Context

Indian Strategic Petroleum Reserves Ltd (ISPRL) has invited bids for constructing 2.5 MT of underground storage of crude oil at Padur in Karnataka paving way for India’s first commercial crude oil strategic storage.

Padur II Reserve Project: A Strategic Petroleum Reserves Project

• The Padur II reserve will be a part of Phase-II of the Strategic Petroleum Reserves Project.
• Phase II: It will build an additional 6.5 MMT of Strategic Petroleum Reserves in underground unlined rock caverns along with above ground facilities.
  • It will include offshore and onshore SPM and associated pipelines at two locations Chandikhol (4 MMT) in Odisha and at Padur (2.5 MMT) under Public Private Partnership (PPP) model.
• The Phase-I storages were built at government expense.

The Padur II Reserve Project

• Storage capacity: It will store 2.5 million tonnes of crude oil at a cost of ₹5,514 crore.
• Construction Model: It will be constructed in a PPP (public-private partnership) model where private parties will design, build, finance, and operate the storage.
  • The operator of Padur-II will lease out the storage to any oil company wishing to store oil and charge a fee. The companies storing oil can sell it to domestic refiners. But in case of an emergency, India will hold the first right on oil usage.
• ISPRL acquired about 215 acres of land for Padur-II.

Strategic Petroleum Reserves (SPRs)

• Mandated by IEA membership: Strategic Petroleum Reserves needs to be maintained by every nation belonging to the International Energy Agency (IEA) as per the terms of the International Energy Programme (I.E.P.) agreement.
  • Countries are required to maintain emergency reserves of oil amounting to a minimum of 90 days’ worth of their net oil imports.
  • The U.S., China, and Japan are leading crude oil consumers and maintain the largest strategic reserves.
• Present capacity: India’s existing strategic storage is of 5.33 million tonnes (39 million barrels) meeting  approximately 9.5 days of national demand.
• Objective: To ensure the country’s energy security,by building a strategic reserve of oil which can be used in case of emergency situations.
• Implementing Agency: Indian Strategic Petroleum Reserve Limited (ISPRL) It  is a wholly owned subsidiary (WOS) of Oil Industry Development Board (OIDB), which is a Body Corporate is a  special purpose vehicle created by the government for building and operating strategic petroleum reserves in the country.

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Context

SARAH is a digital health promoter prototype launched by the World Health Organization (WHO).

• Previous versions of SARAH under the name Florence, was  used to disseminate critical public health messages, during the COVID-19 pandemic on the virus, vaccines, tobacco use, healthy eating and physical activity.

SARAH (Smart AI Resource Assistant for Health)

• Powered by: SARAH is an Generative AI based digital health model with technology  supported by Soul Machines Biological AI.
• It represents an evolution of AI-powered health information avatars and uses  new language models and cutting-edge technology.
• It can engage users 24 hours a day in 8 languages on multiple health topics, on any device.
• Features:  
• • Information dissemination:  To provide information across major health issues  including healthy habits and mental health, to help people optimize their health and well-being journey.
  • Right to health: As an additional tool in the hands of  people to realize their rights to health.
  • Real time information: The Generative AI model ensures real-time response with enhanced accuracy.
  • Human touch: It will provide nuanced, empathetic responses to users by engaging in dynamic personalized conversations at scale that more accurately mirror human interactions
  • To develop better understanding of risk factors: SARAH can help people in assessing risk factors for some of the major diseases including cancer, heart disease, lung disease, and diabetes etc
  • Repository of Information for a healthy lifestyle: SARAH will enable people to access up-to-date information on quitting tobacco, being active, eating a healthy diet, and de-stressing among other things

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Context

In the first RBI Monetary Policy Committee (MPC) announcement of the Financial Year 2024-25 (FY25), RBI Governor Shaktikanta Das has decided to keep the repo rate at 6.5%.

RBI Maintains Status Quo, Keeps Repo Rate Unchanged

• It is the seventh consecutive time that the repo rate has remained unchanged.
• The decision aims to contract inflation to meet the central bank’s 4% target, with a focus on stable growth.
• The RBI Monetary Policy Committee (MPC) has chosen to maintain its position of “reducing stimulus measures” unchanged, with a majority decision of 5-1.
• The RBI has kept the retail inflation target for FY25 at 4.5%, supported by inflation within the 2-6% band.
• In February, the consumer price index (CPI) recorded retail inflation at 5.09%.

Reasons to Keep Repo Rate Unchanged

• Inflation is still above target: While inflation has remained within the target range for the past 6 months (at 5.09% in February), it’s still higher than the RBI’s target of 4%. 
• Food price uncertainty: The RBI is concerned about potential future increases in food prices, which could push inflation back up as war in Ukraine has affected global grain markets and edible oil prices.
• Supporting economic growth: The Indian economy is growing at a healthy pace (7.6% estimated for FY24), and the RBI wants to maintain this momentum by keeping interest rates stable.
• Global economic slowdown: The RBI is cautious about the slowing global trade outlook, which could impact the Indian economy. Thus, it has taken such measures for the following reasons. 
  • Stability in Interest Rates: The RBI wants to keep interest rates steady to control inflation and keep the value of the Indian rupee stable. 
    • This helps make Indian goods cheaper for foreign buyers, boosting exports.
  • Encouraging Domestic Investment: By keeping interest rates steady, the RBI hopes to encourage Indian businesses to invest more. 
    • This helps grow the economy within India itself, reducing the need to rely too much on selling goods abroad.
• Persistent inflation in developed economies: They’re concerned that inflation might remain high in developed countries, which could put upward pressure on global prices.
• Monetary transmission: The RBI wants to ensure that changes in repo rate are effectively reflected in lending rates by banks.

