The Impact of Ultra-Processed Foods on Public Health in Nepal: A Growing Concern

Introduction

Food processing involves any method that changes food from its natural form, such as drying, freezing, milling, canning, or adding ingredients like salt, sugar, fat, or other additives for flavor or preservation. Nearly all foods and beverages undergo some form of processing before they are bought or consumed. The term "processed foods" includes a wide range of items, from frozen vegetables and canned beans to candies, chips, and sodas. To classify these foods based on the degree and purpose of processing, researchers developed the NOVA classification system. It has classified food into four groups: unprocessed/minimally processed, processed culinary ingredients, processed foods, and ultra-processed foods (UPFs).

UPFs are industrially produced edible items derived from natural or synthetic sources, designed for high profitability and convenience, often enhanced with additives like preservatives, colorings, and flavorings. They are commonly processed through methods such as molding, extruding, hydrogenation, or frying. These products include sugary beverages, snacks, ready-to-eat meals, and reconstituted meat products. The rapid dietary transition in lower and middle-income countries (LMICs) is marked by an increasing demand for UPFs.

The Rise of Ultra-Processed Foods in Nepal

The proliferation of UPFs is driven by socioeconomic factors including urbanization, economic growth, and lifestyle changes. Marketing strategies target all age groups, with children and adolescents being particularly vulnerable. Cultural shifts towards convenience and fast-paced lifestyles have made UPFs a dietary mainstay. Economic disparities also play a role, as lower-income populations often rely on cheaper energy-dense UPFs due to financial constraints.

Over the past 60 years, advancements in food science and grocery retailing have led to a significant increase in the production and consumption of ultra-processed foods. Initially prevalent in high-income countries, this trend has now spread globally across all income levels. The increasing consumption of UPFs is a significant public health issue with profound implications for nutrition and health outcomes. Their consumption has surged globally, correlating with rising rates of obesity, diabetes, cardiovascular diseases, and other non-communicable diseases (NCDs).

Nutrient Composition of Ultra-Processed Foods

Ultra-processed foods are characterized by their high energy content and excessive levels of added sugars, sodium, unhealthy fats like trans fats and saturated fats, and refined carbohydrates. They also tend to lack essential nutrients found in less-processed and whole foods, such as dietary fiber, vitamins (particularly vitamin C and B vitamins), and minerals like potassium and magnesium. UPFs undergo extensive processing that often removes natural nutrients and fiber, replacing them with synthetic additives to improve flavor, texture, and shelf-life. This nutrient profile contributes to their calorie-dense nature and raises concerns about their potential negative impact on health when consumed regularly as a significant part of the diet. They promote overeating due to their convenience, hyper-palatable formulations, disruption of satiety signals, and pervasive marketing, often aimed at children.

Additionally, UPFs frequently contain harmful chemicals such as contaminants from high-temperature cooking, industrial additives that cause inflammation and gut microbiota imbalances, and hormone-disrupting compounds from plastics used in food manufacturing and packaging.

Health Implications of UPF Consumption

Ultra-processed foods present significant health risks that extend well beyond their nutritional content and calorie density. Unlike natural whole foods, where components are digested slowly within their original matrix, UPFs are typically dense in calories and rich in free sugars, refined starches, unhealthy fats, and sodium. These factors contribute to their association with rising global rates of obesity and non-communicable diseases. Beyond their poor nutritional quality, UPFs are hyper-palatable and may contain potentially addictive additives that our digestive systems struggle to break down, altering the gut microbiome and potentially promoting disease in susceptible individuals.

Intensive processing methods can further disrupt the food's structure, affecting digestion and nutrient absorption, while additives like non-sugar sweeteners and emulsifiers have been linked to adverse health effects such as gut inflammation and cancer. Industrial processes used in UPFs also produce harmful substances like acrylamide and advanced glycation end products, which are implicated in chronic inflammatory conditions. Similarly, contaminants from packaging materials used in UPFs pose additional health risks, such as leukemia and other systemic cancers. These diverse factors collectively underscore the complex mechanisms through which UPFs contribute to adverse health outcomes, highlighting the importance of minimizing their consumption in favor of whole, minimally processed foods for overall health and well-being.

