THE CHANGING PATTERN OF DISEASE IN DEVELOPING COUNTRIES
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In this Issue
swasth
hind
Jyaistha—Asadha
Page No
June 1986
The Changing pattern of disease in developing
countries
B. O- Osuntokun
117
A methodology for occupational health educa
tion in industry
X. C. Samikkannu
121
Vol. XXX No. 6
Saka 1908
Preventing occupational diseases
Pritam Lal
125
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Family in urbanization—New meaning
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126
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129
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133
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135
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impressive evidence has
collected by Trowell & Burkitt
(/) on the increasing prevalence in
developing countries of non-commu
nicable diseases previously seen only
in the industrial world. However, it
must be emphasized that most deve
loping countries lack reliable data.
Many are unable to organize a cen
sus each decade as recommended
by the United Nations, and surveys
on 'patterns of disease, morbidity
and mortality, based on represen
tative samples, are equally scarce.
There is an urgent need for more
facts and figures from developing
countries: accurate data will help
planners to assess what health care
is needed.
ome
S
THE CHANGING PATTERN
OF DISEASE IN
DEVELOPING COUNTRIES
B. O. OSUNTOKUN
With some exceptions, the infor
mation on disease patterns in deve
loping countries is derived from
hospital data, which are unrepre-'
sentative of the communities. Of
ten the reported prevalence of a
particular disease reflects only the
interest in it of medical practi
tioners.
Nevertheless, the follow
ing examples indicate that the si
tuation in developing countries is
rapidly changing and now merits
serious consideration by those res
ponsible for public health.
Hypertension
Many afflictions that are common today were rare or
absent in our ancestors and can be seen as the results of
man’s poor adaptation to significant environmental
changes.
In comparatively recent times, following
industrialization, such changes have occurred in living
and working conditions, means of transport, the atmo
sphere, and agriculture, and even the preparation of food
has been affected, Man has adopted habits that are not
conductive to good health, such as sedentary living
smoking, the use of alcohol and drugs, and overeating
without regard to a good dietary balance.
June 1986
Ideally, blood pressure should
not rise with age. In developed
countries, however, it does,
and
there is some evidence that life
style, environment and diet may be
determinant factors.
In Kenya, Uganda, and the Unit
ed Republic of Tanzania, clinical
and epidemiological evidence sug
gested that between 1929 and
1940 hypertension did not occur
in any African: the first patient
was reported in 1941 (2). In other
parts of Africa, several studies in
black Africans over the last three
decades have shown
consistent
findings of blood 'pressure rising
117
with age and prevalence rates of
hypertension similar to those in
black and white communities else
where (5). Mean arterial pressures
were usually higher in urban than
in rural populations, which might
be explained by diet and obesity.
About thirty isolated, primitive
communities have been identified
in several parts of the world where
people’s blood
pressure did not
rise with age, and studies of some
of these have led. to speculation
that life-style could be responsible.
The reasons may include the die
tary pattern (high in fibre, com
plex carbohydrates, and potas
sium; low in fat and sodium), the
degree of physical activity, absence
of stress, and environmental fac
tors.
. In one such isolated communi
ty—the Samburus of Kenya (4)—r
it was found that when the men
were recruited into the Kenyan
army their way of life underwent
considerable changes, particularly
as far as their dietary habits and
physical activity were concerned.
Significant changes occurred in
body structure and skinfold thick
ness, and subsequently blood pres
sure rose with age.
Coronary Artery
Disease
and
Atherosclerosis
There is no doubt that heart
disease was hardly seen until re
cently in developing countries and
was particularly uncommon in Afri
ca.
Williams
and
cu-workers (5)
showed that atherosclerosis of the
coronary vessels, aorta, and cereb
ral vessels was minimal in Nigerians
compared with Caucasians and Ame
rican blacks in Minneapolis, USA.
Coronary artery disease is consi
dered rare in South African urban
blacks, including those who are.
hypertensive and hypercholesterolaemic, and is far less common than
118
in South African whites and Indians low physical activity is known to
of similar age and sex (6). Athe be a risk factor for atherosclero
rosclerosis is equally unusual even sis. Generally, the prevalence rate
in diabetic Africans, among whom of obesity in developing countries
the commonest risk factors for even now is much less than the rate
gangrene are peripheral neuropathy, in developed countries, about 3%
trauma, and infections. On the compared with 25%.
other hand, some communities in
Industrialization
and
urbani
India appear to be unusually sus
zation, with their associated social
ceptible to heart problems both in
problems and stress, were un
their native land and when they
known in primitive communities.
migrate to more prosperous coun
These factors, taken together with
tries.
changes in eating habits—less
Coronary artery disease associat fibre and starch together with more
ed with cigarette smoking is a ma fatty foods, alcohol, and refined
jor recent feature in India, Pakistan, carbohydrates such as sugar—
and the Philippines (7). In New are recognized as being likely rea
Zealand, too, the introduction of sons for the high prevalence of
diseases.
smoking among the Maoris has a some noncommunicable
They
are
now
becoming
increas
lot to answer for: the Maori
ingly
visible
in
many
developing
women’s death rate from heart dis
ease and from lung cancer has countries.
been found to be the highest in
Diabetes
the world.
