Baa Baa Black Sheep - The origin of the Poem

Educational reasons for the poem "Baa, baa black sheep"poem

The reason to the words and history to this song were to associate wool and wool products with the animal that produces it, not to mention the sound that a sheep would make! The first grasp of language for a child or baby is to imitate the sounds or noises that animals make - onomatopoeia (words sound like their meaning e.g. baa baa in "Baa, baa black sheep"). In some of the earlier versions of "Baa, baa black sheep" the title is actually given as "Ba, ba black sheep" - it is difficult to spell sounds!

The History and Origins of Baa Baa Black Sheep Nursery Rhyme
The wool industry was critical to the country's economy from the Middle Ages until the nineteenth century so it is therefore not surprising that it is celebrated in the Baa Baa Black Sheep Nursery Rhyme. An historical connection for this rhyme has been suggested - a political satire said to refer to the Plantagenet King Richard III (the Master) and the the export tax imposed in Britain in 1275 in which the English Customs Statute authorised the king to collect a tax on all exports of wool in every port in the country. But our further research indicates another possible connection of this Nursery rhyme to English history relating to King Edward II (1307-1327). The best wool in Europe was produced in England but the cloth workers from Flanders, Bruges and Lille were better skilled in the complex finishing trades such as dying and fulling (cleansing, shrinking, and thickening the cloth). King Edward II encouraged Flemmish weavers and cloth dyers to improve the quality of the final English products.

See the origin of another poem at
http://www.nellaimedicos.com/blog/bruno/2005/04/rain-rain-go-away.html

I have Broad Band at my home now.....

So......, after being associated with computers for almost 2 decades and browsing for 7 years, I have at last got a Broad Band in my home......

The process was quite simple......

I registered last Feb..... and then forgot it

A couple of days ago, I got a telephone call asking me to pay the money and that the connection will be given. I went and paid the money in the afternoon. They have even begun to collect money at 5 PM (compared to the yesteryears when we had to wait in long queues)

Two telephone personnel came to my home today morning and installed the modem. The guys were really helpful and even gave me few softwares which they had downloaded from net.

And what was more surprising is that they refused "informal payments"...... DOT (Dept of Telecom) is changing..... and no doubt BSNL is leading from the front....

Hats off to all responsible for this

At 1:56 AM, injinuity said…

telecom ppl refused a bribe... jesus christ... they've must been on drugs.. no other explanation doc.

At 1:51 AM, Doctor Bruno said…

One more explanation...

1. The person who came was the cadre of JE

In my opinion it is the lower and the higher rungs that are MOST Corrupt....

In telecom and electricity, maximum corruption iss seen among wireman, kalasis, gangs and other Grade IV staff....

And in the level of GM and Supdt Engineer, they earn in lakhs in Contracts....

'I'll never work at a call centre again!'

Taken from http://in.rediff.com/getahead/2004/nov/18ga-bpo.htm

The BPO/ITES sector is only expected to grow larger, and more profitable, over the next few years.

Most young people are eager to jump on the money-making BPO bandwagon.

But is working for a BPO all that it's made out to be?

No, says Subhash Mukherjee (name changed on request), who recently quit his job at a call centre.

This, in his own words, is his story:

I am 20 years old.

I was recently hired by a call centre in Kolkata to work for an overseas-based company. I was earning Rs 7,500 per month.

My workday began with calls I had to answer for five hours continuously, without a break.

As soon as I was through with one call, the next one would be waiting.

There was no time for me to even say a few words to the person sitting next to me.
After five hours of constantly answering calls, I would get a 20-minute break.

Then, I would take calls again for another three hours. Without a break.

I would take around 350 calls a day.

One day, I reached breaking point.

After taking 156 calls at a stretch, my throat started to hurt terribly.

I paused to take a breath and, in the process, I missed a call.

The calls that are directed to us were constantly monitored by a machine. Immediately, it alerted my supervisor to the fact that I had missed a call. My supervisor came and asked me why I was in the 'wrap mode'.

What this means is that my dialler shows a red bar when the person on the other end of the line hangs up without getting a response. The red bar is an indication that I did not take the call -- that the call was not 'live'.

At that moment, I just wanted to pick up my bag and leave. Permanently.

Instead, I stayed calm for the duration of my hours at work.

I fielded all my calls till 1 am.

But I had made up my mind -- I would quit this job with its inhuman pressures and its lack of empathy for employees.

Workplaces like this have only one goal -- to make money. This job expects you to work even if you are feeling ill; even if your throat hurts.

You cannot take even a 10-second break; the dialler throws calls at you continuously and you have to start pitching (taking them) immediately.