Obesity and Metabolic Syndrome

Research consistently links high UPF consumption to an increased risk of obesity and metabolic syndrome. A study conducted in Brazil found a 7% increase in the risk of developing Metabolic Syndrome (MetS) for every additional 150 grams of ultra-processed food consumed per day. Furthermore, individuals in the highest quartile of UPF consumption had a 33% higher risk compared to those in the lowest quartile. Studies show that individuals consuming high amounts of UPFs have higher body mass indices (BMIs) and greater waist circumferences.

Cardiovascular Diseases

The high levels of trans fats, sodium, and added sugars in UPFs contribute to hypertension, dyslipidemia, and other cardiovascular risk factors. UPF consumption has been associated with higher rates of heart disease and stroke, attributed to poor diet quality and the promotion of atherogenic and inflammatory pathways. In the Framingham Offspring Study, an 18-year follow-up revealed that each additional daily serving of ultra-processed foods increased the risk of developing cardiovascular disease (CVD) by 7%. Similarly, the French NutriNet-Santé cohort study found a 12% higher risk of CVD with increased consumption of ultra-processed foods. Meta-analyses provide strong evidence that certain ultra-processed products, such as processed meats and sugar-sweetened beverages, along with nutrients commonly found in these foods, like trans fats and sodium, elevate the risk of CVD. Additionally, epidemiological studies have connected ultra-processed foods to various CVD risk factors.

Diabetes

Diets rich in ultra-processed foods have been implicated in the development of type 2 diabetes. The high glycemic index of many UPFs causes rapid spikes in blood glucose levels, which increases the risk of insulin resistance. Furthermore, the lack of fiber and essential nutrients in these foods exacerbates this risk. Observational studies consistently link ultra-processed food intake with an increased risk of diabetes, with particular emphasis on certain food groups like sugar-sweetened beverages and processed meats. However, there is a notable gap in meta-analyses evaluating the overall risk of diabetes across all ultra-processed food groups. A meta-analysis found that 72% of included studies showed a positive association between ultra-processed foods and diabetes risk. The meta-analysis revealed that moderate intake of ultra-processed foods increased the risk of diabetes by 12%, while high intake increased the risk by 31%.

Cancer

Emerging evidence suggests a link between UPF consumption and certain cancers. Additives, packaging chemicals, and the high calorie content of UPFs may contribute to carcinogenesis. Studies have reported associations between high UPF intake and increased risks of breast, colorectal, and other cancers. The systematic analysis over different time periods reveals a significant positive association between ultra-processed food intake and increased risk of various cancers, excluding prostate cancer, after adjusting for confounding factors. Specifically, higher UPF consumption is linked to increased risks of overall cancer, breast cancer, colorectal cancer, and pancreatic cancer. Additionally, more modest associations were observed for chronic lymphocytic leukemia and central nervous system tumors.

Other Chronic Diseases

Ultra-processed foods have been increasingly linked to various chronic diseases, including hypertension and depression. Studies indicate that diets high in UPFs often contribute to elevated blood pressure due to their high sodium content and poor nutrient profile. Research has shown that individuals consuming more UPFs are at a higher risk of developing hypertension compared to those with lower UPF intake. For example, the Australian Longitudinal Study on Women’s Health investigated the impact of ultra-processed foods on incident cardiovascular disease and hypertension among middle-aged women. The study revealed that those with the highest intake of UPFs (more than 34.2% of total dietary intake) had a 39% increased likelihood of developing hypertension.

