Monday, 25 June 2012

Suicide may soon be leading cause of death in India, reveals 1st National Survey

Four of India's southern states — Tamil Nadu, Andhra Pradesh, Karnakata and Kerala — that together constitute 22% of the country's population recorded 42% of suicide deaths in men and 40% of self-inflicted fatalities in women in 2010.
Maharashtra and West Bengal together accounted for an additional 15% of suicide deaths.
Delhi recorded the lowest suicide rate in the country. In absolute numbers, the most suicide deaths in individuals, aged 15 years or older, were in AP (28,000), Tamil Nadu (24,000) and Maharashtra (19,000).
The first national study of deaths in India, published in the British Medical journal The Lancet on Friday, says that suicide has become the second-leading cause of death among the young in India. Of the total deaths by suicide in individuals aged 15 years or older, about 40% suicide deaths in men and about 56% in women occurred in individuals aged 15-29 years.
Suicide deaths occurred at younger ages in women (average age 25 years) than in men (average age 34 years). Educated persons were at greater risk of completing a suicide. The risk of completing a suicide was 43% higher in men, who finished secondary or higher education, in comparison to those who had not completed primary education. Among women, the risk increased to 90%.
Lead author of the study Professor Vikram Patel of the London School of Hygiene and Tropical Medicine told TOI that the 1.87 lakh people committed suicide in India in 2010. About half of suicide deaths (49% among men, and 44% among women) were due to poisoning, mainly ingesting of pesticides. Hanging was the second most common cause for men and women, while burns accounted for about one-sixth of suicides by women. Professor Patel felt that with the decline in maternal death rates, suicide could soon become the leading cause of death among young women in India.
The study says the National Crime Records Bureau underestimates suicide deaths in men by at least 25% and women (36%). He told TOI, "Overall, more Indian men commit suicide than women, but the male to female ratio for suicides is smaller in India than in many Western countries, in particular among youth. Studies have suggested that social factors such as violence and depression are key determinants of suicide in women."
Prof Patel pointed out to lack of national strategy for suicide prevention in India. He said, "Suicides can be prevented through interventions like banning the most toxic pesticides and teaching rural communities on safe storage of pesticides. India should also start mental health promotion for young people through schools and colleges and introduce crisis counseling services and services for treatment of depression and alcohol addiction." Prof Patel added that although much of the current concern about suicides has focused on agricultural workers, over three in four suicide deaths in India occur in other occupational groups (including those who are unemployed and homemakers).
"Compared to most other countries, suicide rates are especially high in young adults and, in particular, young women for whom suicide rates in India are four to six times higher than in developed countries. The suicide rates vary 10-fold between states with the highest rates in the southern states of India," he added.
Suicide deaths among men were almost 11-times higher in Maharashtra as compared to Delhi. When it came to women, it was four times higher in Maharashtra than Delhi. The study says the age standardized suicide death rate per 100,000 people at all ages was 18.6 for boys and men and 12.7 for girls and women.
The suicide death rate in men aged 15 years or older varied little across age groups in comparison with that of women, which peaked in 15-29 years and decreased thereafter. At ages 15-29 years, suicide was the second leading cause of death in both sexes.
Most suicide deaths occurred in rural areas — the age standardized death rates were about two times higher in rural than in urban areas. In the absence of other causes of death, men aged 15 years or older have a lifetime risk of suicide of 2% or higher in AP, Karnataka, Kerala, and Tamil Nadu.
"The large variations we observed between states clearly point to the role of as yet poorly understood social factors in influencing the risk of suicide in India. We recorded a reduced risk of suicide versus other causes of death in women who were widowed, divorced or separated, compared with married women and men," Prof Patel said. The study says, suicide claims twice as many lives in India as HIV-AIDS and almost as many as maternal deaths in young women. Suicide kills nearly as many Indian men aged 15-29 as transportation accidents. Studies have shown that the most common contributors to suicide are a combination of social problems, such as interpersonal and family problems and financial difficulties, and pre-existing mental illness.
A very large proportion of suicides in India can be attributed to the manner in which families and society at large deal with all forms of mental illness. Where something as common as depression is rarely recognised and when recognised is even more rarely treated because there is a stigma attached to ailments of the mind, there clearly is a problem. What can be easily treated with some medication and counselling more often than not goes untreated till it develops a more serious form. Both government and civil society need to act to change this. Above all awareness must be built that the mind is as liable to be affected as other bodily organs and there is nothing to be ashamed of in acknowledging this.

