Posts filed under ‘Health & Wellness’

Child Mortality

Child Mortality 1

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Child Mortality 2

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Child Mortality 3

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While the info-graphics above need no explanation, for those who lack the time to enlarge the image and peruse them, am mentioning below some key take-aways :

  • 6.6 Mn children under the age of 5 died in 2012
  • The global under-5 mortality rate equals 48 deaths per 1000 births

o   In case you thought the scourge of pneumonia had been banished, think again ; it accounts for 17% of these deaths, and is the largest contributor, along with prematurity. Pneumonia is still the leading cause of deaths in 83 countries

o   Malaria is still a major killer in Sub-Saharan Africa, causing about 14 percent of under-five deaths in the region.

o   Deaths due to diarrhoea have been nearly halved in the past decade but it still accounts for a tenth of all under-five deaths. Deaths due to Diarrhoea are high in countries such as India, Afghanistan, Ethiopia, Somalia, Angola, Niger etc.

  • India, Pakistan, Bangladesh, China, Indonesia, Nigeria and China, 7 of the most populous countries, collectively accounted for half of the total number of under-five deaths globally

o   While China is mentioned among these, it’s under-5 mortality rate (at 14 deaths per 1000 births) is actually much less than that of the other nations , it features on this list die it’s large population base

o   Of these nations, the statistic is the worst for Nigeria, with an under-5 mortality rate of 124 deaths per 1000 births

In case to wish to see statistics on under-5 mortality rates or causes for a particular country, you can click on this link for causes and this link for rates.

  • Ravindra Ramavath

 

June 5, 2014 at 8:32 am Leave a comment

Molecular Diagnostics – An Introduction

Molecular Diagnostics (also known as nucleic acid based diagnostics) studies the composition of an individual’s genetic material – i.e. our DNA – in order to arrive at conclusions that have medical implications. The reason this science that is still in its infancy is hailed by many as the next frontier of medicine is that it is far more precise than previous methods, faster by several orders of magnitude – often giving results in hours vs. the weeks required by conventional tests, and can give results with far lower sample quantities. Additionally, it can sometimes give information that is simply not available from any other test.

Some kinds of molecular diagnostic tests help understand the likelihood of a patient responding positively to a particular medication, others help identify mutations that predict the probability of a healthy individual developing certain ailments in the future, yet others help conclusively identify the ailment at the root of troublesome symptoms so that the cause could be treated properly.

Basics of the science underlying the technique :

(note – those uninterested in a basic biology lesson can skip this section)

The cornerstone of molecular diagnostics is the identification of pathogenic mutations in an individual’s genetic material, i.e. their DNA.

Our DNA is made up of a sequence of pieces called genes. Each gene is made up of a series of bases (Adenosine,Thymine,Cytosine,Guanine, commonly written as A,T,C and G) in a certain order. These bases and the precise locations on the gene at which they are present are a molecular code that carries information required for making all the functional molecules – RNA and proteins – required by us. These proteins, once synthesised, are responsible for our characteristics – whether it’s the colour of our eyes and skin, our blood group, our tendency to gain weight quickly, or male-pattern baldness etc. Thus the bases and the sequence of their location on the genes are responsible for our heritable traits.

Small changes in the sequence of bases on a gene – such as substitution of one base for another, or omission or repetition of a small segment, can change the gene’s function and manifest as a difference, say in physical appearance etc. You can think of these bases on the gene as letters on this page that occur in a certain order to form words and sentences. Occasionally, a typographical error – a missing alphabet, a duplication, or a wrong substitution may occur, some do not matter much and we can still read the words and unnerstand them, but others may gargle (garble) the meaning of a word or sentence.

