India's need to integrate its socio-cultural and scientific epistemology to position itself as a global leader.

Somewhat pitch-forked into a role it had been envisioning for itself for a long time now by the rapidly changing politico-administrative dynamics of the nations across the world and emerging and re-emerging crises limited not the least to wars and pandemics, India needs to leverage its strengths to deliver on the promise it has long held. But India's struggle to stem the outward flow of many of the brightest may just be one among the many factors that can play a spoilsport. The civilizational strength of India has been its cultural-scientific epistemology, strengthening the exploration of which will help it position itself as the global leader. The freedom to question and seek answers, no matter how successful a hypothesis has been in the past, is consistent with its (India's) epistemology, both scientific and cultural.

Measuring the Effect of Ayushman Bharat-Pradhan Mantri Jan Aarogya Yojna (AB-PMJAY) on Health Expenditure among Poor Admitted in a Tertiary Care Hospital in the Northern State of India.

Background: Ayushman Bharat-Pradhan Mantri Jan Aarogya Yojna (AB-PMJAY) as a financial risk protection scheme intends to reduce catastrophic health expenditure (CHE), especially among poor. The current study was carried out to assess the utility of AB-PMJAY in terms of reduction in CHE from before and after admission in a tertiary hospital in the northern state of India. Methodology: It was a hospital-based cross-sectional study carried out from August 2020 to October 2021 at a public tertiary hospital of Himachal Pradesh, India. Data were collected from surgery- and medicine-allied (SA and MA) specialties. Along with socio-demographic details, information for total monthly family expenditure (TMFE), out-of-pocket expenditure (OOPE), and indirect illness-related expenditure (IIE) was recorded before and after hospital admission. CHE was considered as more than 10.0% OOPE of THFE and more than 40.0% of capacity to pay (CTP). Results: A total of 336 participants with a mean age of 46 years were recruited (MA: 54.6%). The majority (~93.0%) of participants had illness of fewer than 6 months. The mean TMFE was observed to be INR 4213.1 (standard deviation: 2483.7) and found to be similar across specialties. The OOPE share of TMFE declined from 76.1% (before admission) to 30.0% (after admission). Before admission, CHE was found among 65.5% (10.0% of THFE) and 54.2% (40.0% of CTP) participants. It reduced to about 29.0% (based on both THE and CTP) after admission to hospital. Conclusion: AB-PMJAY scheme found to be useful in reducing CHE in a tertiary hospital.

Prevalence of type 2 diabetes among tribal population of india: a multi-centric cross-sectional study.

BACKGROUND: The perception among healthcare workers is that the Indian tribal (indigenous) population are less affected by diabetes. This paper reports the prevalence of type 2 diabetes and its associated factors among tribal populations from six districts across India. METHODOLOGY: Random blood glucose (RBG) and fasting blood glucose (FBG) were measured for 8486 and 3131 adults, respectively, with a glucose meter. FBG ≥ 126 mg/dL (7.0 mmol/L) and RBG ≥ 200 mg/dL (11.1 mmol/L) were used to diagnose diabetes. In addition, blood pressure, anthropometric (height, weight, waist and hip circumferences), socio-demographic (age, gender, education, type of tribe and type of village) and behavioural data (tobacco smoking, non-smoking tobacco use and alcohol consumption) were collected. RESULTS: The overall prevalence of type 2 diabetes, based on RBG, was 4.77% (95% CI: 4.33-5.25). The prevalence of type 2 diabetes and prediabetes, based on FBG, was 6.80% (95% CI: 5.95-7.74) and 8.69% (7.72-9.73), respectively. The prevalence of type 2 diabetes was significantly associated with age (p<0.001), smokeless tobacco use (p < 0.05), hypertension (p < 0.001) and obesity (p < 0.01). CONCLUSION: The prevalence of type 2 diabetes among the Indian tribal population reported in this study is less than the national average of 7.3% for the general population. Hypertension and obesity were the major risk factors. Due to changing behavioural patterns, including dietary behaviour, there is likely to be an increase in the prevalence of hypertension and obesity, which further leads to increased prevalence of type 2 diabetes. Hence, appropriate interventions are to be initiated by the primary healthcare system.

Hypertension Prevalence, Awareness, Treatment, Control and Risk Factors in Tribal Population of India: a Multi-Centric Cross-Sectional Study.

