Treating the Silent Epidemic: Health Literacy for All

Since health education is the base of the modern healthcare pyramid, eradicating the silent public health epidemic of health illiteracy is the most cost-effective means to reduce the healthcare burden of developing nations, while moving the populations to greater self-reliance

Vipin Varma

By Vipin Varma

Principal Advisor (Health Affairs) & Founder

THOT Consultants – Ideas Without Borders

 Treating the Silent Epidemic: Health Literacy for All



Health literacy, defined as the ability to seek, process and apply health related information and knowledge is an essential public health investment. My twenty seven years of clinical, management and entrepreneurial journey as a health advocacy communications consultant in India and abroad has convinced me that healthcare literacy across all stakeholders is an essential, scalable, universal, valuable product-service.

Since health education is the base of the modern healthcare pyramid, eradicating the silent public health epidemic of health illiteracy is the most cost-effective means to reduce the healthcare burden of India*, while moving the population to greater self-reliance. Health literacy asymmetry is one of the key fundamentals affecting equity of healthcare and sustainable development. Even as a policy level initiative, this gap needs to be erased first and foremost, while allocating adequate and enhanced budgets for health literacy, education and promotion. In order to truly empower our citizens for self-care, we must provide them complete health literacy in keeping with the universal declaration of human rights and the right to health, as it is one of the main determinants and entitlements of healthcare.

For a perspective, both the USA and China now see it as a public health issue to be managed based on epidemiologic principles & have developed a National Action Plan to Improve Health Literacy. Only 12% of the US population is supposed to be proficient in health literacy and the US projections are a potential saving of almost $236 Billion per annum or up to $ 3.6 Trillion over a decade, as a result of enhanced public health literacy. Given our overall literacy standards, India can therefore, also greatly benefit from a dedicated Health Literacy Program, at various levels of government.

Need of the Hour

‘Prioritize the base of the healthcare pyramid’

Health literacy is the fertile soil on which we must cultivate our citizen-centric public & private sector healthcare systems and institutions. Piecemeal, sporadic IEC (Information, Education, Communication / BCC (Behavior Change Communication) components of various vertical programs have not been able to achieve a society-wide competence in health literacy and shall therefore, require an integrated program approach to achieve short, mid and long-term outcomes of public self-reliance in wellness & healthcare. This has been validated by secondary research and interactions with senior key stakeholders across the healthcare development spectrum.

Way Forward

The Health and Family Welfare Ministries and Departments across national, state and local governments should lead and orchestrate a branded total health literacy program, integrating with the relevant departments like education, women-child development, social welfare, labor, consumer affairs, information-broadcasting, pharmaceuticals, rural and urban development, as necessary. Strategic partnerships with civil society and corporate social responsibility can also be leveraged later.

Monitoring and robust evaluation (M&E) should be built into the plans, to ensure tracking of the positive health outcomes and documentation of the high cost-effectiveness of this integrated approach, as promised by the global evidence base on health literacy. Convergence and social accountability is essential to sustainably scale-up this program. This can also integrate well with both Digital India & Skill India initiatives and at least 6,50,000 jobs** can be created nationwide in this domain, at a modest estimate of 100 health educators per district.

Suggested Policy

Given the silent epidemic prevalence of health illiteracy & the current strategic imperative of public self-reliance for healthcare, we should ideally provision about 5-10% of the healthcare budget at each level of government for dedicated health literacy activities, to achieve optimal impact.

Even for a modestly literate population, the modern healthcare pyramid with health education as its base, suggests a public health literacy program should be allocated at least 5% of the healthcare budget. The minimum spend should be enshrined in policy guidelines at all levels and grantees should also be strongly encouraged to spend this well. This relatively small but strategically significant shift in priorities, can have strong cascade effects on the entire health resource pyramid and can even invert it, if executed well.



*The Health Literacy program concept highlighted in this article is valid for any developing nation globally and I have just written it with my country in context, but I am certain most developing and many developed countries too, still do not attach sufficient significant importance to Health Literacy across the public, social and private health sectors.

**This is a conservative estimate and can vary with the strategic intent and number of districts in the developing country under consideration.