Similarly, most variations are harmless, but some can make the gene faulty; for instance, a particular protein may not be produced properly, or produced in the wrong amounts or not produced at all; such variations that make the gene’s operations faulty are called mutations. These mutations are the signposts that molecular diagnostics searches for and draws conclusions from. Thus the science is based on being able to recognise and map the structure of each gene, and identify mutations in them, as well as the knowledge of those mutations that affect our metabolic processes / physiology. This is not as easy a task as it sounds as human genes have from a few hundred up to two million bases on them (yes, really !) and you have to know and locate the specific mutation that is responsible for the effect under consideration.

(For further information on structure of the DNA, you can read the following :

What is a Genome

What is DNA 

What is a gene

How genes work 

Mutations and health

What is a gene mutation and how does it occur 

Inheriting genetic conditions )

 

Some Scenarios in which a molecular diagnostic test could be used :

Therapy support and therapy monitoring :

Determining probable response rates to certain therapies and their appropriateness for use in specific patients. In doing so, molecular diagnostics enables more personalised / individualised therapies, either with the goal of minimising harmful side-effects and / or judging how well individuals will respond to a planned course of treatment and whether they should go in for it.

This DNA-based approach to treatment, known as pharmacogenomics, is already in use in combating certain cancers.  Chemotherapy is prohibitively expensive and often has extremely painful side-effects, and not all patients respond equally well to a medication or cocktail of medications; getting the combination right often involves an initial trial-and-error phase, a frustrating and physically tortuous time for the patient. In the case of certain types of cancer, molecular diagnostics can help predict a patient’s response to a medication, thus avoiding much trauma – both emotional and physical, and saving time and money.

Take breast cancer, for instance. One of the medications used to avoid a recurrence after radiation therapy or chemotherapy is the drug Herceptin from Genentech. Now about 20-30% of breast cancer patients exhibit an over-expression of the Her2/neu gene and only these patients benefit from treatment with Herceptin.  A molecular diagnostic test to check for presence of the mutation of Her2/neu gene helps identify those that would benefit from the treatment; thus it costs about Rs. 15,000-20,000 to figure out whether a treatment running into lakhs of rupees will actually benefit someone. This is the personalised approach to medicine rather than the one-size-fits-all-with-the-same-ailment approach.

 

Early Detection Testing :

Detecting the presence of pathogens through detection of their RNA or DNA.

Using a molecular diagnostic test, diseases caused by a virus – think HIV and AIDS, HPV and cervical cancer, Hepatitis B, Hepatitis C etc. – could be quickly and reliably diagnosed well before the initial symptoms appear, thus giving physicians a longer treatment window and the patient a chance of earlier treatment and earlier return to good health. In these instances, the tests checks whether the RNA of the virus (ahem, which is significantly different from our DNA) can be detected in the patient’s tissue / sputum / blood sample sent for testing.

These tests can be used to detect other pathogens such as bacteria too. Consider the traditional diagnostic tests for TB which is caused by bacteria (Mycobacterium Tuberculosis). The current battery of tests include the Mantoux tuberculin skin test, a tissue culture, a sputum test, a chest X-Ray and a blood test; in spite of conducting all of these, there is a chance of getting a false positive or false negative result when the results are available a few weeks later. On the contrary, one molecular diagnostic test can confirm not just the presence of TB but also identify the genetic mutations in the bacterium and identify the strain of the bacterium responsible for the symptoms and which drugs it is resistant to, all this within a few hours.

Valuable info indeed in this era of multi-drug resistant TB (MDR-TB), when making a fast and accurate diagnosis of the type of TB infection a patient may have is the most important step to curing a patient.

 

Predisposition testing :

Analysing the probability of an individual developing certain genetically inherited diseases.

Such tests, done for risk analysis of cystic fibrosis, breast cancer and other hereditary diseases, can help understand whether an individual has a higher probability of developing an ailment than the general population. These are not definitive tests, in that they cannot predict whether an individual will get the ailment in future, they can only tell us that an individual has a higher or lower probability than the general population does of getting the ailment. Hence, there is still a lot of debate about whether such information is beneficial for an individual or not, whether it makes them worry unnecessarily about factors which they have no control over.