If you do not respond to the person at the other end of the line, s/he might hang up. That shows on your machine.

You have to ask for permission to go to the toilet. Often, your request is denied by your supervisor.

You repeat the same five sentences 350 times a day.

Isn't it pathetic?

When I started out, there was no pressure. Gradually, though, the stress grew beyond the levels of human tolerance.

Working at the call centre was a great learning experience for me. Now, it was time for a break.

When I worked, I had no time to watch a film, no time to read a book, no time to meet friends, no time to swim.

For the last few months that I worked at the call centre, I had time only for two meals a day. As a result, I lost my appetite.

I would return home at 2.30 am and go to sleep at 4 am. I would get up at noon and go back to work at 3.30 pm.

Now that I have quit, I can go out with my friends. I can spend time rediscovering myself.

With the approximately Rs 65 per hour that I made, I can buy a few books and have some fun.

Maybe that will take away the pain that came with this job.

But, believe me, the money could in no way make up for the pain!

I'll never work at a call centre again. Nothing is worth the ordeal I went through.

Subhash Mukherjee quit his job in mid-October. He is now pursuing an Economics degree at the University of Calcutta.

Shining India’s swanky new sweatshops

Please read this article in Hindustan Times if you are planning to work for Yankees

Taken from http://www.hindustantimes.com/news/181_1527814,0008.htm


Call centres housed in swanky glass towers may represent the new face of 21st-century India, but the labour practices they follow belong to the 19th century.

Though business process outsourcing (BPO) companies are projected as promoters of innovation, flexibility and freedom at workplace, they are actually quite inflexible, eroding even basic rights at work. This is the finding of the first major study of labour practices in Indian call centres.

The BPO industry in India currently employs 350,000 workers, according to the trade body Nasscom.

Superior work environment, the use of latest technologies, higher salaries compared to the manufacturing sector, fancy designations, smart and young peer workers — all these make young employees believe that the job they are doing is of an executive or a professional in a multinational-like environment.

But the organisational structure of call centres is basically ‘dualistic’ — consisting of a core or permanent set of employees and ‘periphery’ or non-permanent workers. All call-centre agents are periphery workers, who are easily substitutable, while team leaders and managers make up the core group.

This is similar to the popular model of work organisations followed in 1980s, the study done by the V.V. Giri National Institute of Labour pointed out. The institute is an autonomous body working under the Labour Ministry. The dualistic workforce model allows firms to regulate the workforce and nip in the bud any signs of collectivism.

The labour practices call centres follow are even much older. Take, for instance, the monitoring of workers at the workplace. “Work is monitored on the spot and after working hours with the help of specially designed software, computer network and closed circuit cameras,” the study says. “The degree of surveillance required at work is even comparable with the situations of 19th century prisons or Roman slave ships.”

In addition, all interactions among employees in office are continuously recorded or taped, and randomly checked by the team leader or manager. Mistakes in work lead to immediate warnings and they are recorded in ‘warning cards’ that form part of the daily ratings of agents. If an employee commits three errors in a day, he or she is warned and gets zero in his or her daily rating. Three consecutive zeros lead to counselling or even dismissal.

Availing oneself of leave without prior notice or consent is treated as unauthorised absence — sufficient reason for termination. During the course of the survey, half a dozen cases of termination due to unauthorised absence were recorded. Even if an employee is sick, it is mandatory to get the consent of the team leaders at least four to six hours before the shift, failing which the leave is considered “unscheduled”.

Human-resource managers play a key role in call centres. Their task is "camouflaging work as fun", detaching workplace feeling from employees and giving them opportunities to air grievances with least damage to the company, the study noted. The HR departments undertake activities such as organizing parties, recreation activities and designing workspaces.

All this gives employees a superficial sense of 'empowerment'. But the actual task of HR managers is to define and enforce roles for separate categories of employees, and define dos and don'ts for them. Yet another example of giving employees a sense of 'illusionary freedom and flexibility' is the number of codes of conduct, which are actually meant to be violated than complied with. For instance, BPO firms insist on a dress code on paper but allow employees to wear clothes of their choice. This is a strategy to make workers happy at no additional cost, the study said.

"HR departments strive to ensure that creativity and productivity of the workers are effectively tapped to strike a 'right' balance between work and fun, thereby creating a productively docile workforce," said Babu P. Remesh, author of the study.

For the study, about 280 customer-care agents from six call centres in Noida were interviewed through a detailed questionnaire. In addition, detailed interviews were done with 40 employees, managers and team leaders from BPO companies in Delhi, Gurgaon and Noida.