The prevalence of hypertension is increasing in the tribal population of India. Lifestyle modifications, including dietary changes and acculturation, are the main reasons for the high prevalence of hypertension among the Indian indigenous (tribal) population. This paper reports hypertension prevalence, awareness, treatment, control and risk factors among tribes in five districts of different geographical zones of India. A cross-sectional study was conducted among the adult tribal population of 7590 from these states. Data related to blood pressure, anthropometry, demographic and behavioural variables were collected with prior consent from the participants. The prevalence of hypertension is 34.0% and 28.3% among men and women, respectively. Of the total hypertensives, 27.5% were aware of their hypertension status; of them, 83.9% were receiving treatment, and blood pressure was in control among 33.5% of patients who were receiving treatment. Age, alcohol intake, sedentary lifestyle, Particularly Vulnerable Tribal Groups status and body mass index are found to be significantly associated with the prevalence of hypertension. The prevalence of hypertension is high among these tribal populations, which could be due to modernization and acculturation. Awareness and treatment-seeking behaviour are poor. Hence, early screening, awareness campaigns for seeking treatment, and health promotion are immediately required. Comprehensive health promotion programs need to promote lifestyle modification and re-orientation of the primary health care system to improve availability and accessibility to hypertension screening and treatment.

Democracy, economics, or health-Time to look to the east for leadership.

While the capabilities of the low and middle-income countries (LMIC) have always been defined as "doubtful" to deal with public health crises of Covid pandemic magnitude, a flip-flop and incoherent response by the high-income countries (HIC) was unexpected. In the unprecedented moment of the pandemic, it is that we are beginning to find among ourselves, across the globe a search for stronger, resilient, scalable, and economy-efficient foundations in health systems that are capable of delivering healthcare to all. The apparently underperforming international health bodies have only increased this willingness of individual nations to look towards multilateralism as the foundational principle for not just the exchange of ideas but to deliver on these. India, a vibrant and the largest democracy, has showed her willingness to overcome, for example, the limitation of the vaccines during COVID to a few by making availability and possible delivery of a safe and effective vaccine to populations across the world. This has not only been seen as a hope to surmount challenges through help from others but also as a show of human resilience in the face of adversity.

Do current concepts of One Health suffer from the physics envy.

The current models of One Health appear to be suffering from a elevated emphasis on a small area of interface involving humans, environment and animals. This may largely be because of an extension of our understanding of physical science to biological world, which, though is far more complexer.

Development, standardization, and contextualization of qualitative tools for possible use in the assessment and valuation of snakebite envenomation.

Background: Snakebite envenoming, a neglected tropical disease (NTD), is an important public health problem that is responsible for more than 1 lakh deaths annually across the world. However, the majority of the data in this regard is from health institutions and data from community settings are scarce. The aim of the current study was to develop valid and reliable qualitative tools for assessing the burden of snakebites and the health-seeking behavior of the community. The tools developed thus will serve in creating a community connection and thereby strengthen primary care teams engaged in managing snakebites at the primary care level. Methods: A four-step design was used; (a) review of the available literature on the burden of disease, tools used to assess the burden, and the guidelines on snakebite (b) development, laying out, and contextualization of questions/items for the tools (c) pilot testing and establishment of validity. Results: A focus group discussion guide, key informant interview schedule for health professionals, community leaders, and traditional faith healers were matured for the implementation. Conclusion: A reliable and valid qualitative tool was developed to discern the speculations related to snakebites and its management in rural field settings.

Need to involve relevant stakeholders -lessons from NFHS data.

Contextualizing data to their settings is perhaps the most important step in deriving a meaning from them. This is no less true for health data. The National Health Survey data are an excellent source of information; however, its strength may not be its contextualization. Our habit of, for example, doing primary care without family physicians or doing public health without understanding the complete domain and involvement of its proponent seems to have extended to this exercise (collection of National Health Survey data) as well. Relegating health data to statistics and calculus alone should be a pitfall all of us must avoid. Identifying the right stakeholders to understand the complexity of health data is the key.

Is it "the conflict of interest" that is influencing our efforts on Climate change, tobacco control and primary care?

What seems to work against making climate change relevant, tobacco control necessary or primary care a felt need despite the efforts being claimed to the contrary? Emerging evidence points to a conflict of interest with academic institutions and academics fighting on both sides with clear support from the industry and others.

"Vasudaiva kutumbakam-one earth, one family, one future: "- India's mantra for a healthy and prosperous earth as the G20 leader.