Diabetes mellitus is said to have
The reasons why some commu been unknown inz- East African
nities in developing countries have countries before 1953, when it
a low prevalence of heart disease was first reported in an overweight
are unknown, but it is noted that African nursemaid. A few wellthe cholesterol and fat content of conducted surveys in developing
their diets is low and the propor countries have produced data to
tion of fibre and starch is high. justify the statement that changes
The intense physical activity of in life-style, associated with urbani
man’s ancestors during hunting for zation and the adoption of “West
have produced
example, as in the bushman and the ern civilization”,
manifold
increases
in
the incidence
Hottentot, who may have run 3040 km a day as routine, must have of diabetes mellitus (<?). The pre
contributed to the complete absen valence of obesity in most develop
ce of obesity in those days, and ing countries has also increased in
the last three decades. A diet low
in
fat and sucrose, and high in
Some important noncommuni
unrefined
starch and fibre could
cable diseases like lung cancer
protect
against
the occurrence of
and heart disease are now becoming
more common in the developing non-insulin-dependent diabetes mel
countries. One reason for this ap litus and also be efficacious in the
pears to be that the people are giv treatment of both this and the ining up their traditional ways of sulin-depedent form of the disease
life and adopting those of the deve ® 9).
loped countries. It has been suggest
Cancer
ed that,' for some of the diseases,
Cancer registries established in
changes in dietary habits are the
many
developing countries have
main causative factor.
Swasth Hind
shown that cancer is not a disease
of Western society alone.
More
than half of the world’s 5.9 mil
lion annual total of new cancer
cases arise in the developing world
(10). The annual total of deaths
from all forms of cancer is esti
mated to be 4.3 million, of which
2.3 million occur in the developing
countries.
ty hygiene, and diet.
High-fat
diets are believed to predispose to
cancers of the large bowel, breast,
and prostate, and a protective effect
is exercised by some dietary com
ponents, especially a high content
of fibre and vitamins A and C.
Accidents and Violence
Road accidents cause many ca
sualties in developing countries.
Nigeria and some of the East Afri
can countries are said to have the
highest number of accidents per
million vehicle-miles in the world.
The Future
The limitations of the data avai
lable are obvious. There is very
little valid information about most
of the diseases, and some of it is
anecdotal. It is unrealistic to com
pare the prevalence of diseases bet
ween countries that have not1 come
to agreements on methods of data
collection and investigation,
nor
on the definition of what is being
studied. In spite of this it is posible to detect an emerging trend.
However, socioeconomic factors,
life-style, behaviour and environ
ment appear to influence the types
of cancer that predominate in
In the light of the experience of
the developing world. Tobacco
Urban violence is also on the developed
countries changes to
consumption in the industrial world
is falling by about' 1% annually, increase, and is one of the com be expected in the pattern of dis
but consumption in the developing monest causes of death in the 18 eases associated With industrializa
countries is rising by twice that, million black population in South tion in developing countries inclu
de:
encouraged . by aggressive market Africa (12).
ing on the part of the tobacco com
panies; this has been called the
TEN RULES FOR THE DRUG TREATMENT
“new slave trade’ (7). Lung cancer
used to be rare in the develop OF HYPERTENSION
ing countries, but now high death
(1) Blood pressure should be lowered gradually.
rates from this cause are reported
(2) Treatment should depend on the individual involved, according to the
from China, Hong Kong,
and
South African blacks in Natal, severity of the disease, the degree of haemodynamic disturbance, and other
while several cases are being re prevailing disease processes.
ported from other parts of Africa
(3) Drugs should be prescribed in a stepped fashion starting with’a single
and tropical America. Traditional drug—except in cases of severe hypertension.
practices such as the chewing of
(4) Combination treatment is preferable to high-dose monotherapy be
betel quid and tobacco or hookah
smoking are hazardous and proba cause it involves the use of lower doses of the individual drugs and thus may
bly constitute the main reason for cause fewer side-effects.
