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A Very Heavy and Weighty 2025 New Year Resolution!

A Very Heavy and Weighty 2025 New Year Resolution!

2025 New Year Resolutions

It’s that time of the year when we make New Year’s Resolutions. This year’s number one resolution that tops the chart is healthy diet and weight loss which is being wished by 51% of the people. Next is wishing for wealth which is wished by 21%. Finally comes spending quality time with friends and family which is wished by 14%. This is much lower this year post covid lockdown. Is there any correlation to the obesity trends in India with the New Year’s Resolutions for 2025?

Obesity Trends in India

Body Mass Index (BMI) scale is used to indicate if one is obese or not. The different classifications are as unde for India. Please note that this is not the same for other countries which may vary or are higher:

  • Normal BMI: 18.0-22.9 kg/m²
  • Overweight: 23.0-24.9 kg/m²
  • Obesity: ≥25 kg/m²

The prevalence of obesity has been increasing, with nearly one in four Indians now considered overweight. Approximately 24% of women and 23% of men aged 15-49 are classified as overweight or obese in India. Obesity rates are higher in urban areas (30% of men and 33% of women) compared to rural areas (19% of men and 25% of women).

Dietary Trends in India

The Economic Survey 2023-24 noted unhealthy diets and rising rates of obesity need to be tackled urgently to improve health parameters, in order to reap the gains of the country’s demographic dividend. Citing the Indian Council of Medical Research’s (ICMR) latest dietary guidelines, published in April this year, it notes the fact that 56.4% of the total disease burden in India is due to unhealthy diets. The ICMR report observes that the upsurge in the consumption of highly processed foods, laden with sugars and fat, coupled with reduced physical activity and limited access to diverse foods, exacerbate micronutrient deficiencies and overweight/obesity problems.

Correlating Obesity, Diet and 2025 New Year’s Resolutions

There seems to be a positive correlation between the weight loss and what people wishing to achieve in 2025 with respect to their diet and weight. These are many reasons for this correlation. These could be:

  • Calling for ill-Health: Obesity leads to chronic inflammation and impact longevity (listen to podcast on longevity https://open.spotify.com/episode/19pvPEE7f5UGgzJyXSlLsS?si=5f06687dfcf64232). Over the years, the body’s organs don’t function as effectively as they should. Damage to the pancreas, for example, leads to diabetes; damage to the heart leads to cardiovascular disease; and damage to the brain leads to dementia. And even if someone loses weight, the damage is not irreversible. (The liver is the only organ that can regenerate itself.) Obesity is also linked to many cancers, musculoskeletal problems, depression and obstructive sleep apnea. Some of the co-morbidities with obesity and overweight people include:
    • Chronic Kidney Disease
    • Type 2 Diabetes         
    • Cardiovascular Disease
    • PAD (Peripheral Arterial Disease)
    • Alzheimer’s  
    • Heart Failure
    • MASH (Fatty Liver Disease)

Sounds very alarming for increasing healthcare costs!

  • Better Employability: As per the National Health and Family Surveys, obese and over weight people have issues with their employability and their ability to work. This is tied to their overall health and their physical abilities. Hence being fit and normal BMI works in their favour.
  • Lifestyle, Fashion and Aesthetics: One of the most fundamental drivers of behavior is the desire to look attractive. Sales for personal care and beauty products easily exceed USD 25 billion by 2029, and sales for apparel reach USD 550 billion by 2029. This is a very aspiration segment. (listen to podcast: https://open.spotify.com/episode/36TCAlD1gglGXoWJtDa27o?si=09dd617d77434985). A significant number of Indians are unhappy with their weight and body image. A study involving participants from 65 countries found that Indians have lower body image satisfaction compared to many other nations.

Meeting and Beating the 2025 New Year Resolutions

Like any resolution, the compliance to any New Year Resolution is very low. Coming to managing ones weight reduction, the compliance is even lower. The level of compliance with weight loss programs among Indians varies widely. Several factors influence this, including cultural attitudes towards weight, accessibility to resources, and individual motivation.

  • Cultural Attitudes: In many parts of India, there is a cultural acceptance of larger body sizes, which can affect motivation to lose weight.
  • Accessibility to Resources: Access to weight loss programs, gyms, and healthy food options can be limited, especially in rural areas.
  • Individual Motivation: Personal commitment and motivation play a crucial role. Many individuals start weight loss programs but struggle to maintain long-term adherence due to lifestyle challenges and lack of support.

With such low levels of compliance and issues surrounding it, what has the healthcare industry done to find solutions to the weighty problems?

Healthcare Industry’s Invasive and Non Invasive Solutions to Obesity

There are several invasive and non-invasive solutions to obesity reduction. Here’s a brief overview of both:

Invasive Solutions

  • Gastric Bypass Surgery: This procedure involves creating a small pouch from the stomach and connecting it directly to the small intestine. This bypasses a large part of the stomach and some of the small intestine, reducing the amount of food you can eat and absorb.
  • Gastric Sleeve Surgery: Also known as sleeve gastrectomy, this surgery removes a large portion of the stomach, leaving a tube-like structure. This limits the amount of food you can consume.
  • Adjustable Gastric Banding: A band is placed around the upper part of the stomach to create a small pouch that holds food. The band can be adjusted to control the amount of food intake.
  • Biliopancreatic Diversion with Duodenal Switch (BPD/DS): This complex surgery involves removing a portion of the stomach and bypassing a significant part of the small intestine. It reduces the amount of food intake and nutrient absorption

Invasive surgery is expensive and not affordable by many. Also, this has to be followed up with non-invasive and other cosmetic surgery later on.

Non-Invasive Solutions

  • CoolSculpting: This technique uses controlled cooling to freeze and destroy fat cells. The body then naturally eliminates these dead cells over time.
  • SculpSure: A laser-based treatment that targets and heats fat cells, causing them to break down and be absorbed by the body.
  • Kybella: An injectable treatment that destroys fat cells under the chin, improving the appearance of a double chin
  • Emsculpt: This procedure uses high-intensity focused electromagnetic energy to induce muscle contractions, which can help reduce fat and build muscle.
  • Lifestyle Modifications: Diet and exercise remain fundamental. Behavioral therapy and support groups can also be effective in managing obesity

Each method has its own benefits and risks, and the best choice depends on individual health conditions, preferences, and goals.

GLP-1 The Magic Pill for Obesity

During 2024, a hype has been created over social media, celebrities both in Bollywood and Hollywood about GLP-1 (glucagon-like peptide-1), the wonder drug and magic pill for weight reduction. For the scientifically advanced beings, brief overview of the mechanism of action of GLP-1 (Glucagon-Like Peptide-1):

  • Secretion: GLP-1 is secreted by the intestinal L-cells in response to food intake.
  • Receptor Binding: GLP-1 binds to its receptors located in various organs, including the pancreas, brain, stomach, and heart.
  • Insulin Secretion: In the pancreas, GLP-1 enhances glucose-dependent insulin secretion.
  • Glucagon Suppression: It suppresses glucagon release, which helps lower blood glucose levels.
  • Gastric Emptying: GLP-1 slows gastric emptying, promoting satiety and reducing food intake.
  • Neuroprotection: It has neuroprotective effects and may improve cognitive function.

