains a cause for concern.  According to Tamil Nadu’s T.S. Selvavinayagam, Director of Public Health (DPH) and Preventive Medicine, at least 50% of women covered under the ‘First 1,000 Days of Life’ initiative, who visit Primary Health Centres (PHC), do not meet the required haemoglobin and weight criteria.“The two criteria [haemoglobin and weight] indicate the kind of antenatal care they are receiving to ensure safe motherhood. These indicators help us to pick up women who are in need of attention. A woman should gain at least nine kg of weight from the start of pregnancy to have a healthy baby. Maintaining ideal body weight and haemoglobin remains a challenge,” he said. It’s important to look beyond the maternal aspect of womanhood, but it is appalling that even in that segment, believed to be of greatest interest to policymakers, there’s a big gap between intent and delivery of services. 

Despite advances in health care, cervical cancer remains the second most common cancer among women in India, with 1.27 lakh cases and around 80,000 deaths being reported annually. Naturally, it figured among our list of stories on the occasion of Women’s Day. Here, Ramya Pinnamaneni, Ananya Awasthi, Dhriti Dhawan and K. Vish Viswanath make an impassioned plea indicating striking out a bold step towards a cervical cancer-free future. The World Health Organization has outlined the ‘90-70-90’ targets by 2030 — for 90% of girls to be fully vaccinated with the HPV vaccine by age 15, for 70% of women to undergo cervical cancer screening tests by the age of 35 and 45, and for 90% of women with cervical cancer to be treated. India’s recent milestone in developing its indigenous quadrivalent vaccine, Cervavac, marks a significant stride towards ensuring accessibility and affordability. Developed by the Serum Institute of India in collaboration with the Department of Biotechnology, and priced at ₹2,000 a dose, Cervavac is cheaper than available vaccines, and holds promise in the fight against HPV infections and cervical cancer. Interestingly, as the roll out proceeds, the authors make a pitch for vaccinating adolescent boys too, to prevent transmission of HPV.

For additional information and a data point-based podcast on awareness or affordability: Why are cervical cancer screening levels low among Indian women, do check this piece by Rebecca Rose Varghese and Sonikka Loganathan.

In tragic news, TV actor Dolly Sohi reportedly died due to cervical cancer hours; nothing of the stunt that small-time actor Poonam Pandey pulled during the beginning of February. 

In a serious development, the Karnataka Government banned the use of harmful colouring agents in Cotton Candy and Gobi Manchurian. This comes after Tamil Nadu banned pink cotton candy, after the industrial dye Rhodamine-B was found in cotton candy samples tested. Andhra Pradesh also followed suit. “All the industrial dyes, such as Rhodamine-B and metanil yellow, are dangerous to health. But they are continued to be used in sweets and other dishes, though their usage has reduced with the increased awareness about its ill effects, a government official in Andhra said. The same chemical - Rhodamine- B- was identified as the colouring agent for gobi manchurian as well, apparently added neither for taste nor flavour, but merely to make it seem more attractive for consumers. In Karnataka, in a study that was conducted by the Public Health department, of the 25 samples of cotton candy, 15 contained Sunset Yellow, Tartrazine and Rodamine B. Of the 171 samples of Gobi Manchurian, 107 were found to contain Tartrazine, Sunset Yellow and Carmoisine. These samples were unsafe for consumption as per The Food Safety and Standards Act, 2006, and The Food Safety and Standards (Food Products Standards and Food Additives) Regulations, 2011.

Not just women, this week saw a spotlight being shined on issues relating to children’s health as well. Mayank Kumar’s sharp report introduced us to India’s ‘zero-food children’. A recent study had ranked India as having the third-highest percentage of children who had not eaten any food for 24 hours. The problem of such extreme food deprivation is severe among children in U.P. A study published in 2023 in eClinical Medicine, part of the noted Lancet Discovery Science, found that U.P. alone accounts for 28.4% of ‘zero-food children’ in India. “The states of Uttar Pradesh (28.4%), Bihar (14.2%), Maharashtra (7.1%), Rajasthan (6.5%), and Madhya Pradesh (6%) account for nearly two-thirds of the total zero-food children in India,” the report said. Experts pointed out that alongside poverty and marginalisation in economic backgrounds, it’s rapid urbanisation and nuclearised families that have contributed to such a large number of ‘zero food children’ in India’s most populous State.

The piteous tale of children falling to hunger in Gaza as Israel heartlessly cuts off supplies is here, not for the faint hearted though, this gruesome tale. 

If you are a parent of a young child, a teen or tween, showing interest in make up and cosmetics, then Dr. Monisha Madhumitha has a few tips you must pay attention to. The unmasking: How make up and skin care products impact children. The authors of a U.S.-based study noted that children are particularly vulnerable to adverse health risks associated with makeup and body products. Behavioural patterns such as hand-to-mouth activity may increase exposure to products through ingestion. Additionally, children’s small body size, rapid growth rate, developing tissues and organs, and immature immune systems make them biologically susceptible to toxicants. There is a deep psychological angle to this as well. As long as a flawless, blemish-free complexion is held up as the ideal standard, children will aspire to it. It imposes unrealistic expectations on the young, influencing their self-esteem and body image. 

There seems to be a lot of COVID-19 research finally hitting the spots that one missed because a full-fledged pandemic had brought life as we know it to a close. All the factors that we need to take into account, efficacy of vaccines, the impact of co-morbidities, the long-term effects of suffering from COVID, and more recently, from the vaccination itself. Here, Bindu Shajan Perappadan reports a study on how undiagnosed diabetes contributed substantially to COVID-19 hospitalisation and deaths in many LMICs, including India. The study, as per its modelling estimates, found that patients with undiagnosed diabetes represented 21.1% of all COVID-19 hospitalisations and 30.5% of all COVID-19 deaths across low- and middle-income eight countries. Eight LMICs were studied — Brazil, China, India, Indonesia, Mexico, Nigeria, Pakistan, and South Africa. While anecdotal evidence did allow doctors to warn those with co-morbidities to be careful about masking and contracting the virus, the real data is extremely sobering. 

