WORLD COPD DAY 2023: EMPOWERING EARLY ACTION, THROUGH BETTER DISEASE AWARENESS

November 16, 2023

India, 2023: India's most recent National Health Policy aims to reduce early deaths from noncommunicable diseases, including chronic respiratory conditions, by 25% by 2025[1]. Chronic Obstructive Pulmonary Disease (COPD) is a major concern in this context. While the disease is the 2^nd leading cause of death and disability-adjusted life years (DALYs) in India[2], a recent study revealed that a staggering 54% of COPD-diagnosed patients had no knowledge about the disease¹. This highlights a clear gap in the effective management of COPD, where awareness plays a crucial role in instigating the process of detection, diagnosis, and intervention. Therefore, on this World COPD Day, medical experts across the nation unite under the global theme of, 'Breathing is Life - Act Earlier,' highlighting the pivotal role of heightened disease awareness in improving disease control, quality of life as well as life expectancy for those grappling with this condition.

An umbrella term for a group of chronic inflammatory lung disorders, COPD is characterized by obstructed airflow and damage to the lungs. Risk factors range from, exposure to indoor pollution e.g., Chulha smoke, tobacco smoke, outdoor air pollution, to occupational-related pollutants in industries like agriculture.² To confirm a COPD diagnosis, a crucial lung function test called spirometry is necessary, which measures the amount of air one can breathe in and out, depicting the lung function of an individual[3]. Although irreversible, the condition is manageable with appropriate treatment strategies, implemented in a timely manner. However, for patients to actively pursue a diagnosis, engage in self-management programs, and make effective use of treatment action plans, it is imperative for them to be able to identify triggers, as well as early symptoms of the condition.

Highlighting the role of better disease awareness for the early detection and treatment of COPD Dr. Konathala Sureendra, Consultant Chest Physician, Vishakhapatnam said, “In a country with diverse medical practices, awareness plays a crucial role in promoting disease diagnosis and rational treatment. Since COPD is a progressive condition, it is essential to control it before there is a significant decline in lung function as well as worsening of symptoms like breathlessness, cough, sputum production, wheezing, and chest tightness^{^[4]}^,^{^[5]}. In fact, with the festive season upon us, the potential exposure to triggers like smoke and airborne pollutants can even result in a flare-up of the disease or a lung attack which can take patients a month or longer to completely recover from.”

Adding on he said, “With nearly two-thirds of cases remaining undiagnosed and only one-fifth receiving rational inhalation treatment, raising awareness can save lives by making sure more people get the care they need¹. The goal of any COPD management plan is to halt progression and reduce decline, and this hinges on a better understanding of the disease and its treatment. Bronchodilator inhalers are crucial for treating COPD, and programs like pulmonary rehabilitation can greatly enhance quality of life[6]. For certain patient populations, e.g., those who have trouble inhaling quickly, nebulized treatments serve as a viable option, especially with portable devices for home care. This can be particularly effective during acute exacerbations.[7] "

World COPD Day 2023 serves as a global call to action to raise awareness about the condition and stress upon the importance of early lung health in COPD management. However, awareness efforts must be met by an ecosystem that enables better access to healthcare support. For example, to commemorate this important day in the country’s journey to improving lung health on a national level, Cipla conducts nationwide lung screening camps to increase awareness and opportunities for diagnosis of COPD. This is in addition to initiatives like ‘Breathefree’. With both a physical and digital presence i.e., the Breathefree Digital Educator, it encompasses the complete patient journey in the areas of screening, counselling, and treatment adherence. Programs like these are important to help patients effectively manage their lung health, enabling better patient outcomes.

