ECO-HEALTH SERIES South-South Solidarity
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Acknowledgements
Among the many people who we want to thank for their assistance
in compiling this report are those specialists from the various
institutes profiled, Since they are too numerous to name, please
refer to Annexure I for a complete listing.
Team Leader: Ms. Jill Carr-Harris.
Principal Investigator: Dr Almas Ali.
Production Associate : Ms. Sangeeta Agrawal.
Word-processing: Mr Harish Bhatia.
f
Table of Contents
Section 1:
Introduction and Overview
Section 2:
Institutional Profile
Annexure
i
I
i
I:
1.
ITRC
2.
NIOH
3.
AIIHPH
4.
NICED
5.
MRC
6.
NEERI
List of People and Organizations Visited.
Annexure II:
Literature Survey
Annexure III:
Viewpoint of the Principal
Investigator on Tribal Health
Eco-Health Series Assessing the Potential of Environmental Health
Research in India.
SECTION I: INTRODUCTION AND OVERVIEW
The environment-health link, or what we are denoting here as ecohealth[l] is an attractive new arena for research in the years
ahead.
It is evident to the public at large that declining
ecosystems -- whether natural or man-made - - are having an
adverse impact on the health of our population^ and this in turn
is compounding the rate of environmental decline,
_______
Needless to
say, this downward environment and health spiral will pose an
immense challenge
< ’ ""
to state planners and administrators in future.
Slogans like 'Health for \11
All by the Year 2000' will become
hollow, and remain like some kind of panacea at best, if the
present state of affairs continues.
In the most recent of the Government's Five Year Plans[2],
industrialization programs and development generally, have to be
accompanied by planned social benefits and environmental
entitlements
to
the weaker sections of
the population,
particularly those most affected by declining ecosystems-— that
is, if constitutional regularity is to be observed[3].
Whatever welfare measures the Government has adopted for the
environmentally destitute have clearly not been adequate,
Part
of the reason may be tha’t Gov e r nm ent—plain lets STe hot. prOperdry
supplied with health status reports on these populations.
The
absence of health reporting is. unfortunate given the scores of
environmental health experts in this country.
Added to this, is
the fact that little attention is paid to evaluating health risks
and potential hazards in development programs.
This is not
techniques
because
are
not available, on the contrary, the
pioneering work carried out in environmental assessment and
monitoring
in
India,
have
quantitative techniques which
apparently
lend themselves readily to health assessment[4].
impacts are rarely considered
spite of this,
health
development projects[5J.
In .
in •
.It goes to
show that the State is more interested in
envi ronmental assessment and monitoring related to regenerating
natural resources than it is in safeguarding people's health.
After all, natural resource preservation will provide a long-term
economic return, whereas health safeguards are merely a welfare
measure requiring more Government investment.
[1] ecosystems and health, not ecology and health.
[2] 1985-89 Five Year Plan.
[3] As
is
the
case
with
many
of
Government's
policy
prescriptions,
entitlements
rarely reach poor households,
In any event an example of such
entitlements is•the case of
the incentives provided to tribal communities to switch over
to settled farming from traditional 'slash and burn'
cultivation.
[4] See discussions with Dr Badrinath at NEERI.
[5] Health impacts are rarely considered both in setting up
industrial
centres, and are also not adequately figured into
development schemes i.e. ground-water
state-sponsored
development, etc.
1
<
ENVIRONMENTAL HEALTH RESEARCH
Environmental health research has hitherto been linked to
a
greater
extent
to
industrialization
or infrastructural
development -- more
than
it has tosocial
development [6].
Consequently in the large body of literature consulted for this
report[7], the research focus generally has either
been on
environmental hygiene or on civil and industrial engineering as
it relates to public health.
This leads researchers to determine
various standards and permissible limits -----related
-1 to_ food, water
and air safety,
quantifying the degree of contamination rather
than looking at its impact on the overall rural and
urban
environment, and the consequent decline of human health.
Moreover scant attention has been paid to the effect of these
ecosystems on the plight of the poor. With a clear in-built bias
towards the urban elite and industrial work-places, it is
difficult for environmental health research to meet contemporary
challenges.
Even with an increasing public: awareness
awareness of
of the
problems of neaitn
health emanating from a g
good environment, only
exceptional studies have dealt with environmental
There are exceptions however,
In this report we have noted some
examples of programs and scientific papers carried out at a
variety of research >centres in India that have advanced these
notions of environmental health. We have categorized these
studies with a view to identifying priority areas for future
research.
It is the contention of the authors that if some of
this research systematically addresses some of the urgent
problems, it could have an impact on the development programs
sponsored by NGOs and governmental bodies in future.
OPPORTUNITIES IN ENVIRONMENTAL HEALTH RESEARCH
Based on a literature review, there seemed to be two progressive
strands of environmental research to date.
Firstly, the micro
studies that have assessed the changing health status of a number
of vulnerable groups because of their environment
(Workers
environment[81.
[8].
in the unorganised sector, tribals, women,
etc.);
and
secondly,
women, etc.); and ______
the studies that use an integrative
(
’
“'
• - •
(interdisciplinary)
approach
to environment and health which evaluates the capability of a
population to withstand a changing external environment,
In what
follows we assess in what institutions, this kind of research is
being carried out.
[6] Environmental health research has been pursued since the
British period of administration.
After Independence
from
the 2nd Five Year Plan onwards such research
research was
was linked
linked to
to
India's infrastructural development. Unlike other development
sectors, it has not become community based technology.
[7] see Annexure II for listing of review publications.
[8] Environment here could mean that which is ecological,
economic, psychosocial and so forth.
•i
2
(A)
Vulnerable Groups
Occupational health of poor in the unorganised sector
An
example of vulnerable groups are the poorer sections of the
labour force.
Mine and quarry workers,
workers r agricultural and
plantation workers, those in agate production, bidi rolling,
glass manufacture, carpet weaving,. to name only a few,
all Jxaw
draw
few
a certain relation between internal health and the external
environment.
In these cases, the environment 1is usually
detrimental to their health and well-being, primarily because the
workers cannot control the economic, political, social conditions
that give rise to their environment.
Microstudies are being carried out which look at some of the
health hazards within these environments.
These have been
done by many of the national institutes and other research
centres.
In the institutional profiles found in this report, the two
institutes principally involved, in environmental health
research of vulnerable workers groups have been ITRC and
NIOH.
Women7s Health - Another example of vulnerable groups
has
been the whole area of women's health.
In this case, actual
experiences with women in mobilizing them to development have
led to a number of development documentaries.
From this
increasingly a holistic approach has been developed in which
the environment (whether physical, psychological,
or
ecological) is believed to be responsible for a process of
general weakening, and the high incidence of morbidity and
mortality among women.
A substantial amount of work has been carried out by groups
in the NGO sector. In view of the interest also generated by
Government institutes/ departments there is a number of
occupational studies concerning women's health that can be
found.
In the institutes surveyed particular attention was
given to this by ITRC and NIOH.
Tribal Health - Specialists relate the degenerating ecosystem
of a given tribal community to their health conditions.
Drawing on clinical, anthropological and other social
studies, they do not so much integrate the disciplines of
environment and health, as presume that tribals (who are
forest dwellers) are ecologically determined. They argue that
their external state mirrors their inner state of health.
Therefore with the current rate of deforestation for
instance, there will be an impact on their rate of morbidity
and mortality.
I
In looking at where environmental health studies on tribals
are being carried out, it is clear some of the Tribal
Research Centres (of which there are more than ten in India)
are doing studies, but some of the most pioneering work is
being carried out by individuals, NGOs and in academic
circles.
Such studies reflect a multi-disciplinary
approach[9].
[9] See Annexure III.
3
B)
INTEGRATIVE AND INTERDISCIPLINARY RESEARCH
The other progressive research thrust Is the attempt to
integrate environment and health sciences either through the
use of an integrative science or
by using an inter or a
multi-disciplinary approach,
In the case of a vulnerable
group, it is a self-evident that a group would have a
deleterious ecosystem.
But for a large portion of the
population it is not visibly evident that the environment is
negatively impacting on the health of this population. That
is why an integrative science/interdisciplinary science is an
important tool.
It is crucial therefore to have a way of assessing the
capacity of a population to adapt to a changing environment.
This requires a method for understanding the point at which a
population begins to weaken and where their natural systems - environment and health — are no longer able to cope.
Judging by the capacity does not mean waiting for their
weakened state to become manifested in disease or death.
As this general weakening process is not part of the clinical
practices held by medical scientists other sciences or
methods are sought.
A few of the examples cited below are
epidemiological methods, population or ecological studies.
Each of these are integrative and are capable of being
incorporated with an inter or multi-disciplinary approach.
Epidemiological Studies:
Many epidemiological studies,' in
illustrating how disease is affecting a given community draw
on data other than clinical observations to substantiate
their claims.
Socio-economic and environmental data are
usually assessed.
Through this integrative technique
environmental conditions which are responsible for rendering
a poor health status of a given population can be identified.
Although the environmental conditions are defined as physical
causal agents by conventional epidemiology, some effort has
been made at using a multi-disciplinary approach so as to
broaden the scope of epidemiological techniques.
In the institutes reviewed, all of them use epidemiology to
varying degrees. What is noteworthy is that the research most
systematically addressing environmental health, are those
with a multi-disciplinary approach.
Population Studies:
Population studies, through the use of
various demographic techniques can project a certain set of
epidemiological variables into the future and suggest the
level of risk to a population's health.
In this sense
population studies carried out by specialists are using an
integrative approach to environmental health.
Studies that have been pioneering new techniques for
assessing the health status of ecologically vulnerable
populations tend to take a quasi-holistic approach, and are
4
(
(
not as much an integrative science.
Drawing on social
sciences and developmental research, they can show some of
the
social
consequences
of
environmental
decline,
particularly on people affected by development projects and
on those affected due to a declining resource base.
The
destructiveness of this environmental change can be verified
through environmental sciences.
INSTITUTIONAL REVIEW
Simultaneous to the literature review, we carried out an
assessment of the capability of a few of the research institutes
in this country, which handle aspects of environmental health, to
evaluate whether they were concerned as institutes (not
individuals in institutes) with
a) the changing health
pattern/ecosysteni of vulnerable groups;
__ integrative or
b)t the
interdisciplinary approach to environmental' health,
Out of six
that were reviewed in detail all of them used the integrative
discipline of epidemiology and only a few focussed on vulnerable
groups[10].
NEER I (National Environmental Engineering Research Institute)
functions under the CSIR (Council of Scientific and Industrial
Research), and has to some extent adopted a multi-disciplinary
approach to the issues of air and water quality assessment and to
the disposal of waste-water and solids (see Sec.II for details).
Although their work may be uniquely interdiscipinary in the
context of environmental engineering, they are not integrating
disciplines of environmental health.
For instance they do not
have quantitative techniques for assessing health risks in their
environmental assessment and monitoring, and they do not have any
medical officers in their institute.
MRC (Malaria Research Centre) — This institute, is a part of the
constellation of the, ICMR (Indian Council of medical Research)
and focuses on the public health hazards related to malaria.
Using a multidisciplinary method drawing from the environmental
and health related sciences, it has located endemic centres and
taken preventive, often bio-environmental control measures, which
are ameliorative both from the social and environmental point of
view.
NIOH
(National Institute of Occupational Health).
This
institute also functions under the ICMR.
They have done an
extensive amount of work on vulnerable/economic groups.
Mostly
focussing on agricultural labourers, and those in the unorganized
sector, fully studying the health hazards associated with their
working environment. They have also tried to promote occupational
safety as a health priority through intersectoral coordination.
ITRC (Industrial Toxicological Research Center) functions under
the aegis of CSIR. It has carried out a number of pioneering
studies on worker's groups. However, less attention has been paid
to environmental health problems in the rural or urban
environments.
[10] We specifically chose research.institutes instead of NGOs in
this study.
We appreciate however that many voluntary
groups have done pioneering work in environmental health.
In the second of the Eco-Health Series, we plan to cover
this.
5
(
AIIHPH (All India Institute of Hygiene and Public Health), is
under the Ministry of Health, Government of India.
It has taken
up some important studies related to sanitary engineering.
In
collaboration with NEERI, it is studying two sites on the Ganga
to determine the quantum of pollution as part of the National
Ganga Action Plan.
Paradoxically these two studies are being
carried out by non-medical staff of the Institute.
NTCEP (National Institute for Cholera and Enteric Diseases)r also
functions under the ICMR.