90% of the 100,000 new cases an
(5) Avoid giving inadequate doses of any drug.
nually of oral cancer in south-east
(6) Never stop treatment abruptly or withdraw one drug suddenly.
Asia.
(7) Familiarize yourself with a limited number of drugs and adhere to
Economic development1 tends to
them.
The newest drug is not necessarily the best one.
to be accompanied by an increas
ed incidence of cancers in the lung,
(8) Drugs that do not affect the mood and mind are preferable since they
large bowel, breast, prostate, blad interfere the least with everyday activities.
der and ovary (11), and by their
(9) In most patients, treatment must be continued indefinitely. Do not
reduced incidence in the oesopha
gus, stomach and liver. This is due change the treatment unless absolutely necessary. Treatment should be
to a variety of reasons, including simple, if possible a single tablet to a day.
the use of tobacco and alcohol, oc
(10) Have patience and (rain your patient to be patient.
cupational exposure to chemicals,
From: Gross. F. ct al. Management of arterial hypertension. A practical guide for the
environmental pollution,
sexual physician
and allied health workers. Geneva, World Health Organization. 1984, p. 53.
behaviour, personal and communi-
June 1986
119
• fewer nutritional deficiencies and
infections, with falls in mortality
rates of infants and young adults;
• more dental caries, obesity, hy
pertension, diabetes and vascular
diseases;
• more gastrointestinal diseases such
as large bowel malignancy, di
verticulitis and appendicitis; and
• fewer cancers in certain sites
(e.g., liver), offset by more in others
(e.g., lung cancer related to smok
ing).
cable diseases likely to come with
industrialization.
4.
Shaper, A. G. et al., East African
medical Journal, 46: 282-289 (1969).
5.
Williams, E. O.
Stroke, 6:
World Health Organization, 62:
182 (1984).
REFERENCES
These changes have already be
gun to appear in many developing
countries and in some groups of
immigrant populations in industri
al countries. Although the develop
ing countries will probably achieve
control of infectious and deficiency
diseases in the future, they must
take appropriate steps now to avoid
the “epidemics” of noncommuni
et al.,
It is necessary to determine how
395-401 (1978)
best to obtain and use information z
on the- prevention and management 6, Seftel, H. C. South African medical
journal, 54: 99-105 (1978).
of noncommunicable diseases in de
veloping countries, and considera 7. Lancet, 1: 23-24(1984)
ble research is required to this end.
Such research would probably be 8. Simmet, P. Diabetes care, 2: 144-153
(1979).
rewarding, as some developed coun
tries have been able to reduce the 9. Anderson, J. & Ward, K. American
incidence of diseases such as hy
journal of clinical nutrition, 32: 23122319(1979X.
pertension and stroke as a result of
active intervention programmes. O 10. Parkin, D. M. et al. Bulletin of the
II.
163—
Doll. R. & Armstrong, B. Cancer. In:
Trowell, Ft. C. & Burkitt, D.P., ed., op.
cit., pp. 93-110.
1.
Trowell, H. C. & Burkitt, D.P.,ed.,
Western diseases. London, Arnold, 1981.
2.
Trowell, B. H. Hypertension, obesity,
12. Walker, A. R. P. South African black,
diabetes mellitus and coronaiy heart
Indian and coloured populations. In:
disease. In: Trowell, H. C. & Burkitt,
Trowell, H. C. & Burkitt, D. P., cd.,
op., cit., pp. 285-318.
D. P., ed., op. cit., pp. 3—32.
3.
Akinkugbe, O. O. The epidemiology of
(Reproduced with permission from the
hypertension in blacks. In : World
World Health Forum, Vol. 6,
epidemiology New York, Raven Press,
No. 4, 1985.}
1985 (in press).
ENVIRONMENT AND ECOLOGY PROTECTION IN
SEVENTH PLAN
AN OUTLAY OF Rs.* 427.91 crore has been provided in the Seventh Plan for the protection of
environment and ecology.
The programmes aim at removing some of the weaknesses in the existing environmental planning
system. Environmental considerations form an important element in the criteria for setting development
targets and assessing plan performance in all sectors under the Seventh Plan. This environmental manage
ment would be integral to all environmental activities.
A major programme for the control and prevention of pollution of the river Ganga is undertaken
as a science and technology mission during the plan period. Under ecological development, the plan aims
at restoration of already degraded eco-systems through practical field schemes such as land reclamation,
afforestation, cleaning of water bodies, etc. The programme is also geared towards arresting further
damage to eco-systems and the promotion of a conservation-based development strategy.
