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Child predators groom and abuse to muzzle victimsParents need to identify behavioural changes in their children and give them space to speak up about such issues, pointed out psychiatrists. Caffeine no different from cocaine in Punjab booksIn fact, the chapter nowhere explains in detail what addiction is, and only briefly touches upon the long-term damage addiction causes to the physical health and social life of addicts. Pregnant goat dies after being gang-raped in HaryanaA medical of the goat will soon be conducted after which the police will take an action against those accused. Drug & rape: Shocking stories of Bihar shelter homeBihar girls give shocking testimonies of being sedated, beaten and raped in shelter home. Neighbours heard screams, but ignored them Storm of news to hit global economy this week before August calm People charged with running or monitoring the world economy are set for a busy week. Artificial intelligence system can identify your personality from eye movements Researchers tracked the eye movements of 42 participants as they undertook everyday tasks around a university campus, and subsequently assessed their personality traits. Child predators groom and abuse to muzzle victims Parents need to identify behavioural changes in their children and give them space to speak up about such issues, pointed out psychiatrists. Caffeine no different from cocaine in Punjab textbooks In fact, the chapter nowhere explains in detail what addiction is, and only briefly touches upon the long-term damage addiction causes to the physical health and social life of addicts. 'We used to cut ourselves with glass to avoid the ganda kaam' Bihar girls give shocking testimonies of being sedated, beaten and raped in shelter home. Neighbours heard screams, but ignored them Final draft of NRC to be released tomorrow amid security The NRC will include the names of all Indian citizens who have been residing in Assam before March 25, 1971. How India's high-quality, low-cost model can save American healthcare By Vijay Govindarajan & Ravi RamamurtiWhile US healthcare companies struggle to make profits from the wealthiest patients and shun the rest, Indian healthcare companies are launching successful IPOs and attracting global investment dollars. How? With innovations that drastically reduce costs while preserving or even raising value.At first glance, Indian healthcare seems an unlikely place to invest. Physician density in India is less than one-third that of the US, and nurse density is roughly one-sixth. The infant mortality rate is almost seven times that of the US and more than four times that of China, and less than 5% of Indians who need heart surgery will receive it.Yet, India has a handful of forprofit hospital systems that can be widely adopted not only in other poor countries but also in struggling healthcare systems in the developed world.Take the example of Narayana Health, which began 18 years ago as a private, for-profit heart hospital in Bengaluru and now has 25 hospitals delivering care in 30 medical specialties. It charges about $3,000 for a typical heart surgery, tens of thousands of dollars less than in the US, and its 30-day mortality rate is lower than that in the US. The company performs 60% of its pediatric surgeries for free or at a steep discount, covering those costs with money made on full-pay patients. And yes, there are profits. Its December 2015 IPO was oversubscribed 8.6 times, raised $100 million in India, and in 2017, its market capitalisation was over $1 billion.Another example is HCG Oncology, which gives away or subsidises care to 20% of its patients and went public in 2016 with a market valuation of $276 million. Aravind Eye Care System also makes money on high-quality, lowcost care. Since it was founded in 1976, the hospital chain has provided free or highly subsidised eye surgery to 3 million people â" half of its surgical patients â" and with no more complications than Britainâs National Health Service. Over the years, Aravind has garnered a net surplus equal to between 35-50% of revenues. Remarkably, since its inception, it has covered the cost of all its free medical care and capital expansion out of operating surpluses. Although it was a not-for-profit hospital and served the highest proportion of free or subsidised patients among the hospitals we studied, its EBITDA margin and net profit margin were the highest in our sample. LV Prasad Eye Institute enjoyed similar success, covering all its operating costs as well as its training and research expenses, with money left over each year.Our study suggests that to promote innovations in healthcare delivery, an environment like Indiaâs is just what the doctor ordered. First, Indiaâs huge, poor, and largely uninsured population offers an untapped market of priceconscious consumers. Second, the countryâs severe shortage of doctors and medical facilities demands that health-care resources be used as productively as possible. And third, Indiaâs emerging health-care market is largely unburdened by legacy pressures that hinder innovation in more developed countries, including government regulation, the fee-forservice reimbursement model, the influence of powerful insurance and pharmaceutical lobbies, or other forms of organised resistance.The