This institute by and large is
confined to the gambit of environmental hygiene in its studies of
communicable diseases.
PRIORITY AREAS FOR ECO-HEALTH RESEARCH
In suggesting some priority areas for future eco-health research,
it is necessary to make a radical departure from present day
environmental health research.
As we have seen in the sample
literature review, and institutional study, these state-of-theart publications are only partially advancing the study of a
degenerating ecosystem and its impact on people's health.
One of the priorities of research is to develop a health
sociology of environmental change.
Over the last two decades
there is increasing recognition of the damage caused by the
destruction of our natural resources, the processes of
industrialization, urbanization and modernization, and the
consequences of underdevelopment and exploitation.
What is less
understood however is how these and other changes impact on
people's immediate environment, and to what extent do they alter
people's conditions predisposing them to disease and premature
death.
Through micro-studies, various environmental health studies can
be recorded.
In achieving a large enough sampling it will be
possible to generalize on some of the health problems that are a
direct result of environmental change, and to determine which are
the most vulnerable populations.
This could be done on a block
by block basis so that it would not be restricted to any
traditional group per se (tribals, women, etc.)
In this way we
would be understanding another major factor of poverty since
India's program of industrialization began.
A second priority area is to look at basic needs. Once these
vulnerable groups
are
identified,
environmental
health
researchers would have to redefine basic needs in a way that
preserves a balance between their internal and external
environments.
rThe
"’
currently practised basic needs focus only on
subsistence and not on ameliorating the environment which causes
the health decline,
New parameters for determining basic needs
will need to be drawn up.
ird—priority area would be to take up health impact
assessment_ in all development projects.
This would mean that
methods for quantifying and forecasting health risks would have
to be refined for assessment and for monitoring, and that these
health risk statements would have to be part of the design and
operationalization of projects.
6
And finally a research priority is JtP_ develop an integrative
approach to environment and healtlT _s.Q preventative measures can
be
taken
in advance.
—
.
.
,
. 'Through
a transdisciplinary method (or at
least a more holistic approach) 5*
the long-term decline of people's
environment and
health
avoided
-- ---_.i can be avoided.
Sociology of Environmental Change
Micro-studies that reflect the large scale destruction of our
natural, physical and social environment can be done using a
systems approach,
By adopting the following five groups as a
reference for the micro studies,, we
’
will be able to reflect upon
the large scale environmental changes and pin-point the
vulnerable groups as well.
These are:
1)
Factors and processes of environmental change leading to a
degeneration of land and land-based ecosystems and the
decline of a population's health.
2)
Factors and processes of environmental change leading to a
degeneration of water and water-based ecosystems and the
decline of a population's health.
3)
Factors and ]processes of environmental change leading to a
degeneration1 of _
urban ecosystems and the decline of a
population's health.
4)
Factors and processes tof environmental change leading to a
degeneration of rural1 ecosystems and the decline of a
population's health.
5)
Factors and processes of environmental change leading to a
degeneration of social environment and the decline of a
population's health.
Basic Needs Assessment of Vulnerable Populations
This can only be carried out once the vulnerable populations are
identified. Basic Needs may include such items as:
1)
Food
Production, availability and distribution
Food Safety
Food Security
2)
Drinking Water and Sanitation
(
Availability,
Distribution and
Conservation
(
4
I
I
7
Looking
at basic needs of food using parameters of eco-health
may involve the following:
I^ent_ifying major causes and contributing factors of
malnutrition (more particularly undernutrition) in
specific circumstances, due to degradation of the
environment and
degeneration of the eco-system (i.e.
drought affected area/arid areas/hilly areas, etc.).
Establishing
linkages and
relationships
between
environmentally
degraded
areas
and
not
only
malnutrition (visible forms like PEM - Gr. III and IV
i.e. . severe
Gr.II - moderate and
and some‘ specific
nutritional deficiency disorders) but also general
physical and psychological weakness.
Detecting
communicable/non-communicable
diseases
communicable/non-communicab 1e
(including genetic disorders) which either aggravate or
precipitate malnutrition.
Detecting maternal malnutrition (particularly among
those having babies with low birth rate and high
perinatal/high seasonal mortality.) °
v
/
Evaluating health risks due to agricultural chemicals
(pesticides, fertilizers etc.) and elaboration of foods
standards and codes of practice relating to various
food contaminants and to chemicals used in food storage
and food processing (additives and preservatives).
Preventing reduction and control of food contamination
of biological origin to prevent food borne diseases.
\/Assessing of safety of food irradiation applied for
preventing food wastage both directly x (extension of
shelf life) and indirectly (primary preventioni of food
borne diseases).
Assessment of Health Impact in Development Projects
There is also an urgent need to incorporate or include
component/health impact analysis statement in all feasibility
studies of infrastructural
(industrial/developmental proj ects
both major/small)
as
aa
as
necessary
part
of
the
broader
environmental 'TImpact Assessment/Analysis (EIA) studies.
This
will also require the development of appropriate methods /
techniques / parameters / indices which could be used in
providing a health impact statement, not only of major projects
(industrial / thermal / mining / irrigation etc.) but also
also on
smaller projects so as to evaluate the health risks involved
(including
determining
the
causal
relationships
between
environmental change and weakening condition of the body.)
Integrative Approach to the Study of Environment and Health
The environment in which we live is an ecosystem or an
integration of physical and social relations,
Therefore usually
the conditions of ill-health are the result of a multiplicity of
This makes the correlation between environment and'ill
Health difficult.
---------Generally
scientists today determine all the
8
. i
environmental factors through clinical testing of the disease and
its causal agents, but this is very partial.
What is necessary
is to identify the social and physical relations, so that
preventive health measures can be established.
Through such an
exercise we can determine the kind of environments that are
connected with ill-health.
The social factors that may impinge on a person's health can be
found in many settings whether in thei home or work-place or in
the rural or urban environments.
difficult to
The physical relations in contrast may be more
Simply stated, a common disease like malaria can
categorize.
be used as an illustration.
Much work has been done in India on the bio-organic conditions
that predispose a population to malaria. Biologists have a clear
notion on the optimal conditions for parasite breeding and vector
transmission such as the quantum of humidity, temperature and
other spatial and temporal conditions.
But along with this,
there has been little exploration of people's use or misuse of
water resources, and its impact on increases in malaria.
This
may be related to such things as the location of settlements, the
impact of modern agriculture and the increased use of pest
management among the field crops, the impact of large-scale dams,
the pollution in urban centres and many other factors that have
raised the incidence of malaria.
Without a shift in viewpoint health specialists will continue to
treat symptoms, and environmentalists will be unable to orient
environmental change towards more balanced human health.
This
although is the greatest of challenges, nonetheless an imperative
of sustainable development for human survival, and new efforts
must be made in this direction.
9
SECTION II:
INSTITUTIONAL PROFILES
Introduction
The purpose of this section is to have an idea about the type of
research being carried out in the field of environmental health
in some of the selected research institutes of the country and to
review research literature on environmental health (with a view
to what ought to be done) available in these institutes.
The
selection of the institutes to be visited was initially not
guided by any specific criteria except that the institute should
be of national stature and importance, relatively old enough and
also should have contributed considerably in the field of
environmental health research.
The following six institutions
were selected for the study:
(1) Industrial Toxicological Research Centre (ITRC), Lucknow.
(2) National Institute of Occupational Health (NIOH), Ahmedabad.
(3) All India Institute of Hygiene and Public Health
Calcutta.
(AIIHPH),
(4) National Institute for Cholera and Enteric Diseases (NICED)t
Calcutta.
(5) Malaria Research Centre (MRC), Delhi.
(6)
Environmental
National
(NEERI), Nagpur.
Engineering
Research
Institute
A four-week travel program was designed to gain an overall
understanding of the type of research work being carried out in
were held with most of the senior
these institutes. Discussions
L
Not only the personnel from these
researchers in each place.
institutes, but others having relevant expertise and experience
were also contacted.
While list of contacts and institutes
appended
in
Annexure I, the list of resource
visited is
from' these institutes is
collected
materials/publications
What
follows
is the profiles of the
appended in Annexure II.
Institutions visited.
10
ITRC_r—flndus_trial Toxicology^Regearch_centre)
Industrial Toxicological Research Centre under the aegis of CSIR
is a pioneer laboratory dealing with effects» of
of industrial
industrial and
environmental pollutants on environment and human health,
A
number of epidemiological surveys have been conducted and
occupational health problems have been studied by
the
epidemiological division of ITRC.
The main categories o f
problems that have been studied in ITRC with an epidemiological
approach have been dealt with in detail i__
__
in paragraphs
that
However, it would be worthwhile to highlight'here
follow.
However,
\
j that,
studies on the role of various factors like age,
sex,
physiological status, nutritional status, genetic make-up in
relation to morbidity which had remained hitherto largely
unexplored in the Indian context are being taken up - as also
multimodel studies establishing links between socio-economic
conditions and toxic stress.
Since the mid 1980s when the project on Human Exposure Assessment
Location (termed HEAL) had been initiated, some attention has
been diverted from occupational health to the studies of human
exposures from air, water and food.
Besides the environmental
monitoring (analysis) of the pollutants in air, water and food,
analysis of environmental pollutants and their metabolites in
blood and urine of populations exposed to metals, pesticides, and
some other chemicals have been also carried out.
Holistic
studies under the National Drinking Water Mission at Koraput and
Barmer have highlighted the need for bringing health protection
to rural masses in times of climatic and environmental stress.
The epidemiological section of this Institute is quite strong
with a good team of doctors, Though a substantial amount of work
has been done in the area of epidemiology focussing on those in
the unorganised sector, sufficient attention has not been
specifically paid in studying such vulnerable groups like women
workers. To sum up, although the work of epidemiological section
may be interdisciplinary in the approach, the epidemiological
studies are lacking in integrating the environmental linkages.
Also, there is no meaningful collaboration and coordination
between different sections of the institute in the process of
designing such interdisciplinary studies.
Therefore, it seems
there is scope and opportunity to develop a more systematic
approach in conducting multidisciplinary epidemiological studies
drawing expertise from the disciplines of environmental sciences
of the various sections of the same institute.
Even
collaborative ventures with environmental institutes like NEERI
may yield more multi-disciplinary findings.
■
The ITRC at Lucknow was founded in 1965 with the following aims
and objectives:
I
x/1’
To identify through systematic epidemiological surveys the
health hazards to which industrial and agricultural workers
are exposed in their work environment.
/2)
To undertake safety evaluation of chemicals used in industry,
agriculture and day to day life.
3)
To conduct experimental studies on the mode of action of
chemical pollutants and develop research capabilities in
relevant scientific disciplines.
«
■3OA/
11
I
4)
To
develop
suitable
diagnostic
remedial/preventive measures and,
5)
To collect
chemicals.
and
disseminate
tests
information
and
suggest
on
hazardous
In 1TRC, indepth toxicological research has been done on priority
chemicals such as heavy metals, industrial dusts and fibres,
plastics and polymers, hydrocarbons, pesticides, detergents, dyes
and food additives,
additives.
These research activities are being done in
separate sections.
Various research and development sections have been listed under
five broad groups, viz:
C
i)
Preventive Toxicology
ii)
Pesticide Toxicology
iii)
Systematic Toxicology
iv)
Ecotoxicology, and
v)
Environmental Health Research
In each group there are many sections.
While in Preventive
Toxicology and Pesticide Toxicology there are six sections,”) in
Systematic Toxicology there are eight, inJ Eco-toxicology there
are four, in Environmental Health Research there are five
sections.
One of the sections belonging to Environmental Health Research
Group is "epidemiology" (where studies of our interest) are
mostly conducted.
The aims and objectives of the Epidemiology section are mainly as
follows:
To study health hazards of workers exposed to various
toxicants in different industries (both organized and
unorganized sectors)
C>
★
To conduct industrial hygiene studies and biological
monitoring to assess the magnitude of the problem;
*
To act as referral centre ffor occupational health problems
encountered in various industries;
★
To identify problems related to workers7
laboratory research is needed, and
★
To suggest preventive measures
working population.
<
a
12
health
on
which
to safeguard the health of
The main categories of problems that have been studied
with an epidemiological approach are:
1.
Observation of the occurrence
categories of workers
of
illness
in
in ITRC
different
The epidemiology division of ITRC has conducted studies on
workers in a number of industries with this objective.
Some
of these are agate grinding industry, cotton textile
industry, hemp processing units, different heavy engineering
industries, glass industry, electronic industries and workers
exposed to pesticides, petrochemicals etc.