. It is now being increasingly recognised that environmental factors and ecological imperatives must
be built into the total planning process if the long-term goal of making development sustainable is to be
achieved. Environmental management, therefore, is a major guiding factor for the national development
in the Seventh Plan. A
—YOJANA
1—15 March, 1986
120
Swasth Hind
A METHODOLOGY FOR
OCCUPATIONAL HEALTH
EDUCATION IN INDUSTRY
K.C. Samikkannu
Community health problems with arise out of
industrialisation,. like pollution of air and water,
■unhealthy living conditions, increased exposure
to communicable diseases, also affect the health
of the workers. To protect, promote and main
tain the health of the workers, occupational
health services (OHS) need to be established, says
the author. This article gives a brief description
of the educational methodology adopted at the
National Model Centre for occupational Health
Services, Tiruchi, in carrying out various occu
pational health education programmes.
V-Z ccupation is the main source
by which man earns his livelihood.
From the old stone age, down to
the present electronic age,
man
has’been pursuing some occupation
or the other. Occupation encom
passes all kinds of economic acti
vity. Times have changed and so
have occupations. But all occupa
tions, without any exception, while
contributing to the sustenance, sur
vival, development and well-being
of mankind are associated with
certain inherent risks to health.
India, till recently an agricultural
counrty, is rapidly getting industri
alised. Workers are exposed to
many hitherto unknown physical,
chemical, mechanical, biological
and psychological hazards due to
new methods of production which
are introduced in the process of
industrialization. Migrant workers
are posed with the problem of ada
ptation to the new environment and
this affects their mental health.
Community health problems which
arise out of industrialization, like
pollution of air and water,
un
healthy living conditions, increased
exposure to communicable diseases
also affect the health of the work
ers. To protect, promote and main
tain the health of the
workers,
Occupational
Health
Services
(OHS) need to be established.
Occupational health services (OHS)
OHS is a comprehensive total
health care programme, made avai
lable at the place of work, to take
care of the health of the workers
from the time of their recruitment
till their retirement. It is a multi
disciplinary approach to health,
involving various disciplines like,
occupational medicine, toxicology,
occupational hygiene, work physio
logy and ergonomics, occupational
psychology, health education, etc.
The need for occupational
education
health
The health of the workers lar
gely depends on the healthy beha
viour they adopt at the place of
work, at home and in the commu
nity. Behaviour profoundly in
fluences our health and behavioural
June 1986
121
change, therefore, makes a lot of PHASE I—PRE-PLANNING
difference in achieving optimal
health. Health education is a pro Identification and training of lea
cess by which we can bring about ders
the required positive behavioural
People often listen to and imi
change. In any health care pro tate their leaders. Leaders are im
gramme, it is an important and portant change agents in any com
integral component for achieving munity. Studies have shown that
purposeful result's. So, in a com leaders have better communica
prehensive health care programme tion with others than the average
like OHS, the role of health educa person has and messages given
tion is vital. This can be substan by them are well received. To en
list the leaders active interest and
tiated by the following points.
participation, it is necessary to
involve them from the beginning.
Every occupation is associated Sometimes the leaders we encoun
with some risk or the other. These ter in our day to day life may not
risks can be minimised but can be ideal leaders with all the lea
not be’ eliminated. Employer has dership qualities. Even in such
a moral obligation to educate his cases it is necessary to involve
employees about the hazards in them because sometimes, if we
volved in particular occupations, don’t do so, they may even work
and also provide all the required against our programmes.
facilities to the worker to protect
The leadership pattern in indus
his health.
try is quite different from
that
of in the community. Among the
The saying ‘prevention is better modern industrial workers there
is a tendency for everyone to con
than cure’ is indeed very true be sider himself as a leader.
Nor
cause diseases related to work can, mally, trade union leaders, shop
if at all, be prevented only and not council and works committee mem
cured. So, health promotion by bers are the informal leaders in
due precautionary measures re our industry. The source credi
quires the services of health edu bility is often vested with them.
cation.
As per . the health education
principle “work through the lea
The prolonged incubation period ders and use group influence”, edu
for many work related diseases to cational programmes are organis
be clinically manifest, makes health ed to actively involve them in our
education imperative since the programmes and use them as our
workers are blissfully ignorant of change agents. In the educational
what can happen after years. Al programmes, the leaders are given
most all health promotive and di inputs on the concepts of occu
sease preventive activities of oc pational health, various approaches
cupational health like persuading to occupational health problems,
the workers to adopt the prescrib major hazards present in different
ed preventive measures at the place areas of the industry, the role of
of work, improving their nutrition OHS in monitoring the work en
al status, increasing their physical vironment and the health of the
fitness, promoting their mental workers, and the role of leaders as
well-being, improving their stand change agents of employees’ health
ards of personal hygiene, making behaviour.