For the least scientifically advanced beings, GLP-1 works in reducing the food appetite and the weight of a person by 15-20%. In addition, GLP-1 also works on other co-morbidies such as

  • Diabetes Management: GLP-1 agonists are medications that help lower blood sugar levels by increasing insulin secretion and decreasing glucagon release. They also slow down gastric emptying, which helps control blood sugar spikes after meals.
  • Weight Loss: These medications are also effective for weight loss. They work by reducing appetite and increasing feelings of fullness, which can lead to reduced calorie intake and weight loss.
  • Cardiovascular Benefits: Some GLP-1 agonists have been shown to provide cardiovascular benefits, such as reducing the risk of heart attack and stroke in people with type 2 diabetes.
  • Potential Kidney Benefits: Emerging research suggests that GLP-1 agonists may also have protective effects on kidney function.
  • Parkinson, Alzheimer’s and Dementia: Early clinical research is showing effective results in patients with neuro issues with a lower risk of the cognitive issues (such as memory loss) that are often an early sign of dementia.
  • Addiction Management: This is still very early and GLP-1 is being tested on animals and showing positive results on addiction to alcohol and nicotine.

Statutory Warning:

All drugs have side effects, and the GLP-1s are no exception. The most common ones are gastro-intestinal problems, for example diarrhea. In addition, the drugs cause the loss of lean muscle mass, which is particularly concerning for the elderly. Moreover, newer formulations or the next generation of GLP-1 are also being researched and will circumvent the side effects.

GLP-1 in India

In India, several GLP-1 (glucagon-like peptide-1) receptor agonists are available for the management of diabetes and obesity. Here are some of the notable ones:

  • Liraglutide: Marketed under the brand name Lirafit™ by Glenmark Pharmaceuticals, this drug is used to improve glycemic control in adults with type 2 diabetes.
  • Semaglutide: Available as an oral formulation, this drug is marketed by Novo Nordisk India and is used for diabetes management.
  • Exenatide: Another GLP-1 agonist used for diabetes treatment, though specific brand names in India may vary.

I am also informed that there is a venture working on GLP-1 extracted from plants peptides under development.

As for me, I am wishing that 2025 will bring in more innovation in GLP-1 solutions which are more effective!

Happy New Year 2025!

Deny, Depose, Defend – Assassination of a CEO – Making of A New Suspense Serial?

Deny, Depose, Defend – Assassination of a CEO – Making of A New Suspense Serial?

Celebrity Assassinations Inspired by Books and Literature

The US has several cases of Presidents and celebrities who have been murdered where the assassin was motivated by a written books and literature and that became the inspiration and the motive to kill someone who is well known. Some of them include:

  • John Lennon’s Assassination: Mark David Chapman, who assassinated John Lennon in 1980, was heavily influenced by J.D. Salinger’s novel The Catcher in the Rye. Chapman was found reading the book at the scene of the crime and later claimed that he identified with the protagonist, Holden Caulfield.
  • Ronald Reagan’s Assassination Attempt: John Hinckley Jr., who attempted to assassinate President Ronald Reagan in 1981, was obsessed with the movie Taxi Driver and its protagonist, Travis Bickle. The character’s actions in the film were inspired by Arthur Bremer’s diary, which was later published as a book.
  • The Assassination of Robert F. Kennedy: Sirhan Sirhan, who assassinated Robert F. Kennedy in 1968, was reportedly influenced by the novel The Secret Agent by Joseph Conrad. The book explores themes of political violence and assassination.
  • The Murder of Rebecca Schaeffer: Robert John Bardo, who murdered actress Rebecca Schaeffer in 1989, was found with a copy of The Catcher in the Rye. This book has been linked to several other high-profile crimes.
  • The Columbine High School Massacre: Eric Harris and Dylan Klebold, the perpetrators of the Columbine High School massacre in 1999, were influenced by Stephen King’s novel Rage. The book, which King later allowed to go out of print, tells the story of a high school student who takes his class hostage.

Nothing comes to my mind about such killings in India, except those inspired by Religious Scriptures.

How can Written Books and Literature be an Inspiration or Prime Motive to Kill?

There are several studies and scholarly articles that explore the influence of books and other media on real-life crimes and killings and their motives. Here are a few key points from the research:

  • Media Effects on Violence and Crime: Research has shown that exposure to violent media, including books, can increase aggressive behaviour and attitudes. However, the direct link between media violence and actual violent crime is more complex and less conclusive.
  • Copycat Crimes: Some studies focus on the phenomenon of copycat crimes, where individuals mimic criminal acts they have read about or seen in media. This includes crimes inspired by books, movies, and even news reports.
  • Psychological Impact: The psychological impact of media on individuals can vary. Factors such as personal susceptibility, mental health, and environmental influences play significant roles in how media content affects behaviour.
  • Case Studies: Specific cases, like the ones we discuss here (e.g., John Lennon’s assassination), are often analyzed to understand the motivations behind such crimes and the role media might have played.

The points highlighted above address the complex relationship between media consumption and real-life actions.

A New Novel and A TV Serial in the Making

“Delay, Deny, Defend: Why Insurance Companies Don’t Pay Claims and What You Can Do About It” by Jay Feinman is an exposé on the practices of the insurance industry. Feinman, a legal scholar and insurance expert, argues that insurance companies often prioritize profits over policyholders by employing strategies to delay, deny, and defend against claims. Some of the excerpts from his book include:

  • Systematic Denial of Claims: Feinman explains that the denial of valid claims is not an occasional error but a systematic practice designed to maximize profits. Insurance companies often delay payments, deny claims without proper justification, and force claimants into lengthy litigation processes.
  • Historical Context: The book provides a historical overview of how these practices developed over time. Feinman traces the evolution of the insurance industry and highlights key changes that have led to the current state of affairs.
  • Consumer Impact: Feinman shares numerous stories of individuals who have been unfairly denied claims, illustrating the real-world impact of these practices on policyholders. These stories highlight the financial and emotional toll on those affected.
  • Legal and Policy Recommendations: The book offers practical advice for consumers on how to protect themselves when dealing with insurance companies. Feinman also outlines necessary legal reforms to prevent future abuses and improve the insurance system.
  • Call to Action: Feinman urges consumers, lawmakers, and regulators to take action against these unfair practices. He emphasizes the need for greater transparency and accountability within the insurance industry.

Overall, “Delay, Deny, Defend” serves as a critical examination of the insurance industry, providing valuable insights and actionable advice for consumers and policymakers alike.

Assassination of the United Healthcare CEO – An Inspired Killing?