Private Banks employ Criminals

See how the private banks about which you shamelessly promote in your writings behave

http://rediff.com/money/2005/oct/13icici.htm

Taking strong exception to the ICICI Bank's use of goondas against a defaulter to recover a two-wheeler financed by it, a consumer court has asked the bank to refund him the entire cost of the vehicle and Rs 20,000 as compensation.
"The fact leaves us aghast at the manner of functioning and goondaism in which the bank is involved for a petty amount of Rs 1,889... such attitude is deplorable and sends chills down the spine", Consumer Disputes Redressal Forum (North) president K K Chopra, members N Mittal and S C Jain said.

Dheeraj Jain had got his scooter financed from the ICICI Bank. On February 12, this year he got an overdue payment notice from the bank giving him seven days' time to pay the outstanding amount of Rs 1,889.

But just two days later, Jain was stopped while travelling on his scooter by four persons near Mori Gate Bus Terminus and was told to hand over the vehicle to them as he had failed to make the payment on time.

They even pointed a pistol at him when he tried to resist, forcing him to give in to their demand. The bank later sold the vehicle. The bank argued that they had taken peaceful possession of the vehicle "after due intimation to the complainant as he was irregular in remitting the monthly instalments".

But the court found out that the records proved otherwise. "The bank had the option to recover dues through legal means. They have no legal right to snatch the vehicle in such a manner which amounts to robbery," the court said.

As the vehicle was already sold, the Forum directed the bank to refund Rs 32,205 paid till then by the complainant towards the loan besides ordering a compensation of Rs 20,000 and Rs 1000 as the cost of litigation.

A small mishap by Govt sector and there are "pseudo liberals" (they are just after the bones thrown by the MNCs) cry loud umpteen times That govt should not do this and .... blah blah....What can they tell about this blatant act of rowdyism......

I have already written... India is not yet "ripe" for privatisation of banking sector...... We will get these incidents and one fine morning ICICI will disappear with the hard earned money of common indian.... Who will pay them

It is high time, govt intervenes and stops all these private banks and nationalise the banking sector

Dr.Anbumani Ramadoss as Lancet Author

It is not surprising that Dr.Anbumani (Ramadoss is his father's name and not surname) has written the article

The article is not a critic of his ministry, as you will think at first instance.

In fact, it stresses the need for the programmes he is implementing during his period and justifies his actions like

1. Banning Tobacco in movies - Once you read the article, you will understand his points of contention

India is the world's second largest producer as well as consumer of tobacco. As a source of excise revenue, export earnings, and employment, tobacco occupies an important place in the Indian economy. The strong measures initiated by the Government of India for tobacco control have overcome fierce resistance from the tobacco industry. In this respect, India becomes an excellent role model for other developing countries.

2. Asking MBBS Students to work in village for one year after MBBS before PG
3. Setting up of a Diabetic Control Program (like Blindness and TB Control Program)

Though few of his actions like curtailing the autonomy of Medical Council of India and alloting excess money to quackeries like Homeo and Ayurveda are questionable, he is a Health Minister (may by after decades) who seems to be concentrating on the entire aspect of health (Unlike the previous ministers who used to concentrate on buying drugs, buying equipments and finalising contracts for buildings)

Indian Express at http://www.indianexpress.com/full_story.php?content_id=79523:
The article talks extensively about chronic diseases in India — heart disease, cancer and diabetes — and unlike the releases from the minister’s office, criticises the current policy on them.

He is criticising the current policies and NOT HIS POLICIES he is trying to implement


Please NOTE : Since this is not an article published in the PAID Section, we have reproduced this. If any one has an objection, it will be immediately removed

The Lancet Early Online Publication, 5 October 2005

DOI:10.1016/S0140-6736(05)67343-6

Responding to the threat of chronic diseases in India
K Srinath Reddy a , Bela Shah b, Cherian Varghese c and Anbumani Ramadoss d

See Comment

Summary

Burden of chronic diseases: the rising tide

Risk factor levels: grim portents

Existing chronic disease prevention and control programmes

Action needed

Conclusion

References

Summary
At the present stage of India's health transition, chronic diseases contribute to an estimated 53% of deaths and 44% of disability-adjusted life-years lost. Cardiovascular diseases and diabetes are highly prevalent in urban areas. Tobacco-related cancers account for a large proportion of all cancers. Tobacco consumption, in diverse smoked and smokeless forms, is common, especially among the poor and rural population segments. Hypertension and dyslipidaemia, although common, are inadequately detected and treated. Demographic and socioeconomic factors are hastening the health transition, with sharp escalation of chronic disease burdens expected over the next 20 years. A national cancer control programme, initiated in 1975, has established 13 registries and increased the capacity for treatment. A comprehensive law for tobacco control was enacted in 2003. An integrated national programme for the prevention and control of cardiovascular diseases and diabetes is under development. There is a need to increase resource allocation, coordinate multisectoral policy interventions, and enhance the engagement of the health system in activities related to chronic disease prevention and control.