2.
Qbservation—of changes in the occurrence of illness
Follow up studies on victims of Bhopal disaster have been
conducted to observe changes in morbidity. Lung function and
behavioural studies have been performed in many industries to
observe the change in morbidity following exposure to
industrial toxins in tropical conditions which may be quite
di fferent from those reported from industries in western
countries.
3.
Diagnostic studies for completing the clinical picture
Major efforts have been put in for completing the clinical
picture of occupational diseases among industrial workers.
Clinical psychology parameters have been used to study
preclinical neurological morbidity induced by toxic agents
like petrol, benzene, xylene, toulene, pesticides and heavy
metals.
Harmful effects on lungs produced by various
industrial toxins like inorganic and organic dusts,
chemicals, metals,
fumes etc. have been assessed by
performing pulmonary physiological studies to elicit the
early and late changes. Acute effects have also been studied
using pre and post shift studies.
Studies conducted by ITRC
in the villages of Unnao district in UP on persons suffering
from Jja t hy r i sm have for the first time reported the
synergistic—action of Lathyrus sativus consumption and high
manganese content in food and water.
It has
for the first
time reported the occurrence of sub-clinical cases of
Lathyrism.
ITRC, for the first time, described a syndrome
Flour workers' disease”.
Epidemiological studies showed
that the workers engaged in grinding wheat and other cereals
at small flour mills were
suffering from respiratory
symptoms and the cause of this high prevalence of respiratory
morbidity was the increased numbers of spores and mycelia of
various fungi such as Aspergillus niger, penicillium, mucor
etc.
V
4.
Multiple causes in Occupational Diseases
Various factors which may have a role in the causation of
occupational disease are routinely investigated in almost all
ne epidemiologieal studies carried out in ITRC. As mentioned
r ier the factor of age, nutritional status, exposure to
S
coinkined effects of environmental conditions
een illustrated among glass workers, pesticide sprayers
■
•!
13
I
etc.
Multimetal exposure was found to be responsible for
penumoconiosis type of respiratory morbidity among glass
workers.
5.
Study of Diseases for which Animal models do not exist:
Animal models are often not available for many conditions
encountered in our industrial workers, Industrial bronchitis
is a case in this context,
It is common among majority of
industrial workers, Detailed studies on the specific role of
di f f erent industrial toxins in producing symptoms of
bronchitis have been conducted. A number of ocular problems
occurring among industrial workers may also be cited as other
examples.
Glass workers have been studied for this problem
with special reference to occupational exposure.
6.
Exposure Effect and Exposure Response Relationship
Exposure related studies have been conducted to find the
effects of various heavy metals in relation to morbidity
observed among glass workers. Such studies using behavioural
test battery have also been conducted to study neurological
damages caused by neurotoxic industrial chemicals.
Attempts
have also been made to correlate combined exposures to
subliminal changes in ocular system.
Studies conducted by ITRC have showed that Threshold Limit
Values (TLV) recommended by the western countries are not
Workers in heat treatment
applicable in Indian conditions,
and case hardening plants in a factory were found to be
suffering from typical symptoms of cyanide poisoning and
their biological monitoring shewed a higher concentration of
cyanide and thiocyanate in blood1 and urine whereas the
concentration of cyanide in the ambient environment was well
within permissible limits as per western guidelines.
Similarly workers exposed to organic solvents like xylene and
toulene suffered from various symptoms and were found to have
impaired performance on behavioural test battery although the
concentration of these chemicals was within permissible
limit.
ITRC studies have emphasised the need for having
National Threshold Limit Values for various toxic chemicals
in India.
7.
Measurement of the effect of Prevention:
Intervention measures have been proposed in case of hemp
Evaluation of improvement has also been
workers disease.
assessed. A rapid detection test of phenol in urine has been
developed by ITRC.
It is in the form of a tablet over which
the person has to pass urine and the colour changes in the
urine reveal the presence or absence of phenol in it.
Thus
the workers exposed to benzene during their occupation can
monitor themselves and know whether they are over exposed.
ITRC has also developed such tests to diagnose manganese
toxicity among exposed workers.
ITRC has adopted and standardized various behavioural tests
for the earliest detection of the adverse effects of
chemical, physical and psychological factors on the workers.
This behavioural test battery has been used in a number of
ITRC studies and has yielded very useful information.
>
14
ITRC has collected voluminous data on lung function in a wide
range of population, both urban and rural of different age
groups and belonging to different ethnic groups with varying
'‘
,
ITRC is
physical, nutritional and environmental conditions,
also credited with the publication of national norms for
ventilatory functions in male and female populations
belonging to different geographical areas of the country.
ITRC has for the first time compared the lung function data
of Indian population with those of ;foreign population
particularly of European descent, American negros and
Caucasians.
No doubt the focus of the studies conducted by ITRC is primarily
on assessment and abatement of problems in occupational and
environmental toxicology, however at least two other areas in
which some significant work has been done, are:
J
1)
Studies on Food colours
2)
Studies on water quality assessment.
Studies on Food Colours: A major programme, on the evaluation
. / 1.
the
magnitude
and usage pattern of artificial synthetic
of
-colours in food stuffs was initiated by ITRC and the first 10
years of a detailed survey revealed that 70% of food stuffs
non-oermissible synthetic colours and as many as 18
contained non-permissible
prohibited dye were used quite commonly. Another 10-year survey
showed that the usage pattern of non-permissible food colours.has
changed. About 30% of food stuffs in rural areas still contained
non-permissible food colours. The improvement in urban usage was
perhaps due to ITRC data which focussed the attention of
regulatory authorities on the need to take necessary steps, the
report reveals.
Detailed studies were also undertaken to
elucidate the toxicity of various dyes.
Similarly, another
survey showed that of 1100 samples of mustard oil collected from
57 districts of UP, 28.5% were adulterated, 34 samples contained
synthetic cancer producing colours such as butter yellow while 13
oils contained argemone alkaloids which produce paralytic
syndrome.
ITRC has also developed a_portable minicolumn., kit.^for
rapid identification of aflotoxin in food commoditie^under field_
conditions.
2. Studies on Water Quality Assessment
Safety evaluation of
Assessment:;
drinking water was carried out by ITRC in 13 problem districts in
11 states covering over 14 lakhs of population from over 2600
villages of UP, West Bengal, Meghalaya, Mizoram., Arunachal
Pradesh, Sikkim, Orissa, Rajasthan, Jammu & Kashmir, Himachal
Pradesh and Maharashtra.
The studies involved physico-chemical
and bacteriological analysis of water samples from drinking water
supply sources.
Water from hand pumps in Bankura, Mirzapur,
Tripura and Nagpur districts gave coliform counts <10 per 100 ml
in 96,76,83 , and 79 per cent of samples respectively and faecal
coliform counts of
<1/100 ml were observed in between 83.3 and
95% of samples. Very few open dugwells were satisfactory. Piped
water supply schemes showed significant variation in water
quality: between 10.8 and 57.1 per cent of samples from different
areas contained
<1 thermotolerant coliforms per 100 ml.
ITRC
has also developed a portable water analysis kit for water
analysis and a model water analysis laboratory.
15
NIOH - National Institute of Occupational Healtfr,
NIOH functions under ICMR and has done extensive amount of work
on vulnerable/economic groups, mostly focussing on those in the
unorganised sectors and^agricultural labourers, and studying in a
systematic manner the health hazards associated with their
working environments!
Though the research activities of NIOH
cover a wide spectrum of areas viz: environmental work-stress
monitoring, laboratory based toxicological investigation and
operational research,
however,
the major thrust is
on
multidisciplinary epidemiological studies related to occupational
health problems of workers of both organized and unorganized
sectors of industries.
Brief summaries of some of the important
epidemiological studies undertaken by NIOH are presented in the
paras that follows.
J
From the inception of the Institute till about 1983/84, most of
the studies were of conventional nature with a focus on organised
industrial sector, vtfovever, since 19 8 5_. onwards there is a
definite _shift in the priority areas and more emphasis has been
given to occupational health studies in the unorganized
agricultural and small scale industries sector (mostly in rural
areas) which are generally not covered by existing health and
safety legislationsk/ Most of the research inputs of NIOH
presently aim at recognizing the magnitude of this above
mentioned problem, the causative factors and there cause-effect
relationships followed by developing appropriate intervention
strategies to bring about improvement in the work environment and
workers health.
The more important and positive aspects in some of the recent
research studies carried out by NIOH is the occupational health
problems of working women, especially those employed in cottage
industry where health risks are high.
A study to assess the
workstress and adverse health impact on women in sewing operation
has showed the prevalence of work related backache, pain,
swelling in legs as most common causes of morbidity among these
women.
Another interesting study on indoor air pollution and its effect
on rural women, showed that indoor air-levels of PAH (Polycyclic
Aromatic Hydrocarbons) were exceptionally high in houses using
cattle dung and wood and were less in houses using coal.
To sum up, most of the research inputs of NIOH aim at recognising
the magnitude of the problem, the causative factors and their
cause-effect relationship, followed by developing appropriate
intervention strategies to bring about improvement in the work
environment and workers health. It is satisfying to note that the
epidemiological studies carried out in this institute are more
systematically planned and designed by meaningfully collaborating
with other sections like toxicology, environmental pollution and
operational research.
Some of the studies are truly
interdiscipinary in nature where links between socio-economic
conditions, environment and health are established, because of
the non-conventional nature of such studies, where more socio
economic criteria for assessment are used (not strictly medical
oriented in their approach).
16
Because of their interdisciplinary integrated approach, it seems
that they may be in a better position to look into the
environmental linkages while focussing on unorganized sector in
future. Moreover, there is much scope for an institute like NIOH
to do pioneering work in the area of environmentally vulnerable
population and to look at the whole setting of urban environment
and health. Unfortunately no serious work has been done in this
area so far.
The NIOH at Ahmedabad was started with a view to study
interactions between work and health. The main objectives of NIOH
are the following:
To help provide a safe, healthy and comfortable environment for
work and living through multi-disciplinary approach:
Education
Research
Service.
Research
★
Epidemiological and Environmental monitoring and corollary
occupations
for
“
studies
in
hazardous
toxicological
recognition and evaluation of risk factors.
*
Development
impairment.
*
Designing of appropriate intervention measures for prevention
of hazards at work places.
of
tools
for
early
diagnosis
of
health
Education
University courses:
D.O.I.H.(Diploma),
M.D. ,
Ph.D.
courses,
Orientation courses:
For doctors, safety officers, factory inspectors,
managers, to promote health and safety, and
and
worker's education for health awareness.
Service
to
Government
regulatory
authorities
•k
Consultancy
industries.
*
Retrieval
and dissemination
of
information
publication of monographs and technical reports.
and
through
The Thrust Areas of Research which the institute has identified
are the following:
i)
Occupational epidemiology,
ii)
Toxicology
iii) Environmental pollution
iv)
Development of safety normi", and
v)
Operational Research.
17
e
The sub-areas under each head are:
Epidemiology: Occupational health — Problems of
V1’ Occupational
Population in agricultural, unorganised, and organized
sectors of industry,
workers.
and vulnerable groups women and child
\ /i) Toxicology; Controlled exposure experiments and toxicological
investigations on early detection of health impairment for:
Pesticides
X
Fertilizers
Metals
Solvents
Dyes
Dusts, and
Chemical carcinogens.
iii) Environmental pollution:
Air pollution
Water
Agrochemicals pesticides
Metals (Lead, Mercury, Cadmium).
iv)
Development of Safety Norms:
Chemicals
Physical agents: Heat, noise, illumination.
v)
Operational Research
Models for delivery of occupational health care system for
workers
through
primary
health
centres
and
group
occupational health clinics. Research activities, that are
currently being carried out in the NIOH, the specific
studies on occupational health problems of agricultural
sectors, which are the following.
Pesticide exposure in applicators
Exposure to vegetable
rice (paddy)
dusts
like
cotton,
tobacco
and
Plantation workers (tea and coir)
Ergonomic studies on agricultural tools, agricultural
accidents and work safety in agricultural jobs.
18
In the unorganized sector, the specific studies/activities are on
the following areas:
★
Silicosis in quartz crushing units,
pencil, and ceramic industries.
quarries.
slate-
Exposure to toxic chemicals, dyes, pesticides and metals.
*
Health problems in carpet weaving,
industry and metal artwares.
match and fireworks
In the organized sector: Studies on heal_th___probleins_ in asbestos,
cotton textiles, jute and glass manufacture, pesticides,
petrochemicals, solvents and fertilizers industries were taken
2ip_.
