Content

1. NATIONAL ACTION PLAN ON ANTIMICROBIAL RESISTANCE (NAP-AMR 2.0, 2025-29)
2. HEART-RESILIENT URBAN PLANNING (World Habitat Day 2025)

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NATIONAL ACTION PLAN ON ANTIMICROBIAL RESISTANCE (NAP-AMR 2.0, 2025-29)

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Why is it in News?

• India has released NAP-AMR 2.0 (2025–29) at a time when AMR is expanding across human health, veterinary systems, aquaculture, agriculture, food chains and waste systems.
• It marks a shift from a “technical guidance document” to a governance-oriented, implementation-focused plan.
• Comes amid rising global concern: WHO estimates AMR could cause 10 million deaths annually by 2050 and significantly cut global GDP.
• India is among the largest consumers of antibiotics, with high rates of resistant pathogens such as Klebsiella, E. coli, MRSA.

Relevance

GS2 – Health Governance, Federalism

• Centre–State coordination issues.
• National Health Mission linkages.
• Regulatory gaps, private sector role.

GS3 – Biotechnology, Environment, Agriculture

• One Health, food chain contamination.
• Wastewater surveillance, effluent management.
• Role of diagnostics and innovation.

Practice Questions

• Critically examine whether NAP-AMR 2.0 (2025–29) represents a meaningful governance shift from the 2017–21 AMR framework. Does it address India’s Centre–State coordination deficit effectively?(250 Words)

What is AMR?

• Definition: Resistance developed by microbes (bacteria, viruses, fungi, parasites) against antimicrobial drugs.
• Major Drivers: Irrational prescriptions, over-the-counter antibiotic sales, poultry and dairy misuse, aquaculture antibiotics, hospital-acquired infections, pharmaceutical and hospital wastewater.

Why AMR is a One Health Crisis

• Moves across humans–animals–environment linkages.
• Pathways include wastewater, soil, food chains, unregulated veterinary antibiotic use, aquaculture residues.
• India’s agriculture and livestock dependence amplifies cross-sector exposure.

Evolution of India’s Action Plan: First NAP-AMR (2017-21)

Achievements

• Introduced AMR as a national priority.
• Set up multi-sectoral frameworks; strengthened ICMR-lab networks.
• Improved surveillance; strengthened stewardship and awareness.

Gaps

• Weak state-level uptake: Only 7 States drafted State Action Plans (Kerala, MP, Delhi, AP, Gujarat, Sikkim, Punjab).
• Implementation remained fragmented; One Health structures absent in most States.
• Key levers—health administration, veterinary oversight, pharmacy regulation—lie with States, limiting central enforcement.

NAP-AMR 2.0 (2025-29): Key Features

Stronger Governance Architecture

• National oversight placed under NITI Aayog through a Coordination and Monitoring Committee.
• Mandates every State/UT to set up State AMR Cells + prepare State Action Plans.
• National dashboard for real-time progress reporting.

Deepened One Health Approach

• Integrates human health, veterinary, livestock, aquaculture, agricultural, food safety, waste management and environmental sectors.
• Focus on food-system pathways, environmental contamination, and wastewater surveillance.

Science, Innovation and Technology

• Greater emphasis on:
  • Rapid diagnostics
  • Point-of-care testing
  • Alternatives to antibiotics (phage therapy, probiotics, immunomodulators)
  • Environmental monitoring tools
• Focus on R&D to reduce dependency on last-line antibiotics.

Private Sector Engagement

• Recognizes that private sector contributes a major share of Indian healthcare.
• Focus on private hospitals, pharmaceutical manufacturers, veterinary practitioners, poultry and aquaculture industries.

Integrated Surveillance

• Harmonised AMR surveillance across:
  • Human pathogens (ICMR)
  • Veterinary (DAHD)
  • Food safety (FSSAI)
  • Environment (CPCB, SPCBs)
• Addresses earlier fragmentation of databases.

Where NAP-AMR 2.0 Falls Short

No Binding Mechanism for State Action

• States “expected” to create Plans, but:
  • No statutory obligation
  • No joint Centre-State review platform
  • No mandated compliance
  • No State accountability structure

No Financial Pathway

• No conditional grants under NHM or earmarked funding streams.
• Without economic incentives, State participation historically remains low.

Weak Political and Administrative Anchoring

• No mechanism like the National Tuberculosis Elimination Programme, which uses:
  • Joint monitoring missions
  • Defined responsibilities
  • Shared accountability
• AMR remains a technical plan, not a political priority.

Why Implementation Is Difficult in India

• States control most AMR drivers:
  • Hospital administration
  • Pharmacy regulations
  • Veterinary antibiotic use
  • Agriculture & aquaculture antibiotic governance
  • Waste systems, effluent norms
• Without a unified governance architecture, national plans cannot translate into field-level implementation.

Way Forward

1. Centre–State AMR Council

• Chaired by Union Health Minister, with NITI Aayog coordination.
• Regular review cycles, joint accountability framework.

2. Mandatory State AMR Plans

• Formal Union government communication through Chief Secretaries.
• Annual review + notification timelines.

3. Conditional Funding

• NHM-linked grants for:
  • Infection prevention
  • Stewardship programmes
  • Surveillance labs
  • Regulatory strengthening

4. Unified National Dashboard

• Real-time tracking, publicly available performance indicators.
• Ensures transparency + nudges States.

5. Strengthening Veterinary and Food Systems Governance

• Strict regulation of animal antibiotics, especially critical antibiotics.
• Monitoring of antibiotic residues in food supply.

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HEART-RESILIENT URBAN PLANNING (World Habitat Day 2025)

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Why is it in News?