On Wednesday 4 December 2024, Brian Thompson, the CEO of United Healthcare, was shot at targeted fatal on a midtown Manhattan sidewalk. This has sent shock waves in the industry in the US. Brian Thompson was not an ex-US President in a Presidential race, but yet he was targeted. Well, Brian managed over USD 250 billion healthcare insurance business of the United Healthcare. Hence, he would be in a Presidential status of a smaller country than the US. It seems that Brian Thompson’s assassination, could have been inspired and linked to a 2010 book titled “Delay, Deny, Defend: Why Insurance Companies Don’t Pay Claims and What You Can Do About It” by Jay Feinman. Police found shell casings at the crime scene engraved with the words “deny,” “depose,” and “defend,” which closely resemble the themes of Feinman’s book.

This blog is not about the condolences to the dead corporate executive, but the change in the mentality of the killers to attach corporate executives.

Industry Achievements of Assassinated United Healthcare CEO

Brian Thompson had several health insurance industry accomplishments and led several specific initiatives during crises that showcased his strategic and compassionate leadership:

  • COVID-19 Response: During the COVID-19 pandemic, Thompson spearheaded initiatives to expand telehealth services, ensuring that patients could access healthcare safely from their homes. He also implemented support programs for frontline healthcare workers, providing them with necessary resources and mental health support.
  • Telehealth Expansion: Recognizing the need for remote healthcare solutions during the pandemic, Thompson accelerated the rollout of telehealth services. This initiative allowed patients to receive medical consultations and care without risking exposure to the virus.
  • Support for Frontline Workers: Thompson introduced programs to support frontline healthcare workers, including mental health resources and financial assistance. These measures were crucial in helping healthcare professionals cope with the immense pressures of the pandemic.
  • Regulatory Compliance and Advocacy: Thompson effectively managed regulatory challenges by working closely with policymakers. He advocated for policies that would benefit both the company and its members, ensuring that UnitedHealthcare remained compliant while continuing to innovate.
  • Cybersecurity Enhancements: In response to increasing cybersecurity threats, Thompson prioritized investments in advanced security technologies. This initiative aimed to protect sensitive patient data and maintain trust with members and stakeholders.
  • Public Relations Management: Thompson handled public relations crises with transparency and accountability. For example, when faced with criticism over healthcare costs, he addressed concerns openly and implemented solutions to improve member satisfaction.

These initiatives highlight Thompson’s ability to lead effectively during crises, ensuring that UnitedHealthcare could navigate challenges while continuing to provide essential services and support to its members and employees. I had met Brian briefly in Minneapolis in 2016 when he was not the CEO of United Healthcare. He came out to be a compassionate and a visionary. But why would someone want to kill him?

Reforms in the US Healthcare Industry Emerging out of “Delay, Deny, Defend”

Based on the events, the wider question to be asked is what needs to be done that Healthcare Executives are not targeted. Here are some of my thoughts coming out of Jay Feinman book. Let me inform the readers here, that I am no expert on the US Healthcare System. I am replaying some of the points Jay Feinman suggests several key reforms to address the systemic issues within the insurance industry to create a more equitable and transparent insurance system, ensuring that policyholders receive the coverage and support consumers are entitled to:

  • Enhanced Regulatory Oversight: Feinman advocates for stronger regulatory oversight to ensure that insurance companies adhere to fair practices. This includes stricter enforcement of existing laws and the introduction of new regulations to prevent the delay, denial, and unjust defense of claims.
  • Transparency Requirements: He calls for greater transparency in the insurance claims process. This would involve clear communication from insurers about the reasons for claim denials and the criteria used to evaluate claims.
  • Consumer Protection Laws: Feinman suggests the implementation of more robust consumer protection laws to safeguard policyholders. These laws would provide better recourse for consumers who are unfairly denied claims and ensure that they receive timely and fair settlements.
  • Penalties for Unfair Practices: He recommends imposing significant penalties on insurance companies that engage in unfair practices. This would serve as a deterrent against the systematic denial of valid claims and encourage insurers to act in good faith.
  • Support for Legal Reforms: Feinman supports legal reforms that make it easier for consumers to challenge unfair claim denials. This includes simplifying the process for filing complaints and pursuing legal action against insurers.
  • Public Awareness Campaigns: He emphasizes the importance of public awareness campaigns to educate consumers about their rights and the tactics used by insurance companies. This knowledge would empower policyholders to better navigate the claims process and protect themselves against unfair practices.

All I can imagine is that the assassin was denied healthcare that he was entitled to by United Healthcare and he thought it as an extreme step to redeem it with the life of the top honcho of United Healthcare CEO.

We will wait for the investigators and police to apprehend the killer and figure out the real motive. But for the time being, Jay Feinman’s book is now going to be a best seller and material for dramatization into a TV serial or a movie.

I am deeply shocked and my sincere condolences to those who feel the loss of Brian Thompson.

Ministry of Sex – Undemographic Dividends?

Ministry of Sex – Undemographic Dividends

Preamble

Various Industry Bodies are working with Niti Aayog for the Viksit Bharat@2047 policy recommendations. Mine was on the Amrit Kaal for healthcare for all by 2047. Parts of the thinking has been outlined in some our my blogs and podcasts. Read Amrit Kaal : Budget 2022 | Kapil Khandelwal KK.

But an interesting announcement by Russia came across my eyes and it makes me wonder on the timing and its effectiveness. Recently, Russia announced a new Ministry – The Ministry of Sex. The title of the Ministry may sound obscene, but its objectives are not to regulate illicit sex in the country. I can understand that is part of a broader effort by Russian authorities to reverse the country’s demographic decline, due to the fatalities suffered by the Russian in the ongoing conflict with Ukraine. In 2024, Russia’s birth rate is approximately 11.108 births per 1,000. This represents a slight decline from the previous year.

Let’s understand the objectives of this new Ministry in Russia and similar initiatives around the world and in India to improve their demographic dividends.

World Crude Birthrate
World Crude Birthrate

What is Ministry of Sex?

Russia’s Russia aimed at addressing the country’s declining birth rate. The idea is to create a dedicated government body to coordinate various efforts to boost the population and birth rate to derive demographic dividends in the future. Some of the proposed measures include:

  • Turning off the internet and lights between 10 PM and 2 AM to encourage intimacy among couples;
  • Financial incentives for first dates, with the government paying up to 5,000 roubles (around ₹4,395);
  • State-funded wedding nights in hotels, with expenses covered up to 26,300 roubles (around ₹23,122); and
  • Compensation for stay-at-home mothers for household chores, which would count towards their pensions.

Let us understand if such measures can lead to increase in babies in Russia.

Key Drivers of Increasing Birth Rate of a Country

Russia is not alone as a country that is witnessing the decline in the population due to birth rate. See Map.