For instance, consider the BRCA1 and BRCA2 genes that belong to a class of genes known as tumour suppressor. A woman who has inherited a harmful mutation in BRCA1 or BRCA2 is about five times more likely to develop breast cancer than a woman who does not have such a mutation.

In a family with a history of breast or ovarian cancer, it may be informative to analyse a tissue sample of a patient (sufferer of breast cancer) and identify which harmful mutations are present; then other family members can be tested to find out if they also have the same mutation and their probability of developing breast cancer later can be computed. However, while a negative result can rule out breast cancer and bring a sense of relief, a positive test result only provides information about a person’s probability of developing cancer in future. It cannot tell whether an individual will definitely develop cancer; not all women who inherit a harmful BRCA1 or BRCA2 mutation will develop breast or ovarian cancer.

Note : Common medical problems such as heart disease, diabetes, and obesity do not have a single genetic cause—they are likely associated with the effects of multiple genes in combination with lifestyle and environmental factors, in such cases, genetics has a smaller, more complex role to play. More on this and other matters in another post.

  •  Zenobia Driver

(with a lot of assistance from assorted secondary sources)

March 10, 2014 at 12:54 pm Leave a comment

Updates

On Lifebuoy colour changing handwash :

Over a year ago, we’d written about the Lifebuoy team’s efforts to change the hand-wash habits (or lack of the same) of Indians in this post.  The post called attention to one aspect of Lifebuoy’s Swasthya Chetana campaign, the ‘glowgerm’ demonstration that children were invited to take part in. This involved applying a white powder to the palms of their hands, then washing with water only. Hands were then held under an ultra-violet light and the powder glowed where dirt remained, showing that hand-washing without soap was not enough. The children then repeated the process, this time using soap, only to discover the UV light showed no trace of the powder. This countered the common misconception that ‘visibly clean’ is ‘hygienically clean’, and, in an easy-to-understand manner, drove home the message that even clean-looking hands are dirty until washed with soap.

lifebuoy colour changing handwash 2

Now they’ve used colour changes to make another point with their latest product, Lifebuoy colour changing handwash. This time, the foam turns green after ten seconds to signal that all the germs have been wiped out. Am sure that the change in the colour as they scrub will grab every kid’s attention and ensure that they don’t wash the soap off immediately but scrub for a full ten seconds, at least while the product and the effect are still a novelty. As a communication tool, felt that the hulk mascot worked well too. You can view the ad for the product here.  

 

On the frozen yogurt market :

frozen yogurt brands

One of the trends we commented upon last year was the increasing popularity of hip frozen yogurt stores which could be termed cafés in terms of their popularity as hang-out places for youngsters.

The rapid expansion of this market has seen more competitors entering, read about the entry of foreign brands including the U.S based ‘Red Mango’, Canadian ‘Kiwi Kiss’ and others here, here, here and here.

 

  • Zenobia Driver

 

December 28, 2012 at 9:54 am Leave a comment

Update

Sometime last year, we’d run a series of posts on the topic on dealing with the challenge of ‘need, but don’t want’ in the health and wellness domain – you can read the posts in the series here, here, here and here. These discussed the problem of physiological (and often, medical) need for the product, but no desire to buy from the consumer; it’s a topic that we keep thinking about and researching ourselves, while keeping our eyes peeled for information on this topic from other sources.

As we mentioned in one of these posts :

In the healthcare space, while it’s tempting to say that there is the tangible benefit of getting better and that should matter to patients, the basic issue is that all the ill-effects of ailments such as diabetes, high cholesterol or BP are typically not evident immediately, thus, the benefit of taking medication regularly and of making other lifestyle modifications is unclear to many patients. Habit change is always hard, when the reward for it is nebulous and indeterminate, it only becomes more so.

Recently, thanks to my friends R & G, I came across this TED Talk that threw more light on this subject and I just had to share it with readers of this blog. In a nutshell, the speaker says that giving people medical information in a form that they can comprehend and that helps them see the way ahead to better outcomes, can actually boost their motivation to do something to achieve those outcomes.