Presently, NIOH has two Regional Centres viz: 1) Regional
Occupational Health Centre (Southern Region - located at
Bangalore) and ii) Regional Occupational Health Centre (Eastern
Region - located at Calcutta) . While the Eastern-Regional Centre
(Calcutta) is supposed to specialize in occupational respiratory
diseases (Pneumoconiosis in coal miners, respiratory diseases
among jute mill workers, etc.J^^the Southern-Regional centre
(Bangalore) in occupational agricultural health problems of
workers in coir industry (especially in Kerala) and tea
plantation workersv^
The three main groups working in NIOH are the following::
1)
Health Science Group
2)
Environmental Work-stress group
3)
Group on "Experimental Studies.
Following are the sections under each group:
1.
2.
Health Science Group:
i)
Occupational Epidemiology
ii)
Respiratory physiology
iii)
Statistics (Bio-statistics)
iv)
Radiology.
Environmental Stress Group:
i)
Occupational Hygiene
ii)
Occupational Psychology
iii)
Work physiology/ergonomics
iv)
Air pollution.
19
Experimental Studies:
3.
i)
Environmental carcinogenesis
ii)
Medical Toxicology
iii)
Experimental Toxicology
iv)
Aquatic Toxicology
v)
Histiochemistry
vi)
Agricultural health
vii)
Instrumentation
viii)
Biochemistry.
Some of the epidemiological studies of our interest which have
been taken up by NIOH are the following:
*
Asbestosis in Miners
*
High altitude pneumoconiosis
*
Pneumoconiosis in underground coal miners
■k
Byssinosis in textile mills
*
Health survey in Ginning industry
*
Dye related water pollution and its impact on health
★
Nicotine toxicity among workers working in tobacco fields.
Asbestosis in Miners
The objective of this study was to find out the prevalence of
asbestosis in asbestos miners and the study was carried out in
two mines and six mills located in Andhra Pradesh, 633 workers
(52% in mining units and 32% in milling units), were evaluated by
medical examination, Pulmonary Function Test (PFT), Vocal
Capacity (VC), Forced Vocal Capacity (FVC), Forced Expiratory
Volume (FEV), and chest radiographs.
The overall prevalence of
asbestosis was as high as 11.5% and was more common in milling
workers about 21% as compared to mining workers little less than
4% and it increased with duration of exposure.
High Altitude Pneumoconiosis:
An environmental-cum-health/medical study was undertaken by the
institute
to investigate the cause of high prevalence of
respiratory morbidity in three villages at high altitudes in
Central Ladakh.
Three villages with different frequencies of
dust storms situated near Leh were selected for this study, The
results of medical/health and radiological investigations in 150
subjects from each of the three villages showed high prevalence
of pneumoconiosis over 45% in the village, where they are more
frequent, aboit 20% in the village where they are less frequent
and • only about 2% in the village where they are rare, thus
showing a direct correlation to the frequency of occurrence of
20
dust storms in these villages. The occurrence of Pneumoconiosis
cases in the absence of occupational exposure is exceedingly rare
and this is the first study in our country on non-occupational
pneumoconiosis in the community.
An environmental hygiene survey of seven mines and health/medical
study of 1575 miners was conducted and the prevalence of
pneumoconiosis was around 4%.
Byssinosis in Textile Mills:
An epidemiological study was conducted during the year 1983-86 in
three textile mills at Ahmedabad. Byssinosis is an occupational
lung disease often observed among workers exposed to cotton, flax
and hemp dust. The extent of the problem are well recognised in
the developed countries and control measures have been
implemented to prevent the disease but this is not true in the
case of India where the severity and extent of the problem are
not well studied and therefore preventive measures are virtually
nonexistent.
929 workers were studied/examined in three textile
mills at Ahmedabad. The important finding of this study was that
the prevalence of byssinosis is not low in the textile mills (as
reported in many earlier studies) , it is high.
The mean
prevalence of byssinosis in the blow section was about 30%
whereas in the card section was over 37% (the concentration of
cotton dust (dustless fly) were high in both the sections).
Health Survey in Ginning Industry:
Though there are several studies/reports or prevalence of
byssinosis in cotton textile mills in the country, this study is
the first of its kind to evaluate the cotton dust exposure and
health status of cotton ginning workers in the unorganised
sector.
This environmental-cum medical survey was undertaken in
four roller type gins in Gujarat and cotton dust (dustless fly)
levels
in 289 workers were also measured, About 40% of workers
complained of work related symptoms i.e. dry cough, chest
lightness, breathlessness and burning eyes.
Dye Related Pollution and Its Impact on Health
A study of impact of pollution of river Bhader on the health of
the population living in between Jetpur and Dhoraji (in Gujarat)
as part of the Technology Mission on Drinking Water was carried
out. The main objective was to assess the impact of Pollution of
river water caused by cotton dyeing industry, which is a
household cottage industry in that region, on the population
dependent on this water for drinking, bathing, washing etc.
To
assess the pollution pattern of the river water works, detailed
physio-chemical and microbial analysis of water was carried out.
A total of 743 residents were clinically examined from this area
(belt) and for comparison 391 persons belonging to an upstream
village were also clinically examined, as a control group.
In
the exposed population, municipal water supply is the major
source of water for drinking, bathing, washing, etc. The
municipal water works draws polluted water, usually red in colour
from the river Bhader. The health survey revealed that about 19%
of exposed popula-tion had immediate health related complaints,
C.l. tract complaints/nanifestations (i.e.pain in throat,
mainly G.I.
burning in epigastric region and itching over the skin following
the use of municipal water for drinking and bathincjA^^Jl£weverr
30 AI
21
/rloo
I 31
the control population, which included residents of an upstream
village reported no such complaints.
Nicotine Toxicity in Tobacco Workers:
A study has been initiated by NIOH among the Tobacco workers, It
is observed that through the skin the tobacco worker absorbs
nicotine.
Nicotine (in small doses is no doubt a stimulant,
while in large doses it acts as a ganglion blocking agent).
Therefore, the symptoms of nicotine toxicity generally observed
are nausea,
The tobacco
nausea, vomiting, giddiness, headache etc.
workers (majority about 80%) showed these symptoms after 5-6
However, these symptoms gradually disappear
hours of work,
during the rest period, It was also observed that blood nicotine
levels were much higher (about 3-4 times higher than control
Nicotine exposure was confirmed
group) in the tobacco workers.
by measuring nicotine and its metabolites in urine in the study.
Some of the older, not current studies of interest taken up by
the NIOH during the late 70s and early 80s are the following:
in silicosis in slate pencil workers at Mandsaur
1.
Studies
(M.P.)
2.
Multicentric study on body burdens of DDT and BHC in Indian
population at Agra, Ahmedabad, Bangalore, Bhopal, Bombay,
Calcutta, Chandigarh.
3.
Effects of BHC on malaria spraymen.
4.
Evaluation
exposed to
1.
Silicosis in Slate Pencil Workers at Mandasur:
of
health hazards in workers occupationally
pesticides other than spraying operations.
Amongst a sample of 593 slate pencil workers an overall
incidence of about 55 per cent of silicosis was found in the
initial study.
In a follow up undertaken 16 months later,
only about 300 of the original workers surveyed
:
could be
traced 3.9 per cent of whom had expired in the interim
period. All of them had progressive massive fibrosis at the
outset.
It was found that in this occupation it took about
seven years to produce radiologically manifest silicosis and
the progression to the next higher category took about three
years.
/ 2.
Multicentric Study on the body burdens of DDT and BHC in
Indian Population at Agra, Ahmedabad, Bangalore, Bhopal,
Bombay, Calcutta, Chandigarh:
Fat samples from cases of medico-legal autopsies from urban
areas of various centres indicated mean values of 11.05 ppm
and 3.49 ppm of DDT and BHC respectively. Wide variations,
reflecting variation in intensity of use of the pesticides,
were observed between centres.
These findings were of
obvious relevance to the pesticide policy of India.
Effects of BHC on Malaria Spraymen:
Short term study showed1 thau after one seasonal round of
clinical signs and symptoms,
spraying, there were no specific
:
22
no haematological abnormalities. Serum BHC residue increased
3-5 times over pre-exposure values. Long term studies showed
that repeated exposure gave rise to dermatitis and
neurological abnormalities such as impairment of coordination
and imbalance in a few cases. These findings were of obvious
importance to the national malaria spraying programme in
existence (at that point of time).
4.
Ey a lua ti on—o_f ..._health hazards in workers occupationally
exposed—to—pesticides other than in spraying operations:
The study revealed 70 per cent of pesticide formulations
showed depressed cholinesterase activity and associated
clinical signs and symptom changes in biochemical and ECG
parameters were seen in 22 per cent.
Though the research activities of NIOH cover a wide spectrum of
areas viz: epidemiological survey, environmental work-stress
monitoring, laboratory based toxicological investigation and
applied, operational research, however, the major thrust was and
still is on occupational health problems of workers of both
organized and unorganized sectors of industries.
23
AIIHPH (All India Institute of Hygiene and Public Health).
AIIHPH functions under the Ministry of Health <and the only
department which is actively engaged in the studyr of various
environmental health problems is the department of Sanitary
Engineering. Most of their work is devoted to water pollution and
solid waste management. The water pollution study is a
collaborative venture with NEERI, where AIIHPH is supposed to
study the health aspects, while NEERI is to provide the expertise
on environmental side.
Paradoxically the team in the Sanitary
Engineering department is mostly composed of engineers and there
is only one doctor.
In contrast, the department of Epidemiology
which has a number of health experts and which in the past had
done pioneering, work in the field of Public Health is currently
engaged mostly in conducting traditional types of epidemiological
studies.
To sum up most of the studies carried out in this Institute are
of conventional nature, excepting a few studies <conducted
'
by
Sanitary Engineering department, which has adopted a more or less
integrated approach.
It is however, surprising to note that the department of
Epidemiology which has expertise and potentiality for conducting
interdisciplinary studies for dealing with the ecologically
vulnerable groups is not utilising this opportunity. It would be
worthwhile if this department along with the sanitary engineering
department could take up collaborative studies with NEERI on
various dimensions of environmental health. Being located in one
of the major metropolitan cities of the country it has also the
potentiality of studying the deteriorating urban environment and
its impact on health, particularly among the slum dwellers of
Calcutta.
AIIHPH is the oldest institute of Public Health
established about 60 years back, i.e. in 1932 .
obj ectives of AIIHPH are:
in India,
The
main
•k
To develop health manpower
training facilities;
k
to conduct research directed towards the solution of various
problems of health and disease in people; and
k
to conduct fundamental and operational research to develop
methods for optimum utilization of health resources and
application of these findings for protection and promotion of
health of the people.
by
providing
post-graduate
There are fourteen departments in the Institute viz: i)
Biochemistry and Nutrition, ii) Epidemiology, iii) Health
Education, iv) Maternal and Child Health, v) Microbiology, vi)
Occupational Health, vii) Preventive and Social Medicine, viii)
Public Health Administration, ix) Public Health Nursing, x).
Sanitary Engineering, xi) Statistics and Demography, xii)
Veterinary Training centre, Singhu, xiv) Urban Health Centre,
Chetla.
24
To be frank, most (almost all) departments are concentrating
mainly on teaching.
Even, a department like Biochemistry and
Nutrition, which is supposed to give importance to applied
research (operational research) is more concerned with basic
teaching or research (general biochemistry/basic research type) .
The department of Health Education is mostly engaged in teaching
health personnel who undertake different courses. Out of all the
14 departments, the three departments, where some work of our
interest/concern is being carried out are:
1)
Sanitary Engineering
2)
Epidemiology and
3)
Occupational Health.
Again, out of these three departments, both Epidemiology and
Occupational health are supposed to give more time and attention
towards research and carry out comprehensive studies, however, in
actual practice due to lack of sufficient person power and the
demanding pressures towards teaching, not much is being done (as
expected from an institute like AIIHPH where in the past the
department of Epidemiology had pioneered methodology for health
surveys of various kinds).
No doubt, presently the epidemiology
division is engaged in some studies of epidemiological
surveillance of communicable diseases and chronic arsenic
poisons. However, even the department of occupational health is
not able to give much time for research (as it ought to).
As mentioned earlier, the only department which is actively
engaged in the study of various environmental health problems is
the Department of Sanitary Engineering.
Most of their work has
been devoted in the areas of water pollution and solid waste
management.