While Russia’s measures to regulate couples to encourage more sex and babies in the short-term is laudable, the key drivers to improve the birth rate of a country are dependent on multiple factors addressing various social, economic, and policy-related factors. Here are some key drivers:

  • Economic Stability and Growth: Economic prosperity can encourage higher birth rates as families feel more secure in their financial future.
  • Affordable Childcare and Education: Providing affordable and high-quality childcare and education can reduce the financial burden on families and make it easier for parents to balance work and family life2.
  • Parental Leave Policies: Generous parental leave policies, including paid maternity and paternity leave, can support parents during the early stages of child-rearing.
  • Housing Policies: Affordable housing can make it easier for young families to establish a stable home environment, which is conducive to having more children.
  • Healthcare Access: Ensuring access to comprehensive healthcare, including reproductive health services, can help families plan and support larger families.
  • Work-Life Balance: Policies that promote flexible working hours and remote work options can help parents manage their professional and personal responsibilities more effectively.
  • Social and Cultural Support: Creating a family-friendly culture that values and supports parenthood can encourage higher birth rates. This includes community support systems and positive societal attitudes towards families.
  • Financial Incentives: Direct financial incentives, such as child allowances, tax breaks, and subsidies for families with children, can alleviate some of the economic pressures associated with raising children.
  • Education and Awareness: Promoting awareness about the benefits of family planning and providing education on reproductive health can empower individuals to make informed decisions about having children.
  • Social Media Blackouts: This is a new one coming from Russia. Reducing social media chatter and addiction can improve sexual health and sex.

Addressing these factors comprehensively can create an environment that supports and encourages higher birth rates in a country. Let’s compare these with some of the measures taken by some of the countries to increase their birth rates in their country.

Birth Rate Increasing Measures by Country

Here are some examples of countries that have taken measures to increase the birth rate in their country by encouraging couples to have more babies.

Country Measures Other Unique Measures
Singapore ·        Financial incentives

·        Housing benefits

·        Extended parental leave

 ·        Promote dating events and matchmaking services to help singles find partners
Japan ·        Subsidized childcare

·        Parental leave

·        Financial incentives

 ·        Community programs to encourage social interaction and dating among young people
France ·        Generous family policies

·        Extensive parental leave

·        Subsidized childcare

·        Financial incentives

 ·        France has the most generous family policies in the EU to promote family welfare

·        Free education and healthcare for children
South Korea ·        Financial incentives

·        Community programs for parental support

 ·        Financial support for fertility treatments

·        Policies to improve work-life balance and family and family-friendly workplaces
Hungary ·        Financial incentives

·        Tax benefits

 ·        Loan waivers for having multiple children

·        Subsidies for housing and car purchases
Greece ·        Tax benefits

·         

 ·        Subsidies for childcare

·        Payments for new parents
Poland ·        Financial incentives ·        Known for its “Family 500+” program,

·        Monthly payments to families for each child

Anti-Measures That Accelerate Ministry of Sex Type Initiatives Around the World

There are several anti-measures or counter trends that are accelerating the Ministry of Sex type of initiative around the world in the future to provide incentives people to marry, starting a family. Some of them, though not an exhaustive list are as under:

The #MeToo Awakening:

The #MeToo movement has contributed to a broader cultural shift that affects how people view and approach relationships, which in turn may be impact birth rates, although it is early to establish a co-relation. In the U.S., there was a notable drop in the number of babies born in 2017, with an estimated 3.84 million births, down by more than 100,000 from the previous year. This decline has been partially attributed to the “romantic reckoning” following the #MeToo movement. The societal changes after the #MeToo has many counter trends. These include:

  • Increased Awareness and Caution: The movement has heightened awareness about consent and respectful relationships. This has led to more cautious and deliberate romantic interactions, which has delayed relationship progression and family planning of the past.
  • Shift in Social Dynamics: The emphasis on addressing and preventing sexual harassment has changed how people approach dating and relationships. This shift can lead to more thoughtful and slower relationship development, potentially delaying decisions about marriage and having children.
  • Economic and Career Considerations: The movement has also highlighted gender inequalities in the workplace, prompting many women to focus on their careers and financial independence before considering starting a family.
  • Psychological Impact: For some, the movement has brought up past traumas and led to a reevaluation of personal priorities and relationships. This can influence decisions about marriage and parenthood.

Influence of Wokeism:

“Wokeism,” can influence birth rates in several ways. These include:

  • Changing Social Norms: The emphasis on social justice and equality can lead to shifts in traditional family structures and roles. People may prioritize personal development, career goals, and social activism over starting a family.
  • Economic and Career Focus: With a strong focus on addressing systemic inequalities, many individuals may choose to invest more time in their careers and financial stability before considering marriage and children.
  • Gender Equality: The push for gender equality can lead to more balanced domestic responsibilities and career opportunities for women. This can result in delayed family planning as both partners may focus on their careers.
  • Environmental Concerns: Wokeism often includes a strong environmental component, with concerns about overpopulation and sustainability. Some people may choose to have fewer children or none at all to reduce their environmental footprint.
  • Support for Diverse Family Structures: There is greater acceptance of diverse family structures, including single parenthood, cohabitation without marriage, and same-sex parenting. This can lead to different timelines and approaches to family planning.

BirthStrike Like Movements:

BirthStrike is a movement founded by Blythe Pepino in 2019, primarily in the UK, to raise awareness about the severe threats posed by climate change and how these threats influence decisions about having children. BirthStrike members, who are mostly young women, publicly declare their decision not to have children due to fears about the future impacts of climate change. BirthStrike helped to humanize the climate crisis by connecting it to deeply personal decisions about family planning. BirthStrike has played a significant role in bringing attention to the existential threats of climate change and how they affect personal decisions about having children. It underscores the deep connections between environmental activism and individual life choices. Some of the impact are:

  • Psychological and Social Impact: BirthStrike provided a platform to express their anxieties about the future and find solidarity with others who share similar concerns and also starting the family. This collective action also served as a form of protest, aiming to pressure governments and corporations to take more decisive action on climate change.
  • Broader Influence: BirthStrike is part of a larger trend where environmental concerns influence reproductive decisions. Similar movements, like Conceivable Future in the U.S. and No Future No Children in Canada, also highlight the intersection of climate anxiety and family planning.

Technoference:

The interference of technology in personal relationships, can have several indirect impacts on birth rates:

  • Relationship Quality: Technoference can lead to decreased relationship satisfaction and increased conflict. When partners feel neglected due to excessive technology use, it can strain the relationship, potentially leading to lower levels of intimacy and connection. This strain can reduce the likelihood of couples deciding to have children.
  • Reduced Communication: Constant interruptions from technology can hinder meaningful communication between partners. Effective communication is crucial for resolving conflicts and making joint decisions, including those about starting a family.
  • Increased Stress and Anxiety: The constant presence of technology can contribute to higher stress and anxiety levels. This can affect mental health and overall well-being, making individuals less inclined to consider having children.
  • Work-Life Balance: Technology often blurs the boundaries between work and personal life. The pressure to be constantly available for work can reduce the time and energy couples have for each other, impacting their decisions about family planning.
  • Parent-Child Relationships: For existing parents, technoference can affect the quality of interactions with their children. Parents distracted by technology may be less responsive and engaged, which can impact their desire to expand their family.

