Public Health

From Treatment to wellness:Is India really unhealthy

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Yesterday I was doing some research on the chyawanprash market in India and I found some rather interesting stats. The Chyawanprash market which is roughly Rs 400 crore saw a 25% growth in 2010. This is after a decade of single digit growth for the category.

Then in the evening I was reading how Pepsico was investing heavily in the health and wellness segment with its juices and brands like Quaker oats.

And at night I read an article which showed that Britannia was heavily investing in the ‘Nutrichoice’ brand to promote wellness.

So everyone has suddenly jumped on the wellness band wagon. From Dabur to Ranbaxy and from Britannia to Pepsi all want to make products to make you healthy.
But that brought me to another question, what has changed all of a sudden? Why concentrate on wellness now? Is Indian really in danger of being declared unhealthy?

One easy solution I found on the WHO site was that when corporations focus on disease they limit their market, but when they concentrate on wellness they have the entire human population. In India’s case almost 1 billion plus market make a very attractive proposition.

Terms like baked, low fat, no fat, cholesterol free, 3 omega, etc have become marketing clutch words. The focus is to get us healthy and wise. But do we really need these products?

My twelve years in the healthcare industry combined with the 7 years in medical school have taught me that the human body is more than capable of taking care of itself absorbing the right nutrients from the diet. The balaced diet chart that all of us read since kindergarten.

Stress levels among Indians is actually lower this year as compared to last year. Ina survey by accounting and consulting firm Grant Thornton, reveals that only 42% of Indian businesses felt an increase in stress levels as compared to 56% last year. The study was conducted amongst 6,000 businesses globally.

So probably taking these wellness supplements have helped Indians reduce their stress levels. To add to this many other initiatives like Yoga Camps and Art of living classes might have contributed to the lowering stress levels.

But the question still remains why the emphasis on wellness now, maybe the competition in normal products have forced companies to jump on to the wellness bandwagon.

The results will be known only after a while but for now enjoy your low fat snack…

Healthcare Delivery Public Health

Malnutrition and not Obesity is India’s biggest health challenge for the 21st century


Obesity is one aspect that is heavily covered in media in India. There are numerous reports on how the ‘Fight against Fat’is the paradigm shift in Indian public health policy. Obesity has been linked to heart diseases, diabetes and hypertension. And the information is all correct.

But I believe in a country of a billion people plus a problem affecting 50-60 million people is hardly the concern. Lets take the case of diabetes for example, the situation today affects about 50 million people with another 30-40 million undetected cases.

But India’s greatest challenge is malnutrition. yes did i hear it right, it is Malnutrition. So all those basic biology classes on balanced diet are the need of the hour for India.

According to a report by the UN and the World Bank, India is ranked second in the number of children suffering from malnutrition. The other country ahead of us is Bangladesh. Almost 47 % of the children in India are affecting by this disease.

Another alarming statistic is that India has about 150 million children contributing almost 18 % of the population. Also four children die every minute from preventable diseases like diarrhea, Measles and Typhoid which are usually more severe due to the prevalent malnutrition.

The icing on the cake is the 2011 Global Hunger Index (GHI) where India is ranked 67. Some of the other countries on the list are very small and poorer than us, but still have shown improvement. Sri Lanka for example has a index score of 14, while India lands an alarming 23.7. Even Niger has a score of 23.

But Media and industry continue to focus on obesity. The reasons are very simple. The obese population are also the ones with higher disposable income and hence a good target market for these companies.

In the days since liberalization Gyms, Clinics, Supplements and diets have grown manifold. A recent quest for a personal instructor by my wife saw numerous coaches show up at our doorstep, some with their own assistants.

But what about the hungry kids? This situation of malnutrition is leading to be a stumbling block to India’s progress in the long run with disease, disability and economic backwardness on the horizon for almost 20 % of India;s future.

There are a few steps that we can take.

Encourage the mid day meal schemes started by some of the government schools. The novel idea was the brainchild of the former Tamilnadu chief minister M G Ramachandran. This resulted in increased literacy and also improved nourishment.

Contribute to institutions like Akshay Patra. The Akshay Patra foundation has been the leading voice on nutrition. They run schemes to feed under privileged children.

Thirdly encourage the local community programs on nutrition. A good place is to start with the focus on domestic helps and their wards ensuring they have a balanced diet and educate them on it as well.

Unfortunately there are no quick fixes for the malnutrition issue. It is a deep socio-economic problem but a beginning has to be made somewhere and it is better to start late rather than not start at all.

Healthcare Delivery Public Health

The new Measles eradication campaign in Indian Public Health space

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After declaring and winning the war against polio, the Indian public health administration has declared war on Measles.

Measles is a viral disease which kills about a million people a year. Out of the million almost 90 % are children. In India the statistics is very alarming as almost 500 children die daily because of Measles infection. This is mostly due to non availability of the vaccines in most Indian states with the coverage ranging from 60-50 % in most states. All this data is available on the .

The new Measles eradication program is planning to do just that increasing the coverage of the vaccines to a 100%.