One interesting study on health impacts of Ganga
Action Plan (at two points in Nabadweep and Varanasi) is being
carried out in collaboration with NEERI, however the results are
yet to come.
In this department all the scientific staff is from Engineering
background and only two years back one doctor joined the
Even the urban health Centre which is supposed to
department.
identify priority urban health problems and carry out action
research is busy only in training activities.
Another interesting study carried out by Sanitary Engineering
Department is on "Socio-economic and health aspects of recycling
The
of urban solid waste through scavenging in Calcutta.”
-1— main
--objectives of the study were:
•k
To collect baseline information regarding the status of
scavenging of solid waste in Calcutta;
To evaluate the health risk associated with the living and
working environment of the scavengers by conducting
epidemiological surveys among them;
★
To study the socio-economic aspects> of occupation and to
evaluate the role of scavengers in solid waste management and
resume recycling.
The epidemiological study has shown that of the three open
25
i
systems of the body viz. i) the respiratory system,
ii) the
gastrointestinal system and
iii) the skin, the scavengers are
particularly vulnerable to the diseases of the respiratory and
G.I. tract.
The prevalence of respiratory diseases among the
scavengers were over 70 percent as compared to that among control
group which was 34 percent.
The prevalence of diarrhoeal
diseases and protozoal and helminthic infestations was also very
high among the scavengers as compared to control group.
Occupational health hazard of the scavenging population becomes
all the more significant when one considers that the control
population itself has a very poor socio-economic status and lives
in extremely unhygienic and insanitary environment.
26
NICED (National Institute of cholera and Enteric Diseases) .
NICED functions under the ICMR and has carried out studies mostly
relating to diarrhoeal diseases and has done some pioneering work
on cholera and Oral Rehydration Therapy (ORT). However, research
studies on various aspects of health and environment adopting an
integrated
and
interdiscipinary
approach
or
even
an
epidemiological approach were missing.
Most of the studies
conducted by this institute are of more fundamental nature giving
importance to microbiology, biochemistry or genetics rather than
of applied
nature.
7" * in the past the major focus of the
..
•
Although
studies was on cholera and diarrhoeal*
r
.1^ 1it has
--- - diseases,
-i----- - Currently
shifted its attention to the newly emerging problem of AIDS.
NICED started about
institute are:
30
years back.
The ten divisions
i)
Division of Microbiology
ii)
Division of Epidemiology
iii)
Division of Immunology
iv)
Division of Pathophysiology
v)
Division of Virology
vi)
Division of Clinical Medicine
vii)
Division of Biochemistry
viii)
Division of Microbial Genetics
ix)
Division of Electron Microscopy
x)
Division of Training and Extension
of
the
Moreover, there is a Vibrio Phage Reference Laboratory and three
sections viz: i)Media section, ii)Maintenance, Instruments and
Equipments Section, and iii) Animal House Section. Community
studies occupy an important place in the research agenda of the
Institute and most of them are related to diarrhoeal diseases
(including some epidemic investigations).
An interesting study (from our point of view) on "Intervention
of
”
transmission of eltor cholera in Calcutta communities (urban
slums), effect of simple sanitational measures" (using "sorai"
"sorai —
an earthenware narrowneck vessel) was carried out by NICED. Since
eltor cholera appears to have an endemic tendency, cases are
regularly being reported from city slums in the country every
year. Though, poverty, malnutrition, overcrowding and unhygienic
living conditions are important contributory factors, but
persistence of the disease in these communities has been
attributed to the large number of inapparent infections by the
eltor organism and mild cases throughout the year.
The exact
mode of transmission of this disease is still poorly understood
and sometimes even the role of drinking water in the transmission
of cholera in highly endemic areas is still debated or
questioned.
The study points out that cholera control measures
27
are very often practised arbitrarily in our country without
having any proper scientific basis and perhaps these hypothetical
measures are mostly responsible for the failure of control
programs .
Some of the earlier studies of the Institute on the mode of
transmission
of
vibrio
cholera
in
the
families
of
bacteriologically confirmed patients in Calcutta, showed that the
contact of cholera cases had higher rate of isolation of vibrio
cholera from their stools and finger washings as compared to
those in control houses.
Stored water which is liable to
frequent contamination by fingers in the former group also showed
higher isolation rates than those in the control group.
All
these observations point towards the fact that simple provision
of safe water supply (provision of tubewell water of presumed
good quality) in the community might not prevent transmission of
infections. Only improvement of hygienic habits coupled with
supply of a reasonably safe water might cut down the transmission
of infections to a significant level. With the above objectives
in view
a study was undertaken by NICED to determine whether
simple measures (sanitational interventions) that are cheap —
affordable--could effectively breakdown the chain of infection of
eltor cholera in communities of lower socio-economic status. Two
methods — chlorination of stored water and use of a narrow
necked earthenware vessel "sorai" for storing the water were
found to be effective in reducing the transmission of infection
among the family contacts of cholera patients. According to the
findings of the study the cholera carrier rates in the
chlorination and "sorai" intervention groups were 7.3% and 4.4%
respectively, compared with 17.3% in the control group. Moreover
the "sorai" is cheap and was well accepted by the local
communities, its narrow neck prevented the introduction of the
hand and contamination of the stored water.
Another study on "Intra-familial transmission of vibrio cholera
and control group of houses, respectively, showed that the former
had higher rates of positive stools (9.7%) and fingerwashes
(5.6%) for vibrio cholera.
The respective rates in control
houses were only 0.8% and 0.4%. Simultaneous examination of five
types of water sources actually used left-over cooked food and
flies in these houses for a period of five consecutive days
showed that only stored water (8.5%) and cooked food (8.5%) had
significantly higher detection rates of vibrio cholera as
compared to those in control houses,
On the basis of the
simple
observations from the above study, it is argued that
provision of safe water in the community may not be sufficient to
control the spread of cholera infection as is evident from higher
positive rate of stored water.
In the absence of continuous
piped water supply within the houses, people will be compelled to
store water in an unhygienic fashion thus leading to transmission
of the infection.
A prospective community based study was also conducted by NICED
to evaluate the effect of handwashing on the incidence of
diarrhoeal diseases in Calcutta slums.
Handwashing was
implemented in one slum and the other nearby slum without
handwashing program served as control. The difference in the
incidence of watery diarrhoea during the thirteen-month period,
between the study and control groups was not significantly
different.
However, the incidence of dysentery in individuals
above five years of age in the control group was significantly
28
higher as compared to those in the study group.
The results of
this study indicated that handwashing with soap may reduce the
incidence of dysentric cases in the community by interruption of
transmission of the pathogens from one person to the other.
I
i
•i
i
i
29
MRC (Malaria Research Centre).
MRC is an institute of ICMR which has made considerable strides
in its use of an interdisciplinary approach in malaria research
in the country. The institute has contributed quite a lot and has
considerable conceptual research capability — building to design
the protocols for conducting such studies where in addition to
physical indices, sociological linkages have been established
using multidisciplinary methods drawn from the
social,
environmental and health related sciences.
The institute has also located endemic centres in different ecosettings and has taken preventive, often bio-environmental
control measures, which are ameliorative both from social and
environmental point of view.
Such types of integrative studies
conducted by this institute have not only been significant
achievements but have also been major path finders providing
deeper insights to problems of other public health hazards in a
holistic manner.
Malaria Research Centre (MRC), which is one of the permanent
Institutes of the Indian Council of Medical Research (ICMR) was
established with a mandate for undertaking research on Malaria, a
problem of immense public health importance in India, Presently,
every year about two million new cases of malaria are being
reported in our country and tragically enough, tne malaria
situation has stagnated at this level for about a decade and
malaria control has become problematic with the change in Vector
behaviour, insecticide resistance, chloroquine resistance in
Plasmodium falciparum and operational failures.
Besides this
large parts of the country are becoming more receptive to malaria
as a result of increase in irrigation, population migration,
urban growth and factors related to human ecology.
With this
background in mind most of the studies which are being undertaken
by the MRC are directed to help control malaria on scientific
lines utilizing the results of an interdisciplinary approach.
MRC has five broad divisions viz:
i)
Entomology
ii)
Parasitology
iii)
Epidemiology
iv)
Immunology and
v)
Bio-environmental control strategy.
During the last few years MRC has provided thrust to the Bioenvironmental control of Malaria in the country.
In order to
provide support to the bio-environmental control strategy not
only field research mainly by the Division of Epidemiology but
also applied/basic research by other divisions (Entomology,
Immunology, Parasitology) is undertaken.
One of the areas of
applied field research by the MRC on the role of Anopheles
culicifacies sibling species is being used in the malariogenic
stratification for prospective planning of malaria control, and
results of stratification ha^e found application in decision
making on suitability or otherwise of the continuation or change
30
of insecticidal spraying to interrupt transmission.
As MRC is
the premier Institute in developing the bio-environmental control
strategy (involving an integrated and inter-disciplinary approach
and is of interest for us from eco-health point of view) , it
would be worthwhile to discuss in detail the bio environmental
control strategy.
Bio-environmental Control Strategy:
The return of malaria in the seventies on a nationwide scale was
a matter of serious concern and required a long term solution,
cases.
By 1976, total malaria incidence reached 6.4 million cases.
It
was very difficult for the Government to combat the widespread
resurgence of the disease, however, with the revised strategy of
NMEP known as MPO (Modified Plan of Action) the malaria situation
showed some improvement and by 1983 annual malaria incidence was
reduced to about 2 million malaria cases per year, but thereafter
there was stagnation and no further progress could be made.
The epidemiological profile of the disease showed a distinctive
pattern.
The spraying strategy made little or no impact on
malaria status in the hills, foothills and forested areas, These
areas are predominantly tribal areas with high Plasmodium
falciparum incidence (presently though most of the malaria cases
are due to Plasmodium vivax, but tragically the proportion of
P. falciparum is increasing and now accounts for about 35% of
total infections) with nearly perennial transmission, under the
influence of more than one vector.
These areas are also
subjected to population movement for exploitation of forest
wealth and other development projects.
It was difficult to
implement insecticidal spray strategy due to the terrain of these
regions.
The Annual Parasite Incidence (API) was highest in the
North-Eastern States, foothills of Orissa and West Bengal and
hilly and forested areas of Andhra Pradesh, Maharashtra and
Gujarat. Among urban areas, Madras city alone contributed 60-70%
of total malaria.
A large number of factors contributed to the deteriorating
malaria situation and some of the important factors were:
Refusal to accept spray in rural areas:
The community acceptance of insecticidal spray was very
poor (or as low as 30%) and thus there was no impact on
transmission.
Development of resistance to insecticides in vector
The rural vector A.culicifacies has shown widespread
resistance to DDT and BHC.
Alternative insecticides
were very costly and could not be used.
Complacency in health workers and lowering of priority
of malaria programme in health sector.
The peripheral worker under MPW scheme gave low
x
’
priority
to> surveillance on account of emphasis on ,
family planning and other health activities.
Thus .due to multifaceted problems,, viz. Technical, Operational,
as well as financial, it had
---- become apparent that there was an
1
31
&z 0
r,r' '
AND
urgent need for an innovative technology which would be
indigenous, appropriate and socially acceptable and at the same
time, would not rely entirely on the use of insecticides.
This challenge was accepted by the MRC and a theoretical model
for such an approach to malaria control was evolved with the back
up of basic and applied research.
It was envisaged that soon
after the successful demonstration of feasibility trials the
alternate strategy would constitute a basis for a long term
solution to the problem of malaria in the country.
With this background the MRC took up the first Integrated Disease
Vector Control (IDVC) programme in 1983 in high malaria incidence
villages of Kheda district. First it was only a field station of
MRC in Nadiad taluk to test the feasibility of malaria control by
integrating non-insecticidal methods.
In subsequent years, the
experimental areas were expanded and project was converted to
feasibility-cum-demonstration project.
In this area falciparum
malaria epidemic was ongoing with the problems of drainage,
vector resistance, parasite resistance, problems connected with
spraying and innumerable mosquito breeding sites.
In this
difficult terrain implementation of bio-environmental methods
produced
promising results i.e. malaria incidence was greatly
Public
reduced and many collateral benefits were observed.
acceptance and people's participation in the scheme was
phenomenal.
The IDVC project exclusively uses non-insecticidal methods of
disease Vector Control such as environmental modification and
manipulation coupled with biological control of aquatic stages of
vector.
In this approach community involvement and cooperation
is the key factor.
Other supportive measures such as social
forestry, provision of smokeless chulahs, soakage pits, and other
income generating schemes such as fisheries are implemented in
the study villages.