A few sentences from the transcript of the talk are reproduced below to whet your appetite, hope you actually watch the entire video after reading these.

You’re looking at things where people are actually given information, and they’re not following through with it. It’s a problem that manifests itself in diabetes, obesity, many forms of heart disease, even some forms of cancer- when you think of smoking. Those are all behaviours where people know what they’re supposed to do. They know what they’re supposed to be doing, but they’re not doing it.

……

But for as much as clinical medicine agonises over behaviour change, there’s not a lot of work done in terms of trying to fix that problem. So the crux of it comes down to this notion of decision-making – giving people information in a form that doesn’t just educate them or inform them, but actually leads them to make better decisions, better choices in their lives. 

  • Zenobia Driver

September 7, 2012 at 10:41 am 2 comments

Turning Medical Services Upside Down

When I buy a book on Amazon or Flipkart, I can see the ratings and comments by hundreds of customers. But when I need to choose a doctor, I have to rely on the inefficient and inadequate method of asking friends, with whom I may or may not want to share my ailments. This is true whether I am trying to find a GP or a surgeon. And, after seeing the doctor, there is no way for me to rate him or her even for mundane things like whether or not he shows up on time to the clinic, let alone more important comments regarding his or her approach to medical care!  In contrast, I can easily find gigabytes of information about whether the keypad of a particular laptop model becomes sticky after use.

Another point to consider: Different people look for different things from a doctor: some may want the reassurance of the (imagined) old time family doctor, while others may prefer a “just give me the facts, I’ve brought my own sugar coating” approach. Why assume that we have the same expectations from doctors while we have entirely difference preferences for the texture of our cookies or the settings on our Facebook accounts?

Much of the discussion about modernization of medicine gets stuck in technology discussion (digital versus human interface).  However, what we need is a thorough modernization of medicine inside out, seriously thinking through which aspects of medical care would benefit from more information (including customer feedback) and which aspects would benefit from more customization and personal preference being taken into account.

Industry experts focus on customer segments and behavior for FMCG consumer products, but what about customer segments for the ultimate consumer product – medical care — the one that determines our life and health?  Isn’t it about time that the medical services industry starts thinking beyond the simplistic considerations of digitization of patient records, or focus on specialized clinics versus primary care, rural versus urban customers?

 

By,

Richa Govil

(Richa shares her thoughts on rural businesses at ‘Stirring the Pyramid’)

June 4, 2012 at 9:59 am Leave a comment

Reflections on the doctor-patient interaction

Last week, I shared two interesting articles on this blog, one of which was the transcript of an interview with Dr. Eric Topol, author of the book, ‘The Creative Destruction of Medicine’. Buried in this article was a very interesting question posed by the interviewer :

Is there a possible irony that in using all this technology to “personalize” medicine you “depersonalize” it instead ?

A valid concern indeed! While the advances in science and technology make it possible to treat every individual’s physiology as unique and we now often have the means to tell apart conditions that are symptomatically similar but in fact are different diseases altogether, in all the exhilaration about the advances in medical science we tend to forget that there’s a person-to-person connect that we humans yearn for – especially when faced with bad news, and this seems to be slowly reducing.

A few years ago, a friend’s father developed an eye problem that needed surgery. It was complicated and he was referred to a surgeon well-known for his expertise in the field. The surgeon examined him, confirmed the diagnosis, scheduled the surgery and then – undoubtedly with the best intentions – blandly told him to be prepared for the worst as the operation had a high failure rate. As luck (and the surgeon’s skill) would have it, the operation was successful and the gentleman is fine now. However, his children still remember their father’s distress at hearing the news and wish it could have been presented in a gentler, more humane fashion; at that time I remember that they bubbled over in anger and resentment at the “cold, heartless” surgeon.

I’ve heard similar versions of this story from multiple people that met a thoroughly competent but not-empathetic-enough doctor/ surgeon/ other clinician. Not just those suffering from an ailment of some sort, even pregnant women that visit their gynaecologist voice a similar desire for time, information, and most of all, reassurance.