The Divorce Pandemic:

The trend of increasing divorce rates, often referred to as the “divorce pandemic,” has been influenced by several factors:

  • Economic Stress: Financial instability, exacerbated by the COVID-19 pandemic, has put a strain on many marriages. Job losses, reduced income, and economic uncertainty can lead to increased marital conflict and, ultimately, divorce.
  • Changing Social Norms: There is less stigma associated with divorce today compared to previous generations. This shift in societal attitudes makes it easier for individuals to consider divorce as an option when facing marital difficulties.
  • Later-Life Divorces: Known as “gray divorces,” the rate of divorce among adults aged 50 and older has surged. This trend is partly due to the baby boomer generation, who are more likely to seek divorce later in life compared to previous generations. This is impacting younger generations to evaluate marriage as an option.
  • Pandemic-Related Stress: The COVID-19 pandemic has intensified existing marital issues for many couples. Lockdowns, quarantine measures, and the stress of managing work and family life from home have contributed to a rise in divorce rates.
  • Personal Growth and Independence: There is a growing emphasis on personal growth and independence. Many individuals, especially women, are more financially independent and feel empowered to leave unsatisfactory marriages.

The Dating Apps Raps:

Digital dating apps have significantly transformed the landscape of romantic relationships. but they also come with several negative impacts, including people finding the right choice for the younger generations and delay in finding a life-long relationship to settle down and start a family. These include:

  • Mental Health Issues: Frequent use of dating apps can lead to mental health problems such as anxiety, depression, and low self-esteem. The constant exposure to rejection and the pressure to present an idealized version of oneself can be damaging.
  • Superficial Judgments: Dating apps often encourage users to make quick judgments based on appearance. This can lead to superficial connections and a focus on physical attributes over deeper compatibility.
  • Addictive Behavior: The design of many dating apps, with their swipe-based interfaces, can be addictive. Users may spend excessive amounts of time on these apps, which can interfere with their daily lives and relationships.
  • Ghosting and Rejection: The ease of ending communication without explanation, known as ghosting, is common on dating apps. This behavior can be emotionally hurtful and lead to feelings of insecurity and mistrust in the process.
  • Harassment and Safety Concerns: Many users, particularly women, report experiencing harassment, unsolicited explicit messages, and other forms of inappropriate behavior on dating apps. This can create a hostile and unsafe environment and mistrusts for the future relationship.
  • Decreased Relationship Satisfaction: Some studies suggest that relationships formed through dating apps may have lower levels of satisfaction and stability compared to those formed through traditional means. The abundance of choices can lead to a “grass is greener” mentality, where users are always looking for a better match.

There are around 20 countries which are experiencing negative population growth. Moreover, more than 100 countries and territories have fertility rates below the replacement level of 2.1 births per woman. While India is still not at that cusp of replacement level of 2.1 births. But it is certain that a Ministry of Sex measures are required for more than 50 countries given their demographics. However, some of the countertrends could accelerate this even faster. 

Rebooting Age: Long-Living India

Rebooting Age : Long-living India

Podcast

QuoteUnQuote with KK and Dr. Deepak Kumar Saini, Convener, Longevity India and Professor, Dept. of Developmental Biology & Genetics Indian Institute of Science (IISC), discuss Bet #3 on anti-ageing tech and products that is going to be a major trend in the next 5 years. Why is it so? 

As 50s is the new 30s now. Present Genx and seniors would like to reverse age or age slowly. By 2047, over 300 million Indian would be Senior Citizens and our dependency ratio will be around 40%. Indian would like to extend their lifespan 20% to 50%. But the trick here is to ensure that the end of life after prolonged life is a quick process rather than a prolonged decline. 

Indexation and Canons of Taxation: Have We Learnt Anything from Angel Tax?

Indexation and Canons of Taxation: Have We Learnt Anything from Angel Tax?

Preamble

In my Macroeconomics Course in College, I was introduced to the Canons of Taxation are principles that guide the design of a fair and efficient tax system. Adam Smith, in his book *The Wealth of Nations*, introduced four fundamental canons of taxation:

  • Equity: Taxes should be proportional to the taxpayer’s ability to pay. This means that individuals with higher incomes should pay more taxes than those with lower incomes.
  • Certainty: The tax amount, payment time, and method should be clear and certain to the taxpayer. This helps in planning and reduces the chances of arbitrary taxation.
  • Convenience: The tax system should be convenient for taxpayers to comply with. This includes the timing and method of tax payments.
  • Economy: The cost of collecting taxes should be minimal. The tax system should not be overly expensive to administer.

Modern economists have expanded these canons to include additional principles such as productivity, elasticity, simplicity, and diversity.

However many Governments around the world, including India do not follow these Canons of Taxation and make the taxation more complex rather than simplistic. From an investor point of view, the latest Budget for FY 2024-25 is one such instance where the Ministry of Finance has demonstrated one case of positive and one case of negative principles of canons of taxation. From an investor point of view, on the positive side, the Budget has abolished the Angel Tax and on the negative side, the Budget has abolished the indexation applied on Long-Term Capital Gains (LTCG) for computation of LTCG by reducing the LTCG rate from 20% with indexation to flat 12.5%. Let’s discuss this in detail.

Angel Tax Abolition  – Positive Canon of Taxation

When late Finance Minister and President of India Pranob Mukherjee, introduced the Angel tax in 2012, the justification given was that it was to prevent money laundering through inflated valuations. However, most start ups are valued higher than fair market value. Most angel investor would value these angel investments looking at the future growth potential and at the time of investments, these start ups had no or low revenues and profits. It is but obvious that the valuation methodologies would be higher than the market value. The angel tax had several significant impacts on startups in India:

  • Valuation Challenges: Startups often faced difficulties in justifying their valuations to tax authorities, leading to disputes and potential tax liabilities.
  • Investor Hesitation: The tax created uncertainty and risk for angel investors, making them more cautious about investing in early-stage startups.
  • Cash Flow Issues: Startups had to allocate funds to cover potential tax liabilities, which could otherwise have been used for growth and development.
  • Administrative Burden: The process of proving fair market value and dealing with tax assessments added to the administrative burden on startups.
  • Stifling Innovation: The overall environment of uncertainty and additional financial strain could stifle innovation and discourage entrepreneurship.

With the abolition of the angel tax in 2024, the startup ecosystem is expected to benefit from increased investor confidence and a more supportive regulatory environment.

Conclusion

The Angel tax did not pass the Canons of Taxation test and met its stated objectives. After lobbying for many years it is now abolished.