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This is the third in a Series of four papers about chronic diseases.

Burden of chronic diseases: the rising tide
India is experiencing a rapid health transition, with large and rising burdens of chronic diseases, which are estimated to account for 53% of all deaths and 44% of disability-adjusted life-years (DALYs) lost in 2005 (figure 1). Earlier estimates, from the Global Burden of Disease Study, projected that the number of deaths attributable to chronic diseases would rise from 3·78 million in 1990 (40·4% of all deaths) to 7·63 million in 2020 (66·7% of all deaths).1


Click to enlarge image

Figure 1. Estimated proportions of total deaths and DALYs lost by cause in India (all ages, 2005)




Many of these deaths occur at relatively early ages. Compared with all other countries, India suffers the highest loss in potentially productive years of life, due to deaths from cardiovascular disease in people aged 35–64 years (9·2 million years lost in 2000). By 2030, this loss is expected to rise to 17·9 million years—940% greater than the corresponding loss in the USA, which has a population a third the size of India's.2

The burden of cardiovascular disease is rising in India. The estimated prevalence of coronary heart disease is around 3–4% in rural areas and 8–10% in urban areas among adults older than 20 years, representing a two-fold rise in rural areas and a six-fold rise in urban areas over the past four decades. About 29·8 million people were estimated to have coronary heart disease in India in 2003; 14·1 million in urban areas and 15·7 million in rural areas.3 The prevalence of stroke is thought to be 203 per 100000 population among people older than 20 years.4

Data on cancer mortality are available from six centres across the country, which are part of the National Cancer Registry Programme of the Indian Council of Medical Research (ICMR). About 800000 new cases of cancer are estimated to occur every year. The age-adjusted incidence rates in men vary from 44 per 100000 in rural Maharashtra to 121 per 100000 in Delhi.5 The major cancers in men are mostly tobacco-related (lung, oral cavity, larynx, oesophagus, and pharynx). In women, the leading cancer sites include those related to tobacco (oral cavity, oesophagus, and lung), and cervix, breast, and ovary cancer. India has the largest number of oral cancers in the world, due to the widespread habit of chewing tobacco.

India also has the largest number of people with diabetes in the world, with an estimated 19·3 million in 1995 and projected 57·2 million in 2025.6 The prevalence of type 2 diabetes in urban Indian adults has been reported to have increased from less than 3·0% in 1970 to about 12·0% in 2000.7 On the basis of recent surveys, the ICMR estimates the prevalence of diabetes in adults to be 3·8% in rural areas and 11·8% in urban areas.

The prevalence of hypertension has been reported to range between 20–40% in urban adults and 12–17% among rural adults.8 The number of people with hypertension is expected to increase from 118·2 million in 2000 to 213·5 million in 2025, with nearly equal numbers of men and women.9

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Risk factor levels: grim portents
These advancing epidemics are propelled by demographic, economic, and social factors, of which urbanisation, industrialisation, and globalisation, are the main determinants. The Indian economy is growing at 7% per year. With increasing life expectancy, the proportion of the population older than 35 years is expected to rise from 28% in 1981 to 42% in 2021.10 The proportion of people in urban residence, presently around 30%, is expected to rise to about 43% in 2021. During the decade 1991–2001, the population grew by 18% in the rural areas and 31% in urban regions.11 Urbanisation and industrialisation are changing the patterns of living in ways that increase behavioural and biological risk factor levels in the population. Substantial variations exist between different regions, but risk levels are rising across the country, most notably in urban areas of demographically and economically more advanced states of India.

An excess risk of death from coronary disease has been observed in men and women of south-Asian origin, by comparison with other ethnic groups, and there is a progressive rise in risk from rural to urban to migrant environments.12,13 The increased risk of cardiovascular problems noted in Indian migrants is a portent of the further rise in risk that Indians are likely to experience alongside the developmental transition of their country.

A high frequency of diabetes, central obesity, and other features of the metabolic syndrome (especially the characteristic dyslipidaemia of reduced HDL cholesterol and raised triglycerides) have been reported in migrant and urban Indian population groups.14,15 Comparisons between migrant and non-migrant groups and rural and urban populations have also highlighted the importance of conventional risk factors like smoking, blood pressure, plasma cholesterol, and body-mass index (BMI).10,12 The INTERHEART study16 found that the cluster of nine coronary risk factors identified in the global population was also applicable to south Asians as a group.