What is the Repo Rate?

• Definition: Repo rate is the interest rate at which the central bank lends money to commercial banks.
• Regulating Liquidity: The Reserve Bank of India (RBI) uses the repo rate to manage liquidity in the economy.
• Banking Connection: Repo rate is associated with ‘repurchase options’ or ‘repurchase agreements’ in banking.
• Borrowing from the Central Bank: During fund shortages, commercial banks borrow from the central bank at the repo rate.
• • Secured Loans: Central bank provides short-term loans against securities like treasury bills or government bonds.
• Monetary Policy Tool: Repo rate adjustments are used by the central bank to control inflation and enhance bank liquidity.
• Rate Changes Impact: An increase in repo rate aims to control prices and borrowing, while a decrease stimulates economic growth.
  • Changes in repo rate affect public borrowings, including home loans and EMIs.
  • Unchanged repo rate typically shows steady interest rates on loans offered to consumers and businesses.
• Financial Implications: Various financial and investment instruments, from loan interest rates to deposit returns, are indirectly influenced by repo rate adjustments.

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Context

There is a hearing on whether states have the authority to levy excise duty on industrial alcohol by a 9-judge Bench of the Supreme Court. 

Excise Taxes On Alcohol

• Excise taxes on alcohol is a key component in state finances.
• Additional excise duties are commonly imposed by states to increase  their income from alcohol consumption.

About Industrial Alcohol

• Industrial alcohol is also called denatured alcohol.
  • Denaturation is the process of making industrial alcohol unsuitable for misuse or consumption.
    • It involves adding substances such as methanol or other chemicals.
  • Denaturation makes the alcohol toxic or unpalatable, ensuring it’s not fit for drinking purposes.
• Its primary use lies in industrial, commercial, and scientific sectors rather than as a beverage.
• Applications:
  • Raw Material: It serves as a base material in various industries.
  • Solvent: Used in making paints, varnishes, and coatings.
  • Fuel: Employed as a fuel additive or in biofuel production.
  • Pharmaceuticals: Essential in manufacturing medicines and extracts.
  • Chemical Processes: Vital for numerous chemical reactions.

Legal Framework

• State List (Entry 8): 

  • This list Grants states the power to legislate on the production, manufacture, possession, transport, purchase, and sale of “intoxicating liquors.”

• Union List (Entry 52) and Concurrent List (Entry 33):

  • Entry 52 gives control over industries to the Union.
  • Entry 33 allows for industries’ regulation to both state and union
    • The entries of these industries are  declared expedient in the public interest by Parliament.

• Concurrent List Dynamics:

  • Subjects in the Concurrent List can be regulated by both states and the Centre.
  • However, if a central law exists, state laws cannot contradict it.

• Industrial Alcohol Regulation:

• • Industrial alcohol falls under the Industries (Development and Regulation) Act, 1951 (IDRA).

Previous Judicial Consideration

• Synthetics & Chemicals Ltd v. State of Uttar Pradesh (1989):
  • Court Decision:
    • In 1989, a 7-judge Constitution Bench ruled on Synthetics & Chemicals Ltd v. State of Uttar Pradesh.
    • The Supreme Court (SC) clarified that states’ authority under Entry 8 of the State List is limited to regulating “intoxicating liquors,” distinct from industrial alcohol.
  • Interpretation of State Powers:
    • While states can prevent industrial alcohol misuse as a drink, their power primarily concerns consumable alcohol regulation.
    • The SC emphasized that taxes and levies on industrial alcohol aim at revenue generation, not regulation or prevention of its misuse.
  • Center’s Exclusive Authority:
    • The SC affirmed that only the Centre has the authority to impose levies or taxes on industrial alcohol, which is not intended for human consumption.
  • Reference to Ch Tika Ramji v State of UP (1956):
    • The SC did not consider its prior decision of Ch Tika Ramji v State of UP in Synthetics & Chemicals Ltd v. State of Uttar Pradesh (1989) case. 
    • In Ch Tika Ramji v State of UP (1956), the Supreme Court (SC) upheld legislation by the Uttar Pradesh (UP) government to regulate sugarcane supply and purchase.
      • The legislation faced a challenge based on Section 18-G of the Industries (Development and Regulation) Act (IDRA), which grants exclusive jurisdiction to the Centre over sugar industry regulation.
        • It emphasized that Section 18-G does not cover all aspects of the sugar industry, allowing states to legislate under Entry 33 of the Concurrent List.

Legal Battle Over Industrial Alcohol Regulation

• UP Government’s Notification (1999):

  • In 1999, the Uttar Pradesh (UP) government implemented a notification.
  • This notification introduced a 15% fee for sales to license holders under the UP Excise Act, 1910.
    • The fee applied to sales involving alcohol directly used or acting as a solvent for vehicles.
    • Additionally, it covered instances where alcohol appeared in the final product to some degree.

• Challenge and High Court Ruling (February 2004):

  • A motor oil and diesel distributor contested the fee notification.
  • They argued that the Center held sole authority over industrial alcohol as outlined in Section 18-G of the IDRA.

• In February 2004, the Allahabad High Court Invalidated the Notification:

  • It ruled that the state lacked authority over denatured spirits’ general regulation, only having control over drinkable alcohol.
  • Later, The High Court ordered the state to refund collected fees with a 10% per annum interest.

• Supreme Court Intervention (August 2004): 

• • The decision was appealed to the Supreme Court (SC), which stayed the High Court’s judgment in August 2004.