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Lessons from DWCRA (Andhra Pradesh)
Article By Velavartipati Vachaspati.
M.A (Political Science) M.A (Anthropology) NET (Anthropology)

The empowerment of women became necessary as they are almost fifty percent of the population and are being discriminated at all fronts. The moral inferiority of Indians, especially Hindus, was supposed to be demonstrated by the barbaric practices followed against women. Writing in the nineteenth century, John Stuart Mill considered Hindu civilization crude and immoral. Thus colonial historians justified the British rule in India by arguing that Hindu women received the protection and intervention of the colonial rule, as at that time the practice ‘sati’ was widely practiced. Even from the Brahmanical sources, there sufficient evidence to show that the structure of institutions that ensured the subordination of women was complete long before Muslims as a religious community had even come into being. As for property is concerned, women not only did not own property, they were considered to be property or commodity, the bride, for example, being gifted to groom along with other goods. The for present days problems like bride burning, domestic violence, suicides of wives, daughters and sisters, the origins were laid by our ancestors out of ignorance. Hence, the solution lies in empowering women to eliminate the Economic Inequalities, Social Inequalities, Physical Inequalities, and Political Inequalities. Economic Inequalities of women may be in terms of inheritance of property, salary, contribution to the maintenance of the family etc. women have no right to inherit the property on equal basis on par with her brothers as per Dharma Sastras. This social deformity resulted in the raise of Dowry System in the Hindu Society. Social Inequality means inequality in terms of literacy, education in which women are not on par with men. As per Census 2001, the female literacy is 54.16 per cent compared to the male literacy of 75.6 per cent. These statistics speaks volumes out Census. This was due to discouragement of female education by men, who may be brothers, fathers and others, or as a whole. On levels of education too, a women from her childhood, who is eager to study has to overcome ‘n’ number of obstacles, which may be social, cultural and biological. In India, female entrance into colleges is mere 35.5 per cent, and the percentage of female entrance into post graduation and in other higher studies is dismal. Even though she completed her education, her decision to do the job or a particular job depends at the mercy of the male members of the family, as they suddenly attain the feudal face and the women’s decision would be turned down by a single stroke of word. The political inequality is at high degree, which is visible to the naked eye, and can be seen by observing the number of women representatives in the legislatures. Women have been politically marginalized in our country and most of them live extremely restricted lives. They are not allowed to have much of a voice even within their community or family’s decision-making processes, live alone a meaningful say in the national politics. Not just politicians but also even many intellectuals are angrily rejecting the idea of reservations for women and calling it a retrogressive move even in societies where women exercise relatively more freedom in day-to-day living, they remain politically marginalized. Women have done extremely well in the Scandinavian countries, Sweden (34 M.Ps), Norway (39 Maps), Denmark, Finland, where they are moving in the direction of near equal participation. In these societies, women have begun to seriously alter the very nature of politics and have made enduring and substantial gains for themselves in every field. In India, the problem is more serious because while women are inching forward bit by bit, in India the participation of women in politics is actually declining. In the 1996 elections they are 6.4 percent of 543 seats in the Parliament, in 1999 elections they are 6.5 per cent. In the State’s legislatures, the representation of women shows the contradictory features as they do not show the relationship between the rate of literacy of women and their participation in politics. A comparison between the status of Kerala and Rajasthan, whose literacy rates are at the opposite ends of the spectrum. In Kerala, the overall literacy rate is reportedly 90 per cent with 80 percent female literacy. By contrast, in Rajasthan, the female literacy is mere 20 percent and only 12 of the females are literate in rural areas. Kerala has a matrimonial tradition in which women have a much larger measure of autonomy and freedom of movement while most of the women in Rajasthan live far more lives that are restricted in aggressively patriarchal communities. However, not all the cultural and educational advantages of women in Kerala have translated into higher political participation. The percentage of women in Kerala legislative assembly rose from less than one percent in 1967 to six per cent in 1991. In Rajasthan, the representation of women was four percent in 1967 and reached eight percent in 1986-90. By contrast, U.P, Bihar and Madhya Pradesh, which are known for their low educational levels and repressive cultural norms for women, have not only sent a relatively larger portion of women to the Lok Sabha but have also elected relatively more women MLAs. This is a huge disproportionate of representation in the Legislatures from statistics of literacy. Physical inequality is another form, which is the hallmark of patriarchy and causing the physical elimination of girl child. The character of Indian Society and culture, satirically saying, which is hailed as great, may be known by observing the fluctuating sex ratio against women; here sex ratio means the number of women per thousand men. In year 1901, it was 972, in 1921, it was 955, in 1931, it was 950, in 1941, it was 945, in 1951, it was 946, in 1961, it was 941, in 1971-it was930, in 1981, it was 935, in 1991, it was 929, and in 2001, it was 934. As per Census 2001, though the sex ratio has increased from 929 in 1991 to 933 in 2001, still against women, where as in developed countries there are 1060 female for 1000 male, as in those countries the life expectancy of women is generally longer than men due to the availability of health facilities. Moreover, according to the recent census the decrease in sex ratio in the age group of 0-6 is alarming.