1)
Nadiad and Sahjanpur - Control of rural malaria
2)
Madras and Delhi - Urban malaria
3)
Hardwar (BHEL, IDPL): Control of Industrial malaria
4)
Haldwani: Control of Malaria in green revolution area
5)
Allahabad (Sankargarh): Quarry areas and backward rural area
6)
Gandla: Tribal and forested avea
7)
Sonepur (Assam).
One area of Eco-Health research that has made strides in its use
of an interdisciplinary approach is malaria research. MRC, Delhi
has contributed quite a lot in conducting such studies.
In
addition to physical indices, sociological linkages have been
established in some of the studies conducted by this institute.
3?
NEERI(National Environmental Engineering Research Institute)
The National Environmental Engineering Research Institute
(NEERI), which functions under CSIR, started as CPHERI i.e.
Central Public Health Engineering Research Institute 30 years
back and its objectives were essentially confined to help public
health departments of various state governments in adopting
scientific methods to control water-borne diseases. It was in
fact the great jaundice epidemic in 1956 in Delhi that awakened
the Health authorities to the fact that with the rapid
modernisation and urbanisation (even in the fifties!) the old
conventional notions about water and its purity need to be
revised.
The Jaundice Enquiry Committee Report brought forth the fact that
most of the water treatment plants were operated by persons who
were neither trained nor properly qualified.
And this report
initiated the Public Health Engineering Research Committee
(PHERC) of the CSIR to propose that a Public Health Engineering
Research Institute be set up under the CSIR.
Thus the CPHERI
(now NEERI) was born.
In the formative stages, scientists from this institute
interacted with public health agencies attached to state and
central governments in disseminating to public, information on
In fact the research and development
hygiene and public health,
programmes of CPHERI (now NEERI) were confined for quite some
time to health related problems demanding the expertise
essentially of biologists, chemists, and civil engineers, in the
training in public health.
The institute has to some extent
adopted a multidisciplinary approach to issues of quality control
in respect of air and water and to use of disposal of waste water
and solids.
Although, the institute's work is of unique
interdisciplinary nature from a purely environmental point of
view they are not integrating disciplines of medical sciences,
even though they have an epidemiology section, manned mostly by
biologists and without any medical doctors.
Morevoer, though
there is ample scope and potentiality for a more integrative
approach, in devising and developing techniques for health risks
in Environmental Impact Assessment (EIA) and monitoring no
serious attempt or effort has so far been made by the institute
to incorporate health component in the EIA statement.
The synthesis between research and effectiveness in technological
development is sought to be accomplished in selected areas of
activities which are:
*
Analytical capabilities to improve detection and precision in
monitoring of pollutants in air, water, and soil.
★
Characterisation and assessment of liquid industrial
effluents to develop indigenous processes leading to
development of appropriate pollution control technology.
*
Environmental monitoring with special reference to air, water
and land.
★
Waste recycling
agriculture.
re-use
and
33
through
aquaculture
and
★
Urban and industrial solid waste management systems.
*
Environmental system analysis leading to air and water
quality modelling techniques to forecast environmental impact
of development programs.
Environmental impact analysis and assessment of major
developmental projects including mining, iron, steel complex,
thermal power complex, fertilizer, hydel power projects,
industrial irrigation, and urban-projects etc.
★
Environmental
support
programs
in
development to minimize health hazards.
*
Appropriate technological process development for water
treatment.
Impact to toxic and hazardous wastes on
environment and ecology.
*
Environmental information systems and sources with a strong
database.
integrated
rural
Some of the other functions which NEERI undertakes are:
*
Advising and consultancy
industrial undertakings.
■k
Designing curriculae in environmental science and engineering
with suitable linkages.
k
Liaisoning activities with local, state, national and
international
agencies
engaged
in
implementation
of
environmental programmes.
services to
other
Supporting the environmental programmes
demonstration units in the field.
institutes
by
and
insta11ing
During the past 30 years, NEERI has been engaged in a number of
activities leading to indigenous and competent solutions of
several environmental problems which has helped in laying down
criteria and guidelines to safeguard environmental quality. Some
of the immediate objectives of the institute is to provide R&D
support to national programmes related to water supply,
sanitation, and Environmental projection. In addition to being a
nodal
point
for
almost
all
R&D activities
concerning
environmental issues, pertaining to air, water, waste water,
solid waste and rural sanitation, its efforts in near future are
supposed to focus on the following areas:
*
Recycling and re-use of wastes (liquid, solid, etc.) of
municipal and industrial origin to utilize the nutrient
and
energy
contents
ensuring
environmental
compatibility.
*
Promote appropriate technology by using available
resources in the field of air, water, waste water and
solid waste management (Research thrust: Advanced
technologies in appropriate and relevant areas will be
developed.)
*
Provide R&D
support to activities of national water
34
supply and sanitation programme and Health For A] 1 by
2000 AD.
★
Evolve microbial cultures for degradation of specific
wastes leading to process development in the field of
biotechnology for pollution control.
★
Undertake studies in the areas such as acid rains and
modelling in environmental engineering using computers.
★
Centre
Work
as
a
National
Documentation
Environmental Engineering and Science using
infrastructure
available
information
base,
expertise to
publish books, journals, etc.
dissemination of knowledge.
★
Act as a Centre for conducting advanced level training
programmes in field of water, waste water.
★
Assist the Dept, of Environment in
policies for environmental management.
★
Participate in environmental impact, statement /
assessment
process
that
need
improvement
for
scrutinizing of planning and decision making.
for
the
and
for
formulation
of
The various Divisions under NEERI are the following:
1)
Air Pollution Control Division.
2)
Basic Research & Training Division.
3)
Computer Applications Division.
4)
Environmental
Section.
5)
Environmental Impact Assessment Division.
6)
Instrumentation Division
7)
Library and Documentation Division.
8)
Recalcitrant
9)
Solid Wastes Division.
10)
Technology utilization and demonstration Division
11)
Water Division.
12)
Water Engineering Division.
13)
Waste Water Engineering Division.
Bio-technology Division of Epidemiology
Industrial Hazardous Wastes Division.
Since problems of one region differ from those prevailing in
other regions, NEERI has set up nine zonal laboratories in.major
cities, i.e. 1) Bombay, 2) Ahmedabad, 3) Calcutta, 4) Cochin, 5)
The
Hyderabad, 6) Delhi, 7) Madras, 8) Kanpur and 9) Jaipur,
zonal laboratories essentially investigate the problems of the
region, keeping the objectives of NEERI in mind.
I
35
___
workers illustrates the hazards involved in the use of raw sewage
for farming.
Environmental Impact Assessment (EIA) is an anticipatory
mechanism which establishes quantitative parameters indicating
the quality of the environment and natural systems, before,
during and after the proposed developmental activity, thus
allowing measures ensuring environmental compatibility and
economic efficacy. Environmental risks are inherent in design and
operation for large and complex industrial units.
Any failure in the system could lead to a disaster resulting in
heavy toll of human life and devastating losses to ecology and
property.
Therefore, a comprehensive and scientific approach to
risk assessment and management is considered essential in view of
increasing number and magnitude of environmental risks. Various
types of EIA studies have been undertaken by NEERI which includes
ranking of alternatives for selection of site, rapid EIA based on
one season data and comprehensive EIA based on three seasons data
collection. EIA division has also developed methodology for
regional EIA and carrying capacity based development planning
process.
However, Dr.Badrinath, Head EIA division, regretted
that no serious effort has been so far made to incorporate
health component in EIA studies and stressed the need to re
examine the applicability of already available health impact
assessment techniques in the Indian context.
Current Research Thrust
Apart from the Epidemiological studies and EIA studies the other
research and development activities of NEERI are mainly
concentrated on air, water,
waste wacer,
solid water,
instrumentation, and analytical techniques development.
1.
Air:
i
Monitoring and collection of Baseline data:
A national air quality monitoring programme is being
carried out in Ahmedabad, Bombay, Calcutta, Cochin, Delhi,
Hyderabad, Jaipur, Kanpur, Madras, and Nagpur. Parameters
included are oxides of sulphur, and nitrogen and suspended
particulate matter (SPM), siltation rate and dust fall.
Water: Waste water and Sewage: Baseline data is being collected
on heavy metals and organo chlorine pesticides levels in
urban water supplies at Calcutta, Delhi and Kanpur.
The
study reveals the presence of most of heavy metals in raw
waters. Extensive surveys have been conducted on aquatic
eco-systems with different degrees of pollution.
The
studies on water quality assessment with reference to
faecal indicator and pathogenic organisms are also being
conducted in rural and urban areas.
Leakage detection,
assessment and control studies have been carried out in 10
cities and it is observed that leakage levels is 20 to 30
percent of total water supply.
Water quality monitoring
in Jamuna river is also being carried out at effluent out
falls from Mathura and Karnal refineries.
Field testing of integrated water supply and waste water
disposal in a Haryana village and studies of different
entroviruses in Nagpur sewage is also being conducted.
37
2.
Air:
Evaluation of Treatment methods/plants
Studies have been conducted to evaluate the effectiveness
of air pollution control equipments.
Water: Research and development work in defluoridation has
resulted in the
development of "Nalgonda Technique” for
defluoridation of portable water, The technique has been
tested on domestic, community and large scale levels •
including rural areas and has been found most effective.
Performance water treatment plants from different regions
of the country have been evaluated.
Waste: Pilot plant studies on the treatment of sewage of
water Ahmedabad city and performance evaluation of various
sewage treatment plants are being carried out.
and
Sewage
3.
Development of process and products
Air:
Research and development work is being done
on
standardisation of
analytical techniques and quality
control procedure for air pollution studies.
Water: Development of analytical techniques of water research
(monitoring
of water quality and development of
methodologies for determination of
fluoride, cyanide,
silver, sulphide, nitrite, ammonia, etc.)
Processes have been evolved for the treatment of low
waver temperature coal carbonization wastes, organophosphorous
and
wastes,
pharmaceutical wastes and pesticides wastes.
Sewage
I
38
Concluding Remarks
While reviewing the six research institutes (five belonging to
the Health sector and one to the Environment sector) it was noted
that all the institutes reviewed without exception carried out
epidemiological studies.
However, the nature, type, methodology
of these studies, and the target groups surveyed, varied a lot.
It was refreshing also to note that most Institutes barring a
few
adopted
a
multidisciplinary approach
for
studying
environmental health issues.
Worth mentioning is the MRC which
has made considerable strides in its use of an interdisciplinary
approach to malaria research in India.
Most
of
these
epidemiological
studies
encompassing
multidisciplinary approach, meet some of the urgent challenges of
environmental health, but they often have a reductionist
approach, therefore we should also look forward to opportunities
with greater potential to prevent adverse health effects
resulting from environmental modifications that may occur with
development projects.
In our country today, some attention is
given to the environmental
concerns while planning an
infrastructural developmental project by conducting EIA studies,
but health components in this type of assessment is sadly
lacking. This calls for ensuring visibility and attention of the
health component in these efforts. Which is possible only by
incorporating health impact analysis statement in all feasibility
studies of development projects as a necessary part of the
broader EIA studies.
9
39
-:A1
1: ANNEXURE I
Per sons contacted and Institutes visited
Lucknow
Institution : Industrial Toxicological Research Centre (ITRC).
Persons contacted:
1.
2.
3.
4 .'
5.
6.
7.
8.
9.
TO .
11.
12 .
13 .
Dr PK Ray, Director, ITRC.
Dr(Mrs) Q Rahman, Head, Fibre Toxicology Section.
Dr SK Khanna, Head, Dyes & Food Toxicology Section.
Dr PN Vishwanathan, Head, Ecotoxicology Group.
Dr BN Gupta, Head Epidemiology Section.
Dr SK Rastogi, Epidemiology Section.
Dr AK Shrivastva, Epidemiology Section.
Mr Neeraj Mathur, Epidemiology Section.
Mr Tanvir Hussain, Epidemiology Section.
Mr SK Bhargava, Environmental Monitoring Section.
Dr PK Seth, Head, Development Toxicology Section.
Dr(Mrs) F Jaffery, Ecotoxicology Section.
Dr Virendra Misra, Ecotoxicology Section.
Ahnedabad
Institution: National Institute of Occupational Health (NIOH)
Persons Contacted:
1.
2.
3.
4.
5.
6.
7.
Dr SK Kashyap, Director, NIOH.
Deputy Director and Group Head o f
Dr SK Nigam,
Experimental Studies.