Moreover, UPFs have also been implicated in mental health issues such as depression. A study published in the British Journal of Psychiatry highlighted that higher consumption of processed foods, including UPFs, was associated with an increased likelihood of developing depression. The mechanisms behind this association involve nutrient deficiencies and the inflammatory effects of UPFs, which may adversely affect brain function and mood regulation over time. The study underscored that diets rich in fruits, vegetables, and whole grains, which are typically low in UPFs, were inversely associated with depression risk.

Similarly, a study conducted among non-Hispanic White females found that compared to individuals with the lowest quintile of ultra-processed food consumption, those in the highest quintile showed an increased risk of depression as indicated by both strict (HR 1.49; 95% CI 1.26-1.76; P < 0.001) and broad definitions (HR 1.34; 95% CI 1.20-1.50; P < 0.001). Also, comparing the highest and lowest quintiles, the study found that only artificially sweetened beverages (HR 1.37; 95% CI 1.19-1.57; P < 0.001) and artificial sweeteners (HR 1.26; 95% CI 1.10-1.43; P < 0.001) were significantly associated with an increased risk of depression.

Public Health Measures in Nepal

To reduce the consumption of ultra-processed foods, it is essential to combine education, policy, and community initiatives. Launching public campaigns and incorporating nutrition education in schools can raise awareness about the health risks of ultra-processed foods. Implementing clear labeling on food packaging, restricting advertising, and introducing taxes on these foods can further discourage their consumption. Promoting healthy alternatives through subsidies for fresh foods and supporting farmers' markets can make nutritious options more accessible. Community initiatives like establishing community gardens and offering cooking classes can encourage healthier eating habits.

Additionally, encouraging workplaces, schools, and hospitals to provide healthy food options and replacing ultra-processed snacks in vending machines can create supportive environments. Promoting home cooking through meal planning and sharing nutritious recipes, along with working with retailers to prioritize healthier foods and designing urban areas that support access to fresh food markets, can collectively help shift dietary habits towards healthier choices.

Conclusion

Ultra-processed foods pose significant health risks across various chronic diseases, including obesity, metabolic disorders, diabetes, heart diseases, hypertension, cancer, and depression. Studies consistently demonstrate that higher consumption of UPFs correlates with elevated odds of developing different chronic diseases. These findings underscore the detrimental impact of UPFs on both physical and mental health outcomes. To address these challenges, effective public health measures are crucial, including educational campaigns, nutritional interventions in schools, clear food labeling, restrictions on advertising, and taxation of UPFs. Promoting access to fresh foods, supporting community-based initiatives, and fostering environments conducive to healthier dietary choices are essential steps towards mitigating the adverse health effects of UPFs on a population level in Nepal.

Article was jointly Authored by Dr. Suman Paudel and Ms. Rojina Basnet !!!

Rare Diseases are Not Rare in Nepal - A Global Perspective

Rare diseases, despite their name, impact millions of lives globally. The complexity and uniqueness of these diseases demand focused attention and specialized care. This blog post explores the landscape of rare diseases, with a particular focus on initiatives in the United States and the prevalence of certain diseases in Nepal.

Rare Diseases: An Overview

Genetic and Rare Diseases (GARD) Program in the USA

The National Institute of Health (NIH) in the United States runs the Genetic and Rare Diseases (GARD) program, which plays a crucial role in providing comprehensive information about rare diseases. This initiative focuses on:

• Diagnosis and Clinical Information: Simplified and accessible information on various rare diseases.
• Support Systems: Technical, emotional, and social support for individuals and families affected by rare diseases.
• Guidance on Management: Resources and guidance for managing and handling rare diseases.

A disease is classified as rare in the USA if it affects fewer than 200,000 people. There are an estimated 7,000 different rare diseases affecting approximately 30 million Americans. These diseases are not only rare due to the number of people affected but also because of their genetic and pathological intricacies. Many rare diseases stem from unexplained genetic or chromosomal changes. Interestingly, some infectious diseases, particularly those of tropical origin, are also classified as rare in the USA due to their limited prevalence, despite having well-understood mechanisms and management protocols.