The general tendency of life expectancy of women is higher, is common to all over the world, but the sex ratio in India is against women. It is because the practice of female infanticide, particularly in urban areas likes Bombay, New Delhi, Hyderabad, Madras etc. The middle class families in particular are the main perpetrators of this practice due to economic reasons as bearing a girl child is uneconomical to them and the parents think the expenditure spent on her is lost forever, and another cause is the preference of the male child. In fact, women live longer, if they are allowed to live. In spite of having higher life expectancy, the number of women is low as indicated by the fluctuating sex ratios, which are against women. It is more serious in Haryana and Punjab where the sex ratio is seriously against women. The girl child has to encounter the first attempt before her birth. The medical test, amniocentesis, which is meant to test the health of the foetus, is being used to test the sex of the foetus. If the foetus is female, then there will be termination of the pregnancy. Here this termination issue is also decided not by that pregnant mother, but by her husband or in-laws. Hence, the saga of sorrows starts right from the womb. The girl child not only eliminated before birth, but also, if survived, sold to others by the parents due to poverty, as some tribal societies are presently doing, or neglected nutritionally during the growing period, which ultimately may result in maternal deaths, or subjected to burning for want of dowry, or often commit suicides. Even though, if she overcomes all these obstacles, then there is the threat of rapes and kidnaps in this so-called great Indian civilized society. More than 11000 rapes, more than 12000 kidnappings per year are reported in India. Ironically, age of victim may very from three year to 80 year old and the age of rapist could be from student to eighty-year-old man. Most of the atrocities against the girl child are unreported to the police officials due to fear of humiliation. In India, every one of three married women is subjected to atrocities like beating, burning, withdrawal, sexual harassment etc. The life of women particularly when she attained the age of marriage is miserable. She bound to face the several comments from street side Romeos and those Romeos may be a teenager or middle-aged man or ‘elderly’ like man. Women instead of protest became habituated to this kind of social harassment. Even in settling her marriage, her opinion is often overlooked or may consider not necessary by the family members, particularly by the male members what is the basic violation of Human Rights, and is an offence under Civil Procedure Code and Criminal Procedure Code. Some girls are made to get married even before the constitutionally prescribed age, 18. All these offences against women suggest the character of Indian society is not at all civilized and treats women as second-class or marginalized citizen; leave along the Right to dignity, their physical survival is in question. The Indian Society shows the unique distinction that whatever is the religion, caste, class or creed, it treats women alike, and commits atrocities against women alike with the similar intentions, and all the men treat women alike. Hence, it is a unique way of showing the Unity in Diversity. The exceptional qualities of Ms.Jayalalithaa like Intelligence, Mental Toughness, Making critics silent seldom expressed by the Indian women, though they posses those qualities. At the same time, women prime minister and the Chief Ministers failed to instil the sense of confidence among Indian women. They were just after election mockery and political manipulations. It is N.T.R that gave the Equal Property Inheritance to women, not Indira Gandhi or not any other women leader. Women do not inherit equal property except Andhra Pradesh, Maharashtra and Tamil Nadu. Because of this throughout the life, they tend to depend for their survival on their father before their marriage, husband after the marriage, sons after the death of her husband. Hence, the autonomy in decision-making is out of question, as she bound to obey whatever her patron orders. If she has any source of income she could definitely influence the decisions of the male members of her family. The women do not posses even the right on her sexuality, whether to have children or not to have children, is not within the rights of women. Her choice on her reproductive rights is almost ‘ZERO’, as she has been dependent on somebody. Hence, she is giving births to cricket teams or football team numbered children throughout her life beyond her biological capacity. Hence, there is population explosion in

