Chronic Health Conditions & Public Policies

Chronic conditions are the health issues that require ongoing management over a period of years or decades. They include chronic non-communicable diseases (NCDs) but also a few communicable diseases and conditions (like disabilities) that lasts longer. The chronic conditions are on the rise globally and in India, where it has become a leading cause of deaths and disabilities. There are several factors implicated in the rise in chronic conditions, from genetics and individual lifestyle to changes in demography and the broader environment. Therefore, prevention and management of chronic conditions require an inter-disciplinary and inter-sectoral engagement.

In this cluster, we are specifically interested in how health policies and policies across other related sectors impact prevention and control of chronic conditions at a population level, including the major risk factors for such conditions such as tobacco and alcohol use, unhealthy diet and inadequate physical exercise. The cluster builds on the premise that broader social determinants of health operating at the macro- and the meso-level influence the individual behavioural choices (lifestyle) as well as shape the environment in which these choices are to be made.

Hence, our focus on public policies and intersectoral actions for health. In this context, we are also interested in studying the increasing role being played by commercial entities in shaping the epidemic of chronic conditions as well as the policy responses. The cluster aims to deepen our work on some of the relevant concepts/approaches including but not limited to ‘social determinants of health’, ‘political economy of health’, ‘health-in all policy’ and ‘harm industries’.

The following are, at present, the major thematic areas within this cluster:

Tobacco control
In India, 28.6% of adults and 14.6% of youth – in total over 26.7 crores (~ 266 million) are the current users of tobacco in some form. Tobacco use causes over 12.8 lakh (~1.2 million) deaths every year in India. Total economic cost from all the diseases caused by tobacco use in India in a year is estimated to be INR 104500 crore (~ 1045 billion). Tobacco use is a common major risk factor for chronic conditions, including cancers, cardiovascular diseases, chronic respiratory diseases and diabetes. This thematic explores empirical ways to reduce tobacco use in India and the associated health, economic and ecologic burden.

Road Safety
Road crashes are the leading cause of death in young people aged 15 – 29 years. Globally each year about 1.3 million people lose their lives in road crashes. Nearly 90% of all road fatalities occur in low- and middle- income countries, which have less than half of the world’s vehicles. In India, one road crash happens each minute and one life is lost to road crashes every four minutes – with over 150000 individuals losing their lives in road crashes each year. Under this thematic, we explore how to strengthen policies for road safety and their implementation at different levels.

Multisectoral Actions for Health
Health is seen as a dynamic state of physical, mental and social well-being. Health, especially at a population level, is impacted by several social, economic, environmental, cultural and political factors. Hence, enhancing population health requires coordinated actions across sectors, beyond just the healthcare sector. This thematic explores ways of engendering multisectoral actions for health and promoting health through public policies across different sectors (health-in all policy approach)

