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Drug Free........ and Healthy India?

OPINION

Drug Free India?.......

Prof. T K Thomas

26 Feb, 2019 
Two weeks back, this column carried a piece entitled “Hooch Victims: Not Just Numbers!” about death of over 40 people after drinking illicit liquor. A bigger hooch tragedy last week killed over 150 tea garden workers and over 300 hospitalized for critical care in Assam’s Golaghat. A friend asked why such frequent occurrence of hooch tragedies and deaths of poor and marginalized people and why no action is being taken to prevent such tragedies. Familiar with the problem of addiction in the country, he wondered why the government was more concerned about drug addiction and not on alcohol addiction. It took some time to explain to him how the two problems were being handled by two separate ministries of the government of India-Ministry of Social Justice and Empowerment for drugs and the Ministry of Health and Family Welfare for alcohol.
Last week on 19th February, the Prime Minister through a video address launched a campaign for #DrugFreeIndia at an event at Guru Jhambeshwar University in Hisar in Haryana. This shows the concern of the central government about the major national problem of drug addiction. It is worth reproducing what the PM said about addiction. Quoting WHO estimates, he pointed out that over three crore people around the world are suffering from drug addiction.”In addition to the terrible problems and destruction of families due to substance abuse, narcotics trade is one of the biggest sources of income for terrorists and anti national elements and the money sourced by these elements through drug trade is used to destabilize the nation.”

Urging the young generation to support and help those reeling from drug addiction, he said that, ”only through conversation , counselling and continued love and support we can bring those under addiction to the path of rehabilitation”. He also highlighted the National Action Plan for Drug Demand Reduction initiated in 2018 which focuses on “awareness generation, capacity building, rehabilitation and specific intervention in vulnerable areas to ensure drug demand reduction by 2023”.

Incidentally, in December 2017 the Ministry of Social Justice and Empowerment had informed a Supreme Court Bench headed by Chief Justice Dipak Misra that the government would formulate an action plan for combating drug abuse. The apex court had also asked the Ministry in December 2016 while deciding a P I L by Nobel laureate Kailash Sathyarthi’s NGO to formulate within six months the national action plan to curb rising substance abuse cases among schoolchildren and had also ordered a national survey to gauge the extent of the menace. It may be added that the P I L had pointed out that the national capital alone has approximately one lakh street children and substance abuse is reported as a major health problem among these children.

In its affidavit the Ministry had said that it had assigned the National Drug Dependence Treatment Centre under All India Institute of Medical Sciences to conduct a national survey on the extent and pattern of substance use.

A combination of two data collection approaches was employed; firstly a Household Sample Survey [HSS] was conducted among a representative sample of the 10-75 years old population of all the states and UTs of the country. During HHS 200,111 households were visited in 186 districts of the country and a total of 473,569 individuals were interviewed. Secondly a Respondent Driven Sampling [RDS] survey was conducted covering 135 districts and 72,642 people suffering from dependence on illicit drugs. The report is intended to provide a framework to planners and policy makers, researchers and academicians and would help further in finalizing the National Action Plan for drug demand reduction formulated by the Ministry of Social Justice and Empowerment for the period 2018- 25.

It is understood that though the draft National Action Plan for drug demand reduction has been finalized, it seems the draft demand reduction policy has been withdrawn. The country has to wait for a multi-pronged strategy –involving prevention education, de-addiction and rehabilitation of affected individuals and their families and at work place.

However, with the policy for drug demand reduction yet to be finalized, the Ministry of Social Justice and Empowerment, has now brought out a document on the “Magnitude of Substance Use in India” by the National Drug Dependence Treatment Center, All India Institute of Medical Sciences. In the absence of a comprehensive policy, this document seems to be an apology. Cannabis in the form of bhang consumed during festivals like Holi is legal but derivatives like ganja or hashish are banned substances. According to the report the prevalence of cannabis use [ charas/ganja] is the highest in Sikkim at 7.3 % followed by Nagaland 4.7% while the all India average is 2.8%. The prevalence of Opioid [derivatives from opium] groups of substances which include opium, heroin [also street drugs like brown sugar/smack] and pharmaceutical opioids is 2.06%. Uttar Pradesh, Punjab and Haryana lead in the number of opioid users. There are also a variety of pharmaceutical sedatives. The survey reveals that 1.08 % people are sedative users. In terms of sheer numbers it works out to 1.18 crore people!

