Date : 30/08/2023

Relevance: GS Paper 2- Social Justice - Health

Keywords: Social determinants of health, Nutrition as a Vaccine, Health For All

Context-

• In the realm of scientific literature, it is rare for a study to truly captivate attention. Last week, the RATIONS study did just that. This groundbreaking research explores the impact of nutrition subsidies on public health, underscoring the need to integrate social determinants of diseases into healthcare strategies.
• The study's findings shed light on the powerful connection between nutrition and disease mitigation, presenting a paradigm shift in healthcare.

Stunning Results Amidst Challenges

• What makes the RATIONS study truly remarkable is its execution during the initial year of the pandemic, amidst extended lockdowns across the country. Despite these challenges, the research maintained a high level of fidelity to the protocol, a testament to the dedication of the field research teams.
• The parent study demonstrated a 5% weight gain in the initial months of food supplementation, leading to a remarkable 60% reduction in the risk of mortality.

• Equally astonishing was the secondary study's finding that providing food to infected individuals' families led to a 50% decrease in lab-confirmed TB infection among household members.

Unearthing Historical Clues

• These findings echo historical and clinical evidence that suggests the profound impact of improved living conditions and nourishment on disease incidence.
• The first half of the 20th century witnessed significant declines in TB incidence and mortality in Western countries, predating the discovery of TB antibiotics.
• These improvements were attributed to reduced poverty and enhanced living conditions, including access to nutritious food. Despite these observations, the focus shifted to biomedical interventions with the advent of TB medications, sidelining the importance of addressing social determinants of health.

Expanding the Horizon of Healthcare

• The implications of the RATIONS study are not limited to TB alone.
• Its findings align with evidence from various disciplines, including psychiatry, where addressing social factors has proven instrumental in improving health outcomes. Income support for impoverished families, combating violence, and providing housing assistance for those with mental illnesses have all demonstrated positive impacts on health.
• This body of evidence underscores the necessity for healthcare to extend beyond biomedical interventions to encompass social determinants.

Universal Healthcare: Beyond Biomedicine

• The concept of universal health coverage, embraced by governments globally, must encompass not only medical interventions but also the social determinants linked to health.
• Integrating social welfare services within primary and secondary care facilities can pave the way for a comprehensive approach to healthcare, strengthening the public sector's role in catering to the majority of the population.

Nutrition as a Vaccine: A Game-Changer

• The RATIONS study convincingly positions food supplementation as a transformative strategy. By bolstering the immune system, nutrition serves not only as a treatment for TB but also as an effective vaccine for family members.
• If nutrition can yield such remarkable benefits for TB, the potential extends to other infectious diseases and broader health conditions.
• Addressing social determinants within healthcare systems holds the promise of better outcomes across the spectrum of diseases.

The synergy between Science and Society

• This collaboration between academia and civil society organizations, funded by the Indian Council of Medical Research, exemplifies how partnerships can yield groundbreaking science. Fostering such alliances, especially under the proposed National Research Foundation, is pivotal for driving scientific advancement and public health simultaneously.
• Ultimately, generating top-tier medical research that addresses the health needs of India's marginalized masses is a crucial governmental mission. Collaborations with civil society organizations offer a unique opportunity to build a healthier, scientifically advanced nation. The RATIONS study marks a pivotal step towards recognizing nutrition's role as a vaccine and shaping a holistic, effective healthcare system.

Government Initiatives and Future Prospects

• The Indian government's Nikshay Poshan Yojana, launched in 2018, reflects the recognition of nutrition's importance in disease management. The RATIONS study serves as a rallying call to enhance this initiative by ensuring synchronized delivery of food supplementation alongside medications.
• Expanding coverage to all household members can significantly contribute to the ambitious goal of eradicating TB by 2025.

Challenges hinder the integration of Social Determinants of Health (SDH) for improved outcomes:

• Individual-Centric Focus: Indian public health historically prioritized healthcare institutions, particularly maternal and child health, and infectious diseases, lacking a comprehensive population-based approach.
• Short-Term Orientation: Resource limitations in India lead to actions with the immediate visibility and tangible outcomes. The intricate nature of SDH makes it less appealing to policymakers seeking quick results.
• Misconstrued Benefits: Erroneous belief that addressing social determinants suits only affluent nations, ignoring its applicability to India's context.
• Segmented Policy Approach: Health policy formulation in India often operates in isolation, necessitating a holistic "health in all policies" approach to truly enhance social determinants of health. It involves considering non-health sectors' impact on health equity.

The government has taken steps to implement the SDH framework through targeted interventions:

• Nutrition: National Nutrition Mission
• Clean Water: Jal Jeevan Mission
• Air Quality: Ujjwala Yojna (addressing indoor air pollution)
• Sanitation: Swachh Bharat Yojana
• Gender Equality: Beti Bachao Beti Padhao

For effective adoption of the SDH approach to address widespread health challenges, a comprehensive "health in all policies" strategy is vital. Additionally, dedicated research into the application of SDH in India can provide insights crucial for informed policy decisions.

Conclusion

The RATIONS study's revelations have thrust the significance of nutrition subsidies and addressing social determinants of diseases into the spotlight. As science intersects with societal needs, healthcare can evolve into a comprehensive strategy that not only treats illnesses but also prevents their occurrence. By integrating nutrition as a vaccine, India's healthcare system can embark on a transformative journey towards better health outcomes for all.

Source - The Indian Express