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COP21: Salute Inscindibile dal Futuro del Pianeta

A causa dei cambiamenti climatici la nostra salute è messa in pericolo ogni giorno. Un'aria satura di gas nocivi e fenomeni atmosferici sempre più imprevedibili e violenti danneggiano noi e l'ambiente in cui viviamo. Il recente Accordo COP21 siglato a Parigi lo scorso 12 Dicembre è un primo passo volto a ridurre l'emissione di gas effetto serra e quindi la presenza di quei fenomeni che ne sono diretta conseguenza. Ma, l’Accordo è davvero un impegno concreto da parte degli Stati? O la discrezionalità di questi ultimi ancora prevale?


by Pietro Dionisio

Degree in Political Science, International Relations

Cesare Alfieri School, University of Florence, Italy

COP21: Salute Inscindibile dal Futuro del Pianeta


Il recente accordo sui cambiamenti climatici siglato a Parigi il 12 dicembre 2015 dimostra la vitale importanza su scala mondiale di un  problema per il quale non è più possibile perdere tempo.

Le manifestazioni del mutamento climatico in atto sono molteplici. Alcune sono talmente discrete da non essere nel breve periodo percepibili, altre, purtroppo, si palesano brutalmente con devastazioni ambientali e alta letalità, impattando criticamente sulle economie dei Paesi colpiti e sulla salute umana, animale e vegetale.

La stessa Direttrice Generale dell’Organizzazione Mondiale della Sanità (OMS) Margaret Chan, in un discorso rilasciato lo scorso 8 Dicembre a Parigi nel contesto della Conferenza COP21, affermava che “l’accordo sui cambiamenti climatici non è un trattato atto soltanto a salvare il pianeta da danni profondi e irreversibili. Ma è anche un trattato sulla salute pubblica, con l’immenso potenziale di salvare vite umane in tutto il mondo.”

Fonti OMS informano che dal 2030 i costi previsti per la sanità dovuti ai danni provocati dai cambiamenti climatici potrebbero essere pari a 2-4 miliardi di dollari all’anno. Mentre, tra il 2030 e il 2050 si potrebbero registrare circa 250.000 morti per anno causate da malnutrizione, malaria, diarrea e stress fisico da ondate di calore.

Nessuna regione nel mondo è immune dagli effetti delle mutazioni climatiche, ormai in ascesa quasi esponenziale  e responsabili di effetti diretti e  indiretti sulla salute. Per effetti diretti generalmente si intendono le immediate conseguenze di siccità, inondazioni, ondate di calore o di freddo, e di tempeste di inaudita violenza. Per effetti indiretti si  intendono, invece, le possibili conseguenze comunque connesse al cambiamento climatico: tra gli esempi, le migrazioni di popoli (con correlato rischio conflitti), ovvero la comparsa, o l’incremento, di malattie precedentemente assenti o di minimo riscontro in un habitat specifico.

Il fatto che i Paesi partecipanti alla Conferenza di Parigi abbiano deciso di impegnarsi, anche mediante adozione di fonti energetiche “green economy”,  a ridurre l’emissione di gas effetto serra (Art.4) e a contenere l’aumento della temperatura non oltre +1,5°C rispetto ai livelli pre-industriali (Art.2)  potrebbe sicuramente implicare effetti positivi per la salute individuale e collettiva. All’opposto di una economia ancorata a carburanti fossili e perciò responsabile di maggior incidenza di malattie e neoplasie polmonari secondarie all’eccesso indotto di CO2 nell’aria respirata.

Oltre ad effetti ancora più gravi individuabili nel riscaldamento ambientale foriero di incontrollabili fenomeni atmosferici conseguenti a livelli mai prima raggiunti di gas effetto serra.

Ridurre l’emissione dei gas serra, quindi, è estremamente importante, con ricadute positive  attese sul miglioramento della salute delle popolazioni e sulla diversificazione nell’allocazione dei budget nazionali e familiari da spese sanitarie ad altri beni di consumo, con correlato risparmio per le casse statali. Nel merito, la Commissione Europea ha stimato che la diminuzione della mortalità ottenuta mediante la riduzione degli inquinanti atmosferici comporterebbe benefici stimabili in €17 miliardi per il 2030 e fino a €38 miliardi per il 2050.

