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