Most of the trained leaders are
them participate in immunization
and man maintenance programmes, actively involved in various occu
etc., require the active assistance of pational health programmes and
they extend all possible help and
health education.
co-operation. The leaders play
an active role in motivating the
The following is the description employees to adopt the measures
of the methodology
followed in prescribed by OHS. They also
organising the health education pro bring the occupational health pro
grammes at the OHS Model Cen blems in their areas to the notice
tre.
of occupational health staff.
122
In addition to frequent meetings
of the leaders at' the shop floor
organised by the occupational hea
lth team, periodic meetings of the
leaders are arranged to brief them
about new developments and pro
grammes. These meetings give the
leaders an opportunity to express
their opinions and put forward their
suggestions. These meetings serve
to establish a long standing and
sustained contact with the leaders.
Identification of the target group
for health education
The target group for health edu
cation is identified in the following
manner:
The work environment! surveys
carried out by the occupational hy*
giene wing provide the required
information on various health
hazards present in different opera
tions and areas of industry. On
the basis of this information, de
pending on the seriousness of the
hazard, the need for health educa
tion for a particular occupational
group is identified.
The other approach to identify
the target group is visiting the shop
floor frequently. These visits are
made by a team comprising a medi
cal officer, a health educator and
an occupational hygienist. When
ever it is found that a particular
section of employees are not adop
ting the prescribed preventive mea
sures against any hazard, emplo
yees of that particular occupation
are taken up for health education.
Sometimes the target group for
health education is identified on the
basis of the findings of a particular
survey. For example, soon after
the inception of OHS in Bharat
Heavy Electricals Limited (BHEL),
an industrial dermatoses survey
was conducted among the emplo
yees who worked in contact with
cutting oils and coolants. The sur
vey revealed that 145 employees
had early signs of oil folliculitis.
So, the need for educating the em
ployees on the importance of per
sonal cleanliness and the proper
use of barrier cream was identifi
ed and a health education progra
mme for the prevention of oil fol
liculitis was organised.
Swasth Hind
In the wakejif industrialisation, workers often are exposed to many hitherto unknown
physical, chemical and biological and psychological hazards.
PHASE II—PLANNING
STAGE I
Planning the health education pro
gramme
Once the target .group for health
education is identified, the content
of the health education programme
is planned. While deciding on the
content of health education, fac
tors like occupation, present work
practice, educational status, the
level of understanding, receptivity
iQvel, religious beliefs and values,
etc., are taken into consideration.
Sometimes knowledge, attitude and
practice surveys are conducted to
obtain information in these areas.
Taking all these factors into ac
count, tailor made programmes
are planned for different groups.
The educational methods to be
adopted and audio-visual aids to
June 1986
be used are decided on the basis of
their availability, and effectiveness.
PHASE II—PLANNING
STAGE II
Following this, the area mana
gers of the shop floor are contact
ed by the occupational health team
and the need for imparting health
education for the employees work
ing under them is explained. The
number of persons who could be
relieved from duty for attenting
the health education programme,
and the exact date of commence
ment of the programme are decid
ed by taking into consideration the
practical constraints at the shop
floor. Normally a supervisor is
nominated by the manager to co
ordinate the programme from the
shop floor. The nominated super
visor in turn prepares the list of
employees who have to attend the
health education programme on
each day and sends it to OHS
team. A copy of this list is also
sent to the time office for regula
rising the absence of the employees
from duty. Afterwards the health
education unit sends letters to the
employees through 4heir heads of
the departments. Thus arrange
ments are made for the employees
to attend the programme during
their working hours. The venue
of the programme, is fixed taking
into consideration the convenience
of the employees to attend the pro
gramme.
PHASE III—
IMPLEMENTATION
Implementation of the programme
During the implementation of the
programme, health education ses
sions are conducted by
health
123
educators,
medical officers,
oc
cupational hygienists, social work
ers, audiologist and nurses. So, as
one can see, it is not educators
alone who do it.
PHASE IV—EVALU ATION
Evaluation of the programme
The evaluation of the effective
ness of health education program
mes is done by administering a
questionnaire at the end of the pro
gramme. This is not done for all
programmes. Sometimes progra
mme review sessions are conduct
ed to know the usefulness of the
programme to the employees. A
change in the behaviour after at
tending the health education pro
gramme is reflected in the form of
using the prescribed
preventive
measures at the place of work by
the workers. This is observed by
the occupational health team mak
ing shop floor visits. In our ex
perience we found that a change
in knowledge is not immediately
followed by a change in behaviour.
