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. Dsouza R, Bhojani U. Strategic and contested use of food laws to ban smokeless tobacco products in India: a qualitative analysis of litigationTobacco Control Published Online First: 20 August 2021. doi: 10.1136/tobaccocontrol-2020-056241
  2. Bhojani U, Varma A, Hebbar PB, Mandal G, Gupte H. LifeFirst: Impact of a school-based tobacco and supari cessation intervention among adolescent students in Mumbai, India. Population Medicine. 2021;3(May):12. doi:10.18332/popmed/134990.
  3. Varma A, Chilgod L, Bhojani UDiverse and competing interests around tobacco: qualitative analysis of two decades of parliamentary questions in India. BMJ Global Health 2021;6:e004093. doi:10.1136/bmjgh-2020-004093
  4. Chugh A, Bassi S, Nazar G P, Bhojani U, Alexander C, Lal P, Gupta P C, Arora M. Tobacco Industry Interference Index: Implementation of the World Health Organization’s Framework Convention on Tobacco Control Article 5.3 in India. Asia Pacific Journal of Public Health 2020 (doi: 10.1177/1010539520917793)
  5. Mir G, Karlsen S, Mitullah W, Bhojani U, Uzochukwu B, Okeke C, Mirzoev T, Ebenso B, Dracup N, Dymski G, Duong DTT, Ha BTT, Ouma S, Onibon F, Ogwezi J, Adris S. Achieving SDG 10: a global review of public service inclusion strategies for ethnic and religious minorities. Occasional paper 5 Geneva: United Nations Research Institute for Social Development; 2020:1-29
  6. Bhojani U. Review of “Health inequities in India: a synthesis of recent evidence.” T. K. Sundari Ravindran, Rakhal Gaitonde (eds). Springer Nature Singapore Pte Ltd. Current Science 2019;117(04):706-707
  7. Bhojani U, Madegowda C, Prashanth NS, Hebbar P, Mirzoev T, Karlsen S, Mir G. Affirmative action, minorities, and public services in India: Charting a future research and practice agenda. Indian Journal of Medical Ethics 2019;4(4):265-273
  8. 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
  9. 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
  10. 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
  11. 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
  12. 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
  13. 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
  14. Bhojani U, Hebbar P, Rao V, Shah V. Litigation for claiming health rights: insights from tobacco control. Health and Human Rights 2014
  15. 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
  16. 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)
  17. Bhojani U, Elias MA, Devadasan N. Adolescents’ perceptions about smoker in Karnataka, India. BMC Public Health 2011;11:563
  18. Bhojani U, Venkataraman V, Manganawar B. Public policies and the tobacco industry. Economic and Political Weekly 2011;XLVI(28):27-30
  19. 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
  20. 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 Prevent tobacco lobby interreference. Deccan Herald; 2020
  2. Bhojani U, Lal P, Assunta M. Size doesn’t matter when it comes to tobacco industry interference: some observations from South Asia. South Asian Regional Consortium Centre for Combating Tobacco; 2019
  3. Bhojani U. Curbing tobacco: K’taka success story. Deccan Herald; 2018
  4. Bhojani U. Strengthening the governance for effective tobacco control in India. Health For Millions; 2017
  5. Bhojani U. How tobacco industry is misleading people with its ads. Newslaundry; 2016
  6. Prashanth NS, Bhojani U. Modi-fying India’s health: health in the times of India’s new prime minister. International Health Policies; 2015
  7. Pan masala – a way for the tobacco industry
  8. Jithendra A, Bhojani U. How the tobacco industry wins friends and influences policy. Newslaundry; 2015
  9. Arora R, Bhojani U. The semantics of commitment. International Health Policies; 2015
  10. Jitendra A. Pan masala – a way for the tobacco industry to bypass the gutkha ban? BMJ Blog; 2015
  11. Hebbar P, Rao V. Tobacco or job? BMJ Blog; 2014
  12. Hebbar P, Bhojani U, Rao V. Television as a public awareness tool to reduce tobacco use in India. eSocialSciences; 2013
  13. Bhojani U. Killing interference. The Week; 2012
  14. Venkataraman V, Bhojani U. India: code of conduct on dealings with tobacco industry.  News Analysis – Tobacco Control; 2011
  15. Bhojani U. When a picture paints a 1,000 words. Deccan Chronicle; 2011
  16. Bhojani U. Venkataraman V. India: court bans tobacco board from trade show. News Analysis – Tobacco Control; 2010

Others

  1. Dsouza R, Bhojani U. A report on the mapping and analysis of tobacco-related litigations in Karnataka. Submitted to the Karnataka State Anti Tobacco Cell, Department of Health and Family Welfare Services, Government of Karnataka. Institute of Public Health, Bengaluru; 2020
  2. 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
  3. 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)
  4. 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
  5. 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.
Updates
Preventing TII in Karnataka

Preventing TII in Karnataka

‘Symposium on Applied Research in Tobacco Control and Regional Stakeholder Meeting’ (Virtual) was held on 16th September 2021 in association with the Tobacco Control Capacity Programme and State Tobacco Control Cell, Government of Karnataka. Dr. Upendra Bhojani...

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Anusthana’s protocol paper published in BMJ

Anusthana’s protocol paper published in BMJ

Dr. Pragati Hebbar together with Vivek Dsouza, Upendra Bhojani, Onno CP van Schayck, Dr. Giridhara Babu, and Gera Nagelhout co-authored a protocol paper titled “Implementation research for taking tobacco control policies to scale in India: a realist evaluation study...

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Workshop on Preventing TII (Chhattisgarh & Manipur)

Workshop on Preventing TII (Chhattisgarh & Manipur)

In two separate workshops held in December last year, Dr. Upendra Bhojani (Director, IPH-Bengaluru) was invited to serve as a resource person (virtual) on Tobacco Industry Interference (TII). The workshops were held in Chhattisgarh (16th December, 2020) and Manipur...

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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).


People
Upendra Bhojani

Upendra Bhojani

Cluster lead

Praveen Rao S

Praveen Rao S

Associates

Werner Soors

Werner Soors

Adjunct Faculty

Pragati B Hebbar

Pragati B Hebbar

Faculty

Riddhi D'souza

Riddhi D'souza

Associates

Bruno Marchal

Bruno Marchal

Adjunct Faculty

Amiti Varma

Amiti Varma

Associates

Vivek D'souza

Vivek D'souza

Associates

Neethi V Rao

Neethi V Rao

Honorary Associates

Mahesh K

Mahesh K

Associates

Ketki Shah

Ketki Shah

Associates

Chandrashekar Kottagi

Chandrashekar Kottagi

Associates

Vishal Rao

Vishal Rao

Adjunct Faculty