Dr SK Dave, Asst Director, Head of Health Science Group
Dr JR Parikh, Incharge, Respiratory Physiology Section,
Health Science Group.
Dr DJ Parikh, Asst Director, Head of Environmental
Stress Group.
Dr TS Patel, Air Pollution Section, Environmental Stress
Group.
Dr CB Pandya, Environmental Stress Group.
Nagpur
Institution:
National
Institute (NEERI)
Environmental
Engineering
Research
Persons Contacted:
1.
2.
4 .
5.
6.
7.
Dr SD Badrinath, Deputy Director, Head of
Environmental Impact Assessment (EIA) Division.
Dr SK Gadkari, Scientist, EIA Division
Dr PVRC Panicker, Head Epidemiology Section,
Environmental Biotechnology Division.
Dr (Mrs) AS Gadkari, Scientist,, Epidemiology Section,
Environmental Biotechnology Division.
Dr KR Bulusu, Deputy Director, Head of Water Division.
Dr WG Nawlakhe, Scientist Water.Division.
AL Aggarwal, Head of Air Pollution Control Division.
Al
8.
9.
2:-
Dr Phadke, Air Pollution Division.
Mr SG Bhat, Officer Incharge of Library and Documentation.
Bombay
Institutions:
1.
2.
3.
4.
5.
Foundation for Research in Community Health (FRCH)
Tata Memorial Cancer Centre (TMCC)
King Edward Memorial Hospital (KEM)
Central Labour Institute (CLI)
Air Quality Monitoring Station, Bombay Municipal Corporation.
Persons contacted:
1.
2.
3.
4 .
5.
6.
7.
8.
9.
Dr NH Antia, FRCH.
Dr Ravi Duggal, FRCH
Ms Sonia Gill, FRCH
Dr LD Sanghvi, Head Cancer Registry, ICMR, TMCC.
Dr Sumati Bhide, Head, Biology Division TMCC.
Prof SR Kamat, Retired Professor, Chest Diseases, KEM
Hospital.
Prof AA Mahashur, Professor Chest Diseases, KEM Hospital.
Medical Section CLI.
Dr Surendranath, Director,
Dr S Deshpande, Head of Air Quality Monitoring Station,
Bombay Municipal Corporation.
Calcutta
Institutions:
1. A11 India Institute of Hygiene & Public Health (AIIHPH)
2. National Institute of Cholera and Enteric Diseases
3.School of Tropical Medicine.
(NiCED)
Persons Contacted:
Dr BN Ghosh, Director, AIIHPH.
Prof AK Chakrabarti, Head, Epidemiology/Director
Grade Scientist, AIIHPH.
Dr KJ Nath, Head, Sanitary Engg. Deptt., AIIHPH.
3.
Dr A Kundu, Physician, Sanitary Engg. Deptt, AIIHPH.
4 ..
Dr A Mazumdar, Associate Prof, Sanitary Engg. Deptt, AIIHPH.
5.
Dr Samarjit Jana, Asst. Prof, Occupational Health Deptt,
6.
AIIHPH
7.
Dr SC Pal, Director, NICED.
8.
Dr BC Deb, Director - Grade Scientist, NICED.
Dr Dipankar Chakrabarty, Head, School of Environmental
9.
Studies, Jadavpur University.
10 . Dr DN Guha Mazumdar, Prof of Medicine, Institute of '
Postgraduate Medicine and Education & Research.
Dr J.Sil, Prof Microbiology, Medical College, Calcutta
11.
University.
Prof Jayati Hazra, Senior Fellow of Geographic Dept.,
12 .
Calcutta University.
13.. Dr’ S* Chakraborty, Head, Virology, School of Tropical
Medicine.
1.
2.
Al
3:-
Delhi
Institutions:
Malaria Research Centre (MRC)
South East Asia Regional Office (SEARO), WHO.
Persons Contacted:
1.
2.
Dr VP Shanna, Director, MRC.
Dr George A Garland, Chief Technical Advisor,
Environmental Health Division, SEARO, WHO.
ANNEXURE II
List of Publications consulted/resource material collected.
AHMEDABAD
Technical Review of Pneumoconiosis in India, Special Report
Series No.4 by Dr MN Gupta ICMR 1970.
2 . Technical Information Bulletin No. 4, on Byssinosis prepared
by Adhoc Committee of ICMR, 1967.
3 . Working Manual No.l, on the Health Problems of Bhopal gas
victims:Assessment and Management prepared by Dr SK Jain and
Dr SK Dave, ICMR and DST Centre for Visceral Mechanism, 1986.
Pollution due to chlorinated insecticides
,4 . Pesticide
especially DDT in the environment of man and other livestock
in the country, Dr SK Chatterjee, Dr SK Kashyap, Dr SK Gupta,
NIOH, DST Project (1976-1980).
5 . Diagnosis and Treatment of Pesticide Poisoning Technical
Report series No.11 by Dr SK Kashyap, ICMR, 1971).
6. Monograph - I, Ahmedabad Autoexhaust Pollution Survey, and
its effect on exposed occupational group by by AS Agrawal, TS
Patel et al, NIOH, 1979.
7 . Integrated Air-quality surveillance Study over Vadodara Urban
Development Areas (VUDA), NIOH, 1989.
8 . Comprehensive report on the integrated environmental
programmes on heavy metals phase I (April 1983-87) and Phase
II (Oct 1987-June 1989), sponsored by Deptt. of Environment,
Forest and Wild Life.
9 . Pneumoconiosis due to Mica dust inhalation in the Mica
processing industries in India, NIOH, 1982.
10. Proceedings of the Workshop on Safe Use of Pesticides
(jointly organised by NIOH and Indian Pest Control
Association, New Delhi August 1990).
11. Proceedings of WHO-ICMR Training course on 'Evaluation and
Control of Industrial Environment' 17 Feb 197 6 to 1 March
1976, ICMR 1976.
12. Hazards in chemical industry .— Proceedings of the Symposium
organised by Gujarat Chemical Association in collaboration
with NIOH (28 Dec 1988).
13. Status report on Genotoxicity Research (quick screening test
for Identification and Quantification of Chemical Toxicants
During Accidents), NIOH.
14. Status report on air-pollution study NIOH.
(on agro15. Status report on experimental toxicology
environmental chemicals), NIOH.
16. Status report on neurobehavioural toxicology NIOH.
.7. Status report on reproductive toxicology, NIOH.
.8. Status report on microbiology research programme NIOH.
An
.9. Status report on health effects of Pesticides in Man
appraisal and approaches — SK Kashyap, NIOH.
!0. Status report un Child Labour — Dr SS Ramaswamy, Dr SK Dave,
Dr SK Kashyap, NIOH 1987.
',1. Environmental Exposure to Cadmium (A selected Bibliography)
1921-'86, ENVIS.
:2. 1Environmental Exposure to Manganese (A selected Bibliography)
1928-1986, ENVIS.
Environmental
Exposure to Mercury (A selected Bibliography) ,
’.3. 1
.1935-'86, ENVIS.
1.
€
Annex.2-List of Publications (contd)
4
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2:-
24. Environmental Exposure to Lead (A selected Bibliography)
1921-'86,ENVIS.
25. Environmental Exposure to Zinc and Arsenic (A selected
Bibliography)1935-1986, ENVIS.
26. Environmental and Health Safety Guides:Asbestos Everyday
Problems, ENVIS.
27. Environmental and Health Safety Guides: DDT, ENVIS.
28. Environmental and Health Safety Guides: Dyes and Dye Stuff
Industry. ENVIS.
29. Environmental and Health Safety guide: Chlorine. ENVIS.
30. Carcinogenicity of Organochlorine Insecticides — DDT and BHC
'
in experimental animals, ENVIS.
31. Environmental Informations: Abstracts on Occupational Health.
ENVIS.
32. Experimental and Human surveillance on BHC and DDT
insecticides commonly used in India — SK Nigam et al, Annals
New York Academy Sciences.
33. Health effects among workers involved in the manufacture of
Hexachlorocyclohexane, P Chattopadhyay et al, J Soc. Occu.
Med,38,1988.
34. Environmental lead exposure as a health problem in India (an
overview) — CB Pandya et al
35. Lead poisoning — A community threat: Shah GM, Pandya, CB,
Sathawara, NG, Parikh DJ and Kashyap, SK, Paper presented in
the National Seminar on Lead and Environment, New Delhi, Feb
1991.
36. Biological monitoring of workers Occupationally Exposed to
Lead — CB Pandya et al.
37. Health Hazards of Lead and Monitoring of Health Status by RC
Murthy and SV Chandra, Paper presented in the National
Seminar on Lead and Environment, New Delhi, Feb 1991.
38. Environmental Lead Levels in Greater Bombay by RN Khandekar,
Paper presented in the National Seminar on Lead and
Environment, New Delhi, Feb 1991.
39. Brochure on HEAL Project, WHO/UNEP Publication.
40. ’’Autoexhaust and its effects on traffic policemen and
shopkeepers” by TS Patel et al, published in Annual Report
1982, NIOH.
41. Economic Aspects of Environmental Pollution in India
An
Exploratory Study by Arun C Vakil, 1984.
42 . A Review of Occupational Health Research in India -third
Review 1963 - 83, by BB Chatterjee, NL Ranganathan, MN Gupta,
MN Rao, Special Report series No 61, ICMR, 1970.
43. Occupation, smoking and Lung Cancer by SK Dave et al, NIOH,
1988.
44. Annual Reports of NIOH for the years 1978-81, 1983-84 & 198889.
Studies/Research Papers of Special Interest:
* Health Problems related to Pesticide Exposure in applicators.
* Exposure to Vegetable dusts like cotton, tobacco and paddy etc.
and related health problems.
* Ergonomic studies in agricultural tools, agricultural accidents
and work safety in agricultural jobs.
* ]Health Problems of Plantation (tea and coir) workers.
'* Silicosis in quartz crushing units, quarries, slate-pencil,
and ceramic industries.
Annex.2-List of Publications (contd)
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3:-
* Exposure to toxic chemicals, dyes, pesticides, and metals and
its impact on health
* Health problems in carpet weaving, match and fireworks
industry and metal art-wares.
* Asbestosis in Miners.
* High altitude pneumoconiosis.
* Pneumoconiosis in underground coal miners.
* Byssinosis in textile mills.
* Health survey in Ginning industry.
* Dye related water pollution and its impact on health.
* Nicotine toxicity among workers working in tobacco fields.
Bombay
1.
2.
3.
5.
6.
7.
8.
9.
10.
Adverse health effects from industrial pollution - SR Kamat.
Sequential Health effect study in relation to Air pollution
in Bombay, SR Kamat and VB Doshi in Europ. J.,Epidemiology
Sept. 1987
The health effects of Automobile exhaust and total ambient,
pollution in Bombay; SR Kamat et al., Lung India VII, No.l.
(1989).
Methyl Isocynate survivors of Bhopal sequential flow volume
loop changes observed in 18 months follow up - MH Patel,
SR
Kamat and others — Lung India , V No 2,(1987).
Sequential Respiratory changes in those exposed to the gas
leak at Bhopal - SR Kamat, AA Mahashur and others, Indian
Journal Of Medical Research, 86(Suppl), 1987.
Early observations on pulmonary changes and clinical
morbidity due to the isocyanate gas leak at Bhopal - SR
Kamat, AA Mahashur et al., Journal of Post Graduate
Medicine, Vol. 31, No. 2, (1985).
FRCH Newsletter July-August 1987, Vol.I, No.5. .
Tobacco and Health: The Indian Scene - L.D. Sanghvi and
Perin Notani, Published by International Union Against
Cancer and TMCC, Bombay.
Annual Report - 1982 - National Cancer Registry - A Project
of ICMR.
Bombay Air Pollution - Health Study - Municipal Corporation
of Bombay, 1983.
The Important Research Papers/Studies in the Document:
★ Prospective Three Year Study of Health Morbidity in relation to
Air Pollution In Bombay.
* A Cross-sectional Comparative Study between three Urban
Communities with different Air Pollution levels for health
morbidity and Lung Function.
* Fluctuations of daily Air Pollution levels and Respiratory
Symptoms in four Communities in Bombay.
* Contribution of Food, Water and Air Pollution to the Health
Status in Central Bombay.
* Seasonal Factors in Health Morbidity with Air Pollution.
Annex.2-List of Publications (contd)
*
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Delhi
1.
2.
3.
4.
5.
6.
7.
•8 .
9.
Prevention, Diagnosis and Treatment of insecticide poisoning
- R Plestina, WHO, Geneva, 1984.