Nationally representative distribution data are available for a few risk factors. Several community-based surveys, done in different parts of India at different times, have contributed to a patchwork profile of risk in segments of the population, but there have been very few multicentre studies with standardised methodology. In the past few years, two surveillance systems have been established to provide risk factor data from different parts of the country, using WHO's STEPS methodology.17 In 2002, ICMR, with technical assistance from WHO, established a community-based surveillance system involving five centres. During 2000–04, another WHO-assisted project established a sentinel surveillance system for cardiovascular risk factors and events in ten large industries across the country, involving the employees and their family members.

The prevalence of tobacco use, in myriad smoked and smokeless forms, has been estimated in the National Sample Survey and the National Family Health Survey (figure 2).18 In the Indian component of the Global Youth Tobacco Survey (2000–04), 25·1% of the students aged 13–15 years reported that they had ever used tobacco, whereas current use was reported by 17·5%.19 A national survey in 2002, reported that the overall prevalence of current tobacco use in men and boys aged 12–60 years was 55·8%, ranging from 21·6% in those aged 12–18 years to 71·5% in the 51–60 year age group.20


Click to enlarge image

Figure 2. Prevalence of tobacco chewing, smoking, and alcohol habits in men and women older than 15 years in rural and urban India (1998–99)18




Many cross-sectional surveys, as well as the industrial surveillance project, recorded a high urban prevalence of central obesity and overweight (especially when the lower thresholds recommended by WHO for Asian people are used). Though the prevalence of obesity (BMI 30) is usually lower than that observed in the western population, the overweight category (BMI 25) includes almost a third to half the population in every survey. Women and men are equally affected.21,22 Small birth size, with rebound obesity in early childhood, predicted diabetes and glucose intolerance in adulthood, in an Indian cohort.23

The few available standardised studies of physical activity revealed low levels in urban areas (compared with rural) and in the upper-income and middle-income groups (compared with low-income). Low levels of physical activity have been reported in 61–66% of men and 51–75% of women, in urban surveys.22,24

Most surveys have also shown higher mean concentrations of plasma cholesterol in urban population groups (4·6–5·2 mmol/L) compared with rural groups (4·3–4·6 mmol/L), with a low mean concentration of HDL cholesterol.25 The ICMR surveillance project observed that the prevalence of dyslipidaemia (ratio of total cholesterol to HDL cholesterol 4·5) was 37·5% in individuals aged 15–64 years. Even in a relatively young industrial population (20–59 years), 62·0% had dyslipidaemia.26 Levels of awareness, treatment, and adequate control are low for hypertension, diabetes, and dyslipidaemia, especially in rural areas.26,27

With advancing health transition, the poor are increasingly affected by chronic diseases and their risk factors. Low levels of education and income now predict not only higher levels of tobacco consumption, but also increased risk of coronary heart disease.19,28 Since India's daily consumption of fruits and vegetables is 130 g per person per day, poor people may also have deficiencies of protective phytonutrients. Urban slums in Delhi have high rates of diabetes and dyslipidaemia.29 Lack of awareness of risk factors and diseases, and inadequate access to health care, increase the risk of early death or severe disability in such disadvantaged groups.

The policy response: current scenario
The advancing epidemics of chronic diseases require a comprehensive policy response that caters to the varied needs of population-based prevention and essential clinical care. The health systems are presently geared to provide prioritised care for communicable diseases and services related to maternal and child health. The agenda of health promotion and chronic disease prevention has not yet been adequately incorporated. Clinical services, too, are not currently designed to provide the required level of care for these diseases in primary and secondary health-care settings.

As in other developing countries, public health advocacy has been mostly devoted to communicable diseases, nutritional deficiencies, population stabilisation, and recently to HIV/AIDS. Clinical health-care providers, on the other hand, were more focused on developing advanced health-care facilities for treatment of established chronic diseases. Policymakers have been impeded, until recently, by inadequacy of data on the burdens of chronic diseases. Perceptions that these diseases mainly affect the rich, who can purchase private health care, also prevented public sector resources from flowing into chronic disease prevention and control. The limited health budgets were not ready to take on the additional costs of treating chronic diseases at state expense. The huge expenditure that the state and society are incurring on the tertiary care of advanced chronic diseases has only been recently recognised. The cost of treating three tobacco-related diseases (cancers, coronary heart disease, and chronic obstructive pulmonary disease) was an estimated US$7·2 billion in the year 2002–03.19

