Country Level Aging and Disease Burden(cont...)

India

India is in the early stages of the demographic transition, which is expected to advance in the future (Figure 2.4). The proportion of the population 65 years and older will move from 4.4 percent in 2000 to 7.6 percent in 2025.

Figure 2.4 Age stru cture in India, 2000 and 2025

Source: U.S. Census Bureau. www.census.gov/ipc, accessed July 1, 2010.

Country-level Aging and Disease Burden(cont...)

Bhutan

Bhutan is in the early stages of the demographic transition, but, because of significant reductions in fertility in the last 20 years, its expected to age more rapidly than some of its neighbors (Figure 2.3). The proportion of the population 65 years and older will move from 4.4 percent in 2000 to 7.3 percent by 2025. The prevalence of NCDs increases with age and thus the burden of disease caused by NCDs will also rise.

Figure 2.3 Age structure in Bhutan, 2000 and 2025

Country-level Aging and Disease Burden(cont...)

Bangladesh

Bangladesh is in the early stages of the demographic transition, which is expected to advance in the future (Figure 2.2). The proportion of the population 65 years and older will move from 4.5 percent in 2000 to 6.6 percent in 2025.

Figure 2.2 Age structure in Bangladesh, 2000 and 2025 .

Source: U.S Census Bureau. www.census.gov/ipc, accessed July 1, 2010.

Country-level Aging and Disease Burden(cont...)

Introduction

The major findings in Chapter 1 were from the WHO Global Burden of Disease Study and global tobacco use studies, both of which used standard methods across countries. However, further regional comparisons are challenging for two reasons: few other NCD studies are available across the region in all the countries, and studies that are available often use different methods and analyses that limit valid comparisons.

Country-level Aging and Disease Burden

Key Messages

* Among South Asia countries, Afghanistan is at the earliest stage and Sri Lanka and the latest

stage of the demographic transition.

* Among all countries, CVD, diabetes, cancer, chronic respiratory diseases, and injuries are

important causes of morbidity and mortality. In addition, mental health is an important issue,

particularly for Afghanistan and Pakistan.

Country-level Aging and Disease Burden(cont..)

Afghanistan

Afghanistan is yet to start the demographic transition that will just start to be evident in 2025 (Figure 2.1). The proportion of the population 65 years and older will move from 2.1 percent in 2000 to 2.9 percent in 2025.

Figure 2.1 Age structure in Afghanistan, 2000 and 2025

Source: U.S Census Bureau. www.census.gov/ipc, accessed July 1, 2010.

In 2004, NCDs accounted for 43 percent of the total forgone DALYs, with the remainder from

communicable diseases and MCH issues. Of the total DALY burden, CVD accounts for 14.0 percent, mental health 6.7 percent, cancer 4.0 percent, respiratory diseases 2.3 percent, diabetes 0.6 percent, and injuries 6.4 percent.

Economic Burden(cont...)

Lost Income

When ill with NCDs, most people cannot continue working and so forgo personal and household income. A study in India found that duration of illness, defined as days when people could not work, was in the range of about 50–70 days for some NCDs, or greater than from other conditions (Mahal et al. 2010) (Figure 1.8). The annual income loss from missed work, time given for care taking, and premature death are also significant (Figure 1.9).

Figure 1.8 Duration of illnessa for hospitalized surviving persons and for outpatients, India, 2004

Economic Burden(cont...)

Financing of Care

Still, direct quantitative evidence of specific chronic NCDs, pushing households or individuals below the poverty line in a strict causal sense is missing. However, several studies have assessed whether medical expenditures for chronic NCD are high in proportion to overall household expenditures.

In India, the risk of distress borrowing and distress selling of assets increases significantly for hospitalized patients if they are smokers (Bonu et al. 2005). Surprisingly, the risk is even higher for those who do not smoke themselves but belong to households in which other people smoke or drink (or both).

Economic burden(cont...)

Consumption Patterns

One study considered the opportunity costs of smoking for poor households in Bangladesh by comparing the amount of money spent on tobacco to the calories that could be “bought” with the forgone money (Ali et al. 2003). The average amounts spent on tobacco each day would generally be enough to make the difference between at least one family member having just enough to eat to keep from being malnourished (Ali et al. 2003, p. 12).