relatively free rein of Indiaâs healthcare market forces the countryâs innovators to cut costs and sharpen efficiencies in radical ways. At Narayana, for example, certain surgical clamps are professionally sterilised and reused â" as permitted by the US accrediting agency â" but in the US they are routinely thrown away after one use. At Aravind, highly optimised processes allow its surgeons to perform five-six surgeries per hour compared to one per hour in the US. HCG operates its expensive MRI machines 24/7, offering discounts for night appointments. When a multinational supplier of hospital gowns refused to budge on a high quote, Narayana partnered with a local manufacturer to make gowns for a fraction of the price. Everyone benefits from the high volume resulting from the combination of free and paying patients, reaping significant economies of scale.The hospitals we studied also use an operationally efficient hub-and-spoke delivery network that treats less demanding cases in regional clinics and funnels serious surgeries to specialists in well-equipped medical centres. They take task-shifting to extremes, maximising every minute of service from highly paid specialists and delegating less specialised work to lower paid staff and even to patientsâ family members, who are trained to deliver care both in the hospital and upon discharge.Could these innovations work in more developed countries? To some extent, yes. In fact, we have seen several promising experiments in Indianlike delivery methods take root in the US. And frugality, a universal mindset in India, is certainly returning to first world hospitals, because it has to.From a more global perspective, all of the for-profit hospitals we saw in India could thrive in much of the developing world. Some are already there, and others are on their way. CARE Hospitals, a Hyderabad-based low-price cardiac chain, was bought in 2016 by a profit-minded Dubai-based group, which hopes to transplant CAREâs business model to Africa. Aravind has conducted community ophthalmology training in 30 countries, and Narayana Health set up a 104-bed hospital in Grand Cayman four years ago. So far, the facility has treated patients primarily from the Caribbean and Central America, but Narayana is clearly waiting for Americans to take advantage of the savings that are only a short plane ride away.(Govindarajan and Ramamurti are authors of a new book, Reverse Innovation in Health Care: How to Make Value-Based Delivery Work) Lifestyle diseases: FSSAI launches 'Eat Right Movement' Alarmed by the rise of lifestyle diseases, the FSSAI has launched the âEat Right Movementâ, and food companies around the country have pledged their support.In November 2017, top officials at the Food Safety and Standards Authority of India (FSSAI) sat up when they flipped through the pages of the India State-level Disease Burden Trends report. While life expectancy had gone up, more Indians were dying of non-communicable diseases such as ischemic heart disease, chronic obstructive pulmonary disease (COPD), stroke, diabetes, and chronic kidney disease, the report stated. âRisks, which include diets low in fruit, vegetables, and whole grains, but high in salt and fat, were Indiaâs third leading risk factor for health loss in 2016â.According to FSSAI, one in four Indians is at risk of dying from one of the Non-Communicable Diseases, such diabetes, blood pressure, heart disease or cancer. And diabetes has become Indiaâs fastest growing disease since 2000, according to a study released in 2017 by two research institutes â" The Indian Council for Medical Research and the Institute for Health Metrics and Evaluation â" and advocacy group Public Health Foundation of India. The same year, the International Diabetes Federation claimed there were over 72 million cases of diabetes in India, a number which, some experts say, will almost double by 2025, if current dietary trends continue. These numbers forced the food safety regulator to not just accelerate its ongoing draft regulation on labelling packaged foods with high fat, sugar and salt (HFSS) content with red dots, but put their best minds together to draw up a larger plan.On July 10, the Eat Right Movement was launched to usher in a ânew food cultureâ by nudging businesses and consumers to cut down on salt, sugar and trans-fat in their food. In a video on the campaignâs website, actor Rajkummar Rao, the pro bono ambassador for the âmovementâ, as the stakeholders like to call it, recites the campaignâs tagline â" âAaj se thoda kam.â The idea is not to go cold turkey but slowly reduce the amount of salt and sugar that you eat, which should be easier for people to follow. In another video, Rao asks whether the heart or the head should decide what you eat, concluding that health is a matter of the mind, so be smart about what you eat.While government agencies have often laid down regulations for industry to push healthier food options, what has remained unaddressed is awareness among consumers. The Eat Right Movement aims to strike that balance. âIt is the classic chicken-and-egg case. Consumers complain they do not have healthy options when they eat out or buy packaged food whereas the businesses say consumers do not want healthy options. So we thought how can we break this cycle? Businesses will have to take the first step while