This gradual change in behaviour
is possible when health education
sessions are followed by frequent
personal contacts,
reinforcements
and group influence.
The health education pro
gramme organised for emplo
yees exposed* to noise explains
how the methodology descri
bed above was put into prac
tice.
CASE STUDY
How the target group for - health
education was identified?
A noise survey undertaken in
certain work stations revealed that
the levels were high. The occu
pational health team visiting the
shop floor also observed that' the
employees working in these areas
were not using any protective de
vices against noise. The need for
educating the employees on the
importance of using the protective
device was thus identified.
How* the education programme was
planned*?
The health education unit
in
consultation with the occupational
•physician and audiologist decided
on the content of the health edu
cation programme by taking all the
other factors into account- The
duration and venue of the pro
gramme, the educational methods
to be adopted, the*audio-visual aids
to be used, the pamphlets to be
distributed, the faculty, were all
decided in advance and the re
quired preparations were made.
the noise at its source and the ne
cessity to use the protective devices
were emphasised. At the end of
the session, a pamphlet on noise
was issued.
Follow-up
Individual contacts with the em
ployees were made by the members
of the occupational health team
at the shop floor.. The employees
were also motivated by the audio
logist and the occupational physi
cians when the employees came for
audiometry and for the Periodic
Man
Maintenance
Programme
(PMMP).
Evaluation
As the employees were ignorant
about the effects of noise, not! even
a single worker was using protec
tive devices before the health edu
cation programme. During the
Later the shop floor manager
health education sessions, they
was contacted and briefed about the
were
given to know about the effects
need of health education progra
mme for employees working under of noise. Repeated personal con
his control. The manager, through tacts made by different members
one of his supervisors made all the
of the OHS team and motivation
necessary arrangements to relieve
the employees from duty to attend done through the union leaders,
the programme.
helped them realise the need to
wear protective devices. At present
How the programme was imple 45% of the employees working in
mented?
these areas are using the protective
With the use of a sound and slide devices regularly. This positive
presentation the various aspects of
noise were explained to the work change in health behaviour should
ers. During the group discussion solely be attributed to the effect
the practical difficulties to control of health education.
•
WORLD ENVIRONMENT DAY—5 JUNE
June 5 every year is observed as the World Environment Day. The Day seeks to high
light the strategy for environmental protection and rational use of natural resources, assess
ment of environmental impacts, low and non-waste technology, reutilization and recycling
of \vastes, management of hazardous wastes, the protection of flora, fauna and their habitats
and questions to combat environmental pollution.
This issue of Swash -Hind is devoted to Environment, Sanitation and Water.
124
Swasth Hind
Nature is becoming helpless with every passing day as human activities are cre
ating newer and newer sophisticated chemical products. Human organism, a kind
of self-sustained, lab that integrates ail the harmful influences, is incapable to
neutralise these substances in the present day industrialised cities. Therefore, there
is a need of effective preventive measures in protecting the workers from contracting
occupational diseases.
PREVENTING OCCUPATIONAL DISEASES
Pritam Lal
body responds to everything—noise, radia
tion, pollution, stress, etc. Every advancing scien
tific and technological horizons have added conceal
ed professional and accupational diseases to the afore
mentioned health hazards. The impact of occupa
tional diseases remains hidden for quite a long time.
As a result, pneumoconiosis, radiculitis, poisoning
with mercury and lead vapour have now become wide
spread disease phenomena. The use of various chemi
cals and allergens in industry, as well as working under
high pressure, noise, vibration, etc. has become great
risk factor to the health of the personnel working under
such conditions.
uman
H
Helpless nature
Nature is very flexible. Like blotting paper it ab
sorbs every thing and reprocesses what is harmful to
human race in order to protect it. But nature is be
coming helpless with every passing day as human
activities are creating newer and newer sophisticated
chemical products. Human organism—a kind of self
sustained lab that integrates all the harmful influences
—in pressent-day cities’ industrial life is incapable of
neutralising these substances.
For instance, in recent years it has been discovered
that even such a “harmless” operation as videoter
minal (display) control has a negative effect on human
health. What is more alarming is that such installa
tions are widely introduced today in industry and
management. Hundreds of thousands of operators
spend their working hours at the flickering screens of
the storage tubes of videoterminals, thus risking their
eyesight. The main risk factor in this work is a high
frequency of eye movements—upto 35,000 movements
a day—from the keyboard to the display and back.