India is a civilization, not just a country, nation, or government. Taking over the leadership of G20 by India, at a time when the world is battling pandemics, war, energy and climate crisis, and resource restriction is not just appropriately suited politico-economically but socio-culturally as well. COVID-19 proved that the unbelievably diverse world was too complex to be packed into a utopian hold-all one size fits all ideas. However, the fact is that COVID-19 may only have uncovered the crisis, which had been in the making for the latter part of the last century and extending into the current. India's leadership of G20 is therefore a window of opportunity for a more sustainable worldview as the ideas are coming from a civilization with a long history of acceptance of the entire world as one family- Vasudaiva Kutumbakam.

Risk of Childhood Obesity in Children With High Birth Weight in a Rural Cohort of Northern India.

OBJECTIVE: To compare the risk of early childhood obesity (BMI z-score of ³+2SD) among children of more than 7 years of age with a birth weight of more than 3500 g to a birth weight of 2500-2999 g. METHODS: Retrospective birth cohort study among children of 7 to 10 years of age in 22 villages of Himachal Pradesh with not-exposed (birth weight: 2500 to 2999 g) and exposed (> 3500 g) group. RESULTS: A total of 379 and 377 participants were enrolled in not-exposed and exposed group, respectively. Adjusted relative risk (aRR) between exposed and high BMI (>+2SD) was 4.9 (95%CI: 1.3-17.5) adjusted for mean age, gender, mean years of schooling, consumption of butter, fruits, vegetables, and indoor playing. CONCLUSION: High birth weight (>3500 g) increases and normal birth weight decreases the risk of childhood obesity up to five times in rural India.

Globalization through global citizenship and right to migrate.

All human beings of the world should be equal in status and stature. However, in reality human beings are divided by citizen status of nation states that are members of the United Nations. The human development index differs from one nation to another. Therefore quality of life, health, and life expectancy varies across countries and continents. Much depends on the governments representing human groups living in defined territorial boundaries. Governments defend sovereign territories and compete with other governments for business monopolies, territories and natural resources. From empires to colonisation, the world is passing through the phase of globalisation. There is an uneven divide of natural planetary resources and geographical territories. Also there is a continuous flow of financial resources from the poor nation states and in favour of the rich ones. Globalisation can no longer remain a refined chaotic balance of exploitation of one human territory by another. Travel and migration from one territory to another are highly regulated. The true idea of Globalization will only be realised when it is not linked to race, the level of skills, political affiliation or economic dividends and is able to add to the upward movement of the social structure of the poor. In a globalised world there should be equitable and fast paced distribution of benefits of modern development. Otherwise the global citizens of the world should look for alternatives.

Multi-sectoral implementation interface framework (MIIF) to achieve the objective of tobacco-free Himachal Pradesh.

The limitations observed in achieving the goal of a tobacco-free Himachal Pradesh have necessitated the need to contextualize the existing policy directives in tobacco reduction. Our observation has been that despite having clearly defined policy guidelines and laws, the implementation may not have followed suit. An analysis of the gaps observed had led us to develop an implementation interface framework involving stakeholders from multiple sectors.

A multinational Delphi consensus to end the COVID-19 public health threat.

Despite notable scientific and medical advances, broader political, socioeconomic and behavioural factors continue to undercut the response to the COVID-19 pandemic1,2. Here we convened, as part of this Delphi study, a diverse, multidisciplinary panel of 386 academic, health, non-governmental organization, government and other experts in COVID-19 response from 112 countries and territories to recommend specific actions to end this persistent global threat to public health. The panel developed a set of 41 consensus statements and 57 recommendations to governments, health systems, industry and other key stakeholders across six domains: communication; health systems; vaccination; prevention; treatment and care; and inequities. In the wake of nearly three years of fragmented global and national responses, it is instructive to note that three of the highest-ranked recommendations call for the adoption of whole-of-society and whole-of-government approaches1, while maintaining proven prevention measures using a vaccines-plus approach2 that employs a range of public health and financial support measures to complement vaccination. Other recommendations with at least 99% combined agreement advise governments and other stakeholders to improve communication, rebuild public trust and engage communities3 in the management of pandemic responses. The findings of the study, which have been further endorsed by 184 organizations globally, include points of unanimous agreement, as well as six recommendations with >5% disagreement, that provide health and social policy actions to address inadequacies in the pandemic response and help to bring this public health threat to an end.