• Referral to Larger Bench (2007) and Ultimate Resolution (2010):

• • In 2007, the SC referred the case to a larger bench, noting the oversight of the Ch Tika Ramji case.
  • Ultimately, in 2010, a nine-judge Bench was convened to determine states’ powers under Entry 33 of the Concurrent List versus the Centre’s authority under Section 18-G regarding industrial spirits.

Arguments Presented On Behalf of the State of UP

• Interpretation of “Intoxicating Liquors”:

  • It was shown that “intoxicating liquors” in the State List means any liquid containing alcohol.
  • The terms were pointed  like ‘liquor,’ ‘spirit,’ and ‘intoxicant’  as these were used in alcohol laws before the Constitution.

• Union’s Authority and Finished Products:

  • There was an argument that the Union’s control, as per Entry 52, doesn’t cover finished products like industrial alcohol.
    • To control industrial alcohol regulation, the Centre must issue an order under Section 18-G of the IDRA.
    • In the absence of such an order, states have control.

• Preservation of States’ Powers:

• • State of UP warned against weakening states’ authority, referring to a judge’s opinion in a previous case.
    • It was stressed that states shouldn’t be seen as less important than the Centre, and their powers should be protected.

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Context

With the upcoming Lok Sabha elections nearby, misinformation, mostly in the form of shallow fakes has gripped the Internet.

• India ranks first in facing the risk of misinformation and disinformation as per the World Economic Forum’s Global Risk Report 2024.

What Are Shallow Fakes?

• Shallow fakes or cheap fakes are pictures, videos and voice clips created without the help of AI technology but by simple editing or by using other simple software tools like Photoshop.
• Shallow Fakes are named so because they represent a lower quality of image and video editing when compared to the high end creation of Deep Fakes. Comparatively shallow Fakes can be easily created by using basic online tools and also easily recognisable.
• Technology used: They use simple technology and are manually altered or selectively  manually altered or selectively edited.
  • Example: A conventional edit on a photo, or to change the speech patterns of a video, to  mis-caption or mis-contextualize  an existing image or video etc.

• Shallow Fakes Used For?

  • To create a false proof of identity or address by morphing ID documents like passports, licenses etc
  • To create a fake supporting evidence to support a claim or transaction
  • To produce distorted, morphed and inappropriate images and videos
    • Example: Union minister Smriti Irani in a belly dance outfit.
  • Act as a tool for digital forgery
  • To set and spread political narratives and defaming opponents.
    • Example: A video showed AIMIM leader Asaduddin Owaisi singing Shiv Tandav stotra.
  • Sexual blackmailing: Crudely manipulated sexualised images were used to target women by creating  non-consensual sexual or intimate images of women mainly and men.

• Impact: 

  • Snowballing: Tool to spread misinformation and disinformation whereby existing and true information is spun, twisted, recontextualised, reworked and fabricated in varying degrees.
  • On electoral process and democracy: 
    • It influences voter behaviour by shaping their opinions and attitudes towards the candidates and parties. 
    • The spread of Political Propaganda and divisive narratives.
    • It distorts the public perception of political leaders 
  • Spread disharmony and create conflicts: Numerous fake videos and images spread all over the internet targeting specific communities
    • Example: Shahrukh Khan was accused of spitting in a funeral.
  • Create pornographic images: Shallow fakes are often used to create sexualised images of women and defaming them.
    • Example: Rashmika mandanna image morphed. 

• Measures to Be Taken: 

  • Media literacy approach: The SIFT method can be used , which encompasses the following steps ie. Stop (as your emotions are likely being triggered by the images or videos you are seeing), Investigate the source; Find alternative coverage and Trace the original
  • Awareness and literacy campaigns in schools and office spaces.
  • Fact check by the ECI to dispel electoral misinformation
  • Metadata authentication by online platforms: Metadata contains information about a piece of media, such as when it was recorded and on what device thus the metadata embedded in a file can be used to cross-check the origins of the media.
  • Laws: India does not have a specific law on shallow and deep fakes yet but certain  provisions under existing legislations offer both civil and criminal relief.
    • Section 66E of the Information Technology Act, 2000: It is applicable in cases of deepfake crimes that involve the capture, publication, or transmission of a person’s images in mass media thereby violating their privacy.
    • Section 66D of the IT Act:  punishes individuals who use communication devices or computer resources with malicious intent, leading to impersonation or cheating.
    • Sections 67, 67A, and 67B of the IT Act: To  prosecute individuals for publishing or transmitting fakes that are obscene or contain any sexually explicit acts.
    • IPC 1860: Sections 509 (words, gestures, or acts intended to insult the modesty of a woman), 499 (criminal defamation), and 153 (a) and (b) (spreading hate on communal lines) among others.
      • The Delhi Police Special Cell has registered an FIR against unknown persons by invoking Sections 465 (forgery) and 469 (forgery to harm the reputation of a party) in the Mandanna case.
    • Copyright Act of 1957: It can be used if any copyrighted image or video has been used to create shallow fakes 

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Context

Strategic Forces Command (SFC), along with Defence Research and Development Organisation (DRDO), conducted the successful flight-test of New Generation Agni Prime Ballistic Missile from Dr APJ Abdul Kalam Island off the coast of Odisha.

Agni Prime Missile

• About: The solid-fuelled Agni Prime missile is a surface-to-surface missile. It is a nuclear-capable new-generation advanced variant of the Agni class of missiles. 
  • Agni Prime missileis is a two-stage canisterised missile with a maximum range of 1,000 to 2,000 km.
  • Having such a range puts it in the class of medium-range ballistic missiles.