consumers have to become more aware of what they eat,â says Pawan Agarwal, CEO, FSSAI.As a team at FSSAI fleshes out draft regulations on menu labelling and strategically bringing down high fat, salt and sugar content, the regulator reached out to industry, inviting voluntary commitments to initiate the process right away instead of waiting for the regulations to come into effect. âThe labelling regulation was already being considered, but we thought if we wait for that to happen, it will take a year. We began to nudge the food businesses to start working towards healthier options. It had two major advantages. When they begin product reformulation in a few months, we at FSSAI will understand the practical problems in implementing it and that will help us bring in regulations with reasonable thresholds,â Agarwal says.An issue that complicated the picture was that the draft regulations received push back from food companies because none of them wanted their food labeled red, or unhealthy. âAccording to thresholds in draft regulations, a significant part of their portfolio was being labeled red and hence, they were concerned,â Agarwal says. âIf, as a regulator, we say that 80 per cent of the food available in the market is unhealthy, either consumers will ignore it completely or will have limited choice. We do not want a situation where we have standards or thresholds that are significantly different from current practices because reduction of HFSS will happen only over a period of time.âWith the World Health Organisation calling for a complete removal of trans fat from the food supply by 2023, the edible oil industry, bakeries and halwais in India, including Halwai Association and Hotel and Restaurant Association of Northern India, too, have pledged to do their bit, committing to phase it out by 2022 with the pledge âIndia@75 â" freedom from trans fat by 2022.â âAs far as trans fat is concerned, we are coming up with regulations where edible oil cannot have more than two percent of trans fat and final food or bakery product will have not more than 0.5 percent. As soon as these standards are put in place, businesses will have to adhere to it and if they donât, it will be a violation of the Food Safety Act and they will be liable for prosecution,â Agarwal says.Fifteen companies from the packaged food industry â" Nestle, Mapro, MTR, Britannia, Bikanervala, Patanjali, Bagrryâs, Hindustan Unilever, Weikfield, Kraft Heinz, Del Monte, Haldiramâs, Kellogs, ITC and Marico â" have signed up with voluntary commitments to begin reducing salt and sugar in their products by 2020.âIt was an interesting journey to get the industry on board,â Agarwal says. âThough initially there were apprehensions, on the day of signing up for the initiative, they appeared more enthusiastic about it. Some of the enthusiasm might be tempered when they get down to the business, but we will take it forward from there. What was particularly heartening was to see the traditional halwais, the Haldiram and Bikanervala, get on board for this. There are major players like Dabur and Parle that are yet to come forward.âEach company pledge is different. HUL has committed to reducing salt levels to enable intakes of 5g per day. In their tomato ketchup and sauces, for example, this means a 15 to 50 per cent reduction in sodium by 2020 to meet the benchmark of 750mg/100g. They have also pledged to reduce the sugar in their range of childrenâs frozen desserts to a maximum of 12g per portion in the same time frame. âUnilever committed long back to reformulate our products so as to reduce the salt, sugar and fat from our products gradually. The pledge which HUL has signed was just a reiteration of our commitment, which we are already working on for several years,â a company spokesperson said.Likewise, Kraft Heinz will reduce the salt content in its tomato ketchup by 50 per cent in 2025 from its current levels, and to have nutrition declarations on the front of their packaging on all their products by the end of 2020; Kellogg will reduce sugar in their ready-to-eat cereals by 10 to 15 per cent and sodium by 10 to 30 per cent by 2020; Nestle will reduce sugar by 6 per cent on average and salt by 10 per cent by 2020, and MTR will reduce salt and sugar by 6 per cent and 5 per cent by 2025.In addition to the nudge from government, these companies are also reacting to changing consumer preferences and greater awareness of the dangers of eating too much processed food. âIndian breakfast habits and food choices have seen some very interesting shifts over the last decade,â Mohit Anand, managing director, Kellogg South Asia, told Mirror, over email. âChanging lifestyle, travel, experiences, and essentially exposure to a variety of cuisines are significantly impacting changing consumer food choices and attitude towards food. Consumers like to experience âfoodâ. Therefore, food is not just sustenance any more. Another obvious big trend is the rise of âhealth & wellnessâ. Therefore, an education initiative like the âEat Right Movementâ is a multi-stakeholder effort that will empower consumers.