• On October 8, 2025, MoHUA observed World Habitat Day with the theme Urban Solutions to Crisis, highlighting PMAY-U and Smart Cities Mission.
• Experts flagged an emerging, less-discussed crisis: rapid rise in cardiovascular diseases (CVDs) and diabetes in urban India, with prevalence nearly double rural India and rising cases under age 50.
• Points to an urgent need for heart-resilient urban planning integrating health into land use, mobility, housing, and green infrastructure.

Relevance

GS1 – Urbanisation, Social Issues

• Impact of built environment on health.
• Inequities in access to healthcare/green space.

GS2 – Governance, Policy, Urban Missions

• NUHM, Smart Cities, AMRUT.
• Fragmented urban governance and planning reforms.

GS3 – Environment, Climate Change, Infrastructure

• PM2.5 pollution, heat islands, climate-resilient planning.
• Renewable energy, mobility transitions.

Practice  Questions

• How is the built environment in urban India contributing to the rising burden of cardiovascular diseases? Suggest reforms grounded in global evidence. (250 Words)

Basics: What is Heart-Resilient Urban Planning?

• Urban planning that reduces cardiovascular risk through:
  • Walkability
  • Green spaces
  • Clean air
  • Shorter commutes
  • Stress-reducing built environments
  • Equitable access to health services
• Integrates WHO’s Healthy Cities principles, environmental design, and preventive cardiology into urban governance.

Urban India’s Cardiovascular Crisis: The Context

• CVDs now a leading cause of death in cities.
• Prevalence almost twice rural levels.
• Sharp increase among <50 years age group.
• Key drivers:
  • Long commutes
  • Sedentary lifestyles
  • Air pollution (PM2.5)
  • Heat stress
  • Shrinking green cover
  • Ultra-processed diets
  • High stress, poor access to preventive care
• Healthcare distribution follows market logic, not population need, leading to underserved pockets.

Current Urban Planning Issues (Problem Diagnosis)

• Fragmented planning: Transport, housing, health, and environment dispersed across agencies.
• Car-centric development: Expressways → long commutes, emissions, sedentary behaviour.
• Unplanned food environments: Fast-food clusters → unhealthy diet patterns.
• Urban heat islands: Concrete-heavy zones → higher cardiovascular stress.
• Healthcare inequity: Hospitals cluster in profitable areas; low-income areas underserved.
• Environmental hazards:
  • PM2.5 triggers strokes and heart attacks
  • Heatwaves worsen cardiac stress
  • Poor water/waste systems worsen metabolic disorders

Integrated Urban Planning: The Needed Shift

Why Integration Works ?

• Cities shape behaviours: travel, exercise, diet, stress, exposure to pollution.
• Integrated planning reduces chronic disease risk by designing environments that support healthy living.

Global Evidence

• WHO Healthy Cities Network: Cities that embed health in governance saw reductions in chronic disease burden.
• Evidence from Europe, Japan, and South America shows improved cardiac outcomes with green, compact, walkable planning.

Pillars of Heart-Healthy, Resilient Urban Planning

1. Walkability & Active Mobility

• Safe footpaths, shaded walkways, cycle lanes, pedestrian-first zones.
• Reduces hypertension, diabetes, obesity, and stress.

2. Green Infrastructure

• Tree-lined streets, parks, urban forests.
• Reduces heat, filters pollutants, lowers cardiac and respiratory risks.

3. Mixed Land Use (Compact Urban Form)

• Residential + commercial + recreational areas together.
• Cuts commute time; encourages biking, walking; reduces emissions.

4. Public Transport Systems

• Clean-energy mass transit (electric buses, metros).
• Encourages active mobility, reduces pollution and sedentary travel.

5. Healthy Food Ecosystem

• Local produce markets, community gardens.
• Restrictions on junk-food advertising.
• Promotes affordable, heart-friendly diets.

Tackling Invisible Urban Health Threats

Key Risks

• PM2.5 from vehicles/industry: Triggers heart attacks and arrhythmias.
• Urban heat islands: Raise cardiovascular stress and mortality.
• Toxic water/waste systems: Increase metabolic and inflammatory disorders.

Mitigation Tools

• Tree cover expansion
• Renewable energy integration
• Smart water and waste systems
• Digital tools:
  • AI-based heat mapping
  • Air-quality sensors
  • Citizen reporting platforms

Equity as the Foundation

• Low-income communities face:
  • Worst air pollution
  • Least greenery
  • Longest commutes
  • Poor healthcare access
• Disease burden: 2.3× higher CVD rise among marginalised groups (India State-Level Disease Burden Study).
• Need for:
  • Equity audits
  • Community participation
  • Avoiding “green gentrification”
  • Prioritising vulnerable areas with targeted interventions

Alignment With National Missions

• Integrates with:
  • National Urban Health Mission (NUHM)
  • Smart Cities Mission
  • AMRUT
  • Tobacco-Free Youth 3.0
  • ADB 2025 Urban Investment Plan ($10 billion)
• Creates city-level synergy around health, climate resilience, mobility, and sustainability.

An Urban Turning Point: What Can Be Done

• Delhi: Shaded walking corridors linked with air-quality monitoring.
• Chennai: Cycling networks to reduce obesity among youth.
• Surat: Transit-oriented development lowering stress and emissions.
• Tier-2 cities: Compact neighbourhoods lowering long-term CVD risks.

Policy Priorities

• Update planning curricula to include health impacts.
• Mandate digital health audits for all major projects.
• Inter-agency collaboration among MoHUA, Health Ministry, academia, civil society.
• Embed measurable health indicators in master plans.