Labour Safety and industrial hygiene
The foundation of the International Labour Orga
nisation Occupation Safety and Health Hazards Alert
June 1986
System was an important step aimed at transmitting
urgent information on the confirmed, or suspected
occupational hazards to competent bodies. But labour
safety and industrial hygiene problems have remained
as acute as they were in majority of capitalist coun
tries. For instance, 2.5 million industrial casualties
and occupational diseases were registered in the USA,
about 1.5 million in Italy and approximately 500,000
industrial casualities in the UK every year in the 1970s.
During the last 15 years, more than 50 conventions
have been adopted on industrial safety within the In
ternational Labour Organisation (ILO) framework.
These conventions are obligatory to states to develop
and implement comprehensive national policies to
guarantee labour safety, industrial hygiene and salu
brious industrial environment. State bodies and indus
trials have been entrusted with the responsibilities to
provide labour safety.
The USSR takes necessary steps to prevent the
spread of occupational diseases. Specialists are always
alert to encounter instances of vibration disease, bron
chial asthma, and diseases of the peripheral nervous
system caused by the extensive use of vibrating tools
and the saturation of the environment with chemical
compounds, some of which can cause allergy.
All industrial and agricultural enterprises in the
Soviet Union have doctors who have been specially
trained in occupational pathology, who keep a daily
watch on the conditions of work and the changes of
the state of health of the staff of a particular enter
prise. The state sends teams of doctors—neuropatho
logists, otoshinolaryngologists, eye-specialists, derma
tologists, immunologists, biochemists and experts in
functional diagnosis—to factories and plants to detect
such diseases at the earliest possible.
(Contd. oh Page 128}
125
Push and Pull
FAMILY IN URBANISATION
NEW MEANING FOR
SHELTER NEEDS
There is growing concern world over at the rapid rate
of urbanisation and the burgeoning of cities and
towns, especially in the developing countries. The
degradation of life facing an average family in urban
settlements may further worsen at the turn of the
century.
feature of the World
population scenario now and
for decades to come is the fast urba
nisation. The rate is as much that
more and more share of the increase
in population will be absorbed by
the increase in the urban popula
tion. At the beginning of the last
century only three per cent of the
people lived in urban areas. The
figure rose to 10 per cent by the
turn of the century and 25 per cent
in 1950. By the year 2000 this will
be 48 per cent and by 2025 more
than 60 per cent of the world’s po
pulation will be living in cities and
towns.
A
peculiar
of most countries at a loss. In the
developed countries urbanisation
had already reached high levels and
will slow down now. But in the
developing countries the process will
continue to accelerate, and decrease
can be expected only by the turn
of the century.
The share of the developing coun
tries in the total number of big city
agglomerations is also going up
steadily. In 1950, 11 out of 15
largest cities were in the industria
lised world. By 1975 there were 8
only in the developed countries and
by 2000 A.D. only Tokyo, New
York, and Los Angeles will be
While we cannot have any basic there in this list. Greater Bombay,
quarrel about urbanisation itself, Calcutta and Madras are among the
the large number of pshycological burgeoning cities of the world,
and sociological problems generated with their population of 17.1 milli
by this mechanism put governments on, 16.7 million and 12.9 million.
126
There were various reasons for
the urbanisation, but in the deve
loping countries there is a common
syndrome of ‘push’ and ‘pull’ fac
tors. In the rural areas hard and
un-interesting work, low wages, in
sufficient land and job opportuni
ties and lack of social service, all
create a push factor. The pull
factor operating from the cities
attract
rural folk
with
the
lure of employment, better edu
cational and
health facilities,
higher incomes and more entertain
ment. Nearly 40 per cent of the
urban growth during the 1960s in
the developing world was through
migration from the rural areas and
the remaining by natural increase.
There are other contributing factors,
like village dwellers commuting to
work in the cities leading to a sort of
‘rural urbanisation’ with the popu
lation of the semi-urban area in
between increasing dramatically.
There are four main components
in the growth generated by the ur
banisation. One is the urban explo
sion totally distinct from the leisu- .
rely urban growth in the West.
the second is the growth of industrial
economy involving considerable
shift from agriculture to industry,
and from land to factory. This
brings about a series of changes in
areas like capital investment and
credit structure. The third is the
labour force specialisation—emer
gence of a middle class providing
leadersihp for change and a chall
enge to the existing power structure
and tradition. The fourth compo
nent is the growth of nationalism
as the unifying course. This is be
cause in the cities there can be a
broad social
frame of reference
that can do away with differences
in speech, manner, dress, language
and religion.
Swasth Hind
Gigantic Task
One of the main areas where ur
banisation generates problems is
that of housing. The authorities in
the developing countries have not
been able to cope with the everincreasing demand for shelter,
especially in the cities and towns.
The result is that the people on
their own start constructing their
settlements. In this they would
like to be as close to their place
of work and so make their house
holds on payments, under bridges,
against the city walls and so on.