• Advancement in Agni Prime Missile Technology: The ‘Agni Prime missile’ is lighter than all the earlier Agni series of missiles. 
  • It weighs at least 50 per cent less than the Agni 3 missile and has new guidance and propulsion systems.
  • The Prime variant of the Agni missile benefits from advanced sensors, navigation and guidance systems which significantly enhance the precision of the missile and its impact. 
• Canisterised Missile Benefits: Since the missile is canisterised, it can be transported by road and rail and stored for longer periods, significantly reducing the time required for preparation and launch. 
  • Damage Protection: Storing a missile in a canister or launch tube protects it from the elements- dust, debris, and also possible damage during any mode of transport and handling. 
  • Less Maintenance Requirement: It also requires less maintenance. They can also be easily integrated into various platforms for launch- from land, air or sea.
• Earlier Tests: The first test of the ‘Agni Prime missile’ was conducted in 2021. India earlier successfully carried out the first flight test of indigenously developed Agni-5 missile. 
• Use of composite materials: The material is produced by merging two or more materials with different properties, to eventually create a material with certain specific, unique properties.
  • In the case of rockets and missiles, the composites used must be able to withstand the stresses and loads of high-speed flight, withstanding the high temperatures. 
  • Composites are used because they are often lighter and much stronger than some metal alloys. Having lesser overall weight also enhances the payload capacity and range of the missile.

What is a Ballistic Missile and Why is it Named So? 

• A Ballistic missile follows a ballistic flight path which comprises three phases of flight: 
  • First phase or the Boost Phase: The solid-fuel rocket engine propels the missile upward, requiring it to swiftly attain velocity and altitude as it penetrates through the dense layers of Earth’s atmosphere.
  • Second and unpowered phase of flight: It happens in the upper reaches of the earth’s atmosphere or in space, where the missile travels along its pre-determined path, but without the power of its engines.
    • It is known as the coast phase or mid-course phase and during this time, it travels along a horizontal path. 
    • During the coasting, the missile is either in space or the upper atmosphere, where it faces minimal resistance or drag. 
  • Third and final phase or the terminal phase: The missile descends and gets back into the earth’s atmosphere and flies towards its target, while being guided by its on-board systems. 

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Context

Questions have been raised about election symbols allotment to ‘registered unrecognized parties’. Naam Tamilar Katchi (NTK)  got a new symbol, but  Viduthalai Chiruthaigal Katchi (VCK) was denied.

Revised Rules for Allocation of Election Symbols

• Recently, the Election Commission of India (ECI) has revised rules for allocating common symbols to Registered and Unregistered Political Parties, subject to certain conditions.
  • In Maharashtra, the ECI allowed the Eknath Shinde faction of the Shiv Sena to retain the party’s traditional symbol, while the Udbhav Tackeray faction was allotted a new symbol.

Provision of Election Symbols Allotment To Political Parties

• Allocated by: The ECI is responsible for the allotment of symbols as per the Election Symbols (Reservation and Allotment) Order, 1968.
  • It is meant to provide for specification, reservation, choice and allotment of symbols at elections in Parliamentary and Assembly Constituencies, for the recognition of political parties.
• Recognition to the Political Parties: A party is recognised as a ‘national’ or ‘state’ party under the provisions of the Election Symbols (Reservation and Allotment) Order, 1968 (Symbols Order) by the ECI. 
• Classification: Election Symbols can be either reserved, meaning they are exclusive to a recognised political party, or ‘free’.

• • Exclusive Election Symbols: Recognised national and state parties get exclusive symbols. 
    • Example: During selecting an election symbol for the 1993 Uttar Pradesh Assembly polls, Samajwadi Party leader picked the symbol of a bicycle, believing it would represent the farmers, the poor, laborers, and the middle class.
  • Non-Exclusive Election Symbols: For registered but unrecognized political parties, the free symbol is allotted as a common symbol during an election if that party contests in two Lok Sabha constituencies 
  • or in 5% of seats to the Assembly of a State as the case may be.
    • These parties are newly registered or have not secured enough percentage of votes in the Assembly or General elections to fulfill the prescribed criteria for a state party. 

• • • After being selected by parties, in subsequent elections, these symbols are declared free again for others to choose.
• Concession on a Common Symbol: Rule 10B of the Symbols Order provides that the concession of a common free symbol shall be available to a ‘registered unrecognized party’ for two general elections. 
  • Secured Specific Votes: Also, a party shall be eligible for a common symbol in any subsequent general election if it had secured at least 1% of votes polled in the State on the previous occasion when the party availed of this facility. 
  • Time Framework: Such an unrecognized party should however apply for a symbol every time in the prescribed format. This application can be made any time during the period commencing six months prior to the expiry of the term of the Lok Sabha or State Assembly as the case may be. 
    • The symbols are thereafter allotted on a ‘first-come-first-served’ basis.
• On Split: When a recognised political party splits, the Election Commission takes the decision to assign the symbol. 
  • Example: The Congress party, in the first elections of 1952, had a pair of bulls as its symbols. Following splits in the party over the years, the current symbol of hand eventually went to the party.
• Preference of Political Parties on Election Symbols:The 1968 order also states that a party may, can propose three new symbols of their choice, with the names and clear design and drawings of symbol, in the order of preference, for allotment to its candidates.
  • The ECI may consider allotment as its common symbol if there is, in its opinion, no objection in allotting such a symbol.
  • Symbols proposed by the parties should have no resemblance to the existing reserved symbols or free symbols, or any religious or communal connotation, or depict any bird or animal.
• Significance of election Symbols: In the largest democracy where a sizable population is still illiterate, election symbols play a crucial role in the voting process. 