The survey by the National Drug Dependence Treatment Center gives details about alcohol use and addiction. Prevalence of alcohol use in the country is 14.6 %. This means alcohol is a much larger issue than drugs, though alcohol itself is legal and a regulated substance. The emphasis of the document seems to be on treatment rather than on prevention. The absence of a comprehensive alcohol policy is a gaping gap. No wonder our commitment to WHO to reduce alcohol use by 10% seems under achieved. In this context it is worth quoting one of the editorials of ‘Niramaya’, the NCD newsletter of the Ministry of Health and Family Welfare which deals with alcohol addiction, a major NCD or Non communicable Diseases. ”In 2011, the UN High-level Meeting on NCDs identified alcohol as one of the four major risk factors for NCDs. The 66th World Health Assembly [WHA] followed up on the Political Declaration adopted at the highest level meeting by endorsing the WHO Global Action Plan for the prevention and control of NCDs 2013-2020. This action plan reinforces the implementation of the Global strategy to reduce the harmful use of alcohol. The Global monitoring framework includes 25 indicators and a set of nine voluntary global targets. One of these targets is at least 10% relative reduction in the harmful use of alcohol by 2025. India has become the first country to adopt a national framework for prevention and control of NCDs, setting a target of 10% reduction of alcohol use by 2025”. With reports that liquor sales rose by 10% in 2018, it is to be seen how we will ensure 10% relative reduction in the harmful use of alcohol!

Alcohol use and dependence of alcohol are major problems that affect almost all sections of society. The poorer and marginalized sections of the society are more severely affected as poverty and alcohol mix well and the entire family is affected if the man of the house becomes an alcohol dependent. Poverty, deprivation, domestic violence, spurt in NCDs and neglect of children are some of the major effects on an alcohol dependent’s family. Easy availability and social acceptance of alcohol as a legal celebratory drink and the exorbitant price of foreign and Indian Made Foreign Liquor [IMFL] force the poor to go for much cheaper illicit liquor or hooch which are dangerous. The recent death of over 150 tea garden workers drinking spurious liquor illustrates the magnitude of illicit liquor.

Addiction to substances is a psycho -social, physical and spiritual problem. According to Suneel Vatsyayan, a long time friend and associate, a leading prevention expert and Chairman Nada India with very vast experience in alcohol and drug prevention has given many practical suggestions linking it to Sustainable Development Goals [SDGs] of the United Nations. “In July 2016 the Prime Minister had constituted a Group of Ministers [GoM] to examine National Drug Demand Reduction Policy prepared by the Ministry of Social Justice and Empowerment. This shows the government’s commitment to deal effectively with drug demand reduction in India. He had also mentioned about the problem of drug addiction in the first edition of “Man ki Baat”.

The policy examined by the GoM will also help create the required enabling environments to achieve the goal - ”Ensure healthy lives and promote well being for all at all ages.” under Sustainable Development Goals. India has committed to implement the 2030 agenda and achieve its 17 goals, says Vatsyayan. He further calls for integrating drug demand reduction in medical training and lauds the GoM’s proposal for the accreditation of de addiction centers, both private and government run ‘to ensure standardization in rehabilitation by building a skilled cadre of peer educators, rehabilitation social workers psychologists and strengthen the frontline health workforce in the country. This will help in mainstreaming thousands of peer led drug rehabilitation centers across the country. These drug free peer educators can contribute in reducing drug demand substantially as they connect directly at individual and community levels and no measure of technical knowledge can replace the insight of the lived experience. There is need for strengthening patients and create a people centered health care system in and around drug rehabilitation centers. This is vital for 
a drug free and healthy India”.
Source:https://www.pennews.net/opinion/2019/02/26/drug-free-india

“Vendors display tobacco products in ways that are appealing to children and youth.. Alarming

Investigators documented that in 225 tobacco points of sale observed, 91% of displays were at 1 metre – child’s eye level, 54% had no visible health warning; and 90 per cent of displays were, beside candies, sweets and toys, items marketed to children,” noted the study.

A report released on Wednesday finds that tobacco companies in India are systematically targeting children as young as eight by selling tobacco products and placing tobacco advertisements near schools.

These tactics, happening all over the country, is a clear violation of Section 5 and 6 of Cigarettes & Other Tobacco Products Act, it said.

To gather evidence regarding tobacco products being sold around educational institutions in violation of the law, two groups working in the area of tobacco control -- Consumer Voice and Voluntary Health Association of India -- undertook a study in 20 cities across six states in India.