Draft report on hazardous waste management in electroplating
industries of Delhi region - SEARO, WHO, New Delhi.
Paryavaran Abstracts, vol.7 no.l & 2 - Department of
Environment, Forests and Wildlife.
Guidelines for the study of dietary intakes of chemical
contaminants - prepared under the sponsorship of UNEP,
FAO, WHO, Geneva. 1982.
Panel of Experts on Environmental Management for Vector
Control jointly prepared by WHO, FAO, and UNEP (1982, 1986
and 1987), WHO,Geneva, 1982.
Environmental problems in Delhi
status and suggested
measures : by WHO, Jan.1989.
Annual Report 1986, National Institute of Conniunicable
Diseases, Delhi.
Half yearly Progress Report (January-June '89) Integrated
vector control of Malaria, MRC Delhi, ICMR, 1990.
Integrated vector control of Malaria, Filaria and other
vector borne Diseases, Malaria Research Centre, Delhi, 1989.
Calcutta
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Impact of Drainage and Water supply system in Dumdum area on
urban health - by Jayati Das, Paper Presented in the
International Seminar on Health Care Planning in the
Developing World, Feb, Calcutta, 1991.
Environmental hazard in the wake of industrialization Durgapur, A Case Study by Dr Swapna Basu, Paper Presented in
the International Seminar on Health Care Planning in the
Developing World, Feb, Calcutta, 1991.
River Damodar and its effect on human health - A Case study
of Asansol region by Dr Smita Sengupta, Paper Presented in
the International Seminar on Health Care Planning in the
Developing World, Feb, Calcutta, 1991.
Environmental impact assessment of water reservoir/Kamabati
Dam and its impact on health, An interim report by AIIHPH
and NEERI.
EIA of Ganga Action Plan and Health Impact Studies, An
interim report by AIIHPH and NEERI.
Annual report of NICED for the years 1980, 1981, 1982, 1988.
Intra-familial transmission of vibrio cholerae biotype Eltor
in Calcutta slums, BC Deb et al. NICED Publication.
Studies
on
Interventions to
Prevent Eltor iCholera
transmission in urban slums — BC Deb et al. NICED
Publication.
Socio-economic and Health aspects of Recycling of Urban
Solid Waste through scavenging, Report by AIIHPH.
Environmental pollution and chronic arsenic poisoning in
South Bengal by Dr BN Guha-Mazumdar, Paper Presented in the
International Seminar on Health Care Planning in the
Developing World, Feb, Calcutta, 1991.
Annex.2-List of Publications (contd)
-:A2
5:-
Naqpur
Publications of NEERI
1
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Annual Reports of NEERI for the years 1984, 1987-88, 198889 and 1990.
Silver jubilee Souvenir, NEERI, 1984.
Commemoration Volume (25 years of NEERI) 1984.
NEERI Research in Retrospect (1959-'83), 1984’
River Ganga-An Overview* of Environmental Research, 1987,
Air quality in selected Cities in India, 1978-79, National
Air-quality Monitoring Network,
1980.
Orange City Environment — NEERI's Contribution,
1987.
NEERI in the Service of Gujarat, 1987.
NEERI in the Service of Rajasthan, 1986.
Proceedings of Indo-US Workshop on Environmental Impact
Analysis and Assessment, 1982.
Proceedings of ’’Workshop on Research and Development Needs Water Supply and Sanitation Decade (1981-90), 1979.
LUCKNOW
Scientific Papers and Reports Published from ITRC:
1)
2)
3)
4)
5)
6)
7)
8)
9)
10)
ii)
12)
13)
14)
15)
16)
Health effects of industrial pollution in Firozabad; AR
Shrivastava et al.
A study of Respiratory function in glass bangle worker's
pneumoconiosis: SK Rastogi et al.
Case control study of chronic bronchitis in glass bangle
workers: AK Shrivastava et al.
Pulmonary disease due to Multimetal exposure in glass bangle
workers — AK Shrivastava et al.
Pneumoconiosis among flour mill workers — BN Gupta et al.
Respiratory Health effects from Occupational exposure tc
wood dust in saw Mills — SK Rastogi et al.
Data linkage correlations of Morbidity and Mortality in
Relation to Bacteriological quality of water at Nagpur — AK
Shrivastava et al.
Occulotoxins: Effects, implications and importance in
occupational health — AK Shrivastava and BN Gupta.
Study of the Prevalence of Ventilatory Obstruction in
Textile Workers exposed to cotton dust — SK Rastogi et al.
Evaluation of risk factors in the prevalence of Byssinosis
log linear analysis — Neeraj Mathur et al.
Occupational Health Hazards in Beedi Making Industry
A
Review — BN Gupta and SK Rastogi.
Pulmonary Tuberculosis in glass (bangle) industry of
Firozabad — AK Shrivastava and BN Gupta.
Ophthalmic morbidity in Glass Workers — AK Shrivastava and
BN Gupta.
Musculo-skeletal disorders in glass bangle workers in
Firozabad — AK Shrivastava et al.
Effect of Exposure to Toxic Gas on the Population of Bhopal:
Part I--Epidemiological,
Clinical,
Radiological
and
Behavioural Studies — BN Gupta et al.
Effect of Exposure to Toxic Gas on the Population of Bhopal:
Part II — Respiratory Impairment — SK Rastogi et al.
Annex.2-List of Publications (contd)
»
I
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«
6:-
>
17)
>
>
I
»
I
I
I
I
)
I
I
i
Effect of Exposure to Toxic Gas on the Population of Bhopal:
Part III Assessment of Toxic manifestations in Humans Haematological and Biochemical Studies — RC Shrivastava et
al.
Effect of Exposure to Toxic Gas on the Population of Bhopal:
18)
Part IV -- Immunological and Chromosomal Studies -- AK
Saxena et al.
UK
, 19) A clinical study of Toxic Gas Poisoning in Bhopal
Mishra et al.
20) Occupational health problems of Workers in the Unorganized
sector — BN Gupta et al.
Cardio-respiratory studies on glass bangle workers — SK.
21)
Rastogi et al. 22) Thermal stress and physiological strain
of children exposed to hot environments in a glass bangle
factory — SK Rastogi et al.
Physiological responses to thermal stress in a glass bangle
23)
factory — SK Rastogi et al.
Pulmonary function studies among healthy glass bangle
24)
workers — SK Rastogi et al.
25) Pulmonary Effects of silica dust in Asymptomatic agate
workers — SK Rastogi et al.
Prevalence of respiratory impairment in asbestos workers —
26)
SK Rastogi et al.
Diurnal pulmonary function variability in healthy workers —
27)
SK Rastogi et al.
Study of Respiratory impairment among pesticide sprayers in
28)
Mango plantations — SK Rastogi et al.
Abstract of ”A study of chronic bronchitis among Brassware
29)
workers'- — SK Rastogi et al.
Environmental Impact Assessment of Eastern Ghats(Koraput)in
30)
relation to Water Quality and Health Status Studies — AK
Shrivastva et al.
BN
A Threat to our Existence
Environmental Pollution
31)
Gupta.
AK Shrivastava and BN
the Indian Scene
32)
Noise Pollution
Gupta.
A Case Study of
33) Respiratory Morbidity in agate workers
Khambhat, Gujarat.
Plight of Glass Bangle workers - A Study of Morbidity and
34)
socio-economic conditions of workers in glass bangle
industry at Firozabad — 1984.
35)
Scientific Report (Annual Report) ITRC, 1987-89.
36)
Environmental effects of silica dust in Metalware industries
in UP (with special reference to Moradabad) 1989.
37)
Occupational and Environmental Risks of Specific Relevance
to Women — PN Vishwanathan and Farhat N Jaffery.
38) Occupational and Environmental Toxicological Problems of
Developing Countries — PN Vishwanathan and Virendra Misra.
Occupational and Environmental Problems in Rural Communities
39)
— PN vishwanathan.
40)
Effect of Environmental Pollutants on Wildlife - A Survey —
SD Pandey, Virendra Mishra and PN Vishwanathan.
Non-permitted
colours in food and their toxicity — SK
41)
Khanna et al.
SK
42) Use of synthetic dyes in eatables of rural areas
Khanna et al.
43) Trend of adulteration of Mustard oil in rural markets of
Uttar Pradesh, SK Khanna et al.
Annex.2-List of Publications (contd)
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4 4)
45)
>
45)
47)
48)
49)
50)
51)
52)
53 >
54)
7:-
An outbreak of Tricresyl Phosphate Poisoning (TCP) in
Calcutta — AK Shrivastva, Mukul Das, and SK Khanna.
Mobile water testing laboratory for quality and safety of
rural drinking water.
Portable water analysis kit for rural areas.
Bacteriological quality of drinking water in rural India
Bhatacharjee et al.
Seasonal distribution of aeromonas hydrophila in river water
and isolation from river fish — SP Pathak et al.
Seasonal variation in the metal
tolerance of aerobic
heterotrophic bacteria in river Gomati water — SP Pathak et
al.
Bibliography on Industrial and Environmental Health.
Occupational Health Aspects of Textile and Allied Industries
-An Overview with a Bibliography.
Pollution
Problems
in
Pulp
and
Industry
Paper
(Bibliography).
Monitoring of Air, Water and Food Samples and Assessment of
Human Exposure in Chembur, Bombay - A Proposal.
Monitoring of Air, Water and Food Samples and Assessment of
Human Exposure in Kanpur - A Proposal.
Annex.2-List of Publications concluded
i
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1:-
Annexure III
Viewpoint of the Principal Investigator on Tribal Health
The Tribal Research Institutes of Orissa and Bihar have done
considerable thinking and good research in the field of Tribal'
Health falling within our area of interest.
The principal
investigator has been very closely associated with the Tribal
Research Institute, Bhubaneshwar (Orissa), where he started the
tribal
health
cell
in
the
Institute
and
initiated
interdisciplinary studies using research methodologies from both
medical and social sciences.
He has also been associated with
many of the tribal health projects/studies in the country, over
the past 15 years.
While conducting studies on tribal health in the depths of
various tribal areas/pockets of India,
many a tines, he had
contended the conventional methodological and conceptual
approaches to the study, which were usually based on western
reference models, (clinical or at best anthropological studies)
often leading to presentation of a fragmented and materially
distorted account of the social reality in the tribal situation.
He attempted to make the social reality as the starting point for
alternative research methods/approaches in this field.
The
entire methodological edifice in his studies was built around an
integrated concept of the way of life, through a unified
analytical system and Tribal Health was always viewed in a
holistic perspective where (a) effects of environment; (b)
behavioural pattern and life styles; (c) health care delivery and
(d) hereditary and genetic determinants made up the totality of
the health status of the tribals. This approach-, .helped to a
degree to develop deeper insights into key issues concerning all
aspects of Tribal Health.
3
It would not be out of place to refer to differentiation of
"inner" and "outer" conditions as propagated in the theories of
health and illness among some of the primitive tribal groups. The
inner condition refers to a situation that makes an individual
susceptible to illness while the outer condition refers to "the
thing" that takes advantage of this susceptibility.
In these
theories of illness causation, it is believed that the outer
condition is the configuration of natural phenomenon, diet,
supernatural entities and germs which may cause illness when the
individual is susceptible.
On the other hand the inner
susceptibility is determined by innate mystical qualities (?) as
well as by attributes that change in conformity with events in
the individual's life, actions, and ultimately social behaviour.
Tribal theories of illness causation are therefore, non-discrete
and cannot be understood without recognising that they are not
only interrelated but actually interdigitate.
If we try to
look deep into these intricacies, we find that this is a more
holistic and comprehensive way of thinking and relating all
factors involved in the actual causes of health and illness and
emphasizes an eco-system perspective that considers the physical,
biological, and cultural components.
The most important lesson
learnt during the one and half decades of tribal health research
experience was that this eco-system approach recognised that
there is no single cause of a disease and there may be an
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2:-
immediate, clinically detectable stimulus for disease such as a
bacteria, virus, or an intestinal parasite, but disease itself
was ultimately due to a chain of factors related to eco-systemic
imbalances.
This was perhaps the stimulus which triggered, some years ago,
One
the Principal Investigator's early works on tribal health,
such study carried out in Orissa recognised the fact that the
tribal children in tribal belts where natural resource depletion
had disturbed the ecological balance suffered acute malnutrition.
This is just one example. There are many more studies conducted
in the field of Tribal Health which try to establish linkages
with the deterioration of a natural ecosystem and its adverse
impact on health status of the tribals.
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