Partly, our frustration and distress stem from the fact that as patients or friends and relatives of patients, we want the Doctor to be everything, Superman almost. We hanker for the simple comforting relationship and degree of involvement of earlier times, but with all the benefits of better diagnoses and effective medicines that are available today; we want the caring demeanour, the reassurance, the generosity of time that an old-fashioned family doctor gave; yet we also want this person to have the skills and knowledge of a specialist, to have invested the time to be up-to-date with all technological and medical advances and to have the latest scientific facts at his fingertips. Occasionally, we meet such people, but they are rare. It’s a very fine line between doctors telling the patient as it is and being positive about the outcome to keep the patient cheerful and positive. Unfortunately our medical system does not train well for this ‘fuzzy’ part of medical care, and hence it is up to individual doctors how they deal with it.

One that does it very well is an orthopaedist called Dr. Niranjan Deshmukh at Lilavati Hospital in Mumbai. Multiple people that I know have been to see him for various back, shoulder and leg injuries and have given glowing reports of their experience. Apart from a calm reassuring manner, this Doctor also spends time with patients explaining to them why they are in pain, the cure needed, how long it will take etc. He uses 3-D images of our skeleton with the network of muscles and nerves over it to give detailed explanations of the reason for the pain, how it can be mitigated and means of preventing a recurrence.

I think it is time to acknowledge that such Doctors are the exceptions and build a system for the norm; one that is built around our needs as patients for more information to help us feel a bit more in control, for reassurance, and of course, for guidance and treatment. As Dr. Gawande says in his article, we need pit crews.

In some ways, hospitals are beginning to respond to these needs. Some hospitals address this through talk sessions that all their patients and their families can attend. Sometimes, for metabolic ailments, a doctor and a dietician work as a relay team for diagnosis and then ailment management. Additionally, one member of the pit crew could also be a trained medical counsellor, contributing the ‘time to care’ component of ‘quality of care’; someone who would help patients and their family members traverse from denial and anger to acceptance and solution-seeking, giving them all the information they need so that they can make sense of the situation – explain what’s happening, understand treatments available, sort through options etc.

Of course, one key question is that of the payer for these services and to what extent they can be rolled out in a country such as India where large swathes of underserved or un-served populace lack access to even basic medical care. Nevertheless, I think we need to push ahead on both fronts, improving quality of medical care and the overall experience and increasing access.

  • Zenobia Driver

 

May 28, 2012 at 6:19 am 20 comments

Is change afoot in the practice of medicine ?

Two articles that I came across recently got me thinking about the way medicine is practised currently and how it is going to change significantly during our lifetime.

The first is an article by noted physician, writer, and policy-maker Dr. Atul Gawande; titled ‘Cowboys and Pit Crews’, it is the text of Dr. Gawande’s commencement address at Harvard Medical School last year. In this speech he touched upon the way the practise of medicine evolved and the background to the way it is currently structured. Some fragments from the speech are reproduced below to whet your appetite, hope these encourage you to read the entire article :

‘The core structure of medicine—how health care is organized and practiced—emerged in an era when doctors could hold all the key information patients needed in their heads and manage everything required themselves…….The nature of the knowledge lent itself to prizing autonomy, independence, and self-sufficiency among our highest values, and to designing medicine accordingly. But you can’t hold all the information in your head any longer, and you can’t master all the skills. ……We’re all specialists now—even primary-care doctors. A structure that prioritizes the independence of all those specialists will have enormous difficulty achieving great care…..We train, hire, and pay doctors to be cowboys. But its pit crews people need………By a system I mean that the diverse people actually work together to direct their specialized capabilities toward common goals for patients. They are coordinated by design. They are pit crews.’