Over the past 20 years, policies related to tobacco control have been strengthened, culminating in the Indian Parliament unanimously enacting a comprehensive national law for tobacco control in April, 2003 (panel 1). India has also ratified the WHO Framework Convention on Tobacco Control. Many factors cumulatively contributed to the emergence of this national consensus: increasing knowledge of the health, environmental, and developmental damages caused by tobacco; growing global support for tobacco control; WHO's catalytic role in developing policies and programmes for effective action; national research on tobacco-related burdens; vigorous advocacy by Indian civil society groups; decisive interventions by the Indian judiciary and increasing policymaker support across the political spectrum. Implementation of the national law, however, needs to gather strength, through effective mobilisation of central and state level enforcement agencies and community groups.

Panel 1: Key provisions of the Indian Tobacco Control Act, 2003

•Ban on smoking in public places

•Ban on direct and indirect advertisement of cigarettes and other tobacco products in print, electronic and outdoor media (ban on tobacco use in films to be implemented from October, 2005)

•Ban on sales to and by people younger than 18 years

•Tobacco products cannot be sold near educational institutions

•Mandatory depiction of statutory health warning (in one or more Indian languages) and pictorial warning, on all tobacco products

•Product regulation: tar and nicotine levels to be declared on tobacco product packages


India is the world's second largest producer as well as consumer of tobacco. As a source of excise revenue, export earnings, and employment, tobacco occupies an important place in the Indian economy. The strong measures initiated by the Government of India for tobacco control have overcome fierce resistance from the tobacco industry. In this respect, India becomes an excellent role model for other developing countries.

The policy framework needed to implement the WHO Global Strategy on Diet, Physical Activity and Health is still evolving. Although several nutrition programmes exist for correction of nutritional deficiencies, especially among vulnerable groups, they do not incorporate the dietary elements needed for prevention of chronic disease. Coordinated multisectoral initiatives, recommended by the Global Strategy, have not yet been designed. However, efforts have recently been initiated to address these needs. A multi-stakeholder national consultation was held in April, 2005, at the behest of the Indian Health Ministry, to identify action pathways and partnerships for implementing the Global Strategy in the context of India.

Recently the Health Ministry has decided to initiate an integrated national programme for prevention and control of diabetes and cardiovascular diseases (including stroke) and is now developing models. Some state governments, such as Tamil Nadu and Kerala, have identified chronic disease prevention and control as a high priority. The former has incorporated this component into its recently launched statewide health-systems project, which is supported by the World Bank.

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Existing chronic disease prevention and control programmes
Although several national programmes for prevention and control of communicable diseases exist, there are very few such programmes for chronic diseases. The National Cancer Control Programme was the first programme dedicated to a chronic disease. The National Blindness Control Programme has helped to reduce the backlog of cataract operations through wide coverage (about 4·3 million cataract operations per year at the moment). The National Programme on Speech and Hearing provides services related to prevention and control of deafness. The other programmes relevant to chronic diseases are National Iodine Deficiency Disorders Control Programme and National Mental Health Programme.

New programmes that are being initiated this year are likely to have a substantial effect on chronic diseases. The National Rural Health Mission is a country-wide programme for upscaling rural health services, and can be designed to include key elements of health promotion and chronic disease prevention. Special outpatient services for elderly people in all hospitals and two National Institutes of Ageing are also proposed.

In general, most national health programmes have been structured around a technological response and focused on specific targets. The need for multi-component interventions, affecting several behaviours, posed difficulties in designing programmes related to chronic diseases. However, the fact that programmes for population stabilisation and HIV prevention also have major behaviour modification components should open the way for programmes related to chronic disease.

India was one of the first countries to develop a National Cancer Control Programme. Cancer control received early recognition because of strong advocacy from health professionals, emotive appeal to people, and the realisation that the disease affected the poor in large numbers. The programme, which was started in 1975, was initially focused on setting up ten regional cancer centres and procuring cobalt therapy units. It was reformulated in 1984 (panel 2).