âIndustry experts say that several unhealthy products like aerated drinks and vanaspati are being knocked off the shelves, thanks to gradually increasing awareness. âThe consumption of vanaspati has been dwindling and production and consumption has gone down since 2012. Trans fatty acid content, which was between 6 to 10 percent in 2012, has been brought down to less than 5 percent in 2017. This is low as per WHO standards, but our commitment is to bring it down to 2 percent, and work is on to improve the interesterification process (a process that creates oil more suitable for deep frying). However, different countries have different consumption patterns. In Europe and the United States per person fat consumption is 45 kg per annum, while in India it is 13-14 kgs per person per annum,â explains Dr.KD Yadav, chairman of the technical committee of the Vanaspati Manufacturers Association.In a bid to reach out to consumers, professional associations like the Nutrition Society of India, Indian Dietetic Association, Association of Food Scientists and Technologists (India), Indian Medical Association, and Indian Federation of Culinary Associations have come together to support the initiative.âIn India we eat much more salt in our food. While the recommended amount is not more than one teaspoon of salt per day an adult on an average, studies says twice the amount is actually used. We have a whole lot of salty snacks and evening snacking is a persistent habit⦠most snacks are high in fat and salt,â says Sheela Krishnaswamy, noted dietician and national president, Indian Dietetic Association. âTaste is an acquired thing. It can be changed over time. If we, say, reduce salt gradually and supplement it with more use of lime, herbs, and garlic that enhances taste and reduces requirement for salt, it can be done.âMeanwhile Dr B Sasikeran, president, Nutrition Society of India and former director of National Institute of Nutrition, Indian Council of Medical Research, says that changes in diet need to be complemented by exercise. âThe Eat Right Movement attempts to bring about social transformation by bringing in behavioral change. When you tell someone to reduce consumption, compliance is better than asking them to completely avoid it. But along with eating a little less, we also have to tell people to walk and exercise a little more. Once everyone gets into that mode, a year later this campaign can be further intensified,â he says.The challenge for the food companies is, of course, balancing taste, cost and the relative healthiness of their products. âStepwise reduction is key,â says Kelloggâs Anand. âWe also work with our technologies to ensure that taste is not compromised, as we reduce the salt and sugar levels in a phased way. We take a consumer-centric approach on this, which means that we do not compromise on the taste while ensuring that we are delivering nutritious products.âAnkur Bhaumik, the chief operating officer of MRT, admits that reformulation of their offerings will create challenges, but he is confident the company will find a way to adhere to their pledge. âThere may not be new technology deployed to make these changes, but we are working with stakeholders to explore alternate solutions to help us achieve the target,â he says.Similarly, Kraft Heinz will attempt to change the salt and sugar components of their tomato sauce while retaining its flavour. âThe reformulated new recipe will not compromise on the quality and taste of the product, and will maintaining consumer affinity toward the brand,â says Sankalp Potbhare, the companyâs managing director.âBacked by the Ministry of Health and Family Welfare, FSSAI is hoping to work closely with other ministries such as Information and Broadcasting and Food Processing Industries among others to create a buzz around the campaign and weave in other government initiatives into the larger movement. While the body is banking on publicity through mass media, running ads and Rajkummar Raoâs two-minute video in movie halls and public events, it is set to tie up with the Ayushman Bharat project and hand out toolkits to health works at the 1.5 lakh health and wellness centers across the country to reach the rural populace.FSSAI has also proposed that retail chains could nudge consumers to buy healthier food options by ensuring the ingredients and relative healthiness of their products are clearly marked at the points of sale. Of course, there is thin line between educating people about what to eat but leaving it to them to decide and telling people what to eat. The final choice should remain with the individual. If someone wants to eat a salty snack, or a candy bar, he or she should have that option. âConsumer choice should always prevail,â Anand says. âMoreover, there is nothing called âgoodâ or âbadâ food. It is about how one consumes those foods as part of the overall balanced diet. All foods have a place in consumersâ eating preferences and can definitely be eaten within a specific portion size.âThe Eat Right Movement has no choice but to play the long game. It will take years for changes in health indicators and lifestyle indicators to reflect, and it will be last 18 months before most of the companies introduce their new formulations. So the success or failure of the campaign will not be known for years to come. But it is a start and well begun, as they say, is half done. - Mann ki Baat LIVE UPDATES: PM Modi lauds athletes Hima Das, Ekta Bhyan
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Sunday, July 29, 2018
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