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Context

According to data shared by the annual Health of Nation report by Apollo Hospitals, India is rapidly emerging as the “cancer capital of the world”.

India is Fast Emerging as a Cancer Capital of the World

• Rise in NCDs in India: The report sheds light on the rise of non-communicable diseases (NCDs) in India, which significantly impact the nation’s overall health.
  • These NCDs include cancer, diabetes, hypertension, cardiovascular diseases, and mental health issues. 

About Cancer

• About: Cancer is a disease in which some of the body’s cells grow uncontrollably and spread to other parts of the body. 
• Mechanism: Cancer starts when a gene or several genes mutate and create cancerous cells. These cells create cancer clusters, or tumors. 
  • Cancerous cells may break away from tumors, using the lymphatic system or bloodstream to travel to other areas of your body.

Status of Cancer Prevalence in India

• NCD-Related Deaths: Around 63 percent of all deaths in India are due to NCDs. Trend related to cancer cases in India:
  • 1.39 million: Number of cancer cases in 2020
  • 1.57 million: Expected number of cases in 2025
  • 13%: Growth in five year
• Economic Cost of Cancer: By 2030, these diseases are projected to cost India $3.55 trillion in lost economic output.
• Median Age for cancer diagnosis in India: The median age for cancer diagnosis in India is lower than in other countries:
• • 52 years: Average age of breast cancer diagnosis in India versus 63 in the US and Europe
  • 59 years: Average age of lung cancer diagnosis versus 70 years in the West
  • 30%: Share of colon cancer patients aged less than 50 years
• Cancer Screening Rates:  Despite these trends, cancer screening rates in India remain very low:
  • 1.9%: Breast cancer screening in India compared to 82% in the US, 70% in the UK, and 23% in China
  • 0.9%: Cervical cancer screening in India compared to 73% in the US, 70% in the UK, and 43% in China.
  • Cancer screening is looking for cancer before a person has any symptoms. Screening tests can help find cancer at an early stage, before symptoms appear. 
• Extrapolation of Western data in India:  The report highlighted the threshold for Prostate-Specific Antigen (PSA) – a blood test – in Indian men was different from the current standards suggesting the need for local data.
• Rise in Colon Cancer: The hospital found that colon cancer cases were increasing among young people, with 30% of colon cancer patients at Apollo Hospitals aged less than 50 years.
• Rise in Prostate Cancer Cases in India:
  • Current Trend: According to the Latest Lancet Commission paper, prostate cancer accounts for three per cent of all cancers in India, with an estimated 33,000-42,000 new cases diagnosed annually.
    • Prostate cancer incidence in India will double to about 71,000 new cases per year by 2040. 
  • Prostate cancer Related Death:  A large proportion of patients in India are diagnosed in advanced stages which means that the cancer has spread at the time of diagnosis. 
    • As a result, about 65 per cent (18,000-20,000) patients die of their disease.
  • Global status: Cases of prostate cancer are projected to double from 1.4 million per year in 2020 to 2.9 million per year by 2040 worldwide, with low and middle-income countries predicted to see the highest increase. 
    • Globally, prostate cancer accounted for around 3,75,000 deaths worldwide in 2020, making it the fifth leading cause of cancer death among men.

Reasons for Cancer Prevalence in India

• Smoking and Alcohol Use:  

• • Smoking, alcohol use, high BMI (Body Mass Index) Index) and other known risk factors were responsible for over 37% of cancer deaths in India in 2019, as per a Lancet Report.

• Obesity: 

  • Obesity is a significant risk factor for cancer development. Studies have linked it to an increased likelihood of breast, colorectal, pancreatic, and kidney cancers.
    • Obesity incidence has increased from 9% in 2016 to 20% in 2023. Apollo hospital observed that 90% of women and 80% of men had a higher waist-to-hip ratio than recommended.

• Unhealthy Diet: 

  • An unhealthy diet that is high in fat, and low in fibre may increase the risk of many cancers including bowel, lung, prostate and uterine cancers.
    • A diet high in processed or red meats can raise the risk of getting some types of cancer. Excess fats, proteins, and calories in the diet might raise the risk of getting cancer.
    • Besides this, excessive salt intake over a long period has been linked to stomach and gastrointestinal cancers.

• Stress: 

  • Chronic stress can have disastrous effects on your health, including an increased risk of cancer.
    • According to Apollo hospital study, the percentage of depression is highest among those in the age category of 18-25, where one in five was depressed.
    • 80% of young adults (18-30 years) and seniors (above 65 years) reported significant stress levels.

• Poor Oral Hygiene:  

  • Chronic inflammation and infections in the mouth, often associated with poor oral hygiene, have been linked to an increased risk of oral cancers.

• Occupational and Environmental Exposures: 

  • Exposure to certain chemicals and toxins in the workplace or environment, such as asbestos, benzene, and radon, can increase the risk of various cancers.

• Infections: 

  • Certain infections, such as human papillomavirus (HPV), hepatitis B and C viruses, and Helicobacter pylori (H. pylori), are linked to an increased risk of specific cancers, including cervical, liver and stomach cancers.

• Others: 

• • Lack of Physical Activity
  • Excessive Sun Exposure

Why is there a Need for Early Awareness and Detection?

• Lack of Symptoms: For example, Prostate cancer may cause no signs or symptoms in the early stages and it is only in the advanced stages that patients report symptoms like trouble urinating, bone pain, blood in the semen or urine and others. 

