What are the main findings or arguments presented in the article or report?
Air pollution is causing a huge amount of premature deaths
Roughly 1.04 Million premature deaths and 31.4 Million disability adjusted life years(DALYs)
These deaths are not just caused by city pollution but even more deaths are caused by rural household air pollution(HAP) resulting from solid cooking fuels
627,000 premature death and 17.8 Million DALYS from ambient air pollution(AAP)
Need to make great efforts to intevene on HAP and AAP exposure in India in order to reduce disease burdens and improve health of citizens of India
Describe at least three ways that the argument is supported.
the HAP and AAP account for 6% and 3% of the total national burden of disease and together they exceed the 60+ other risk factors examined individually.
HAP exposured daily count of PM2.5 exposures of 285 ug/m^2, 337 ug/m^3, and 204 ug/m^3 for children, women, and men.
PM2.5 of 27.2 ug/m^3 is up 6% from 1990- much higher levels of urban and some rural areas
highly exceed the WHO count
across 503 monitored cites in India, more than half of them have a reading of >90 ug/m^3 of PM10. Poor air quality is proven to be in existance for urban areas of India.
The air quality monitoring is currently being set at 20 and 10 ug/m^3 by WHO AQG values but these values are simply set at the beer minimum. These values are nowhere near the recommended values of air quality. Thus even if these values are met, there is still likelyhood of poor health conditions for citizens.
Result: Great efforts need to be put on transportation and power generation
Most monitoring in India takes place in cities even though 2/3 of population live in the rural region. On top of the 1/4 of PM2.5 emissions come from household emissions; thus it is impossible to bring down AAQ levels withouth reaching out to the rural areas.
Main issue is that there is limided evidence of gainful reductions in emissions and exposures from current biomass cookstove techonologies
HAP need to include innovate ways to increase access to gas and electric stoves
increase research and develop a new and imporved biomass stove so that it can be accurately studied to see if it has reduction in emisssions.
WHO is currently trying to make in home AQG pollutant specific gadgets
there is very limited research and studies done that focus on the adverse health effects, most specifically cardiovascular disease, that are linked to the HAP and AAP risks in India.
The global burden disease project of 2010 took quantitaive exposure estimates and mateched them with exposure response functions to estimate the burden of diseases that include:
high background rates of iscemic heart disease and stroke, chornic/noncommicable disases are est. to account for most of the attributable burden for both HAP and AAP in India and the rest of the world
What three (or more) quotes capture the message of the article or report?
"Global research partnerships would provide an opportunity to strengthen the evidence for exposure response for multiple chronic disease end points that are now becoming the focus for global disease burdens. This new evidence would allow the design of strategies that bring HAP and AAP jointly under the domain of air quality regulation and chronic disease management in India and elsewhere in the world where such exposures coexist."
"Analysis of routinely collected ambient air quality data [Central Pollution Control Board (CPCB) 2012] indicates that annual average concentrations of PM10 (≤ 10 µm in aerodynamic diameter) are critically high (defined as > 90 µg/m3 by the CPCB) at more than half of the 503 locations monitored across India."
"In the comparative risk assessment (Lim et al. 2012), performed as part of the Global Burden of Disease (GBD) 2010 Project, air pollution ranked as a leading contributor to the burden of disease in South Asia."
"Estimates of the burden in India show approximately 1.04 million premature deaths and 31.4 million disability-adjusted life years (DALYs) to be attributable to household air pollution (HAP) resulting from solid cooking fuels, and 627,000 premature deaths and nearly 17.8 million DALYs to be attributable to ambient air pollution (AAP) in the form of fine particulate matter ≤ 2.5 µm in aerodynamic diameter (PM2.5)"
What were the methods, tools and/or data used to produce the claims or arguments made in the article or report?
The article took from the CPCB in ordre to collect data on the pollution levels within india(goes to show that CPCB is actually collecting through its monitors various pollution levels)
refers greatly to the Global Burden of Disease Project of 2010(GBD 2010)
The report relied heavely on the data in order to come to the conclusions and cause of action from this team.
How (if at all) are health disparities or other equity issues addressed in the article or report?
the entire article is focused on the poor levels of air pollution and how these poor levels are able to tanslate into the burden of global healths various diseases.
Where has this article or report been referenced or discussed? (In some journals, you can see this in a sidebar.)
this article was found as issue 1, volume 122 of the Perspectives Editorial.
no information on where the article has been referenced
referenced within the article- WHO, CPCB(2011), Institue for Health Metrics and Evaluation
Can you learn anything from the article or report’s bibliography that tells us something about how the article or report was produced?
The three individuals who worked on this article came from various regions of the world including India, Massachusettes(USA) and California(USA). they are all focused on environmental health and health effects
What three points, details or references from the text did you follow up on to advance your understanding of how air pollution science has been produced and used in governance and education in different settings?
Tried to research further into CPCB with their current data findings on monitoring. the pages would not load or took too long to load- very strange how it is nearly impossible to find ANY current data on the CPCB(potentially could be blocked outside of US???)