Titled Tiny Targets, the study was conducted to determine the extent of tobacco products being marketed and sold around schools in India. A sample of 243 schools and 487 points of sale were closely surveyed during this study.

“Despite the prohibition on sales of tobacco products near educational institutions, numerous shops/vendors/points of sale sell and advertise tobacco products around schools,” found the study.

“Vendors display tobacco products in ways that are appealing to children and youth. Investigators documented that in 225 tobacco points of sale observed, 91% of displays were at 1 metre – child’s eye level, 54% had no visible health warning; and 90 per cent of displays were, beside candies, sweets and toys, items marketed to children,” noted the study.

https://www.thehindu.com/sci-tech/health/tobacco-companies-targeting-children-study/article26006514.ece

Meaningful involvement of People living With NCDs @Nada India

The Healthy India Alliance (Nada India is founding member of HIA) plan to develop a National Advocacy Agenda of People Living with NCDs based on the inputs of those who took part in the five community conversations (Nada organized one such  Community Conversation among alcohol and drug using population ) held in the India.Nada India Team (Ms.Nidhi,Devender Joti peer educator (PLWNCD) ,Pushpa caregiver and Suneel Vatsyayan ) participated and contributed @The Healthy India Alliance Regional Consultancy Meeting for the Northern Region in Delhi on 28th August 2018.Nada India is also member of HIA Working group on patient engagement.

 Nidhi shared her experience and feedback

There's an old conventional way of convening corporate meetings but when we work on fronts of issues related to public at large then engagement of participants in the meeting requires breaking those barriers for formal conversation , cut off the veil and talk about the real things in a realistic way.

Mr.Suneel Vatsyayan had done the same , he shaken the participants in the meeting and tried to bring their attention on the fact that as we have to focus on meaningful engagement of people living with NCDs and it's risk factors like alcohol and drugs to do the same we hv you first meaningfully engage ourself in terms of language , personal real life experiences and real life experiences of people we are talking about.

The body language was intimate and words chosen were close to human beings ,that made most people relate as to talk more openly. 

Kept sticking to and time and again asked others to focus on the topic and reality. 

Perhaps Suneel Vatsyayan Chairperson Nada India was the only one who was more experienced than others in community work.

Very purposefully conveyed his msg. Also shook people to take off mask and talk freely as one time or another we all have to face same difficulties for the purpose we are here for discussions.

 Pushpa both as Nada community worker shared her experience well.

Also as care giver she shared her true feelings. Her wounds are fresh and she needs time to heal. But her spirits are high and ver courageous lady she is.

Devender Joti  of peer educator of Nada India shared his personal experience and professional experience well.

As he has worked in social sector that is unorganized work sector ,he has worked in a free environment with less obligations to adhere to certain way of work and that is good also as we are not in any race for perfection and one should not be.

Its good we as People Living with NCDs got opportunity to express ourselves freely and also hv choice for work. Nidhi Nada India Team

MEANINGFULLY INVOLVING

PEOPLE LIVING WITH NCDs

What is being done and why it matters

https://ncdalliance.org/sites/default...

"At the age of 17 years, Mahesh has given up his schooling to work as a salesman." .... read more

Educate 500 families living with alcohol use & NCD
"At the age of 17 years, Mahesh has given up his schooling to work as a salesman." Alcohol violence in the family is forcing a lot of children to join work force. We target to sensitize 500 children about the issue of alcoholism and NCDs & encourage them to continue their education. Uma's troubles became worse when her husband started using alcohol and abuse became an everyday affair. We intend to counsel, heal 240 women survivors of violence to seek help and to live healthy & productive life.

Challenge
Worldwide, 3 million deaths every year result from harmful use of alcohol. It can lead to a range of mental, behavioural and other non-communicable conditions (NCDs). The harmful use of alcohol also brings significant social and economic losses to individuals and society at large. The recovering addicts and their families are usually not aware of NCDs and its relation with their alcohol and drug use. Moreover, discrimination from society leads to isolation of families affected by alcohol abuse.

Solution

The project aims to meet the need to engage "patient" before they accept this new identity of "patient" and promote informed choices among people effected and affected by NCDs & alcohol. Need has been identified to overcome the stigma and social repression associated with being diseased in order to empower and ensure the entitlement of women and children to assert their right to health. Prevention of NCDs with a focus on alcohol by using treatment readiness peer based approach..... 