Prevalence of Tropical Diseases in Nepal

Many tropical diseases of significant public health concern in Nepal are listed as rare diseases in international registries in Europe and the USA. Marginalized communities in Nepal continue to struggle with diseases that have been eradicated in many other countries. Examples of such diseases include leprosy, lymphatic filariasis, kala-azar, dengue, rabies, and snakebite envenoming.

Nepal has recently faced a significant surge in dengue fever cases, particularly during the rainy season. Despite widespread awareness and treatment facilities, the disease has spread extensively from the Terai region to the hilly and mountainous parts of the country.

In 2018/19, Nepal conducted its first National TB Prevalence Survey, revealing alarming data:

• Prevalence: 416 per 100,000 people, with about 117,000 individuals living with TB.
• Incidence: 245 per 100,000 people, with an estimated 69,000 new cases.
• Mortality: 3.1 times higher than previous estimates.

The high infectivity of TB, combined with increased public movement, poses a significant challenge to eliminating TB in Nepal. Besides TB, diseases like malaria, dengue, rabies, and snakebites are significant public health concerns in Nepal. These are classified as neglected tropical diseases and are often registered under rare diseases.

Solutions and Way Forward

Tackling Infective Rare Diseases

• New Medicines and Active Surveillance: The availability of new medications and active case surveillance are critical in controlling infectious diseases.
• Technology and Education: Utilizing technology and spreading awareness to reduce disease spread are essential strategies.
• Involving Communities: Adopting an integrated approach involving multiple stakeholders and engaging various communities is crucial. For example, sickle cell disease affects multiple generations of specific ethnic groups in the Terai region of Nepal. To combat this disease, the Ministry of Health and central government should implement a national surveillance and prevention program, while local governments should run awareness campaigns. Communities should also promote genetic testing for sickle cell disease before marriage and childbearing.

Addressing Genetic Rare Diseases

• Advanced Genetic Research: High-end genetic research labs and molecular research are crucial for understanding and managing genetic rare diseases.
• Institutional Collaboration: Given Nepal's limited resources, collaboration at the institutional level is necessary to tackle these challenges.

Importance of Disease Registry

• Rapid Development of Disease Registry: Tracking and reporting cases to the national registry is vital for early diagnosis and management.
• Implementation of Treatment Options: Immediate application of the best available treatment options is crucial.
• National Policies: Specific national policies need to be formulated and implemented swiftly. For instance, a malaria control program should start by identifying high numbers of malaria cases, followed by targeted interventions. Similarly, rabies control can be managed through vaccination campaigns and zoonotic spread awareness.

Conclusion

Addressing rare diseases requires a multifaceted approach, combining advanced research, public health initiatives, and international collaboration. By developing robust disease registries and implementing effective national policies, we can make significant strides in managing and potentially eradicating these conditions.

References

1. National Institute of Health - GARD Program
2. National Cancer Institute - Definition of Rare Disease
3. The Increasing Problem of Tuberculosis in Nepal
4. World Health Organization - Nepal Commemorates World Neglected Tropical Diseases and World Leprosy Day 2024

The Evolution of Food and Nutrition: From Ancient Practices to Modern Trends

Food and nutrition have been vital components of human existence since the dawn of civilization. Our ancestors' relationship with food has undergone significant transformations, from hunting and gathering to the development of agriculture, and further into the complexities of modern dietary practices. This blog post explores the historical perspectives on food and nutrition, tracing the journey from ancient times to the 21st century.

Ancient Practices: Hunter-Gatherers to Early Agriculture

Hunter-Gatherer Societies

For thousands of years, human survival depended on hunting wild animals and gathering edible plants. This hunter-gatherer lifestyle required vast knowledge of the natural environment, as people had to identify safe and nutritious food sources. Their diets were diverse, encompassing fruits, nuts, seeds, meat, and fish, providing a variety of nutrients essential for their physical demands.