But unlike the Pulse polio campaign, which had heavy celebrity endorsement from the likes of Amitabh Bachchan the Measles eradication program has gotten off to a very sedate start.

Firstly there is no celebrity endorsement this time. Secondly unlike the Polio campaign there will be no door to door visits by volunteers. Instead there is an expectation on the part of the parents to take the children to the schools which will serve as primary eradication centers.

In an earlier piece I had asked for coupling of Primary care centers with schools to ensure better coverage of the population and utilization of the public infrastructure. Please read the article here

The failure or success of this program would depend on the motivation levels of the parents of the children which is a big challenge especially in those below poverty line.

The North Indian state of Haryana had taken a state wide initiative in late 2010 to eradicate measles. It had launched a special team of 400 volunteers to cover all the districts of the state. The success of this campaign is also yet to be assessed.

India lags even neighbors like Bangladesh and Sri Lanka on Measles eradication programs. In the coming months I will be doing an analysis of this programs to get some idea on the outcomes.

Public Health

Is the Media ignoring Public Health?

Public health seems to be the last priority of media. Despite the importance of public health initiatives , media does not focus upon it as it does on health tragedies. A good case in point was the AMRI Hospital fire which was covered by the media.

Recently India went 11 months without a single new case of polio being declared. this was a hall mark achievement and a crowning success of the pulse polio initiative. But this went unreported.

Now the public health infrastructure has started focusing on eradicating Measles, but again the media has chosen to ignore it.

A similar analogy can be found in the great job being done by the NHS in the UK. Their public health and community dental programs are one of the best in the world. But again the British media often chooses to ignore it rather focusing on the changes and the mismanagement in NHS.

So clearly media is more focused upon reporting a health initiative gone wrong rather than focus on the initiatives that are doing well.

Why is that?

For one I think Media revenues are driven by advertising, which in turn depends on ratings. Ratings are generated by viewership and generally people like to watch sensational news. SO bad news sells while good news may not have the same impact.

A good analogy can be the coverage of the Hooch tragedy in West Bengal. Which has been widely covered by the media but not the success of the pulse polio program.

Secondly to attract audience there need to be some celebrities that focus on some public health initiatives. A good example was Indian super star Amitabh Bachchan who led the pulse polio campaign in India.

Similarly Lance Armstrong has led the campaign against Cancer and Michael J Fox for Parkinson’s disease.

But having celebrities can back fire as most of them have their own agenda’s and this might seriously hamper the message.

Third option could be to develop local champions against a particular disease or health condition. People are more likely to listen to their local community champions rather than some celebrity sitting far away. These champions would make the message more genuine and hence will be able to attract attention to the issue.

In conclusion media would cover public health if and only if it helps them boosts their ratings. Good options are to make the story more sell-able by focusing on the local issues and its impact. this would be definitely covered by the local media.

For national media I think associating public health initiatives with celebrities is the best option. But one has to be careful of the true intention of the celebrity.

Finally local issues even in public health are best pushed by local champions and then it becomes a public interest story.

In conclusion, the media is made up people from the same society that we will live. As long as they don’t feel for the issue, it is difficult for them to cover the issue.

Public Health

Is Pfizer’s patent loss Ranbaxy’s gain: The battle for Lipitor

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Way back when I was in B school the burning question in the Indian pharmaceutical industry was the expiring patents of the global pharmaceutical companies. The top among the list was Lipitor the cholesterol lowering drug that was fuelling most of Pfizer’s revenues.

Lipitor was the first drug to exceed $10 billion a year in sales, and accounted for almost one-quarter of Pfizer’s revenue in the last decade. But all that has changed once Lipitor comes off the patent list on November 30th. This allows companies like Ranbaxy to launch the generic version of Lipitor with a 180 day exclusive window.

Not to be outdone Pfizer has been preparing for this eventuality for some time and has already taken a series of steps to protect its revenues and its margins

The most notable among them is the tie up with Pharmacy benefit management (PBM) companies to pass on the discounts on to members of the pharmacy plans. The discounts are pretty significant and might lower the co- pay for members from $10 to $4. This might result in maintaining the current levels of subscription through the PBMs.

The other angle that Pfizer will do is to lower the price of the drug itself. This will help it compete against the prices set by the generic manufacturers Watson Pharmaceuticals and Ranbaxy.

Interestingly Watson has a licensing agreement with Pfizer under which Watson has to share profits from the sale of the generic version of Lipitor.

Ranbaxy has its own challenges and are currently under an FDA investigation.

The industry has been taking note of this issue. In September IBM came out with a life sciences study which indicated that the current challenges facing the global life sciences are here to stay unless the firms themselves change their model.

The study also indicates that firms might need to start viewing themselves as healthcare solutions providers and focus on health rather than on disease. For more on the study please visit

While the Lipitor issue might settle down in a few years, larger issues remain in the global pharmaceutical industry.

What are your views on the same? Can the current Pharma model sustain itself or will there be a seismic transformation. Please do let me know.