China and India had the biggest fatality tolls from alcohol in 2016... Global status report on alcohol 18

New World Health Organization research shows a strong correlation between rising incomes, alcohol consumption and booze-related deaths in much of Asia

By ALAN BOYD SYDNEY, OCTOBER 6, 2018

Rising incomes are driving up alcohol consumption in much of Asia and the Pacific, with death rates from excessive drinking in Thailand, Vietnam, South Korea and Russia now among the highest anywhere in the world.

Southeast Asia and the Western Pacific are the only two regions that have seen increased per capita consumption since 2000, according to the latest Global Status Report compiled by the World Health Organization (WHO). The UN agency has called for stronger measures to prevent the growing medical toll.

“Concerted actions are needed to achieve at least stabilization of increasing trends in alcohol consumption in the Southeast Asia and Western Pacific regions …,” the report said. “Proven, cost-effective actions include increasing taxes on alcoholic drinks, bans or restrictions on alcohol advertising, and restricting the physical availability of alcohol.”

Only about 33.1% of people aged 15 or over consumed alcohol in the Southeast Asian region in 2016, which includes India and other South Asian countries. In contrast, almost 60% were drinkers in Europe, 54.1% in the Americas and 53.8% in the Western Pacific, a category which includes China in the WHO research.

But while other regions registered decreases, per capita consumption in Southeast Asia surged from 2.4 liters of pure alcohol per capita per year in 2000 to 4.5 liters in 2016, and from 4.8 liters to 7.3 liters in the Western Pacific.

The spikes were largely due to sharp increases in China (from 4.1 liters to 7.2 liters) and India (from 2.4 liters to 5.7 liters) respectively within the period.

AFR (Africa), AMR (Americas), EMR (Eastern Mediterranean) EUR (Europe), SEAR (Southeast Asia + India) WPR (Western Pacific + China) Source: WHO

WHO expects global per capita consumption to reach seven liters in the next 10 years, up from 6.4 liters in 2016, “unless projected increasing trends in alcohol consumption in the region of Americas and the Southeast Asia and Western Pacific regions are stopped and reversed.”

“The highest increase is expected in the Southeast Asia Region, with an increase of 2.2 liters alone in India … The second-highest increase is projected for the populations of the Western Pacific region, where the population of China is the largest, with an increase in per capita consumption of 0.9 liters of pure alcohol by 2025,” the report said.

Smaller increases are expected in Indonesia, Thailand and Vietnam, but consumption will fall in some more advanced countries like Australia. There are 1.4 billion regular drinkers in Southeast Asia and 1.5 billion in the Western Pacific, accounting for half of all consumers worldwide.

Harmful alcohol use is linked to more than 200 health issues, including road injuries, liver diseases, violence, a range of cancers, cardiovascular diseases, suicides, tuberculosis and HIV/AIDS. However, figures on Asia’s death toll are distorted by consumption patterns of just a few countries.

Alcohol contributed to 21.6% of all deaths recorded in Russia in 2016, as well as 7.6% in South Korea, 7.4% in Thailand and 7.3% in Vietnam, according to WHO. Only the small European country of Moldova, where alcohol was a factor in 26.1% of deaths, had a bigger problem with booze in that year.

People drinking inside a bar in the old French Quarter of Vietnam’s capital, Hanoi. Photo: iStock/Getty Images

Yet it contributed to just 1.4% of deaths in Turkey, 1.7% in Indonesia, 2.4% in Singapore and 3.8% in China. The global average was 5.3% deaths in 2016, with three million people losing their lives after abusing alcohol.

WHO said that one factor behind the increasing health risks was the transition from lower-strength beverages like beer to spirits and other more expensive drinks as incomes rise. Spirits are very high in alcohol content in some countries and they often contain harmful additives.

Much is home-made, with “unrecorded” alcohol — generally spirits — accounting for as much as 45.4% of total consumption in Southeast Asia. Spirits comprise about 88% of alcohol consumed in that region, compared with 59% in the Western Pacific region and a global average of 44.8%.

In Thailand, where per capita consumption averaged 8.3 liters of alcohol in 2016, 69% of drinkers consumed spirits, against 28% for beer. Spirits were also the main beverage for 69% of South Koreans, but were favored by only 39% and 8% respectively in less-developed Russia and Vietnam.

Not surprisingly, populous China and India had the biggest fatality tolls from alcohol in absolute numbers among Asian countries in 2016: there were 264,468 deaths in India and 249,906 in China. Russia recorded 63,089 deaths, Thailand 22,448 deaths and Vietnam 21,709 deaths, the WHO report said.

http://www.atimes.com/article/richer-drunker-and-unhealthier-in-asia/