• Regular Screening: Although lifestyle can be managed, early screening in Indian men, especially those above 60 years, is required. 
  • Older men with symptoms or prostate enlargement like frequent and night-time urination, weak urine stream and pain or blood in the urine should seek medical attention and have a PSA blood test done. 

Challenges with Cancer Care in India

• Access to Radiotherapy: 

  • The WHO recommends one megavoltage radiotherapy unit per million people. 
    • To meet this recommendation, India would need an additional 600 or so units to ensure that the 800,000 people with cancer who require radiotherapy each year can be adequately treated. 
    • Moreover, access to radiotherapy has increased but mostly in urban areas. Coverage of modern radiotherapy treatments within government health schemes has improved but the poorest sections have little access even to palliative radiotherapy.

• Opioid Use for Pain Relief:  

  • Its use in late stages is another challenge. In 1985, the Government adopted stringent legislation to regulate narcotic misuse and trafficking.
    • As a result, medical use of morphine decreased by 97 percent, which severely limits access for pain management. 
    • An amendment to the Narcotic Drugs and Psychotropic Substance Act in 2014 improved opioid access, but there is a lag in implementation across the country.

• Lack of Sufficient Infrastructure and Resources:  

  • The healthcare facilities, especially in rural areas, lack the necessary equipment, trained personnel, and treatment options required for comprehensive cancer care. 
    • This leads to delays in diagnosis, limited treatment options, and poorer outcomes for patients.

• Affordable Cancer Treatment: 

  • It remains a significant barrier for many patients.
    • The high cost of cancer drugs, along with expenses related to diagnostics, hospitalization, and supportive care, often push patients and their families into financial distress. 
    • When considering the cost across all hospitals, including charitable and trust-run institutions, cancer care averages INR 61,216 per hospitalisation—a massive financial challenge for large portions of the population.

• Shortage of Skilled Oncologists and Healthcare Professionals: 

  • This shortage not only affects the delivery of cancer care but also contributes to disparities in access to specialized treatment, particularly in rural and underserved areas.
    • The bulk of cancer treatment centres are in cities, while 70 % of the population live in rural areas.

• Social Stigma: 

  • The stigma attached to cancer can lead to isolation and discrimination, severely impacting the mental health and well-being of patients. 
    • This stigma, rooted in cultural beliefs and lack of awareness, exacerbates the challenges faced by patients, hindering timely and effective treatment. 
    • The psychological toll of cancer extends to caregivers and families, disrupting family dynamics and often leading to a diminished quality of life.

Initiatives for Cancer Treatment and Prevention in India

• CAR-T cell therapy:  India’s first home-grown gene therapy launched for cancer at IIT Bombay.
  • It is the world’s most affordable CAR-T cell therapy.
• ProHealth Score: It is a digital health risk assessment tool for assessing an individual’s health and well-being, and evaluates factors such as family history, lifestyle and current symptoms.
• Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY): It offers health insurance up to INR 5 lakhs per family per year for secondary and tertiary care hospitalisation, covering many cancer-related treatments. 
• National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases & Stroke (NPCDCS): It aims to prevent and control chronic non-communicable diseases, including cancer. 
• Rashtriya Arogya Nidhi (RAN): It provides financial assistance to patients living below the poverty line who suffer from life-threatening diseases, including cancer, allowing them to receive medical treatment at government hospitals.
• State Illness Assistance Funds:  Set up by various state governments, offer financial aid to poor patients to cover treatment costs for different diseases, including cancer. Health Minister’s Cancer Patient Fund (HMCPF):  Within Rashtriya Arogya Nidhi, it provides financial assistance for cancer treatment through the procurement of generic drugs. 
• Tertiary Care Cancer Centres (TCCC) scheme: It aims to set up state cancer institutes and tertiary care cancer centres across the country to improve facilities for cancer treatment. Pradhan Mantri Swasthya Suraksha Yojana (PMSSY): It includes the establishment and upgrade of government medical colleges and institutions, enhancing resources for cancer care and strengthening the National Cancer Grid (NCG). 
• First Cancer Care (FCC) initiative: Introduced in 2022, it utilises advanced technology to transform cancer prevention and treatment, focusing on quality, timeliness, precision, and fairness. 
  • The FCC initiative provides a comprehensive framework that encompasses prevention, early detection, curative care, and governance. 

Way Forward

• Investment in Research and Development: 

  • Investment in research and development is needed to discover and develop innovative cancer treatments. 
    • This includes novel therapeutics, targeted therapies, and immunotherapies that offer improved efficacy and fewer side effects. It may include:
    • Enhancing initiatives like NCG through pooled procurement strategies for infrastructure and equipment
    • Providing comprehensive training for healthcare workers, can maximise the utilisation of resources. 
    • Replication and integration of successful initiatives like Tata Memorial Centre’s (TMC) hub-and-spoke model in public healthcare systems, with a focus on telemedicine.
  • Connecting the health and wellness centres under the Ayushman Bharat initiative to the regional cancer centre (RCC) in a hub-and-spoke, could potentially strengthen the rural connectivity and fasten the time to diagnosis and delivery of efficient care.

• Collaboration with Healthcare Providers: 

  • Collaboration between pharmaceutical companies and healthcare providers is essential to ensure the effective delivery of cancer care. 
    • This includes partnerships to improve access to diagnostics, provide training and education for healthcare professionals, and support the establishment of comprehensive cancer centers in underserved areas.

• Patient Assistance Programs: 

  • Pharma companies can establish patient assistance programs to provide financial support to cancer patients who struggle to afford treatment. 
    • These programs may offer discounts, subsidies, or access to free medications for eligible patients, thereby reducing the financial burden of cancer care.