Courtesy:  Kounteya Sinha, Times of India

Friday, 6 April 2012

Leadership Lessons From "The Godfather"

An Offer You Can't Refuse: Leadership Lessons From "The Godfather" BY LYDIA DISHMAN

What does a real-life CEO have in common with the central figures of a fictitious Mafia crime family in The Godfather? According to Justin Moore, CEO and founder of Axcient, plenty. 
Moore is a serial entrepreneur, early-stage advisor, and angel investor. He’s currently at the helm of Axcient, a company he founded that provides backup, business continuity, and disaster recovery services to the small and mid-sized business (SMB) market. Right now, Axcient is protecting more than 2 billion files and applications for businesses across North America.
Moore also happens to think that The Godfather is “one of the best movies ever made” and had a chance to watch it again when the film was aired extensively last week to mark the 40th anniversary of its premiere. Though a decade had passed since the last time Moore watched it, his recent viewing offered an unexpected reward. This time he found the film rife with teaching moments for CEOs running a business today.

“I certainly don’t endorse crime or violence, and I’m not suggesting business should operate like the Mafia,” explains Moore, “but there are some universal themes in the movie I can relate to as a CEO.” Moore says The Godfather offers valuable lessons in community and team building, making tough decisions, and playing to win while not neglecting friends and family.
Here are five essential leadership lessons Moore distilled for Fast Company.

1. Build a powerful community. 
Someday, and that day may never come, I'll call upon you to do a service for me. ~Vito Corleone
Uttered in the iconic rasp of Marlon Brando, the words of Vito Corleone illustrate how he creates a loyal community among those he has helped. Moore says, “By granting these favors and helping people with their problems, Vito Corleone is building a network of influence--relationships that may or may not deliver a specific or quantifiable return, but all which serve to strengthen his power base and which have the potential to be reciprocal in the long run.”
Moore says building strategic partnerships enables companies to work through challenging markets and fast-track overall success. “As a CEO, I see it as part of my job to be a super connector, networking with the technology and investment community without an expectation of reciprocation. Partnerships forged through time, trust, and mutual benefit--such as those Axcient has built with HP, Ingram-Micro, and a vast network of service providers and resellers--are the types of community relationships that bring about the greatest returns.”

2. Hold people accountable. 
What's the matter with you? I think your brain is going soft. ~Vito Corleone
The Godfather reminds us of the importance of being tough when necessary. “As soon as Vito Corleone allowed a few moments of weakness to be seen by his enemy, they attempted to assassinate him. And it was largely because of failures of his team,” Moore observes.
“In business, accountability isn’t achieved by a murderous rampage. But the lesson is this--to be successful in business you have to be tough, and you have to be extremely focused on hitting goals and getting results," says Moore. That doesn’t mean patience and understanding don’t have a place, he says, but ongoing tolerance of low-performing people or products just eats away at the success of the entire company. “You are ultimately responsible for all of your employees and shareholders, and that requires tough and swift decisions.

3. Don’t get emotional. 
It’s not personal, Sonny. It’s strictly business. ~Michael Corleone
“Many people don’t like to talk about the fact that in business, there are winners and losers. When Sonny Corleone reacts impulsively and emotionally, he gets taken out. In business, if you don’t take the opportunity to out-sell, out-bid, or out-market your competitor, they’ll take you out. I’m not suggesting doing anything outside the boundaries of morality or rightness--simply pointing out that when people make emotional decisions, they start making bad decisions. To lead successfully, you have to take your emotion and ego out of the equation.”
Likewise, Moore says it’s important to play to win. In business, that translates to knowing the competition and always staying at least one step ahead. “Operate your business with integrity and have respect for competition, but you also need to seize opportunities to eliminate your competition and win.”

4. Be decisive. 
Moore says that he, like most people who appreciate The Godfather, watch the movie with a combination of shock and respect. “Shock because he is so ruthless that he kills his own family member, but respect for the fact that Don Corleone knows exactly what he wants, executes decisively, and commands respect through unwavering leadership.”
While you don’t have to kill anyone to prove a point, as soon as you know what choice to make, move forward. “Know who on your team is making the right choices, and trust them to take decisive action as well. Hesitation too often leads to missed opportunities.”

5. Spend time with your family. 
Do you spend time with your family? Because a man who doesn’t spend time with his family can never be a real man. ~Vito Corleone 

Moore isn’t endorsing 1940s machismo, but he is decrying 100-hour workweeks that many entrepreneurs fall prey to in hot pursuit of the next big thing. Though he’s been dedicated like that in the past, Moore finds it’s not sustainable in the long run. 
“A leader can’t be successful in creative problem-solving and making excellent decisions unless that person is connected to people and passions outside of work. I find that it’s often time with family and friends that gives me the perspective I need to build the relationships and make the decisive actions required for continued success in business,” says Moore.
Think we missed any big leadership themes from The Godfather? Get thee to the comments and let us know. 