Contestualmente alla riduzione delle emissioni, i sistemi sanitari dei Paesi, soprattutto i più sviluppati, sono tenuti ad un ruolo proattivo così da ottenere una riduzione dei costi e quindi fornire una maggior offerta di servizi economicamente accessibili e con targets non limitati alla gestione e cura delle patologie respiratorie indotte. Al riguardo, l’Ospedale Universitario Nazionale di Cheng Kung di Taiwan, nel 2011 ha promosso un progetto mirato alla riduzione delle emissioni di CO2 per un valore pari a circa 5,259 tons all’anno, così da aumentare il tasso di risparmio energetico complessivo del 150% c.a. e conseguire un risparmio di circa 571,962 dollari. Ma esempi  analoghi sono altresì documentabili negli Stati Uniti, Regno Unito e Corea del Sud.

Ancora citando le parole di Margaret Chan “Un Pianeta rovinato non può sostenere le vite umane in uno stato di buona salute. Un pianeta in salute e persone in salute sono due facce della stessa medaglia”.

Nessun dubbio che l’Accordo COP21 rappresenti un passo di estrema importanza, ma molto resta da fare e molte preoccupazioni devono essere sciolte. Riusciranno i Paesi a mettere da parte gli egoismi economico-politici per il fine superiore di preservare la natura, di cui siamo tutti parte, e  garantire alla generazione presente e a quelle future una vita migliore?

L’Articolo 21 dell’Accordo stabilisce chiaramente che affinchè  il testo entri in vigore e sia legalmente vincolante, almeno 55 Parti alla Convenzione (le cui emissioni costituiscano almeno il 55% di quelle globali) devono averlo firmato e ratificato.

Saranno questi numeri raggiunti in breve tempo? L’esperienza del Protocollo di Kyoto (1997) ci dimostra come i Governi di molti Paesi siano purtroppo lenti ad interiorizzare le giuste richieste, invece troppo spesso vissute come ostacoli al perseguimento dei propri interessi.

Il Protocollo di Kyoto riuscì ad entrare in vigore soltanto il 16 Febbraio del 2005 e gli Stati Uniti non lo hanno mai ratificato!

Lo svolgersi degli aventi sarà diverso per il COP21? L’Accordo è da considerarsi come un ulteriore esempio di buoni propositi o si tradurrà, invece, in celeri azioni condivise nell’interesse delle sorti del pianeta e di tutti i suoi abitanti?

Molti dubbi davvero rimangono poiché, mentre  i 29 Articoli costituenti l’Accordo si limitano a raccomandare agli Stati di tenere comportamenti virtuosi, nessuna sanzione purtroppo è stata prevista.

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Breaking News Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings


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Canada’s New Government Should Reject the TPP Agreement in its Current Form

As it currently stands, the TPP text pushes beyond the rules of the WTO TRIPS Agreement  with the effect of further limiting the room for manoeuvre that countries need in order to protect the public good, including by trying to achieve non-discriminatory, affordable access to medicines. Instead of accepting the TPP provisions in their current form, Canada should demonstrate international leadership and honour its repeated commitments to global health, including access to medicines

Richard Elliottt

By Richard Elliott

Executive Director Canadian HIV/AIDS Legal Network, Toronto

Canada’s New Government Should Reject the TPP Agreement in its Current Form


On 5 November 2015, the text of the Trans-Pacific Partnership (TPP) Agreement was finally made public. Running to more than 6000 pages, it raises a host of grave concerns about its impact on everything from environmental protection to labour and other human rights, from internet privacy to food safety… and much more, including access to affordable medicines.

Before the final text was released, alarm bells were already ringing: for example, Médecins Sans Frontières has called the TPP “the most harmful trade pact ever for access to medicines” – and not just for those in the negotiating countries, but for many more, since the TPP is being billed as a model for future trade agreements across the globe.

What’s the Threat?