Panel 2: National cancer control programme
Objectives


•Primary prevention of tobacco-related cancers

•Early diagnosis and treatment of cervical cancer

•Extension and strengthening of therapeutic services including pain relief, on a national scale, through regional cancer centres and medical and dental colleges


Schemes


•Financial assistance to voluntary organisations

•District cancer control scheme

•Financial assistance for Cobalt Unit installation

•Development of oncology wings in Government Medical College hospitals

•Assistance for regional research and treatment centres


Current status


•205 cancer treatment centres; 22 regional cancer centres; 325 teletherapy units; 113 remote brachytherapy machines

•Availability of oral morphine tablets in registered medical institutions since 1991


Although no separate national programme has, as yet, been established for tobacco control, a National Tobacco Control Cell has been established in the central Health Ministry, with assistance from WHO. Its activities currently extend from supporting civil society initiatives for anti-tobacco education and advocacy to operation of tobacco cessation clinics in selected health-care facilities. A National Programme for Tobacco Control, linked with state-level programmes, has now become necessary for effective implementation of the Indian law and adherence to the WHO Framework Convention on Tobacco Control.

State-subsidised health care is available for treatment of chronic diseases. However, such clinical care facilities are mostly concentrated in large urban centres. There has been a rapid growth of private tertiary-care hospitals, which cater to the urban affluent sections and are now vying to attract international medical tourism. Facilities for both acute and long-term care of chronic diseases are inadequate in rural primary-care settings, and even in secondary-care settings of smaller towns and cities. Essential drugs for treatment of cardiovascular disease and diabetes are available at lower than global prices, but are still too expensive for many people.

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Action needed
The need to provide an effective public-health response to the growing challenge of chronic diseases in India can no longer be ignored without imperilling India's development. A comprehensive strategy must integrate actions to minimise exposure to risk factors at the population level, and reduce risk in individuals at high risk, to provide early, medium-term, and long-term effects.

Interventions that can prevent or reduce the risk of chronic diseases include: policy measures, such as those related to tobacco control, production and supply of healthy foods, regulation of unhealthy foods, and urban planning that promotes physical activity; empowerment of communities through health promotion programmes that can effectively enhance knowledge, motivation, and skills to foster awareness and adoption of healthy behaviours; early detection of individuals at high risk of developing a chronic disease and those with an early manifestation of disease, for imparting effective protection; secondary prevention in people who have developed chronic diseases; and provision of cost-effective and life-saving acute care.

While India is simultaneously experiencing several disease burdens due to old and new infections, nutritional deficiencies, chronic diseases, and injuries, individual interventions for clinical care are unlikely to be affordable on a large scale. Although community empowerment for health promotion is essential, health education alone would be insufficient in the absence of supportive environmental changes. Health messages on chronic disease prevention also have to compete for public attention with many other messages on polio, tuberculosis, HIV, family planning, and other health problems. In such a scenario, policy interventions related to tobacco, food supply, and urban design are likely to have a far greater and quicker effect on chronic disease prevention through their population-wide effect. WHO's stepwise approach to prevention and control provides practical pathways for staged implementation.30

The initiatives taken for tobacco control must be consolidated, by establishing a national regulatory authority for tobacco control to steer the national programme. A national coordinating body, representing multiple stakeholder groups, should be set up to strengthen implementation. The existing food-based dietary guidelines should be revised to reflect the principles of chronic disease prevention and health promotion and, thereafter, widely disseminated in various Indian languages. Through amendments to the Prevention of Food Adulteration Act of 1954, limitations can be placed on the levels of salt, sugar, and saturated fats in manufactured food products. Food labelling also needs to be introduced to facilitate informed choice by consumers. Policies related to urban design and urban transport also need to be formulated to facilitate safe and pleasurable physical activity as a routine component of daily life.

Such multi-sectoral policies can only be implemented when other relevant government departments, civil society, and private sector act in concert with the departments of health at central and state levels. To enable this action, a broad based intersectoral coordinating group would need to be established at the Planning Commission of India.

Data obtained from simple and sustainable surveillance systems would help to guide future policy. The Integrated Disease Surveillance Programme, launched by the Government of India in 2004, incorporates key elements of chronic disease risk factor surveillance and has the potential to yield such nationally representative data.

Demonstration projects of health promotion and chronic disease risk reduction are in progress, in both community and industrial settings. School-based projects have evolved successful models of health promotion.31 Experience from these projects will strengthen the design and delivery of a national programme for chronic disease prevention and control. This programme will also benefit from capacity enhancement in public health, which the government proposes to achieve by establishing a network of new and old schools of public health.

Cost-effective clinical interventions to reduce risk also need to be introduced in primary and secondary health-care settings. India has a strong pharmaceutical industry, which is able to provide many of the drugs needed for chronic disease management at low cost. Inexpensive drugs for treatment of individuals at high risk could be made widely available to the poor through the government health system, and to others through health insurance schemes.