Dr. Gawande’s speech was about the systems and a process involved in healthcare delivery, and his prescriptions were practical, though complex to implement. The second article I’m pointing out to readers is a bit more far-out (or farsighted maybe), a bit like science-fiction-meets-medicine. This article is the transcript of an interview with Dr. Eric Topol, author of the book, ‘The Creative Destruction of Medicine’, a perspective on the changes in healthcare made possible by technology and digitisation. In this interview, Dr. Topol talks about the changes possible and the extent to which personalised medicine / treatment is now available and could benefit people, also about the prevailing system which (he feels) is resisting these changes.

 

  • Zenobia Driver

 

 

May 21, 2012 at 9:35 am 5 comments

Organic – But Naturally!

Lately, I have noticed a sudden burst of organic stores on the scene. So far, I had been seeing small sections dedicated to organic products in supermarkets and other shops, offering a limited range of products. Earlier, buying organic vegetable and fruits was restricted to weekly Farmer’s Market in Bandra or smaller outfits and individual sellers which supplied fresh produce direct to home. Stores like FabIndia, Westside carried a range of packaged organics staples, spices and condiments while several large supermarkets as well specialty stores like Vinita Mathur’s Health Shop – had a small section stocking organic foods from Conscious Foods, 24 Letter Mantra and a few other certified brands.

But suddenly, there are entire stores dedicated to organic products mushrooming around Mumbai. I’d always thought of the category as being niche – premium and metro-centric – given the higher price of all products produced organically as well as the low awareness about its advantages over conventionally produced products. These dedicated organic stores got me very curious in terms of why this sudden spurt – whether the prices had gone down, whether the product offering had changed and whether the cost of a standalone store was really justified for such products. So, I paid a few of them a visit.

Organic Garden (located in Breach Candy and Prabhadevi, Mumbai) has a whole range of vegetables and fruits grown organically, certified by ECOCERT. It’s a small store, stocking only fresh and small quantities of different fruits and vegetables grown in the region.  Despite being higher priced than the regular vegetable seller, the price differential is no longer the 25-50% that it used to be, it was only about 10-15% higher.

Organic Haus (at Kemps Corner, Mumbai) is a premium shopping experience, stocking a whole range of organic products which are imported from Germany and Austria. Their range of products includes foods and beverages, nutritional supplements, cosmetics, baby and home care products. The store is supported by well trained and informed sales personnel who explain not only the advantages of going organic, but also the product ingredients, method of usage, etc. (especially critical since most of the packaging is in German), provide information and explain unfamiliar terms like “gluten-free”, etc. and recommend products according to consumer health conditions and dietary requirements. Such is the confidence in the success of the store and its products that during the launch of its flagship store in Ahmedabad (yes Ahmedabad! not Mumbai or Delhi as one would expect), Organic Haus Chairman Dilip Doshi said, “We are planning to open 8-10 company-owned stores and 10-20 on franchise route across the country. We are in talks with some retail stores for shop-in-shop segment”. Currently plans are underway for a store in New Delhi and Bangalore as well as an online store. The products in the store are definitely much higher priced, but the variety of products is huge as well as the type of products stocked are quite different from the regular organic fare (such as an organic slimming kit which is a rage in Germany, nutrition supplements, beauty cosmetics, etc.). Also, Organic Haus has been heavily marketing – with billboards all along Marine Drive as well as creating a buzz through Facebook.

Navdanya-The Organic Shop (in Andheri, Mumbai) has been started by Navdanya Organization, a network of seed keepers and organic producers spread across 16 states in India, which started out as a research initiative, led by renowned scientist and environmentalist Dr. Vandana Shiva. They sell a wide range of products ranging from fruits and vegetables, staples, spices, condiments, jams and spreads, dry fruits, tea and coffee to seeds for cultivation.

Not only stores, but dedicated restaurants and cafes are also spurring up. Lumiere is a chain of restaurants in Bangalore and Cochin using only organically grown products from their own farms. Navdanya restaurant at Dilli Haat in New Delhi serves delicious meals prepared with organic ingredients. Deli.in is a chain of organic salad and juice bar with outlets in Bangalore and Pune.

