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:


Tenth webinar in the Equilogues series

Institute of Public Health Bengaluru is pleased to announce the tenth webinar in the Equilogues series which was started by the Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology as part of their projet Closing the Gap: Health Equity Research Initiative in India. Please find attached the webinar announcement for the same.

Theme: Inclusion of minorities in public services in India

Upendra Bhojani at the Institute of Public Health (Bengaluru) led the India part of a multi-country collaborative project that aimed at building local network of researchers/practitioners/policymakers that can address social inclusion of ethnic and religious minorities in public services. Drawing on the findings from a scoping review of literature and a series of stakeholders consultations in Karnataka, he will briefly highlight the role of inclusive policies (esp in areas of education, health, governance, employment) in enhancing inclusion of minorities as well as gaps in our knowledge.

read more

Implementation research for taking tobacco control policy interventions to scale in India

Tobacco kills approximately six million people globally and over one million adults in India each year. In India, a comprehensive tobacco control law the Cigarettes and Other Tobacco Products Act (COTPA) 2003 exists. However, the implementation remains sub-optimal. COTPA has worked in some places/contexts/settings and not in others. From a policy and implementation perspective, it is crucial to systematically understand how and why the implementation of this law has occurred. By doing this, we will improve our knowledge of implementing effective tobacco control policies (TCPs) as well as identify system-wide implementation bottlenecks that could affect other sectors like pharmaceutical/food. I aim to improve the implementation of TCP in India by describing and explaining the why and how of its implementation across Indian states. Some of the hypotheses include: a) Champions at either political or bureaucratic level facilitate policy making and implementation process b) Implementation is weakened when restrictive mandates are provided to departments who are not involved in punitive action. The study will be conducted in five phases using quantitative and qualitative methods to map implementation landscape and using theory-driven inquiry to draw lessons. The purpose of this seminar is to seek suggestions to improve the proposal and shape the work that I will be doing over the next 5 years as part of my early career India Alliance fellowship.

read more

Deciphering an epidemic of epic proportion: the role of state and tobacco industry in tobacco control in post-liberalized India (1990-2017)

In this seminar, Upendra Bhojani will present an overview of the research he aims to conduct as part of the India Alliance fellowship for the next 5 years. The purpose is to seek comments/suggestions/critique for refining the proposal. About 3500 Indians die every day due to tobacco-attributable illnesses. Despite several regulatory measures, there has been a marginal decline in tobacco use in the last two decades. In fact, since 1990s, tobacco production and sales have increased. Therefore, this research aims to understand the role played by the state policies (related to tobacco) and the tobacco industry actions during 1990-2017. I will conduct the study in three phases. In Phase-1, I will map public policies related to tobacco in this period. In will use quantitative data to explore associations between the tobacco policies and the trends in tobacco production and consumption. In phase-2 I will use qualitative data to understand how the tobacco industry actors influence tobacco policies in India. How do governments in India respond to the industry influence as well as their own varying (often conflicting) interests in tobacco? Based on these insights, in the phase-3, I will select ten Indian states: five positive (significant decline in tobacco prevalence over time) and five negative (status quo or increase in tobacco prevalence) cases. I will use qualitative comparative analysis to understand the combinations of measures (policies, implementation, tobacco industry) that best explain a significant reduction in tobacco use prevalence.

read more

Tobacco Control Project – Mapping Policy Concerns

Understanding public policy around tobacco use is required to understand the conflicts of interests of state and non-state actors in India. My work revolved around mapping concerns on tobacco expressed as debates by the parliamentary elected representatives by sourcing the official archives of loksabha and rajyasabha.

read more

End of Internship Seminar: Krishna Subedi

Tobacco cessation counselling in NIMHANS, field visits to the primary health care center and the qualitative data analysis of the interest of people's representatives in the Lok Sabha on tobacco and tobacco related products in India Dr.Krishna Subedi IPH Intern...

read more

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).