Women’s health in India has emerged as a major nutritional challenge with the country wrestling largest number of anemic women in the world and the other having to tackle diseases related with obesity –that is on the rise, warns the latest Global Nutrition Report, 2017. It says there is malnutrition among adults globally.A total of 614 million women aged between 15–49 years were affected by anemia. India had the largest number of women impacted, followed by China, Pakistan, Nigeria and Indonesia.In India and Pakistan, more than half of all women of reproductive age have anemia.

It is a global issue that many women in high-income countries also suffer from; prevalence rates may be as high as 18% in countries such as France and Switzerland. Obesity (body mass index (BMI) ≥30) is most common among North American men (33%) and women (34%), and lowest among Asian and African men (6%) and Asian women (9%).

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Overweight and obesity are increasing in almost every country and are a real concern for many low and middle income countries, not just high-income ones.The problem affects more women than men in all the world’s regions, reflecting a wider global gender disparity.

Hypertension is most common (28%) among African women and European men, and lowest (11%) among North American women. A quarter of Asian and Latin American men suffered from raised blood pressure in 2015. While more women worldwide are affected by obesity, the case for diabetes and hypertension is mixed. There is more diabetes among men than women in Asia, Europe, Northern America and Oceania, and more hypertension among men than women in all regions except Africa.

The world now faces a serious nutrition- related challenge, whether stemming from under nutrition or obesity, states Global Nutrition Report 2017.

The report found the vast majority (88%) of countries studied face a serious burden of two or three of these forms of malnutrition. It highlights the damaging impact this burden is having on broader global development efforts.

“The world can’t afford not to act on nutrition or we risk putting the brakes on human development as a whole,” said Corinna Hawkes, Co-Chair of the Global Nutrition Report’s Independent Expert Group and Director of the Centre for Food Policy at City, University London. “We will not achieve any of the Global Goals for Sustainable Development (SDGs) by the 2030 deadline unless there is a critical step change in our response to malnutrition in all its forms. Equally, we need action throughout the goals to tackle the many causes of malnutrition.”

The Report calls for nutrition to be placed at the heart of efforts to end poverty, fight disease, raise educational standards and tackle climate change.

“We know that a well-nourished child is one-third more likely to escape poverty,” said Jessica Fanzo, Bloomberg Distinguished Professor of Global Food and Agriculture Policy Ethics at Johns Hopkins University and Global Nutrition Report CoChair.

• At least 41 million children under five are overweight, with the problem affecting high and lower income countries alike
• At least 10 million children in Africa are now classified as overweight
• One-third of North American men (33%) and women (34%) are obese
• 155 million under-fives are stunted; Africa is the only region where absolute numbers are rising, due to population growth
• 52 million children worldwide are defined as wasted, meaning they do not weigh enough for their height

In all 140 countries studied, the report found ‘significant burdens’ of three important forms of malnutrition used as an indicator of broader trends:
1) childhood stunting-children too short for their age due to lack of nutrients, suffering irreversible damage to brain capacity,
2) anemia in women of reproductive age-a serious condition that can have long term health impacts for mother and child, and
3) overweight adult women-a rising concern as women are disproportionately affected by the global obesity epidemic.

“They will learn better in school, be healthier and grow into productive contributors to their economies. Good nutrition provides the brainpower, the ‘grey matter infrastructure’ to build the economies of the future.”

Rates of undernutrition in children are decreasing, the report said, with recent gains in some countries. But global progress is not fast enough to meet internationally agreed nutrition goals, including the Sustainable Development Goals (SDG) target 2.2 to end all forms of malnutrition by 2030.

EmornUdomkesmalee, Co-Chair of the Global Nutrition Report’s Independent Expert Group and Senior Advisor, Institute of Nutrition, Mahidol University, Thailand, said, “It’s not just about more money – although that is important – it’s also about breaking down silos and addressing malnutrition in a more joined-up way alongside all the other drivers of development. There’s a powerful multiplier effect here that we have to harness.”

The report found that overweight and obesity are on the rise in almost every country.With 2 billion of the world’s 7 billion people are now overweight or obese and a less than 1 per cent chance of meeting the global target of halting the rise in obesity and diabetes by 2025.

Rising rates of anemiaamong women of reproductive age are also cited as a concern with almost one in three women affected worldwide and no country on track to meet global targets. “Historically, maternal anemia and child undernutrition have been separate problems to obesity and noncommunicable diseases,” said MsFanzo. “The reality is they are intimately connected and driven by inequalities everywhere in the world. That’s why governments and their partners need to tackle them holistically, not as distinct problems.” Donor funding for nutrition rose by just two per cent in 2015, to US$867 million, representing a slight fall in the overall percentage of global aid. The report says funding needs to be ‘turbo charged’ and calls for a tripling of global investments in nutrition, to $70bn for over next 10 years to tackle childhood stunting, wasting and anemia and to increase breastfeeding rates. Crucially, donors are only spending 0.01 per cent of official development assistance on diet related Non-Communicable Diseases, a ‘disturbingly low’ level.

Pledges to invest in nutrition must be ‘concrete’ and ‘acted upon’, not ‘empty rhetoric’, the report said. Of the 203 commitments made at the Nutrition for Growth Summit in 2013 those most likely to be classified as ‘on course’ are the UN agencies’ at 86 per cent, followed by ‘other organisations’ at 75 per cent and NGO policy commitments at 73 per cent.