John (2008a) found that in India, households with tobacco users had lower consumption of certain commodities such as milk, education, clean fuels, and entertainment, which may have a more direct bearing on women and children in the household than on men, suggesting that tobacco spending also had negative effects on per capita nutrition intake.

Economic Burden

The economic consequences of NCDs includes three cost types (Suhrcke et al. 2008):

1) Social welfare costs—the value that people place on better health
2) Macroeconomic costs—the GDP losses countries incur due to ill health in the population.
3) Microeconomic costs—household financing of care, changes in consumption patterns, and forgone earnings of individuals and households due to the ill health among members.

Social Welfare Costs

How to Respond

Developing and Applying a Framework for Policy Options

While the health sector bears most of the burden for treating NCDs, preventive interventions lie both inside and outside the health sector.

policy options framework

A “policy options framework” provides policy makers with a tool for making broader systemic decisions that aim at balancing interventions and providing the optimal strategic mix of population-based interventions in the community to reduce risk factors and of individual-based interventions within the clinical setting to treat risk factors and morbidity.

NCD in South Asia(cont...)

Figure 1.6 Age-adjusted prevalence of current smoking of any tobacco product among men and women 15 years old and above, South Asia

Figure 1.7 Prevalence of current smoking of any tobacco product among youth 13–15 years old, South Asia

NCDs in South Asia(cont...)

Figure 1.5 Proportion of total deaths and forgone DALYs due to NCDs, South Asia, 2004

Source: WHO Global Burden of Disease, 2004 update,
http://www.who.int/healthinfo/global_burden_disease/estimates/en/index.html.

Where data are available, the prevalence of NCDs is increasing. In Sri Lanka, where some of the better secular morbidity data are available, successive population-based surveys indicate upward trends in the prevalence of diabetes. The prevalence of diabetes was estimated at round 3–6 percent in adults in the1990s; surveys in 2005 and 2008 reveal a prevalence rate of above 10 percent in adults (Illangasekera et al. 1993; Mendis and Ekanayake 1994; Fernando et al. 1994; Malavige et al. 2002; Illangasekera et al. 2004; Wijewardene 2005; Katulanda et al. 2008).

This regional pattern is characterized by similar country-level NCD risk factor burdens and variable country disease burdens. As said, tobacco use among adults is uniformly high among males (30–50 percent use rate with any form) and is low among women with the exception of Maldives and Nepal (Figure 1.6).

(Lack of data among adults from both Afghanistan and Bhutan highlight the need for better surveillance across the region.) Even more concerning than these profiles among adults are the rates of tobacco use in youth (13–15 years for both boys and girls) ranging from 20 percent in Bhutan to 6 percent in Maldives (Figure 1.7).

Chapter 1: Regional Aging and Disease Burden

Key messages

• The demographic and epidemiologic transitions in South Asia are resulting in an increasing shareof the disease burden related to noncommunicable diseases (NCDs).

• The impact of these two transitions can either allow countries to benefit from the demographicdividend or miss the opportunity due to increased morbidity, disability, and mortality among theworking-age population, and to increased expenses related to care and treatment of NCDs.

• Aging is occurring rapidly but often without the social changes that accompanied

NCDs in South Asia(cont....)

Figure 1.4 DALYs attributable to 10 leading risk factors by sex, adults 15–69 years, South Asia, 2004

Source: WHO Global Burden of Disease, Risk Factors Estimates for 2004,
http://www.who.int/healthinfo/global_burden_disease/risk_factors/en/index.html.

NCDs in South Asia(cont...)

DALYs attributable to 10 leading risk factors by sex, adults 15–69 years, South Asia, 2004

Additional research is finding that cardiovascular risk is highest for South Asians among the world’s regions (Goyal and Yusuf 2006). A recent study of 52 countries from all over the world, including Bangladesh, India, Nepal, Pakistan, and Sri Lanka, found that South Asians were 6 years younger (53 vs59 years) than those in the rest of the world at their first heart attack, had high levels of risk factors for CVD such as diabetes and high lipids, and had low levels of protective factors such as physical activity and healthy dietary habits.