India

as we crossed one billion mark recently. One day her body may take rest permanently after prolonged number of deliveries.

The socio-cultural causes are evolutionary in nature and with the help of religion, men were successful to made women as animate objects. Our great culture discriminates women as our religious texts, which laid foundations basing on hierarchy. Our Great Dharmasastras are against women and equated them with cattle. Particularly, the Manu allowed the husband to beat his wife with the stick if she questioned his orders. Manu even denied education and property rights to women, disallowed remarriage for a widow, and codified the methodology of subjugating the women and this methodology is being indoctrinated generation after generation. Her objections raised out of compulsion are often ignored. Even the 11th century Bhakti saints also equated women with cattle and allowed the husband to beat his wife with stick if she disobeyed his orders. Hence, women are denied of qualitative life under this perfectly framed culture in which they made handicap purposefully and culturally. In this culture, whatever women got from men are gifts only, not their dues. One wonder is this indoctrination has entered up to DNA level! The women born and brought-up in this culture are becoming women patriarchs due to prolonged indoctrination of patriarchal prejudices. The mother, who is women patriarch, purposefully appears herself before her daughters as a model to show that how the women should be. Hence, the vicious circle or fatal triangle ‘Patriarchy-Men-Oppression’ goes on and atrocities against women continue unabated and unstopped. Some mothers who are strict women patriarchs, do not allow their daughters even to laugh, to sit before books even for an hour, believing that girl child should learn to do domestic work first. This is resulting in ignorance of the girl child about the worldly affairs, day-to-day happenings, and changing patterns of the society. Hence, the girl after getting married under patriarchal set up, when enter her family of procreation, need to live with her husband who is aware of worldly affairs, day-to-day happenings, and changing patterns of the society, the girl faces the problems of adjustment within this new environment, which is different from her family of orientation. If her husband is compassionate, then it is well and good. If he is bad person, then the girl, who is ignorant of worldly affairs, day-to-day happenings, and changing patterns of the society, undergoes frustration result in maladjustment, ultimately leads to domestic violence. Even a women who had higher education often get ill-treated or cheated at the husband or in the society, as she has brought up in the patriarchal system, which is undemocratic. Hence, the generations of girls tend to grow in ignorance with indifference to worldly affairs, day-to-day happenings, and changing patterns of the society, their rights and their abilities, hence suffer.

Empowerment of Women started from the South in India that too rigorously from Andhra Pradesh. The women prime minister and the women chief ministers failed to instill any kind of the sense of confidence among women in India. Here the policies matter not personalities. A change, which is radical, has taken place in the family life of the women of rural Andhra Pradesh because of the scheme of DWCRA, which empowered them. The total population of Andhra Pradesh as at 00:00 hrs of 1 March 2001 stood at 75,727,541 as per Provincial Census of India, 2001. Andhra Pradesh occupies the fifth place in population as against the fourth in the previous Census of India. During 1981-1991, this state witnessed an increase of 24.20 per cent in population, which came down to 13.86 per cent during 1991-2001 while the country’s decadal growth rate is 21.34 per cent. This achievement of Andhra Pradesh is spectacular. Andhra Pradesh has shown the sharpest decline in population growth rate among all the states (10.34 per cent). The average annual exponential growth rate has declined to 1.93 per cent in 1991-2001 from 2.14 per cent in 1981-1991. It is can be a hypothesis that it happened because of Empowerment of Women in Andhra Pradesh through DWCRA.