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Conclusion
As chronic disease epidemics gather pace in India and threaten harm to individuals, families, and the society at large, a comprehensive strategy for their prevention and control is needed. Some of the required elements are already in place, such as control programmes for tobacco use and cancer. These efforts need to be upscaled. In other areas, such as diet and physical activity, the process must move from contemplation to action. Health systems need to be reoriented to accommodate the needs of chronic disease prevention and control, by enhancing the skills of health-care providers and equipping health-care facilities to provide services related to health promotion, risk detection, and risk reduction.

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Conflict of interest statement

We declare that we have no conflict of interest.

Acknowledgments

We thank Robert Beaglehole (WHO) for his suggestions and Colin Mathers (WHO) for providing figure 1.

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References
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Affiliations

a Department of Cardiology, All India Institute of Medical Sciences, New Delhi 110029, India
b Division of Non-Communicable Diseases, Indian Council of Medical Research, New Delhi, India
c Office of the WHO Representative to India, New Delhi, India
d Minister of Health and Family Welfare, Government of India, New Delhi, India

Correspondence to: Professor K Srinath Reddy

Nationalisation of Banks

An open letter to Amit Varma for his post at http://indiauncut.blogspot.com/2005/10/kidnapping-of-india.html

Hi Mate,

Your ignorance about nationalisation of banks is blotting your articles

If not the banks were nationalised, who is going to pay my hard earned money which ONE SINGLE guy loots and announces the bank as dissolved

What is the guarantee for my money

We all know that scores of people lost money (they were middle class people who had saved money for their child's school or college fees or wife's pregancy) when the private banks stole their money and announced that the bank is closed

Who is responsible for that.....

You are probably paid by multinational company (so you can be loyal to them and want to sell INDIA to these foreigners) and earn a lot of money ... Rs 5000 may not be a big money for you.... May be you can get that by writing an article ... But that is a big money to me...

If nationalisation of banks is wrong as you have claimed, are you ready to pay money to all poor farmers and teachers who lost their money to the private banks before nationalisation

OR

ARE YOU READY TO GIVE ME MY MONEY depostited in a private bank when the private concern loots my money and tells that the bank is closing and hence all my money is lost

If not, why are you shouting against nationalisation of banks
Remember, there is a lot of hard earned (earned in fields and earned in factories amidst chemicals and earned by running from pillar to post) money at stake.

A hotel needs plethora of licences

The Federation of Hotel and Restaurant Association of India (FHRAI), the apex body, which has circulated guidelines for setting up hotels, says a potential investor has to secure 32 licences from various Central and State Government authorities before setting up a shop.

This is after the basic building rules and procedures.

Following is the list of licences and regulatory authority from whom they have to obtain sanctions:

Excise department: State Excise Commissioner through the local officer:

Bar licence; Manufacture and sale of cakes and pastries; Registration for Service Tax for mandapam keeper and other chargeable services.

Police department and fire and safety officer:

Public performance; lodging house; swimming pool facility; for storing fuel under the Explosives Act; and Boiler inspection.

Local body/health department/corporation:

No Objection Certificate from the municipal health officer from hygienic/sanitary point of view - local body/health officer; Land and Property Tax.

Union ministry of communications or its authorised offices:

For maintaining wireless paging system, if installed beyond permitted frequencies.

Oil companies:

Pre-approval for allotment of furnace oil.

Labour office (State Labour Department):

Registration under the Shops and Establishment Act as also under the Factories Act. (Factories Act is a Central Act whereby hotel's kitchen and maintenance departments come under the definition of a factory); minimum wages; maintenance of records prescribed under the Industrial Disputes Act, 1947; payment of wages and payment of bonus.

Contract Labour (Regulation and Abolition); Industrial Employment Maternity Benefits

Equal Remuneration.

Sales tax/entertainment tax department of the State:

Sales Tax Number

Entertainment Tax

Telephone company:

EPBAX installation.

Income tax (under certification from certain State authorities):

For claiming Income Tax incentives under the IT Act, 1961

Controller of weights and measures (of the State Government):

Permission under Weights and Measures Act

Tourism department/commercial taxes/regional director-indiatourism offices:

Luxury Tax Act; classification in a star category within 3 months of starting operations

Use of guides for tourists.

Employees provident fund commissioner and his offices:

Registration under the Employees Family Pension Scheme, 1971

ESI directorate in the State:

Registration under the Employees State Insurance Act, 1948.

(The permission for captive generation of power which was there earlier has been removed under the newly introduced Electricity Act.)

Federation sources explain that the hotel administration is answerable to all these authorities, just as any other company or corporate body will be to the authorities to whom it has to report.

Taken from http://www.hindu.com/2005/10/01/stories/2005100115530800.htm