Removal of Indexation on LTCG for Sale of Real Estate

In the current budget, the Finance Ministry has removed the indexation benefit for calculating long-term capital gain (LTCG) on non-financial assets (including property). It has also lowered the LTCG tax rate to 12.5% (from 20% previously). The government has clarified that the removal of indexation benefits will not be applicable to old properties held before 2001, which would continue to get indexation benefits. This move is unlikely to impact the end-users who sell their existing house and reinvest in a new house (LTCG is not applicable). However, it will impact investors who would sell their house (investment) and reinvest in other asset classes.

Now the statement coming from the Finance Secretary in the media is that the new LTCG tax regime is in favour of the taxpayer as it lowers the LTCG burden. However,

this is not the case. Let is analyse this in detail.

Indexation on LTCG

There is an adjustment to the cost of acquisition of real estate of offset the inflation. Since 2001 onwards is the time frame when the new LTCG tax regime will impact the taxation, the following chart shows the indexation with 2001-02 as 100.

Indexation for LTCG Since 2001-02 Till Date
Indexation for LTCG Since 2001-02 Till Date

Assuming that an investor bought the property in 2001-02 at INR 100, the indexation benefit will be that if sold in 2024-25 it will be valued at INR 363, that is a multiple of 3.63x and this will be the cost that will be deducted from the sale consideration for computation of LTCG on the profit on the sale of the property. Now this benefit has been removed and a flat rate of 12.5% of sale consideration. This change has its own pros and cons and debunks what the Finance Secretary talked to the media about the new LTCG tax regime. Let’s see the different scenarios and time frame and the tax burden under the two LTCG tax regime.

INR 100 Asset @ 5% pa Appreciation Illustration

INR 100 Asset @ 5% pa Appreciation Illustration
INR 100 Asset @ 5% pa Appreciation Illustration

Clearly, the investor pays more LTCG when the indexation benefit is removed with lower tax rate of 12.5%.

INR 100 Asset @ 10% pa Appreciation Illustration

INR 100 Asset @ 10% pa Appreciation Illustration
INR 100 Asset @ 10% pa Appreciation Illustration

The investor only gains to pay less tax if the property is held for 10 years and more and appreciates in value @10% pa. Therefore we can conclude that the impact on relatively shorter-term investments (<5 years) where market price growth is <10% p.a. is negative. Conversely, the impact of this new regime would be neutral/marginally beneficial for investments with longer holding period (>10 years) and where property price appreciation is at >10% p.a.

It’s a Bummer

As a healthcare real estate fund, the social infrastructure like hospitals do not appreciate > 10% pa. Also the investment and exit timeframe would be <5 years. This means that there is additional tax burden for the investors. However, we are not the only institutional investors who are impacted with this change in LTCG tax computation. The recent change in LTCG tax computation bring about many questions around the cannons of taxation and many more. These include:

  • Healthcare real estate in India is one of the most costliest in the world and hence its relative attractiveness reduces for international investors towards India due to the additional tax burden.
  • There should have been exceptions allowed for funds and institutional investors for their existing investments in property sector to allow for the projected returns. Any new investments could have been based on the new LTCG tax proposal. This will allow for certainty of gains and returns to the investors in their current investments.
  • There are doubts in the minds of the investors about the stability of the LTCG tax regime if they are tweaked in the name of lower tax burden which is totally not true.
  • The secondary sale of the property by investors may alter the exit process by the investors in terms of time and valuation to match the increased LTCG tax burden suddenly imposed under the new regime.
  • The real valuation of the property may be tweaked with cash in the transaction to lower the LTCG tax.
  • Other creative accounting practices may be introduced to capitalise on the property inflate their costs to offset the loss due to increased LTCG tax burden.

To conclude, the new LTCG tax regime on property is not a positive one and does meet the canons of taxation and is not going to meet its objectives like the abolished Angel Tax.

Bharatvarsh – Pilgrim Nation: The Land of Spiritual Wellness Travel

Bharatvarsh: The Destinations for Spiritual Wellness Journeys

Podcast

QuoteUnquote with KK and Dr Devdutt Patnaik, India’s top mythologist and author discusses on our bet #our Bet #22 on mythological/pilgrimage wellness/health that is going to be a major trend in the next 5 years from our 2024 India healthcare and lifesciences investment manifesto. Devdutt, clears the issues on Bharatvarsh, sprituality, spiritualism, the Great Indian Pilgrimage, destinations across Hindu, Jain, Buddhist followers, ancient practices and modern beliefs. He also discusses various emerging counter trends around non-traditional spirituality, conspirituality amongst the extreme rightists and wokes, fake narrative emerging out of AI and ChatGPT and how belief systems are being altered around practice of spirituality and religion.

Excerpts

What is Spirituality?
How is Religion Different from Spirituality?
How is Bharatvarsh defined by Politicians, Pilgrims and Vedas?
Are there Counter Trends to Spiritualism?
How do we address the Saviour Mindset?

Also Listen

The Mantra for Happiness
Veda, Weed and Yoga: Is it ‘Xeno’ to XYZ Gen?

 

GWI-Wellness Real Estate-2024

 

Global Wellness Trends - Trends in Spiritual and Numinous Moments in Architecture

Will Ayodhya Be The Mecca Of Medical Tourism? | Kapil Khandelwal KK

Mooring Around the Future of Chips in AI-dominated India

Mooring Around the Future of Chips in AI-dominated India

Podcast

QuoteUnquote with KK and Nitin Dahad, Tech Evangelist, Editor embedded.com, Writer

Also Watch

Raghu Panicker, CEO of Kaynes Semicon, gives us some background to the origins of the current semiconductor industry in India from the 1980s by two key figures: M.J Zarabi and Wally Rhines.

Hitesh Garg, India country manager for NXP Semiconductors, talks about key markets for NXP globally and in India, particularly automotive and industrial. 

Satya Gupta, a veteran of the Indian electronics industry in India. He has several influential roles in the industry and in policymaking

Bhanupriya Krishna, founder and managing director of Perceptives Solutions, talks about the lack of talent for addressing the semiconductor manufacturing industry in India

Pradeep Vajram challenges the current thinking in India to develop chips and IP for India only, highlighting that scale is key for investors in Indian semiconductor startups

Also Read

India to Build Chip Manufacturing Ecosystem, Talent Pool - Nitin Dahad, EE Times

Emerging Resilience in the Semi Conductor Supply Chain

Emerging Resilience In The Semiconductor Supply Chain

2024 – India Healthcare and Life Sciences Investment Manifesto

2024 - India Healthcare and Life Sciences Investment Manifesto

TV Interview in ET NOW

Coverage in the Press

Express Pharma Q&A : These 40 bests would deliver $30 – $50 bn additional growth to healthcare sector by 2029

Express Healthcare Q&A

Business Standard : Anti-Ageing Tech Likely to Shape Heathcare Demand in Coming Years

Business Standard - Anti Ageing Tech Likely to Shape Heathcare Demand in Coming Years