Peer-reviewed

  1. Shah R, Shah R, Bhojani U, Shah S. Dentists and tobacco cessation: moving beyond the willingness. Journal of Indian Association of Public Health Dentistry 2017;15(3):263-264
  2. Hebbar PB, Bhojani U, Kennedy J, Rao V. From policy to practice: lessons from Karnataka about implementation of tobacco control laws. Indian Journal of Community Medicine 2017;42(2):77-80
  3. Bhojani U, Soors W. Bringing evidence into public health policy: enhancing equity and engendering intersectoral action for health. BMJ Global Health 2016;1(Suppl 1):A1
  4. Bhojani U, Soors W, Yellappa V, Ahluvalia A (eds.) Bringing evidence into public health policy (EPHP) 2016. Equitable India: All for Health and Wellbeing. BMJ Global Health 2016;1(Suppl 1):A2
  5. Rao N, Bhojani U, Shekar P, Daddi S. Conflicts of interest in tobacco control in India: an exploratory study. Tobacco Control 2016;25(6):715-718
  6. Bhojani U, Soors W. Tobacco control in India: a case for Health-in-All Policy approach. National Medical Journal of India 2015;28(2):86-89
  7. Bhojani U, Hebbar P, Rao V, Shah V. Litigation for claiming health rights: insights from tobacco control. Health and Human Rights 2014
  8. Bhojani U, Venkataraman V, Manganawar B. Challenging ties between state and tobacco industry: advocacy lessons from India. Health Promotion Perspectives 2013;3(1):102-112
  9. Van Olmen J, Criel B, Bhojani U, Marchal B, Van Belle S, Chenge MF, Hoeree T, Pirard M, Van Damme W, Kegels G. The health system dynamics framework: the introduction of an analytical model for health system analysis and its application to two case-studies. Health, Culture and Society 2012:2(1)
  10. Bhojani U, Elias MA, Devadasan N. Adolescents’ perceptions about smoker in Karnataka, India. BMC Public Health 2011;11:563
  11. Bhojani U, Venkataraman V, Manganawar B. Public policies and the tobacco industry. Economic and Political Weekly 2011;XLVI(28):27-30
  12. Bhojani U, Chander SJ, Devadasan N. Tobacco use and related factors among preuniversity students in a college in Bangalore, India.  National Medical Journal of India 2009;22(6):294-297
  13. Bhojani U, Devadasan N. What to do with the Epidemic of Diabetes – a Health Systems Response. Christian Medical Journal of India 2008;23(3-4):26-28

Books/Monographs

  1. Bhojani U. Youth and tobacco use: a monograph on perceptions, practices & policies. Bangalore: Institute of Public Health; 2013

Magazine/blogs/popular media

  1. Bhojani U. Curbing tobacco: K’taka success story. Deccan Herald; 2018
  2. Bhojani U. Strengthening the governance for effective tobacco control in India. Health For Millions; 2017
  3. Bhojani U. How tobacco industry is misleading people with its ads. Newslaundry; 2016
  4. Prashanth NS, Bhojani U. Modi-fying India’s health: health in the times of India’s new prime minister. International Health Policies; 2015
  5. Pan masala – a way for the tobacco industry
  6. Jithendra A, Bhojani U. How the tobacco industry wins friends and influences policy. Newslaundry; 2015
  7. Arora R, Bhojani U. The semantics of commitment. International Health Policies; 2015
  8. Jitendra A. Pan masala – a way for the tobacco industry to bypass the gutkha ban? BMJ Blog; 2015
  9. Hebbar P, Rao V. Tobacco or job? BMJ Blog; 2014
  10. Hebbar P, Bhojani U, Rao V. Television as a public awareness tool to reduce tobacco use in India. eSocialSciences; 2013
  11. Bhojani U. Killing interference. The Week; 2012
  12. Venkataraman V, Bhojani U. India: code of conduct on dealings with tobacco industry.  News Analysis – Tobacco Control; 2011
  13. Bhojani U. When a picture paints a 1,000 words. Deccan Chronicle; 2011
  14. Bhojani U. Venkataraman V. India: court bans tobacco board from trade show. News Analysis – Tobacco Control; 2010

Others

  1. Education pack (2009) – This educational material was developed in collaboration with the District Anti Tobacco Cell (Bengaluru Urban) to be used by school teachers (and others) to raise awareness on tobacco use and associated harms among youth
  2. Media pack: collection of factsheets (2009) – This is a collection of five fact sheets on various aspects of tobacco use and policies including (1) tobacco and adverse effects; (2) tobacco and economy; (3) tobacco and livelihoods; (4) tobacco and taxation; and (5) tobacco control and public opinion. This was developed in collaboration with the District Anti Tobacco cell (Bengaluru Urban)
  3. Research brief on ‘Pre-university students and tobacco use in Bangalore city’ – This research brief summarizes the findings of a research study assessing tobacco use and related factors among pre-university students in Bangalore
  4. Policy briefs: Preventing non-communicable diseases through specific non-health ministries (2016) – This is a collection of 12 policy briefs on how policies of specific non-health ministries impact non-communicable diseases and their risk factors.