The South Asians, therefore, appearing to have a greater susceptibility to CVD, it may have an even greater impact in the future than previously appreciated (Goyal and Yusuf 2006; Ramaraj and Chellappa 2008). In terms of DALYs forgone to risk factors, Figure 1.4 (for men and women) shows very different risk profiles. However, for both sexes, most of the risk factors are related to NCDs.

How to Respond (cont...)

NCD Risk Factors

Expand and Harmonize Tobacco Advertising Bans.

Collective bargaining with media entities for advertising and industry for tobacco labeling would give countries more leverage. Most countries ban tobacco advertising for national media, though rarely do they try to with international media that are viewed within their own borders.

Increase and Harmonize Tobacco Taxation

The potential is for negative externalities (increased

NCDs in South Asia(cont...)

Methods to describe the health situation in South Asia

Mortality data in the region are limited. Therefore, to describe the health situation, we use age-standardized undiscounted disability-adjusted life years (DALYs), which measure the
number of years a person would lose due to disability and premature mortality. Death rates
are presented where possible. A number of health surveys have been carried out in the
region; they are very useful at the country level, but often not comparable at the regional
level (Chapter 3).

Demographic, economic, and health profiles for low- and middle-income regions

In the last few years, though, for the first time, all countries in the region have emocratically elected their governments.

Millennium Development Goals (MDGs)
The region's performance on meeting the Millennium Development Goals (MDGs) has been

mixed. Looking beyond consumption and poverty, the region has had encouraging success in some areas: for instance, infant mortality rates have dropped from about 120 in 1980 to 58 in 2008. However, challenges remain in key areas such as child malnutrition, maternal mortality, and gender balance in education and health outcomes.

Regional Demographic and Epidemiologic Transitions(cont...)

Figure 1.1 Dependency ratios in developed and developing countries

Developed Developing

Source: UN 2007.

Many implications from these transitions are evident. First, the burden will grow in the future, overwhelming the health sector and making it less responsive. If unaddressed, the impact of NCDs on individuals in terms of short- and long-term disability and premature death and forgone wages will be significant and worsen dependency ratios.

CAT 2011

Disclaimers Regarding Conduct of CAT

Disclosing, publishing, reproducing, transmitting, storing, or facilitating transmission and storage of the contents of the CAT or any information therein in whole or part thereof in any form or by any means, verbal or written, electronically or mechanically for any purpose, shall be in violation of the Indian Contract Act, 1872 and/or the Copyright Act, 1957 and/or the Information Technology Act, 2000. Such actions and/or abetment thereof as aforementioned may constitute a cognizable offence punishable with imprisonment for a term up to three years and fine up to Rs. two lakhs. Candidates who want to appear for CAT have to agree to a Non-Disclosure Agreement at the time of the test.

How to Respond (cont...)

The framework was used as a basis to assess country capacity and achievements in program implementation for NCDs that are necessary to formulate and implement policy options. Rather than a comprehensive assessment, the focus was on finding strengths that might be enhanced and deficits that could be addressed. Inevitably, gaps in progress were revealed. In the Assess stage, surveillance andburden assessments are receiving generally low levels of efforts and no country is reviewing the evidence base.

* In the Plan stage, some countries have NCD cells and national overarching policies.

* In the Develop and Implement stage, some countries have policies and measures in place, but often their implementation and enforcement has been slow or stalled. For community-based interventions, activity is evident in all countries but efforts and the adoption of explicit policies, especially those for tobacco, are highly variable. For individual-based interventions, less progress is evident.

NCDs in South Asia

Regional Disease Burden and Risk Factors

In South Asia the disease burden is shifting: the burden of NCDs (55 percent including injuries) now more than that of communicable diseases, MCH issues, and nutrition causes combined (46 percent) (Figure 1.3)

Figure 1.3 Burden of disease as a proportion of total forgone DALYs by cause, selected regions, 2004

Source: WHO revised 2004 Global Burden of Disease estimates, http://www.who.int/healthinfo/bodgbd2002revised/en/index.html, accessed July 2009.

Regional Demographic and Epidemiologic Transitions(cont...)

While progression of both transitions is predictable, the rate of progression is not, and can be highly variable—as evident in the South Asia region. These transitions are unfolding at a pace where a substantial residual burden remains from communicable diseases, MCH issues, and nutrition causes—an important point from at least two angles. First, evidence is emerging that links MCH and nutrition issues to NCD risk later in life.