Dr. Fan is a resarch fellow at the Center for Global Develpment
Dr. Fan is highly educated on the work being done and has been done in India as she wrote her Harvard School of Public Health Dissertation on health systems in India
able to provide assesment of INdias health system, the potnetial for universal health coverage, adn the impact of the changing nature of disease on India in public health
What are the main findings or arguments presented in the article or report?
Two forms of healthcare
Private and Public
Most Indias seek private HC
Public health care lacks resources, has been neglected, has worker absenteesim, and low demand for use
Private health care is higher in demand but is unregulated and financed through out of pocket payment-lot of workers only with HS diploma
Two Private areas are the Natioanl Rural Health Mission(NFHM)- run by the Ministry of Health and Family Welfare, and the Rashtriya Swasthya Bima Yojana(RSBY) which is health insurance run through the Mintistry of Labour and Employement. Started in 2006 and even though no evidence it has shown some early signs that it is helping reduce the out of pocket payments for teritary care for people
Universal Health Care
universal health care by WHO means access to healthcare and access where expense will not financially burden ther person. different countries read this defnition differently(ex: china) so it is up to India on how they are going to address the definition.
Increase ini Public Investment by Prime Minister Manmohan Singh and other top officials
the government has pledged to put in more money into healthcare from its GDP. not a bad idea, as it ahs been porven that with more money in teh system will help out of pocket costs
not sure how this money will be dealt out yet(NRHM or RSBY) because no proposal made yet(2012 was said)
70% out of pocket costs
number was too high- potentially outdated reported
most of the money spent out of pocket goes to paying for medical drugs
potentially all gpoing to turn to the free drugs for all idea- already implement in Tamil Nadu( a state in the southern region of India)
sucessful in the state but the govenremnt is differen thtere as they have more capcaibility and capacpcaity to deliever services to the population
not yet aware of this ssystem will work all over india and how its applicaiton will vary state to state
in additoin- putting drugs into the system may lead to causes of increase drug resistance
if healthcare delivery is problemitic, havhign the drugs for free wont matter.
Learn from other countries
shoudl take notes from:
Bangladesh- though a poor country it has tackeled many of hte health issues head on including-
core child health interventions including providing vaccinations, family planning, oral rehydration therapy and other meateran and child hrealth services.
figuring out how to tackle and make the healthcare system right in india will take a whlie because it is very complex, just like in all other countries.
need to have the central governemnt find out what works for the country
Answer big questiosn like- why are indias population suffering from ilness and disased within region of high rates of poverty
how will the set up system deal with challenges like these
today the coutnry is dealing iwth both infectious and chornic disease
both the forms of private health care is putting more focus on one while neglecting the other, especially on the prevention of disease
states need to experiemnt and find out what works for their peopel in terms of healthcare
need to put more money into education of healthcare system
Extra
the country is too late on getting invovled with te public health care system as it is has already died out. must takcle each area individually and address the main issues. so go in and tackle private healthcare issues as much as public.
Describe at least three ways that the argument is supported.
Indias governemnt pledged to do 'universal health care'- the term is loosely based and is up for debate on its future definition-
putting 1.5% more of GDP into the government helathcare system
problems in India are largely based on cost and expense of healthcare as it was reportely 70% out of pocket costs.
What three (or more) quotes capture the message of the article or report?
"Yet there has been renewed attention within India to health reform, and universal health coverage in particular. New Dehli has pledged to increase public spending from 1.0% to 2.5% of GDP, and Prime Minister Manmohan Singh announced a specific emphasis on health in the country’s twelfth five-year plan covering 2012-2017."
WHO Definition of Universal Healthcare(controversial)
"UHC means that everybody receives access to needed healthcare and that people do not suffer major financial risk when seeking services."
"I understand that the government has recently announced a program to provide free drugs for all. The program seems to be modeled on the success of one state, Tamil Nadu, which has a central drug-procurement system; other states will attempt to follow Tamil Nadu.
"Education on improved hygiene, hand-washing, and sanitation, for example, is a severely neglected area in the country. Vaccinations are also a key neglected area, as I mentioned earlier. History has shown that the burden of infectious disease will not go down by treatment alone; prevention through government actions is critical. The same could also be said of chronic disease."
What were the methods, tools and/or data used to produce the claims or arguments made in the article or report?
was an interview so all of hte information came from the background and understanding of Dr. Fan, who has researched the healthcare of India for her disteration.
the information was set out conerstationally yet structured.
very little numerical data just more general content on system and ho wit should imporve in future
How (if at all) are health disparities or other equity issues addressed in the article or report?
the article focuses on the healthcare systems in India and how they need to make it a priortiyt to improve upon these areas in order to live up to the pledges made by teh prime minsiter
Where has this article or report been referenced or discussed? (In some journals, you can see this in a sidebar.)
N/A on where it has been referenced however there are related articles centering on the topic of India and the future
Can you learn anything from the article or report’s bibliography that tells us something about how the article or report was produced?
was produced in 2012 in order to gain insight into the refoms needed to imporve india's healthcare. India, at the time, looked to become a global power so it was important to disect the ocuntries healthare in order to better understand its well being of its citizens.
What three points, details or references from the text did you follow up on to advance your understanding of how air pollution science has been produced and used in governance and education in different settings?
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