Here are the partners who have supported work of this cluster:


Workshop on “Realist evaluation in health policy and systems research”

Theory driven inquiry and realist evaluation in health policy and systems research

Are you thinking of using realist evaluation (RE) in your work? You have heard of realist evaluation but are unsure if it will work for you in your research or evaluation project? Or are you generally curious about health policy and programme evaluation and would like to learn about realist evaluation?

Then this 3 day workshop on realist evaluation is the most appropriate starting point for you to understand this approach. Through this hands-on workshop the concepts of theory-driven inquiry and particularly realist evaluation will be explained. The workshop will help participants understand and design a study based on realist evaluation using practical examples. Realist evaluation is an essential evaluation method that is idea to study programmes and policies in health. The starting point of a realist evaluation is the fact that programmes and policies work for some and not for others and hence the technique allows to explain how and why programmes and policies work, especially in complex health system settings.

If you are working or considering to work in these areas of health policy and systems research and would like to equip yourself with this approach join us from 9 – 11 October in Bengaluru for an immersive learning experience.

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Workshop on Tobacco Control, JIPMER 2019

The 5th National Workshop on Tobacco Control, held in JIPMER from 26th August to 30th August 2019, was attended by IPH researchers, Riddhi Dsouza,  Vivek Dsouza, and Adhip Amin. Three major themes were addressed in the Workshop. First, the history and politics of...

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Inauguration of SARC-CCT in Sri Lanka

Panelists Dr. Mary Assunta & Dr. Upendra Bhojani. Image credit: SARC-CCT The University of Colombo works systematically on tobacco control and was established as a tobacco observatory Sri Lanka in 2016. Recently, this observatory was expanded to the South Asia...

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Policy Roundtable: Urban Health Governance in India

Image credit: Observer Research Foundation Dr. Upendra Bhojani, India Alliance Fellow and Director at IPH, was invited to participate in a Roundtable discussion hosted by Observer Research Foundation (ORF) and World Health Organization, India in Delhi on the 26th July...

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Video on “Tobacco-Free Generation”

"Tobacco-free generation" is a proposal wherein children born after a certain year grow up in tobacco free environments, with legislation in place restricting exposure, sale and use of tobacco for that generation. This is potentially a very powerful intervention, that...

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People

Upendra Bhojani

Upendra Bhojani

Cluster Lead

Pragati B Hebbar

Pragati B Hebbar

Faculty

Amiti Varma

Amiti Varma

Associates

Chandrashekar Kottagi

Chandrashekar Kottagi

Associates

Mahesh S Kadammanavar

Mahesh S Kadammanavar

Asssociates

Vishal Rao

Vishal Rao

Adjunct faculty

Bruno Marchal

Bruno Marchal

Adjunct faculty

Neethi V Rao

Neethi V Rao

Honorary Associates

Werner Soors

Werner Soors

Adjunct faculty

Tobacco Control

In India, 28.6% of adults and 14.6% of youth – in total over 26.7 crores (~ 266 million) are the current users of tobacco in some form. Tobacco use causes over 12.8 lakh (~1.2 million) deaths every year in India. Total economic cost from all the diseases caused by tobacco use in India in a year is estimated to be INR 104500 crore (~ 1045 billion). Tobacco use is a common major risk factor for chronic conditions, including cancers, cardiovascular diseases, chronic respiratory diseases and diabetes. This thematic explores empirical ways to reduce tobacco use in India and the associated health, economic and ecologic burden.


Road Safety

Nearly 90% of all road fatalities occur in low- and middle- income countries, which have less than half of the world’s vehicles. In India, one road crash happens each minute and one life is lost to road crashes every four minutes – with over 150000 individuals losing their lives in road crashes each year. Under this thematic, we explore how to strengthen policies for road safety and their implementation at different levels.


Multisectoral Actions for Health

Health is seen as a dynamic state of physical, mental and social well-being. Health, especially at a population level, is impacted by several social, economic, environmental, cultural and political factors. Hence, enhancing population health requires coordinated actions across sectors, beyond just the healthcare sector. This thematic explores ways of engendering multisectoral actions for health and promoting health through public policies across different sectors (health-in all policy approach).