Example

undernutrition during fetal gestation and early childhood, and low rates of consistent breastfeeding, both common in South Asian populations, are associated with increased risk for chronic NCDs in adult life. Second, individuals with both an NCD and an infectious disease tend to have worse outcomes compared to having either alone.

Aging as a result of these transitions will in itself increase the prevalence of NCDs because they are more common with increasing age. Other factors—including lifestyle changes that may be associated with urbanization and globalization—can also increase the risk of NCD onset at younger ages. In the context of development, the impact of these two transitions is substantial because of the demographic dividend, that is, where developing countries’ working and nondependent population increases and per capita income thus rises (Figure 1.2).

Why the Need to Act Now (cont..)

Opportunities for Prevention and Control

The main finding from studying major declines in CVD mortality seen in several developed countries during the 1960s and 1970s was that nearly half the reduction can be attributed to population-level changes in risk factors, such as tobacco use, and the rest to treatment of disease and its complications— with most of the treatment effect due to early diagnosis and initiation of pharmacological interventions, rather than medical or surgical interventions. Clearly, both prevention and treatment are needed—the challenge is determining the appropriate mix.

Many interventions have been proposed for preventing or reducing the NCD burden.

The interventions are

Regional Demographic and Epidemiologic Transitions

Demographic and epidemiologic transitions

The demographic transition results in lower proportions of children, an adult population growing faster than the entire population, and an emerging elderly population. Developed countries made this transition decades ago. The epidemiologic transition, first described by Omran in 1971, begins with a phase of pestilence and famine and a low life expectancy of 20–30 years, then shifts to a phase of receding pandemics and an increase in life expectancy of 40–50 years, then progresses to a phase where life expectancy is 60 years and above, and chronic diseases become the leading cause of death. South Asia is shifting from the second to the third phase.

ROLE /DUTY/CONCEPT/OF TERRITORIAL ARMY Continue

Army personnel are posted in TA units according to a carefully planned manning policy so that TA units can in times of war or hostilities be able to provide effective support to the Army.

The Tenure of Officer of Regular Army personnel in TA units is regarded as normal regimental duty and is equated with similar appointments in the Army for the -purpose of promotion, career planning etc. Even the directly recruited personnel of TA are given training at the ARMY REGIMENTAL Centre before they are posted and the training given is in three military infantry units.

Thus the functions and duties of TA are integrally connected with the operational plans and requirements of the ARMED FORCES and the members of TA are "Integral to the Armed Forces".

Why the Need to Act Now

Rationale for Action

Several compelling reasons are pushing countries toward tackling NCDs. From both a social and political standpoint, action is warranted. Compared to the rest of the world, South Asians are 6 years younger at their first heart attack. This unfair burden is especially tough on the poor, who after a heart attack, face a lifelong major illness, the need to finance substantial portions of their care out of pocket, and live at great risk for catastrophic spending and worsened impoverishment.

Social determinants also play an important role. Dramatic differences in health are closely linked to the degree of social disadvantage and poverty found within countries, and these inequities arise because of the circumstances in which people live, work, and age,

What is Happening and Its Implications (cont...)

Implications

These findings have major implications for South Asia. Aging will not only increase NCDs, but with it occurring rapidly and without associated economic gains nor social support systems, it can lead to unhealthy aging.
the unhealthy aging characterized by three concepts:

1)Disability and premature death—resulting more quickly in less favorable dependency ratios.

2)The shift of the disease burden toward NCDs—while a significant burden remains of maternal

What is Happening and Its Implications (cont...)

Aging and the Shifting Disease Pattern

Aging

Aging is occurring rapidly but often without the social changes such as improved living conditions, better nutrition, gains in wealth, and better access to health services that accompanied aging in most developed countries decades ago. Aging due to this transition will, alone, increase NCDs because they are more common with increasing age. However, population aging in South Asia is associated with a rapid increase in health problems such as heart diseases, cancers, diabetes, and obesity—in otherwords, unhealthy aging.

Unhealthy Aging

putting new pressure on health systems. Other factors—including lifestyle changes that are often associated with urbanization and globalization—can also increase the risk factors and disease onset at younger ages.