The Neolithic Revolution

The transition from hunting and gathering to agriculture marked a significant turning point in human history. Known as the Neolithic Revolution, this period saw the domestication of plants and animals. Agriculture allowed humans to settle in one place, leading to the establishment of communities and the development of more complex food systems. With the ability to grow and store food, diets diversified and populations increased.

The Rise of Civilizations: Food and Social Structure

Ancient Civilizations

As civilizations arose in regions like the Middle East, India, China, and the Mediterranean, food and nutrition systems became more intricate. The ancient Egyptians, for instance, developed a social hierarchy centered around food, while the Chinese emphasized balance in their dietary practices. These early societies understood the importance of a varied diet, incorporating grains, vegetables, and proteins.

Medieval Period

During the Middle Ages, food became closely linked to religion and social status. Feasts and religious festivals showcased the abundance of food, while the wealthy demonstrated their prestige through elaborate meals. This period also saw the introduction of new culinary techniques and the exchange of ingredients due to trade.

The Age of Exploration: A Culinary Exchange

The 16th century marked the beginning of global exploration and the introduction of new foods and ingredients between the Old World and the New World. European explorers brought back potatoes, tomatoes, maize, and cacao from the Americas, revolutionizing European cuisine. This exchange not only diversified diets but also led to the development of new culinary traditions and techniques.

The 19th Century: Industrialization and Nutrition Science

Industrial Revolution

The 19th century brought dramatic changes with industrialization and urbanization. Advances in food production and preservation techniques, such as canning and refrigeration, allowed for the mass production and distribution of food. This period saw the rise of processed foods, including canned goods, refined sugar, and white flour, which became staples in the modern diet.

Scientific Advances

During this time, significant progress was made in the field of nutrition science. Researchers began to understand the role of vitamins and minerals in the human body, leading to the concept of a balanced diet. The increased availability of nutritional information helped shape public health policies and dietary guidelines.

The 20th Century: Modern Nutrition and Dietary Guidelines

The 20th century continued to build on the advancements of the previous century. The publication of the Dietary Guidelines for Americans in 1980 provided a framework for healthy eating, emphasizing the consumption of a variety of foods to meet nutritional needs. These guidelines have been regularly updated to reflect the latest scientific evidence.

Public Health and Nutrition

Public health efforts in the 20th century focused on combating deficiencies and promoting balanced diets. Food fortification, such as adding vitamins and minerals to staple foods, played a crucial role in preventing diseases like rickets and pellagra. Nutrition education campaigns aimed to inform the public about healthy eating habits.

The 21st Century: Sustainable and Personalized Nutrition

Sustainable Food Systems

The 21st century has seen a shift towards sustainable food systems. There is a growing emphasis on locally-grown, organic, and nutrient-dense foods. Sustainable practices, such as organic farming and vertical farming, aim to reduce environmental impacts and ensure food security. Consumers are increasingly seeking foods free from artificial ingredients, hormones, and preservatives.

Technological Innovations

Advancements in technology have transformed food production and nutrition. Hydroponics, aquaponics, and vertical farming allow for higher yields with less land and water. Additionally, food safety has improved with policies ensuring traceability and quality control.

Personalized Nutrition

The rise of personalized nutrition, driven by technologies like DNA testing and artificial intelligence, offers tailored dietary advice based on individual genetic makeup. This personalized approach aims to optimize health outcomes by considering unique nutritional needs and preferences.

Conclusion

The journey of food and nutrition from ancient practices to modern trends highlights the dynamic relationship humans have with their diets. Understanding this history helps us appreciate the importance of making informed choices about what we eat. As we continue to advance in the fields of food production and nutrition science, the focus remains on promoting health, sustainability, and personalized dietary practices for a better future.

Jointly Authored by Dr. Suman Paudel and Ms. Rojina Basnet !!!

For more insights and updates on food and nutrition, stay tuned to Research Sapling.

