Topic 1 : Sparing no one: cardiac risk factors present even among the very poor
Context
It has conventionally been assumed that prevalence of cardiovascular disease (CVD) risk factors among those living in extreme poverty in low and middle-income countries (LMICs) is low.
Reasons
- Historically, this group has been thought to take in fewer calories and have correspondingly lower body mass index, consume a largely plant-based diet and be in occupations associated with higher physical activity.
- All of these lifestyle patterns we know, decrease the risk of developing CVD and its risk factors.
Assumptions not necessarily true
- In a recent study it was found out that CVD risk factors (hypertension, diabetes, smoking, obesity and dyslipidaemia) were present among adults in extreme poverty.
- Understanding the extent to which this assumption of a low prevalence of CVD risk factors among those in extreme poverty holds true is important for setting priorities within health policy and care delivery, both for equity and effectiveness.
- From an equity perspective, if CVD risk factors mostly affect wealthier population groups in LMICs, then investing in programmes aimed at preventing and treating CVD instead of focusing on those conditions that disproportionately affect those in extreme poverty could further worsen health inequities by wealth.
Defining Poverty and CVD prevalence
- Poverty level was as stratified by World Bank country income category.
- Extreme poverty is generally defined by the international poverty line of $1.90 per day, and to enable comparison with other income groups in LMICs, researchers also examined the prevalence of CVD risk factors for the population with an income <$3.20 and <$5.50 per day, as well as those with an income >$5.50 per day.
- Men had a slightly higher prevalence of hypertension and a far higher prevalence of smoking than women.
- For diabetes, the prevalence was not statistically different between income categories in low-income countries or upper middle-income countries; only in lower middle-income countries did there exist a clear gradient wherein those with higher incomes had a higher prevalence of diabetes.
- The prevalence of obesity displayed a positive income gradient across all World Bank country categories.
- The prevalence of smoking and dyslipidaemia (abnormal lipid levels) was low across poverty levels in low-income countries and high across population income groups in upper middle-income countries.
Poor lack access to medicine
- Among those living in extreme poverty and who had hypertension, only 15.2% reported taking blood pressure (BP)-lowering medication.
- Of those poor living with diabetes, 19.7% reported taking blood glucose-lowering medication.
- Among those living in extreme poverty who should be taking a statin for secondary prevention of CVD according to WHO guidelines, only 1.1% were on the drugs.
- In low-income countries, hypertension treatment and control, diabetes treatment and statin use were low across poverty levels.
Mitigation initiatives
- India has a National Programme for prevention & Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke and State governments have further added on with their own regional surveillance and intervention programmes.
- The program primarily focuses on screening and treatment.
- India is committed to the principles of primary healthcare and Universal Health Coverage (UHC), as outlined in the 2018 Astana Declaration.
Way forward
A key shortcoming in communicating the hazards of smoking is the lack of a vigorous public education . The poor seem to outnumber the rich in smoking, which is a major risk factor for diabetes. We must include education, to see if it has a modifying role in the community.
Topic 2 : Has poverty really dropped to 5% in India?
Context
NITI Aayog B.V.R. Subrahmanyam recently claimed that less than 5% of Indians now live below the poverty line. He made the claim based on the findings of the Household Consumption Expenditure Survey (HCES), 2022-23.
Poverty estimation in India
- Poverty estimation in India is based on the measurement of income or consumption levels by the data collected and evaluated by committees like the Tendulkar Committee, the C Rangarajan Committee, etc.
- Calculating income or consumption levels is the widely used method for poverty estimation in India.
- According to this method, if the household’s income or consumption value falls below the given minimum level, called Poverty Line, it is said to be BPL, i.e., Below the Poverty Line.
Tendulkar Committee of Poverty Estimation
- Tendulkar Committee was formed in 2009. Suresh Tendulkar was the chairperson of the committee.
- Instead of using the Universal Reference period, the Committee used the Mixed Reference period.
- The recommendations of the Tendulkar Committee were as follows:
- Shift of the poverty estimation from calorie consumption level.
- Rural and urban India should have a uniform poverty line basket (PLB).
- The price adjustment methods should be changed to correct temporal and spatial issues with price adjustment.
- Private expenditure should be incorporated into education and health while estimating poverty levels.
Importance of Poverty Estimation
- It’s a Constitutional Requirement – The Indian Constitution promises an equitable society, and poverty estimation in India is an effective method for building such a society.
- Part of a Poverty Elimination of Plan – After poverty estimation, it comes to the conclusion that most people in India live under the poverty line. This will help the government formulate new strategies and plans to eliminate society’s poverty.
- To Measure the Welfare Schemes’ Impact – The estimation of poverty will help to track the successes, failures, and other impacts of the schemes by the government.
Challenges in Poverty Estimation in India
- Poverty Estimation in India is a challenging task as is, due to various factors.
- India is a heavily populated country which makes it even more difficult.
- Generally, poverty estimation is done on the basis of the ratio of consumption and income.
- Independently also, if either of these two factors falls below a certain threshold, the concerned family is considered to be below the poverty line or BPL. This is how poverty estimation in India is mainly done.
- One of the main challenges is the ‘Poverty Line Basket’. Ascertaining the constituents of this basket is a tough task due to the varying prices in all parts of the country.
- There is no declared income poverty line right now.
- Experts are using Tendulkar line adjusted for consumer price inflation and the World Bank’s purchasing power poverty line of $2.15 a day, both of which would give you less than 5% extreme poverty or extreme destitution.
- Another challenge faced in the process of poverty estimation in India is the difference in lifestyle patterns including the eating habits of people in various regions of India.
- A major challenge is a disagreement among people between different ideas expressed in the Tendulkar Committee & the Rangarajan Committee.
Way forward
There is an ardent need for poverty estimation in India owing to various reasons. Firstly, the records not only help in further research and studies but also contribute to the tracking of various government schemes and welfare policies that are ever introduced during the campaigns and otherwise.