2024 India Healthcare and Lifesciences Investment Heatmap

2024 India Healthcare and Lifesciences Investment Heatmap

In 2024, the world will be as uncertain, if not more, as it was and anticipating what will happen next is an ever more challenging task for our Algorithms and our teams. Since 2013, our algorithms have been accurately predicting the investment heatmap in the healthcare and life sciences in India which were predicting with 95% accuracy on the sectoral investment cycle in India till the end of 2019. Since the Covid Pandemic in 2020 we lowered levels of prediction accuracy like we started back in 2013. The fake narratives and echo chambers that were peddled during the pandemic years of 2020-22, that vitiated our predictions during the pandemic years continues in for some other factors. 2023 was even more unpredictable in many ways. Our algos do not penetrate the terrorists, government intelligence and security networks and hence unable to consider events that playouts in the Middle East and impacting geopolitics, investments in Indian Healthcare and Life Sciences to some part of the investment flows from offshore. Hence, we have made attempts to analyse International ‘Geo Politics’ as a separate factor and bolt-on-top of our algo predictive models to adjust our heat map for 2024 to accurately predict whether the heat is on in our 2024 Heat Map.

2024: A Year of Geopolitics than Geo Economics

The biggest political event in India in 2024 will be the Lok Sabha General Elections. Hence H1 2024 will not see any major policy or budgetary directions to the sector till the new Government takes over in New Delhi by June 2024 and then presents its budget. For the first time, in the post pandemic era, almost all global funds, analysts and bankers have a unanimous consensus on India’s positive outlook for 2024, some even covering India as a separate chapter in their reports which was dedicated to China in their Asia Outlook till 2022. However, healthcare and life sciences sub sectors in India have its divergence to the overall India outlook for 2024. We have endeavored to bring out the deeper analysis and specifics out of the broad ‘India Positive’ Outlook for 2024 for the Healthcare and Life Sciences Sector in India.

The wave of optimism for 2024 in Indian healthcare and life sciences stems from the following:

  • The pace of digitization is now veering toward mainstream adoption of Generative Artificial Intelligence (AI) tools and solutions across that are being piloted.
  • New business models/incubation for investments are emerging (see out Future Bets in Healthcare) that will be cross-domain
  • The bills and laws introduced in the Parliament in the Session New Healthcare Bills 2023 Archives | Kapil Khandelwal KK are yet to shape bounce in investments.
  • Muted returns in the private markets will continue in 2024 as the winter of private investments continues in 2024. Let us understand that the best investments tend to occur during times when investment outlooks appear riskier, so the lower prices in many kinds of equity investments might well yield attractive returns over time.
  • Companies listed on the bourses have always underperformed the broader index in the last 2 general elections of 2014 and 2019 by -4.5 to -6.5%. We are expecting the elections results to be neutral this time on the Indian bourses. A few big names to IPO in 2024.
  • With one-third of India’s population now constituting Gen Alpha and Gen Z, the health and wellness aspirations of this cohort is the growing aspirational class that wants to live life post Covid-19 differently and different products and services will serve as the next growth opportunity.
  • The valuations have come back to realistic levels to the pre-covid levels for primary and secondary investments.
  • Debt and equity requirements have stabilised as the cash-crunch situation during the pandemic have ‘normalised’ and so are the return expectations. Both are negatively correlated with yields globally. In other words, investments in equity and its returns will tend to outperform the market, as yields decline.
  • As new Generative AI capabilities emerge, the investments in human capital for newer skills are emerging. Also, newer models of ‘sweat’ equity/debt are emerging.
  • Investments in newer health and wellness solutions to weather climate change are getting exciting. (see out Future Bets in Healthcare).
  • M&A and buyouts are expected to continue, but lower from the peak of 2022.
  • How India plays its geopolitics will also determine the quality and quantum of foreign investments in India in the various sub sectors.

The 2024 India Healthcare and Life Sciences Investment Heat Map is as under:

Healthcare Financing

Newer products for financing healthy lifestyle for the Gen Alpha and Gen Z are emerging. Financing ‘idleness’ and healthy entertainment lifestyle through innovative business models are the key. There is a consumer shift for spending on healthy lifestyle which is a personal investment in longevity of healthy life.

  • 2024 Outlook: Moderate
  • What’s going wrong: slower market/product innovation, right bite for the consumers, reach and penetration to New Gen consumers, financing costs
  • What’s going right: India stack digitisation, uberisation, AI solutions

Medical Education

Valuations are correcting and consolidation activity is accelerating. New regulatory regime will come into force and will require investments in managing the delivery and quality of content. New skills for the new AI tools and newer consumer’s requirements needs is accelerating but not in the curriculum.

  • Outlook: Moderate
  • What’s going wrong: Alignment to new consumers and care, increasing debt burden, new age skills certification, CME with AI-tools
  • What’s going right: Skill-mix churn, upgradation of skills, AI for frontline workers

Med Tech Innovation and Life Sciences Discovery and Clinical Development

Capacity creation and new product development continues as India is now into the China+1 club. Expect a few IPOs this year in this sector. Government grant funding will temper down. Geo polities is a key risk to create supply chain disruptions.

  • 2024 Outlook: Hot
  • What’s going wrong: IP regulation, regulatory bottlenecks on clinical development, newer skill sets for research and acceleration, PLI policy for sub sector, geo politics, supply chain disruptions
  • What’s going right: Human capital, emerging social innovation models, right products selection, market appropriate solution development, peptide based products, chronic diseases product innovation for co morbidities

Pharma and Therapeutic Solutions

Geo politics may affect supply chain and missed topline and profitability estimates. Cost competitiveness like Chinese players to compete globally is the key for growth. Expect a few IPOs, buyouts and exits via secondary sale.

  • 2024 Outlook: Moderate
  • What’s going wrong: price controls, wrong product portfolio, capacity scale up, global or China-level cost competitiveness, exit of PLI incentives, shortage of skilled workforce
  • What’s going right: distribution infrastructure, digital business models, government incentive programs

Healthcare Providers

High levels of leverage is still a concern. Private equity investments slowing down due to valuation expectations. Expect a few IPOs, buyouts and exits via secondary sale. Capacity creation is slowed down due to fund crunch.

  • 2024 Outlook: Moderate
  • What’s going wrong: margin pressures, price controls, execution of programs on the ground, supply and demand mismatch in micromarkets, debt financing costs, gun powder churn, operating cash runway, liquidity and working capital crunch, not exploring newer formats
  • What’s going right: asset-lite models, medical tourism

Healthcare Insurance

Loss ratios and profitability is slowing improving as pricing and products are rationalized. Expect two IPOs of two major players. New products innovation for newer consumer’s requirements is lagging.