• Streamlining Regulatory Environment: 

  • The regulatory authorities need to streamline the approval process for cancer drugs and ensure timely access to innovative therapies for patients. 

• Public Awareness Campaigns: 

  • Concerted efforts are needed in the form of awareness campaigns, community engagement programmes, and educational initiatives.
    • These efforts can serve to emphasise the importance of early detection and lifestyle , dispel myths and misconceptions about cancer, reduce the associated stigma, and encourage early screening and treatment.

• Early Screening: 

• • The surge in prostate cancer cases can be prevented provided all men over 60 get tested early with the same rigour that women are advised for breast screenings after 40. 
    • Artificial intelligence (AI)-based risk assessment models can help identify patients who are at elevated risk and should be enrolled in screening programmes for disease prevention and early detection. 
    • Geographic spread and population density in the country, high-risk and endemic regions can be strategically prioritized for timely and routine screening. Ex-the North East for tobacco related cancers. 

• Implementation of Harmonized and Standardized Clinical Protocols: 

  • These should be promoted across the continuum of cancer care. Current Cancer medicines lie in the 12% bracket of GST. 
    • Placing Cancer medicines in the NIL or 5% tax slab is needed to relieve cost burden on patients.

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Context

The Lancet Report flagged that India’s Total Fertility Rate (TFR) will fall to 1.29 in 2050, significantly below the replacement threshold of 2.1.

• The Lancet estimate is based on a complex demographic modelling, done for 204 countries as part of the global burden of disease study. 

Key Findings of the Lancet Report On Fertility Rate in India & Global

• Fertility Rate in India:

  • TFR Evolution: The total fertility rate in India stood at 6.18 in 1950, dropped to 4.60 in 1980, and subsequently decreased to 1.91 by 2021.
  • Future Projection: 
    • By 2050, one in five people in India will be above the age of 60 in 2050, signaling a transition towards an aging population akin to the demographic challenges currently faced by China.
    • Earlier, the UN Population Fund’s (UNPF) ‘India Ageing Report’ also projected the number of elderly in India will more than double from 149 million in 2022 to 347 million by mid-century .
  • Demographic Shift: The varying TFR rates across states in India as South & Western India are graying faster than those in the North.

• Global Trends: 

  • TFR Evolution: Between 1950 and 2021, the global total fertility rate (TFR) decreased by more than half, dropping from approximately 5 children per woman in 1950 to 2.2 children in 2021.
  • Future Projection: A continued global decline, with an estimated global total fertility rate (TFR) of 1.83 by 2050 (about 76% of the countries will have TFR below replacement threshold ) and 1.59 by 2100 ( about 97% of the countries will have TFR below replacement threshold).

• Regional Shift in Live Birth towards Sub-Saharan Africa: 

  • In 1950, one-third of global live births were in Southeast Asia, East Asia, and Oceania. Since 2011, the majority has shifted to sub-Saharan Africa, rising from 8% in 1950 to nearly 30% by 2021.

Factors of Indian Demographic Transition

• Economic Development: 

  • The rapid pace of economic development, particularly since the early years of the present century is one of the major reasons for declining TFR in India. 
    • Also, due dynamics of inter-generational wealth transfer and increasing expenses associated with living and child-rearing could discourage couples from opting for larger families.

• Low Mortality Rates: 

  • Lower infant and child mortality rates reducing the need to have a large family for old-age support.
    • Maternal and child health initiatives such as the availability of contraceptives and increased awareness of Family Welfare Programme and successful immunization campaigns, have contributed to the assurance of child survival and to maintain smaller family sizes.

• Women Empowerment: 

• • The rise in women’s education and work participation rates have an important impact on demographic transition. 
    • Advancements in female literacy rates and increased participation of women in the workforce have empowered women to make more informed decisions about family planning.

• Social Development: 

  • Improvement in housing conditions and the old-age security system are the other contributing factors.
    • Changing Perspectives in Urban and Rural Areas: In Urban Areas, Trends of women viewing child-rearing as optional rather than obligatory & Some women are exploring alternatives like adoption. Similar trend is also emerging in rural parts of India, indicating a shift in societal norms and attitudes towards family planning.

• High-Stress Lifestyles and Dietary Patterns: 

  • Urban areas with high-stress lifestyles and dietary patterns are seeing a significant proportion of infertility cases, with sedentary employment increasing the risk.
    • Factors, including obesity, stress, smoking, and environmental pollution, contribute to the declining fertility rates in India. 
      • Research indicates a 20% drop in the general fertility rate over the past decade, affecting around 30 million individuals.

Significance of Falling Fertility Rate in India

• Accelerated Economic Growth: 

  • The rapid decline in TFR is a fall in the dependency rate and a larger share of working adults in the population, leading to an overall surplus income which can accelerate economic growth and lead to positive intergenerational transfers. 
    • The dependency ratio (the young and the old as a fraction of the percentage of the working-age population), is projected to go up from 13.8 in 2011 to 23 in 2036 for India.

• Increase in Labour Productivity: 

  • The demographic transition will have a positive impact on several states in the coming years through an increase in labour productivity via three channels:
  • The decline in population growth would increase the amount of capital resources and infrastructure available in per capita terms.
  • The reduction in fertility rate would permit the relocation of resources for the education and skill development of children that would further lead to the increase in labour productivity.
  • The decline in population growth will change the age distribution of the population and increase the fraction of the labour force in the population, although for a limited period, which would accelerate the growth of the overall economy.