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References

- Public health nutrition: a historical perspective [PubMed](https://pubmed.ncbi.nlm.nih.gov/8120295/)

- A brief history of nutrition [Natural Healers](https://www.naturalhealers.com/blog/nutrition-history/)

- History of modern nutrition science [BMJ](https://www.bmj.com/content/361/bmj.k2392)

- The history and future of food fortification in the United States [PubMed](https://pubmed.ncbi.nlm.nih.gov/11842999/)

The Global Threat of Emerging and Resurging Infectious Diseases: A Call for Proactive Measures

The emergence and resurgence of infectious diseases represent a significant public health threat on a global scale. This issue is particularly pronounced in least developed countries with low and lower-middle incomes, such as Nepal. Despite advancements in healthcare, infectious diseases continue to impose a substantial burden on our society, with a notable increase in deaths attributed to emerging and re-emerging viral diseases and new virus infections compared to seasonal and endemic infections.

The Past Century's Pandemics: A Stark Reminder

The past century has witnessed several pandemics caused by RNA viruses, leading to substantial morbidity and mortality worldwide. These include outbreaks of diseases such as the Spanish Flu, Asian Flu, and more recently, the COVID-19 pandemic caused by the SARS-CoV-2 virus. The devastating impact of the COVID-19 pandemic serves as a stark reminder of the urgent need to address emerging infectious threats. In Nepal, the COVID-19 pandemic has severely strained the healthcare system, highlighted gaps in public health preparedness, and exacerbated existing socioeconomic inequalities.

COVID-19 in Nepal: Impact and Challenges

The COVID-19 pandemic hit Nepal hard, exposing the country's vulnerabilities in dealing with large-scale health emergencies. With limited healthcare infrastructure, inadequate medical supplies, and a shortage of healthcare professionals, Nepal faced significant challenges in managing the crisis. The pandemic resulted in widespread illness and death, disrupted daily life, and caused severe economic hardship.

Healthcare System Strain: Hospitals and healthcare facilities in Nepal were overwhelmed with COVID-19 patients, leading to a shortage of hospital beds, ventilators, and oxygen supplies. The healthcare system struggled to provide adequate care, and many non-COVID-19 health services were disrupted.

Economic Impact: The pandemic led to widespread job losses, reduced income, and increased poverty. Lockdowns and restrictions severely impacted industries such as tourism, which is a significant source of revenue for Nepal. The economic downturn has had long-lasting effects on the livelihoods of many Nepalese citizens.

Education Disruption: School closures and the shift to online learning created a digital divide, with many students lacking access to necessary technology. This has resulted in significant learning losses and widened educational inequalities.

Mental Health Crisis: The prolonged pandemic and its associated stressors have led to a rise in mental health issues, including anxiety, depression, and trauma. The mental health infrastructure in Nepal is not equipped to handle this increased demand for services.

Factors Influencing the Spread of Infectious Diseases

The spread of infectious diseases is influenced by various factors, including socioeconomic conditions, land use, climate, and biodiversity. Vector-borne and zoonotic viruses are particularly sensitive to changes in climate and biodiversity, highlighting the interconnectedness of human, animal, and environmental health. This interconnectedness underscores the importance of adopting comprehensive strategies to manage and mitigate these threats.

Case Study: Monkeypox and COVID-19

One example of a viral zoonotic disease is monkeypox, which has garnered attention due to recent outbreaks reported in multiple countries. The spread of monkeypox underscores the importance of adopting a One Health approach, which emphasizes collaboration between human and animal health sectors to detect, prevent, and control infectious diseases. This approach is crucial for effectively managing diseases that can jump from animals to humans, posing significant public health risks.

Similarly, the COVID-19 pandemic, caused by the SARS-CoV-2 virus, has highlighted the need for a coordinated global response to infectious diseases. The pandemic has shown how quickly a virus can spread across borders, causing widespread illness and death, and underscored the importance of international cooperation in disease surveillance, research, and response.