Presently, 4, 20,000 DWCRA groups are working only in Andhra Pradesh that is major portion of total DWCRA groups in India. The main highlights of the DWCRA are the women members of DWCRA form a group of 10 to 15 women at the village level for delivery of services like credit and skill training, cash and infrastructure support for self-employment. Women save one Rupee a day and after watching the performance of a group over nine to twelve months, that group is given a one time grant of Rs.25,000 /- as a Revolving Fund (shared by Central and State Governments in 50:50 ratio) towards infrastructure, purchase of raw materials, marketing, child care and so on. The DWCRA groups formed in Andhra Pradesh cover more than 2 million women and their savings have crossed Rs.15 million so far. It is assumed that the DWCRA has created a sense of confidence among the women of rural Andhra Pradesh and they are moving towards autonomy in decision-making at all fronts which reflected in the reduction of population growth rate in the State. The State of Andhra Pradesh has every right to claim the credits of the statistics of Census of India, 2001 for its performance regarding the population control as it is in the forefront of empowering women in the state by means of DWCRA. The ignorance of DWCRA women in utilizing their saved money to be checked by providing adequate guidance. What will happen, if these DWCRA women started asserting their voting power? The political equations will tilt. What will happen, if these women threaten the all the governments …not to vote if govt., has not given the reservations in the legislatures? These women can even demand legislation in the parliament for inheritance of Equal Property. But somebody should educate them in this direction. And they will ultimately give a final blow to the male domination in the parliament and politics. Yes, it is this DWCRA woman that can initiate a change in this direction in India.

Wherever Women Succeeded If We Look around the world, we find that women have secured a strong Economic, Socio-Cultural and Political Footholds only in those countries or societies where institutions function according to well-defined democratic norms, where the crime, violence in general, women in particular, where over all corruption levels and population growth rate is low to very low, where decision-making is not concentrated in the hands of few, where citizens actively participate in local self government, and the voice of women is listen and respected may be from the family level to the national level. In these countries, where women have begun to seriously alter the very nature of politics and have made enduring and substantial gains from themselves in every field. This situation can be witnessed in the Scandinavian countries like Sweden, Norway, Denmark and Finland, where they are moving in the direction of near equal participation at all fronts. But in India, women are treated as second class citizens, as politicians are thinking of providing reservations to women in the legislature, but failing to come to consensus. This is a paradox in democracies. There are several socio-cultural, economic and political factors for this second class status of the Indian women. They are second class citizens in the sense they do not have autonomy in the decision making process, leave alone at political level, not even in their family particularly on their reproductive rights. Even after witnessing a women Prime Minister, women Chief Ministers and women dignitaries, the Indian women failed to get the moral boost, and remained indifferent to their reproductive rights. Hence, Indian population crossed the One Billion mark, though India initiated the Family Planning Programme way back in 1951. What remain constant are the low economic, social, cultural and political values accorded to the work performed primarily by the women in the conditions of exploitation, no job security, and violations of Human Rights against them, which reflected in the growth of the population. Of late, it is identified that the Empowerment of Women is necessary to check the population growth for sustainable development. Many schemes launched by the both Government of India and State governments failed to attract the attention of Indian women, resulted in partial success only, and failed to imbibe the sense of confidence among women, except the Central Government’s scheme, DWCRA( Development of Women and Children in Rural Areas), in Andhra Pradesh. In Andhra Pradesh, the factors that are responsible for the sharpest decline of population growth rate are little investigated during post-DWCRA period. Hence it is necessary and relevant to study the success stories and social, cultural, economic and political factors involved in the overall perspective of Improving the Quality of the Life in the New Development Perspectives in a Globalizing World.

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WORLD COPD DAY 2023: EMPOWERING EARLY ACTION, THROUGH BETTER DISEASE AWARENESS

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