Regional Demographic and Epidemiologic Transitions

Regional Demographic and Epidemiologic Transitions

South Asia is home to a large, quickly growing, and predominantly poor population. The emergence of
NCDs in South Asia was, in fact, predictable because of the demographic and epidemiologic transitions (Figure 1.1, Box 1.1, and Table 1.2 below). In the demographic transition the characteristically large, young population of developing countries enters adulthood, but due to reduced fertility rates is not replaced by an equal share of children.

The population also experiences longer life expectancy (Figure 1.1).

What is Happening and Its Implications

Chapters 1 and 2 address the South Asian context, aging and the shifting disease pattern, country-level contexts, and the implications of these health transitions.

World Health Organization (WHO)

It defines noncommunicable diseases as including chronic disease (principally cardiovascular disease, diabetes, cancer, and asthma/chronic respiratory disease), injuries, and mental health. This does not include all chronic diseases, such as those of an infectious nature (HIV/AIDS, for instance).

Context

South Asia is home to a large, fast-growing population with a substantial proportion living in poverty. In terms of the demographic transition, it is still relatively young, while the regional average life expectancy at birth, 64 years, is rising.

INTRODUCTION - NCD (cont....)

The book is organized into seven chapters that analyze three key themes.

Chapters 1 and 2

This chapter contains “What is Happening and Its Implications,” and examine the demographic shift toward aging and the impact of the epidemiological shift toward NCDs.

Chapters 3 and 4
“Why the Need to Act Now” and develop the rationale for urgent actions to prevent and control NCDs.

Chapters 5–7

INTRODUCTION - NCD

Increasing life expectancy in South Asia is resulting in a demographic transition that can, under the right circumstances, yield dividends through more favorable dependency ratios for a time. With aging, the disease burden shifts toward noncommunicable diseases (NCDs)1 which can threaten healthy aging.However, securing the gains expected from the demographic dividend—where developing countries’ working and nondependent population increases and per capita income thus rises— is both achievable and affordable through efficiently tacking NCDs with prevention and control efforts.

This book looks primarily at cardiovascular disease (CVD) and tobacco use since they account for a disproportionate amount of the NCD burden—the focus is strategic, rather than comprehensive. It considers both country- and regional-level approaches for tackling NCDs as many of the issues and challenges of mounting an effective response are common to most South Asian countries. For some efforts, especially with prevention, regional cooperation offers additional advantages.

GENERAL STUDIES

1. General Science and Environment Questions on general science and Environment will cover general appreciation and understanding of science including matters of every  day observation and experience as may be expected of a well educated  person who has not made a special study of any particular scientific  discipline.

2. Current Events of National & International Importance  In current events knowledge of significant National and International  leveling will be tested.

ICC World Cup 2011-elecast Rights

ESPN Software India has been acknowledged as the official carrier and broadcaster for the tournament. It has signed an 8 yr deal with ICC that includes World Cup, one T20 series and one Championship League each year.

The deal is valued at about $1.1 billion and the network which includes ESPN, STAR Sports and STAR Cricket, will telecast all 49 matches of the ICC World Cup 2011.

ICC World Cup 2011-Official Sponsors

The ad, sponsor and telecast rights have their own tale to tell. Hyundai Motor India Limited (HMIL) will be the first official car partner of ICC WC from 2011 to 2015.

As part of the agreement ICC officials, players and VIP guests will use Hyundai cars for official transportation for the entire duration of the ICC Cricket World Cup 2011 and the contract extends till 2015. In addition to the World Cup, Hyundai will also be transport partners for the Women's World Cup and the T20 championship.

ICC World Cup 2011- Money Talk

The 10th edition of the ICC cricket world cup 2011 is finally underway and the event has generated tremendous excitement and hype. The WC 2011 is being held in India, Bangladesh and Sri Lanka- three cricket crazy countries.

India with its population of more than 1 billion plus cricket lovers forms the financial powerhouse of the sport. The tournament is often viewed as a perfect platform for many of the big brands to reach out to their consumers. The WC of 2007 proved catastrophic with India's early exit from the tournament. The rest of the tournament witnessed a huge dip in viewer ship and sponsorship revenues.

Here is a look at the business side of the world cup that gives a good indication of the corporate philosophy of some of the biggest brands we know and efforts they go through to make themselves visible. It also gives an interesting insight into the administrative aspect of the game.