The One Health Approach: A Path Forward

In conclusion, proactive measures are essential to address the challenges posed by emerging infectious diseases, particularly those caused by RNA viruses. By adopting a One Health approach and enhancing preparedness efforts, we can mitigate the impact of pandemics and safeguard the health and well-being of our communities. This approach fosters collaboration across various sectors, including public health, veterinary health, and environmental health, ensuring a comprehensive response to infectious disease threats.

Taking Immediate Action and Long-Term Strategies

Immediate Actions

Strengthen Healthcare Systems: Improve healthcare infrastructure and access, particularly in outskirts of Nepal. This involves increasing the number of healthcare facilities, sufficient human resource ensuring adequate medical supplies, and training healthcare professionals.

Enhance Surveillance: Implement robust surveillance systems to detect and monitor infectious diseases promptly. This includes improving diagnostic capabilities, increasing testing availability, and ensuring timely reporting of cases with special attention at the border area of Nepal with India and China from where there is high influx of people. Surveillance program should be further strengthen by building capacitated quarantine facilities. 

Promote Vaccination: Ensure widespread access to vaccines, including COVID-19 vaccines and other essential immunizations. Public health campaigns should focus on educating communities about the importance of vaccination and addressing vaccine hesitancy. Use of national media like Radio, Television, Newspaper and social media can be implemented for addressing hesitancy. 

Provide Economic Support: Offer financial assistance to those affected by the pandemic, including unemployment benefits, business support, and social safety nets. This helps mitigate the economic impact and supports recovery efforts. Effective implementation and monitoring of social security programs endorsed by the government such as health insurance program, The senior citizen's allowance, The disability allowance, Endangered Ethnicity allowance, Bipanna Nagarik Aaushadhi Upachar  etc. 

Enhance Public Awareness: Increase public awareness about the importance of hygiene, vaccination, and early detection to prevent the spread of infections. Public health messaging should be clear, consistent, and accessible to all segments of the population. This message should be flowed from all the healthcare centers at each local level supported by national media. 

Long-Term Strategies

Invest in Research and Innovation: Invest in research to understand emerging pathogens and develop effective treatments and vaccines. This includes funding for scientific research, partnerships with international organizations, and support for innovation in healthcare. Research and collaboration activities should be led by national organizations like Nepal Health Research Council (NHRC). 

Foster International Collaboration: Encourage collaboration between governments, health organizations, and communities to address the root causes of disease emergence. Global cooperation is essential for effective disease surveillance, research, and response. Action should be initiated and regulated from the ministry level. 

Adopt One Health Approach: Promote the One Health approach, which recognizes the interconnectedness of human, animal, and environmental health. This involves coordinated efforts across sectors to prevent and control infectious diseases. All the stakeholders like ministry of health, ministry of agriculture and ministry of environment should come together in order to make collaborative effort on one health approach. 

Improve Environmental Health: Address environmental factors that contribute to the spread of infectious diseases. This includes promoting sustainable land use practices, protecting biodiversity, and mitigating climate change.

Strengthen Health Infrastructure: Build resilient health systems capable of responding to current and future infectious disease threats. This involves investing in healthcare infrastructure, training healthcare professionals, and ensuring access to essential medical supplies.

Promote Education and Technology: Enhance access to education and technology, particularly in rural and underserved areas. This includes expanding digital infrastructure, providing technology for remote learning, and addressing the digital divide.

By taking these proactive steps, we can build resilient health systems capable of responding to current and future infectious disease threats, ultimately protecting global health and ensuring a safer, healthier future for all. The COVID-19 pandemic has provided valuable lessons that should guide our efforts in preparing for and mitigating the impact of future pandemics, ensuring that we are better equipped to handle any public health crises that may arise.

                  Jointly Authored by Dr. Suman Paudel and Dr. Yogendra Shah !!!