• Improvement in Education Quality: 

  • A declining TFR would lead to  a decline in the number of children enrolling in schools, as is already happening in states like Kerala. This could improve educational outcomes without additional resources being spent by the state. 

• More Women Participation: 

  • With declining fertility rate, there will be less time needed for childcare and will enhance the participation of women in the workforce. 
    • A major factor responsible for the low participation of women in the workforce is their engagement in childcare at an age when they should be in the labour force. 
    • Example: The larger share of women in MNREGA employment in the southern states.

• Better Working Conditions: 

  • Industrially developed states like southern states and Gujarat and Maharashtra (have low fertility rates), received cheaper labour from the northern states. 
    • A declining TFR, over the years, must result in improved working conditions, elimination of wage discrimination for migrant workers and the mitigation of security concerns in the receiving states through institutional safeguards.

• Regional Development and Urbanisation: 

  • Declining fertility rates are often accompanied by urbanisation and regional development and lead to growth and development.
    • Also, urbanisation promotes infrastructure development, connectivity, and access to essential services and leads to enhanced overall productivity.

• International Competitiveness: 

  • With declining fertility rate, there will be more resources to enhance a country’s international competitiveness and result in economic stability and development.

• Environment Sustainability: 

• • With declining fertility rate, there will be lower pressure on land, water and other resources and would also contribute to achieving environmental goals.

Challenges of Falling Fertility Rate for India

• Shortage of Working Age Population: Shortage of Manpower will further hinder the nation’s growth.
  • Example: A smaller working age population could lead to labour shortages and affect economic growth like the working-age population of China had contracted by more than 40 million.
• Increase in Elderly Population: Increase in the burden of economic dependency and Health care facility to them.
  • Example: By 2050, over 20% of India’s population will be senior citizens, it poses challenges related to care, support, and health care.
  • Last year, the UN Population Fund’s (UNPF) India Ageing Report projected that the number of elderly in India will more than double from 149 mn in 2022 to 347 mn by mid-century. 
• Irreversal Trend: Historical data from developed nations suggests that once fertility rates drop below the replacement level, reversing the trend becomes exceedingly difficult. 
  • Japan was the first country to experience the implications of falling fertility rates. The increasing dependency ratio has led to near zero GDP growth since the 1990s, and the country is facing fiscal challenges to meet rising social security costs. 

• Skewed Creative Capacity: Falling fertility could diminish the creative capacity of humankind.
  • A paper, “The End of Economic Growth? Unintended Consequences of a Declining Population”, by Stanford economist argues that falling fertility could diminish the creative capacity of humankind. 
  • Human creativity creates ideas for technological advancement and productivity boost, which even artificial intelligence is still not capable of.
• Skewed Sex Ratio & Gender imbalance: Low fertility level may deteriorate the sex ratio and gender equality.
• Impact on National Security: Population decline will also lower the military age population, and affect the military power and impact the national security.
• Difficulties in Funding Entitlement Programs: Less working age population may cause less tax collections to the governments and impact the social security programs for elderly.
• Emotional Crisis: Crisis in end of life care for the elderly will emerge because of insufficient caregivers for them.

Way Forward

• Ensure Social Security & Healthcare Provisions: 

  • With decreasing total fertility rate in India, time has come to ensure adequate social security and healthcare benefits for the growing elderly population.
    • With a growing elderly population, there is a need to provide an affordable social security system that provides pensions to the elderly and takes care of their daily needs and medical expenses.
    • Improvement in life expectancy would be associated with problems of the aged and increased burden of disease, resulting in high demand for health care facilities. India must accept these challenges to make the most of the opportunity.

• Maximizing Demographic Dividend: 

  • At 1.9, total fertility rate in India is currently just below the replacement rate, and according to UNPF calculations, the share of the country’s working-age population will peak in the late 2030s, early 2040s. 
    • Policymakers must utilise this window to maximise India’s demographic dividend, as China did from the late 1980s till the early years of the last decade.

• Skill Development: 

  • There is an urgent need to overcome skill deficits, bolster the knowledge economy and create opportunities to harness skills of the growing elderly population effectively. 
    • Skill development among SCs/STs and religious minorities can ensure there is no dearth of labour in the modern growing sectors. Much of the incremental workforce will come from the gradual process of the fade away of traditional activities.

• Diversification of Employment Pattern: 

  • There is a need for creation of jobs outside the agricultural sector with a focus on the well-paid formal sector.
    • The shifting of the workforce from agriculture to industries and services would balance the sectoral distribution. 

• Attention on Higher Education: 

  • Substantial resources must be allocated to technical and professional education before the window of demographic opportunity closes.
    • An urgent need is to shift the focus to middle and higher education where the drop-out rates are very high.

• Understand the Dimension of Demographic Shift: 

  • The varying TFR rates across states in India is another concern. There are already signs that parts of south India and west India are aging faster than those in the north. Policymakers must be ready to understand the demographic shift in all its dimensions, and prepare for the change.

• Investment in Technology and Innovation: 

• • With increase in the use of Artificial Intelligence (AI) and decline in TFR, the automation sector and AI are most striking to counter the challenge and improve productivity of the growing population.
    • The demand for In Vitro Fertilization (IVF) treatments in India is growing, with the IVF market projected to reach $3.7 billion by 2030. 
    • It reflects the need for supportive reproductive health services and policies.

Conclusion

The Asia 2050 report, prepared by the Asian Development Bank, predicts that the 21st century belongs to Asia, with a very high possibility of India being a major actor. It emphasises sectoral and spatial redistribution of the workforce, skill development and increase in the work participation rate of women and all compensating for the declining share of the working age group in the population.

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