A few years ago, this market was marred by inadequate retail presence, little to no certified branded produce, an incomplete range, uncompetitive price points, and government policies that were skewed towards exports. That said, this space has definitely seen a lot of activity in the past few years – not only in terms of more outlets, higher awareness, higher acceptance despite higher prices, but also in terms of regulations and certification of organic foods by government bodies. The organic food market is still a very niche market – under 5% of the total food market – and has huge scope for growth, some estimates pinning the growth numbers at 40% annually.

This sure has become a space to look out for.

 

By,

Roshni Jhaveri

May 7, 2012 at 9:15 am 2 comments

Why Nuances Matter

The consumer may not always be logical, but understanding his/her thought process is critical to success. Consider an example.

 

Background:

Real Junior juices were launched in 2004 and were targeted at children under six. The juices came in a smaller size (125 ml; the school packs were 200 ml), 2 flavors – Mango and Apple, enriched with calcium, and promised low acidity. The vibrant packs with animated fruit characters were intended to appeal to children by highlighting the taste and nutrition of Real Junior. Despite the different marketing efforts and clear benefits for the children, the brand did not contribute much to the business and was pulled back from the market in 2006.

 

The reasons :

We think, back in 2004, the market was just not ripe for health foods. It is only recently that this health and wellness foods and beverages market has opened up so much because now people have gotten more aware of health problems and perhaps now would be the right time to launch such a product.

Also, during our research on the connection of health and wellness benefits from various products and formats, when asked about the connections they make of nutrients with their source, the consumers said, “Juice with calcium makes no sense, if a milk-based product made a calcium claim, it would be easier to believe”, “If this product had bananas or milk mentioned in it, it would be easier to associate with the calcium claim, juices are associated with vitamins.” In fact, it was after hearing this that we scoured the market landscape for examples of various products that claimed a health benefit from calcium fortification and found the Dabur Junior Juice example.

Lo and behold! Turned out that the nuance we picked up during the research was something that the brand team figured out in hindsight. Basis Sanjay Sharma, General Manager, Sales and Marketing, Dabur Foods, “The problem with Real Junior at the time of launch was more than one. First, it was promoted as a fruit juice rich in calcium, which did not sell. A fruit juice, is after all, a fruit juice, and branding it calcium-rich did not gel well.” (Source: interview given to Business Standard, in 2007)

There were other reasons for the failure too. Basis Sanjay Sharma, “Moreover, it was made available in tetra packs of 125 ml for Rs.10, because that was the quantity Dabur conceived children would be able to finish in one go. So, although the pack size was smaller, packaging costs did not come down and therefore a lower pricing did not bring in revenues. Moreover, other fruit-juices were also available for the same price and pack size, so people did not find much of a reason to switch to Real Junior.”

 

Looking ahead:

But the question to ask is whether Indian households are ready to buy separate products for different members of the household or would much rather prefer a common product that meets everyone’s needs.

In a recent study conducted about health foods and beverages, this is what we heard – “Unless there is something really specific in a product that is critical for the children only, we’d much rather buy a product that all the members in the family can consume”, “a common product helps us control our household expenses as well.”

If you look closely at the recent of Dabur Real ads – the key target are the children in the first and the entire family (child, mumma and dadoo) in the second – but the hook/ the first adopter of the product is the child.

 

So does Dabur really need to segment the market basis age groups or should it stick to its more successful strategy of segmenting basis benefits (Real Juice vs. Real Active)? What do you think? 

 

By,

Roshni Jhaveri

March 7, 2012 at 6:40 am 4 comments

Manana is soon enough for me

The spirit is willing, but the flesh is weak – part 3

These were the questions we’d posed at the end of our first post in this series :

Why do most people fall short of their intentions? Do they try and then give up, or not even try? What do they do in order to stay healthy?

This post explores the answers to these questions.