  • 2024 Outlook: Hot
  • What’s going wrong: product fit to consumer needs, product approvals, IPOs pricing and valuation
  • What’s going right: Consumer demand, reduced loss ratios

Health Retail

The Pharmacy Bill 2023 brings its own set of challenges. AI pilots once mainstream will reduce costs and margin pressure albeit very slowly. The valuation is still a challenge for raising fund and buy-outs, secondary exits. Expect an IPO.

  • 2024 Outlook: Hot
  • What’s going wrong: regulation, operating margins, spurious social media channels affecting consumer confidence, health UPI, time to scale
  • What’s going right: consolidation, newer cross-vertical innovative business models, profitability focus, AI adoption and models

Wellness

2021 was the highest growth year in the last 10 years on the back of discretionary consumer spending on wellness. Digital business model innovation is still lagging. Medical wellness tourism will be recover in Q3 of 2022. M&A activity and consolidation to continue in 2022 but at a slower pace. Corporate Wellness spends to continue to fuel growth in 2022

  • 2024 Outlook: Very Hot
  • What’s going wrong: regulation, maturity to scale, new mass market business models, repeat sales, spurious social media channels, fake outcome/claims
  • What’s going right: newer cross-vertical innovative business models, corporate wellness spending

Alternative Therapies

New Gen consumers are seeking unique experiences and combing with mental health and rejuvenation as their discretionary spends are increasing.      

  • 2024 Outlook: Very Hot
  • What’s going wrong: maturity to scale, consumer education and confidence, clinical research, new product development, inflated valuation, new mass market business models, repeat sales, spurious social media channels, fake outcome/claims
  • What’s going right: discretionary consumer spending, newer cross-vertical innovative business models, mainstream complementary treatment

Moving Forward

As one iconic smart investor said that one should be investing in healthcare and life sciences because you believe smart investing will yield results that are beneficial for society, not just to enrich oneself.

Happy investing and stay strong!

Also Published in Express Pharma February 2024

2024: Healthcare and Life Sciences Investment Outlook

Will Ayodhya Be the Mecca of Medical Tourism?

Will Ayodhya Be the Mecca of Medical Tourism?

Preamble

Today (22 January 2024) marks the formal opening of the Ram Temple at Ayodhya in Uttar Pradesh. Opinion makers and politicians say that Ayodhya will be the largest religious tourist destination in the world in the non-Abrahamic religious category after Mecca and Vatican with an annual footfall of ~75 mil religious tourists annually. With this positive development, there are also thoughts and plans amongst the healthcare industry folks if Ayodhya can be one of the destinations for medical tourism. I can talk more about Mecca and Saudi Arabia as I was involved in the healthcare industry there in early 2000s and can draw comparisons on Ayodhya. 

What is the Tourism Potential for Key Religious/Spiritual Destinations of the World?

The following table will outline and compare Ayodhya with Mecca and Vatican City for starters.

  Vatican City Mecca Ayodhya
Annual Tourists ~ 10 mil  ~ 20 mil ~ 75 mil
Tourism Revenues ~ USD 0.5 bn (not including revenues from Rome) ~ USD 12.5 bn (not including revenues from Jeddah) Yet to start (expected to be ~USD 5.5 bn)
Travel Infra Well connected with Rome Well connected with Jeddah with a separate Haj Air Terminal to facilitate huge pilgrimage volumes Yet to develop an international airport. Rail and domestic connectivity being enhanced
Medical Infra Adequate for the local population Jeddah has over 8500 hospital beds with more being added including a Medical University. Mecca has over 1000 hospital beds Adequate for the local population. Lucknow is the current Tertiary and Quarternary care location including AIMMS
Medical Tourism Revenues NA ~ USD 0.9 bn NA

India ranks 17th in the world as a tourism destination with a share of ~1.5%. However, its share of GDP is ~6.5%. There is a huge potential for growth for medical tourism if international tourism grows. Ayodhya can provide this growth impetus if planned and implemented astutely. We can learn from the Mecca-Jeddah experience on Medical Tourism on what worked and what mistakes to avoid.

Mecca-Jeddah Medical Tourism – Case Study

At the turn of 2000s, Jeddah and Mecca had a very poor medical infrastructure with limited bed capacity. During the Haj season, millions of pilgrims would land at Jeddah’s Haj terminal. However, the quality of manpower and care was not upto international standards apart from not being cost competitive. Saudi Arabia embarked on the Gulf countries, US JCAHO quality accreditation. Two hospitals in the Eastern Province (Dharan and Al-Khobar) took the lead in JCAHO certification. The Western Provincial government and Riyadh Crown Prince took the initiative in boosting the bed capacity in Jeddah and Mecca which doubled in 5 years. In addition, a Medical University and four private medical colleges were established to increase the supply of doctors and nurses. Special travel privileges and visas were also provided by Saudi Arabia. Prior to the Haj Pilgrimage, specialist doctors were allowed to practice in Jeddah private hospitals as Locums/visiting doctors with accelerated credentialing. As a result, Jeddah’s hospitals earn around USD 1 bn through medical tourism.

Building a Case for Ayodhya Medical Tourism

India’s learnings from other medical tourism destination can be replicated here in Ayodhya. Here are some pointers

Learnings from Delhi-Agra-Jaipur Triangle

The golden triangle as a largest hub for medical tourism developed as these became as a go-to destinations for historical monuments. Delhi and Jaipur were the landing points and also significant healthcare infra which was eventually expanded. Ayodhya as a destination will need to add other co-locations either Lucknow or Delhi to grow the options and choices.

Uttar Pradesh Health Infra Diversity

Our State Health Infra Health Map 2021 States Heat Map | Kapil Khandelwal KK had listed Uttar Pradesh as one of the hottest emerging states for investment in health infra. However, the Uttar Pradesh macro and Ayodhya micro health indicators have improved slightly since, but not radically. It seems that all focus was on planning for tourism and relevant infrastructure but not for healthcare infra. The Jeddah-Mecca case study is an example in the making for coordinated planning and development between the Western Provincial Government and the private Medical and Tourism industry. The nearest JCIA accredited international standard hospital is in 150 kms radius.

Niche Positioning of Ayodhya – Promoting Integrative Medicine

Indian traditional medicine and allopathic care needs to be integrated to provide unique wellness care experience along with the ambience and spirituality of Ayodhya to promote healthcare and tourism.

Geriatric Care is another Axis

Assisted living capacity can be built up for the senior citizens. However, this should not be on a push with real estate development without Golden Hour medical back up. Malaysia has promoted several locations for foreigner under the Malaysia My Second Home around Kuala Lampur along with golf tourism for the Asians expats. Ayodhya My Second Vaas would encourage HNI Indians and expats to explore this avenue.   

With the inauguration of the Ram Temple in Ayodhya, the transformation of the destination from a Spiritual Hub to a Medical Tourism Hub can be envisoned. However, we are still far away from being the Mecca of Medical Tourism. We are ranked 10th in the Medical Tourism Index (MTI), 12th in top 20 wellness tourism markets globally, and 5th in wellness tourism markets in APAC.

Jai Sri Ram!