Hemanth C.S. meanwhile, reports on a study that shows that the Covishield vaccine demonstrated a more robust immune response compared to Covaxin. A new study by a consortium of 11 institutes, led by scientists from the National Centre for Biological Sciences (NCBS), has found that the Covishield vaccine demonstrated more robust immune responses compared to Covaxin. It compared the immunogenicity of Covishield and Covaxin, the two primary COVID-19 vaccines widely used in India.“Notably, Covishield exhibited a near-complete immune response in the majority of participants, whereas the response to Covaxin was variable, particularly among those inoculated before the emergence of the omicron variant,” state the key findings released by NCBS.

More recently, the man who had received a record 217 COVID-19 vaccine shots made news. Here, Puneet Kumar and Vipin M. Vashishtha break it down: what does his body teach us? on March 4, a study published in The Lancet reported a shocking case of “over-vaccination” by a 62-year-old German man who received over 217 COVID-19 shots over 29 months for “private reasons”.

Researchers found out about his case from media reports and conducted a detailed study to investigate the immunological and other effects of over-vaccination on his body. Their investigation revealed much about immune function and the effects of over-vaccination. They compared their findings to a reference cohort of 29 healthy persons who received ‘only’ three COVID-19 vaccine doses. While the individual tolerated well all the shots, experts have discussed ‘immune tolerance’ and ‘immune exhaustion’ — especially of the T cells. Long COVID pathogenesis, when the SARS-CoV-2 virus persists in the body for a long time, has been carefully investigated in relation to this issue. Scientists have found no evidence that COVID-19 vaccinations do this. The vaccines merely briefly expose the immune system to antigens. Each shot injects a small quantity of antigen, triggering a momentary immunological response.

In the new study, immunological profiling indicated repeated vaccinations or infections stimulated the immune system, making it more responsive. Interestingly, the immune system also developed faster, stronger, and broader, protecting against more new variants. And yet, the authors recommended caution about over-vaccinating oneself.

Do read Vinod Scaria’s opinion piece on why India urgently needs a legal framework for genomics. Despite significant established capacity and expertise in India, a significant number of samples from India are sequenced and/or analysed by companies abroad with little oversight and regulation, he says. These are some of the issues he raises: Data protection is one of the important components that urgently require a legal framework; another issue is the fragmentation of genetic data, with a number of organisations providing genetic testing services, the data remain in silos. Discrimination based on genetic information is indeed a real concern due to the lack of laws preventing it; equity and diversity to genetic data also is a concern that needs to be addressed especially in a diverse country like India, as unregulated market forces could widen the already acute barriers for access to better healthcare, especially for the poor and ethnic minorities. Also, he argues, ensuring ethical use of the technology is paramount.

In our Tailpiece segment this week, is this very important story by Murali Neelakantan and Parth Sharma: The tale of ‘have money, buy miracle drug’. They highlight that many of the ‘magic drugs’, which are being promoted in the media, have not undergone clinical trials in India. With these unapproved “miracle drugs”, there have been no clinical trials in India. That means we do not know if Indians will react differently to the drug. Should doctors prescribe a new drug when it is not approved for sale in India? Are doctors recommending these drugs? Or are their clients demanding them based on new reports of miracles? What is the duty of the doctors in these situations? What are the incentives for the doctors? To learn further about this, do check out the link.

From the Health page

If you have a few extra moments, do also read:

R. Prasad reports: Can resveratrol-copper be used to prevent metastasis without trials?

Aaratrika Bhaumik explains: What is the historic amendment that enshrined abortion access in France’s Constitution? 

Zubeda Hamid discusses in the In Focus podcast: How will the change in surrogacy rules impact prospective parents? 

France’s Macron announces Bill for assisted dying.

India efforts to combat measles, rubella earn prestigious award.

This is the section where we bring you health content from across the country. You can pick what you want to read:  

Andhra Pradesh

Health camps, fun activities mark celebrations on International Women’s Day eve.

Delhi NCR

Over 90 hospitalised in twin food poisoning cases in Noida, Greater Noida.

Kerala

Kerala unveils health sciences research policy.

Ayush sector in Kerala will be made a health hub, says Minister.

App to nominate Ayush doctors for government award.

Drug sellers threaten to stop supply to Kozhikode MCH.

Tamil Nadu

Vastu pooja performed for AIIMS in Madurai; MP slams move as publicity stunt.

Serena Josephine M. reports: At RGGGH in Chennai, more patients turn to hospital food.

T.N. Health Minister lays foundation stone for facilities worth ₹256 crore in medical colleges, hospitals.

Health Minister orders action on hospital, individuals for violating provisions of Surrogacy Act.

State Government provides 200 dialysis units across TN, says Health Minister .

District health officers in Tamil Nadu told to develop heat action plan.

Scholarships worth ₹1.7 crore given away to medical students.

Private eye hospital in Chennai introduces advanced treatment for myopia.

Telangana

Siddharth Kumar Singh writes Health Minister envisions global recognition for health education and medical tourism in Telangana.

Telangana surpasses pulse polio immunisation target, vaccinates 40.77 lakh children in four days.

As always, do put us on your radar, as we bring more health content your way. Get more of The Hindu’s health coverage here.

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