Most people fall short of their intentions for one key reason –  ‘the man~ana factor’. ‘Man~ana’ is  Spanish for an indefinite time in the future, tomorrow or sometime later; ‘the man~ana factor’ is our term for procrastination, an attitude described with a lot of wit and a fair bit of accuracy in a popular song from decades ago with the refrain ‘man~ana is soon enough for me’.

While they are aware of long-term health problems and maintaining good health is important to them, most people don’t see it as a key problem for themselves; a previous post titled ‘everybody says I’m fine’ had described this attitude. Hence, while they intend to do something about it, it isn’t critical except when they are feeling unwell. As a respondent pithily expressed the fact that practising healthy habits is limited to when one feels unwell,“takleef gayi tho buri aadatein shuru”. Now add to this the fact that time is a commodity in short supply in everyone’s lives, and you know why intent doesn’t translate into action very often.

The people that do exercise regularly are of two types. One, those that are extremely health conscious or appearance conscious – this is the sliver of the population we’ve referred to in multiple posts (here and here). In addition, a chunk of this regularly exercising group is those that already have some health problem and need to manage it, for instance, those that have back pain and do yoga regularly, or those that have diabetes and walk every morning. Often, the shock of having and suffering from the ailment is the wake-up call that jolts them from a state of intent to one of action.

Women often exercise even less than men do;  one, the belief that housework itself constitutes sufficient exercise and two, a tendency to put anything related to themselves right at the bottom of their list of priorities. Even women that do take care of their health sometimes feel the need to rationalise it as necessary in order to ensure that they can take care of the rest of the family; as one woman expressed it, ‘agar tire hi achhi nahin hai, tho gaadi kaise chalegi?’ (‘if the tyres aren’t in good shape, how will the vehicle run?’). Yoga and walking are the preferred modes of exercise amongst women that do exercise regularly; one wonders whether the reason for the popularity of these two is that neither requires special equipment or surroundings, both of which would mean spending on themselves.

Women either wake up early to do yoga (we’ve actually met women that got up at 4 a.m. in order to do an hour of yoga before their daily chores begin!) or do it in the afternoon. Yes, the spurt in the number of yoga channels such as Baba Ramdev’s has added to the popularity of this mode of exercise. Walking is another popular method, though they often cheat their conscience by accepting hot weather / rainy weather / cold weather, in fact, anything less than perfect weather as an excuse for not stepping out. One exceptional lady we met in Bombay though, solved this problem by deciding not to travel via vehicle to any place that was within 2 hours of home – so she walked to the grocer, walked to work, walked to her children’s school, etc. and this kept her fit as a fiddle.

Given the lack of time to exercise, most people rely more on controlling their diet – or trying to – than on regular exercise. Most people, both men and women, believe that eating fresh home-cooked food is one of the best things to maintain good health; hence being on a healthy diet is something that is not too difficult, except for those that have a job that involves travel. Within this broad framework, housewives also recognise the need for some amount of control, so they try to moderate the amount of rice, sugar, oil, etc. they consume and use for cooking, and to increase the amount of green leafy vegetables and cereals consumed. Sometimes leading to frustrating results; as one lady told us, her husband complained about the amount of oil she used and its effects on his health, but when she made parathas with less oil, he refused to eat them as they weren’t tasty enough ! Her solution, to make the parathas with ‘enough’ oil and then dab them with a paper napkin before serving them so that no oil was visible !

Unlike the belief that they are getting a reasonably healthy diet, most people recognise that they are getting nowhere near the required amount of exercise. Concerns about this cause a heightened awareness of exercise solutions available, and probably an over-stated intention to exercise in order to stay healthy as seen in the survey.

Before ending this post, let me mention that while most people believe that their diet is reasonably healthy, they also believe that they need to tweak it slightly in order to address certain specific health issues. Understanding which health issues these are and creating offerings that address them has been the key to many a successful product launch in the past, and it is only this understanding which can lead to the high growth rates that have been estimated for this sector.

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Zenobia Driver

February 7, 2012 at 6:18 am 2 comments

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