Saturday, 31 December 2011

Happy New Year 2012

Erase Past and Join The Future

May the new year in 2012 erases the scars and unhappiness of the past year 2011. May something new and nice happens in this new year as we all leave the past behinds us and embrace 2012 with strength to live a brighter and peaceful future.. May all your dreams and resolutions come true. Happy New Year 2012.

Friday, 7 October 2011

Which is the best health system in the world?

  1. John Appleby, chief economist
  1. 1 King’s Fund, London, UK
It may be nice to find your country at the top of healthcare rankings, but the relevance to policymakers is strictly limited, explains John Appleby
According to the World Health Organization, the country with the best health system overall in the world in 2000 was France, with the UK ranked 18th and Burma (Myanmar) coming last at 190th.1 In 2009, according to the EuroHealth Consumer Index, France was ranked seventh out of 33 (mainly European countries) and the Netherlands first (UK trailed in at 14th).2 Meanwhile, last year’s regular 11 country survey of health system performance from the Commonwealth Fund in New York suggested that the UK ranked first in terms of the smallest proportion of members of the public polled thinking the system needed fundamental changes or complete rebuilding (fig 1).3 A parallel Commonwealth Fund survey of seven countries in 2010 ranked the Netherlands top (and the UK second) on a basket of performance dimensions (fig 2).4
Fig 1 Overall public views of the healthcare system, 20103
Fig 2 Performance ranking of seven countries, 20104
Although the authors of these surveys are of course aware of the tremendous difficulty in comparing the performance of different countries’ health systems, the temptation to reduce the comparison to the equivalent of “marks out of 10” is often too great. The Commonwealth Fund resists in its 11 country comparison1 but succumbs in the seven country assessment.4 Different analyses also use different numbers of comparator countries, which makes comparing ranks confusing; coming second out of six is similar to coming 20th out of 60 (that is, both in the top 30%), but the second ranking sounds much worse. Equally, coming last in a ranking of, say, a small number of elite, Western industrialised countries may not be considered as bad as last in the whole world.
Nevertheless, the question, “Which is the best system?” remains a compelling one to try to answer.
Although it may not feel like it at the moment, reforming healthcare systems is not just an English obsession. While 34% of a sample of the UK public think the health system needs fundamental change according to one Commonwealth Fund survey, people in the 10 other countries surveyed reported higher levels of dissatisfaction (fig 1).3 Politicians and policymakers in all countries grapple with changes to their systems to tackle public worries. Scouting around for new policy ideas starts with questions about where to look and then naturally to questions about other countries’ systems and their performance. Has someone else solved the difficult problems we are facing—spending too much, poor patient care, lack of health impact, poor cost effectiveness?
But here comes a central set of difficulties in answering the comparative question: the performance of healthcare systems is multidimensional; it may, in the end, be about health, but it is also about efficiency and effectiveness and affordability and acceptability . . . .5 WHO and the EuroHealth Consumer Index recognise this (as do many such comparative surveys) and construct performance “dimensions” populated with varying numbers of statistics (six dimensions and 38 statistics in the case of the EuroHealth survey2).
Inevitably, such an approach will mean that countries will do better on some dimensions than on others; the UK ranked second best on the distribution of health across its population in WHO’s 2000 health system evaluation but 26th on patient responsiveness. Pulling these measures into one overall number or rank requires some weighting for each individual performance measure—they are unlikely to be of equal importance. But whose values to use? The public’s? Policymakers’?6 And how should we take account of different weightings by different countries’ populations?
Even if this and other problems are answered, the next question for policymakers is why France is first (or is it 7th?) and the UK 18th (or 14th or 2nd). While I make no claims for such a simplistic model, it is interesting to note just how strong the relationship is between where a country is ranked (by either WHO or EuroHealth Consumer) and how much it spends per capita on healthcare: no causation is claimed, but it seems that as spending increases, ranking improves (fig 3). Of course, if all countries increased their spending the rankings may be left unaltered; even if performance is increased in all countries, ranking position may remain the same.
Fig 3 Relation between per capita health spend8 and health system perfomance ranking (data for 24 European countries common to both WHO and EuroHealth Consumer Index analyses1 2). Logarithmic regression produced the highest correlation (R2 varying between 0 (no correlation) and 1 (perfect correlation)) between rankings (response variable) and (log of) per capita spending on healthcare (explanatory variable)
Even less claim can be made for the apparent positive correlation between the WHO health system ranking of countries and the FIFA ranking of international football teams; in 2000 both placed France in first position.7
Frustratingly, given the importance of the policy questions they raise, perhaps the best that can be said for many comparative ranking exercises is that they provoke a ready headline and can generate debate but fail to provide definitive answers.


Cite this as: BMJ 2011;343:d6267