As outlined by the Legal Network and several other NGOs in an open letter to the newly-elected Liberal government, various aspects of the TPP are cause for concern when it comes to access to medicines:

  • New intellectual property (IP) rules on patents, as well as rules on “data exclusivity” over information submitted to get marketing approval of drugs, would be even more restrictive than what already exist at the World Trade Organization (WTO). These would further impede and delay the competition from generic drugs that is key to pushing down prices and therefore making medicines available to many more people. In addition, new, harsher provisions on enforcement of private IP rights would be available to big pharma to try to undermine competition – including injunctions, higher damages for patent infringement, and various border measures that could interfere with transit of legitimate generic medicines based on mere suspicion of infringing intellectual property rights claimed by big pharma.
  • So-called “transparency” provisions would create more opportunities for drug companies to challenge governments’ decisions about reimbursing medicines under public health insurance programs, while also allowing more direct marketing to consumers by drug companies. In the Canadian context, this would create an additional hurdle to overcome in eventually creating a truly national, equitable pharmacare programme, which has been a long-standing and major gap in the country’s system of public health insurance.
  • Finally, the TPP would expand so-called “investor-state dispute settlement” rules to cover IP rights. This would allow drug companies to sue governments if they interfere with companies “expectations of profit” through public interest laws or regulations on things such as patents, the use of data submitted in getting marketing approval for drugs, and setting prices of pharmaceuticals, including the prices at which drugs are covered under public health insurance plans. Canada is already facing the world’s first such suit by the pharmaceutical company Eli Lilly, which is attempting to push into new territory the interpretation of similar provisions in the North America Free Trade Agreement (NAFTA) – in which the company seeks to force changes to well-settled principles of patent law in Canada after two courts ruled two of the company’s patents were invalid because the product in question did not live up to the scope of the patent claimed. This is an unprecedented proceeding in seeking to expand investor-state dispute settlement provisions to IP claims; now the text of the TPP would give an explicit green light to such mischief, in a wider array of countries, with yet more of a chilling effect on the ability or willingness of governments to regulate in the public interest.

Time for Action

But there’s still time to head off this disaster for public health and human rights.

The TPP has to be ratified and implemented by the 12 negotiating countries before it takes effect.This makes it all the more critical that governments hear from the public, whose rights, health and lives will be affected by the TPP’s provisions.

This includes the new government in Ottawa. While PM Trudeau and the Liberal Party have stated support for the TPP in principle during the election, the party also declared that “it must keep its word and defend Canadian interests during these negotiations.”

Those interests clearly include access to affordable medicines. Canadians already pay some of the highest drug prices in the world and spending on pharmaceutical products is one of the three largest elements of our overall health care spending, year after year. No wonder, then, that Canadians have repeatedly expressed their opposition to longer patents for drug companies.

“Canadian interests” also include a commitment to ending the tragic global gap in access to medicines, particularly burdensome for developing countries facing multiple major public health challenges – including, but not limited to, HIV. This commitment was reflected in the widespread support – including from 80% of Canadians polled – for fixing the flaws in Canada’s Access to Medicines Regime (CAMR). Such fixes were, and are, needed so that the regime could deliver on Parliament’s previous unanimous pledge (a decade ago!) to support developing countries in getting more affordable, generic medicines.

Sadly, a bill to fix CAMR was narrowly defeated by the previous government in the last Parliament – and while the new government has not yet specifically committed to supporting those reforms again in the new Parliament (as it did previously), it did declare during the election that “there is no question that we need to get more low-cost medicines and other essential medical supplies and equipment to people in developing countries.”

Canada’s new government should not only fix the existing flawed CAMR, but also reject the TPP in its current form. The agreement’s provisions stand in direct contradiction to the goals of improving access to medicines, for Canadians and for people in developing countries. Canada should:

  • commit to a full public consultation on the TPP, including an independent assessment of its impact on human rights (including access to medicines), among other concerns;
  • refuse to ratify the TPP as long as it contains any “TRIPS-plus” provisions that exceed the already-restrictive rules on intellectual property that have been adopted at the WTO; and
  • reject any deal that extends the discredited, damaging “investor-state dispute settlement” system to cover intellectual property or other laws and regulations affecting pharmaceuticals, as this would enable pharmaceutical companies to impede regulation of this sector in the public interest.



Related articles:

TPP: Up With Corporate Profits Outweighing Equity in Health!

Impact Of The TPP On The Pharma Industry

TPP Strengthens Controversial IP Arbitration

US ITC notice for public comment, Jan 13, 2016 hearing, and Commission report on the TransPacific Partnership Agreement (TPP)