The report found there is a critical need for better data on nutrition – many countries don’t have enough data to track the nutrition targets they signed up to and to identify who is being left behind.

Report says the world consumes too much salt. Intake varies by region, but no region had intakes within the WHO-recommended limits of 2 g/day of sodium. Asia has the highest intake (4.3 g/day of sodium), followed by Europe (4.0 g/day of sodium). At national level, only seven countries (Burundi, Comoros, Gabon, Jamaica, Kenya, Malawi and Rwanda) have sodium intakes within desirable limit).

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GST a loan waited game changer is now about to become a reality for Indian economy. Talking about the world’s second largest population and huge health care market, the GST is going to make or mar the industry. With positive move of One Indian One Tax, the rates and procedure is going to ultimately decide the result of GST.

Introduction to Indian Taxation System

The Indian Taxation system is one of its own types in the world with numerous taxes and complex compliance system. And perhaps very few in the country actually understand the complete taxation system. While the entity has to collect and pay huge amount of taxes, what is more difficult is the compliance system of the country. The continuous efforts of various government for years has been to make the system simple and industry friendly has ultimately resulted in implementation of GST.

GST History

It all started with establishment of empowered committee headed by Asim Dasgupta in the year 2000 by the Vajpayee Government. The UPA1 and UPA2 government took it forward and finally after a very long time in 2016 again NDA government is going to implement the same.

General Expectation from GST

While manufacturers are quite optimistic about the new tax law. Commoners are not sure how it is going to impact their lives as yet. The expectation form GST is to simplify and streamline the tax structure in India.

The industry in general feels that this is a milestone for Indian economic development and will provide a huge fillip to manufacturing. This step is also expected to accelerate prime minister’s ‘Make in India’ initiative and lower prices for the consumers. The immediate impact of GST may also increase the cost of finished products in some sectors. However in the long term this would prove beneficial to the industry and consumers, and augur well for our overall economic development.

Indian Healthcare Industry

The emerging economy of India is one of the largest producers of generics. And also experiencing a boom in medical tourism which generates additional returns for the healthcare industry. Globally India’s pharmaceutical industry currently is ranking in the top 5 in terms of volume and top 15 in terms of value. To provide the required healthcare facility to the growing population of the country, the government has raised the FDI cap for Brownfield Pharmaceutical investments to 74% in June. Eventually, 100% FDI is allowed in Greenfield Pharmaceutical investments and beyond 74% under government approval in Brownfield Pharmaceutical investments. This step is expected to develop more qualified personnel and provide state-of-the-art facilities and technologies to patients.

Though the rates of GST are recently notified and item wise list is pending. It is expected to have a positive effect on the pharmaceutical sector in an overall sense. The GST is expected to simplify the tax structure, since eight different taxes are levied at state, central and municipal level in the pharmaceutical industry at the moment. GST, by

consolidating all these into one tax would increase the ease of doing business. As well as mitigate the cascading effects of multiple taxes applied on one product. Apart from this, GST will also result in operational efficiency by streamlining the supply chain which can alone add 2% to India’s pharmaceutical market size.

The pharmaceutical companies need to move to a hub-and-spoke model with primary and secondary hubs across states, besides overhauling the process of the companies used to select their warehousing network with cities like Chandigarh, Lucknow, Guwahati, and Nagpur emerging as primary hubs in addition to the metros.

GST implementation will also envisage a seamless flow of tax credit, account for improvement in overall compliance and is also expected to create a level-playing field for pharmaceutical companies in India. A big advantage for companies will be the reduction in transaction costs with the discontinuance of Central Sales Tax (CST). GST is expected to bring down the manufacturing cost. Even a 2% reduction in production or distribution cost is believed to add over 20% to profits. GST, if its rate is below the current total tax rate, will eventually help consumers by making healthcare and drugs more affordable which already is a big goal for the Indian Government.

Although, the new tax legislation is believed to bring down the manufacturing cost. It cannot be said with certainty as to how the ultimate consumer will be benefited through this as most of the medicines are available at the MRP which is inclusive of the taxes, how is the end consumer going to benefit from that? It will be ultimately the industry’s call whether to share their profit margin with their customers or not.

India’s healthcare industry is worried that the implementation of the goods and services tax (GST) may lead to higher taxes that could erode its profits, even as it hopes that the new regime will help streamline the supply chain.

GST will help companies rationalize their supply chain. However, if the overall tax cost goes up above 12% there won’t be any savings as such.

GST, once implemented, would put various sectors under the purview of service tax. The list of exempted services presently includes healthcare sector. It is expected to continue after the GST regime at least for initial period until basic cost of healthcare sector becomes affordable to the common man of the country. It is believed that levying service tax on healthcare services and facilities will be a retrograde step. An it will certainly push back the agenda to provide best in class healthcare.

Overall, the effects of GST implementation on the healthcare and pharmaceutical sector are still uncertain. However, industry experts believe that GST will set industry players and consumers in a win-win situation. In case the tax rate is set at an efficient level. The healthcare industry will benefit as GST certainly reduces complexities and removes many hurdles to the industry’s growth. The industry is on a path of promising growth and increased productivity.

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