More than one third of the urban
population in cities now like in
such
squatter-settlements.
Their
number will double in six years
from now.
Housing needs of a family in a
city have social and economic fac
tors that pose big challenges. There
is often great disparity between the
needs oft the urban population and
the natural, technical and financial
resources available with the autho
rities.
Delhi for example would
double its poulation in the next 15
years and would need four times
the water now supplied. The se
werage treatment capacity needed
would be 900 million gallon per
day as against the present available
level of just 118 MGD. The power
demand by the turn of the century
would by 2500 MW, more than
four times what Delhi gets now
even with borrowing from other
States.
One of the main areas where urbani
sation generates problems is that of
housing. {World Bank Photo)
Colonial Hangover
poorer sections
may present the
same picture they in New Delhi,
in Mexico city, Lima or Dhaka.
In the beginning people make the
best use of the available amenities
but very soon garbage overflows
into the balcony and courtyard and
goats and chicken and pets live on
the stair case, landing and corridors.
The aspirations of families are
varying. Some of them want access
to technical and financial resources
so that they could build their own
house. Some others would like to
live in blocks of dwelling as this
would confirm
some amount of
social status and mobility. In any
case, special care, has to be given
in planning and designing to the
requirements of the aged, the handi
capped and the children.
own dwelling and this dwelling will
reflect the living pattern and the
aspiration of the family more than
any package housing unit provided
to them.
Mankind being- but one global
family, the World community will
have to jointly tackle the problems
of families in the face of urbanisa
tion.
—PIB
Governments in the developing
countries are no doubt conscious
of their obligations
but various
forces are at work, which not only
impede the progress of shelter con
struction but also create such living
and environmental conditions that
ultimately will turn a housing pro
ject into a seething, unclean slum. Variety of Aspirations
In the fifties and sixties, architectu
It has been observed that fami
ral planning and construction was lies can take care of their environ Special Needs
done by engineers and architects ment where they can control to
India, alongwith other developed
trained in European, American and some extent. That is why the inside countries is aiming at private hous
to each family by the
Russian
universities.
Low-cost of the dwellings may be well-looked ing units
housing using traditional and lo after and in some cases families close of the century. The job is
cally available material was often have even remodeled or added to not as easy as it seems, for in India
scorned as perpetrating the miser their plans. In India we have rea the present shortage runs into some
able conditions
of the villagers. lised this long back and have all 24 million housing units. There
have been a number of attempts
Instead
prefabricated
building along considered
the ownership to discuss and coordinate activities
blocks and apartment-clusters be right of the land as a very import
on national and International level
came the style.
ant aspects of
helping a family on urbanisation but no conference
own a shelter. Once a family has has attempted to cover all dimen
This sort of housing development some legally recognised land, over sions of the problem relating to the
soon creates slums out of housing a period of time it will build its family in the urban setting.
projects through overcrowding, poor
scope for maintenance, breakdown
of services and improper water
supply and sewerage. In this res
pect the housing colonies of the
(Could, from Page 125)
Workers and office staff undergo all-round tests
which help detect those who have the disease but do
not feel its symptoms as yet and those who are likely
to get it. Specialists submit a list of people to the
director of the concerned enterprise and recommend
necessary changes in the working conditions, in diet
and also preventive and special measures.
Trade
Union committees see that all recommendations are
carried out.
Research
Scientists study those factors which can adversely
affect the workers health, particularly vibration, noise,
chemicals, magnetic and electromagnetic fields, in order
to establish their safe levels. Medical researchers also
help develop more effective purification facilities, parti
cularly dust catchers. For instance, coal dust and
128
toxic substances are inevitable byproducts of the
coke industry. Scientists initiated a reconditioning
scheme for the industry—especially the development of
a new system of charging 'coke ovens, which stopped
discharge of coal dust into the atmosphere. Remote
control and recirculation technology has resulted in
substantially reducing the danger of workers’ contact
with many adverse environmental factors.
These effective preventive measures helped in pro
tecting workers from contracting industrial diseases.
The preventive and treatment measures are taken by
the health authorities in collaboration with manage
ment bodies and trade unions. That is why the maxi
mum permissible concentration of potentially dange
rous substances in production premises and in the
environment in the USSR is the lowest in the world.
—Soviet Feature
Swasth Hind
BASIC HEALTH CARE OF CHILDREN
Dr Meharban Singh
Children are the future potential and national asset of a country and both
parents are responsible to ensure optimal physical, emotional, mental and
social.growth and development of their children. They must be cared and
reared fondly to evolve them as useful members of the society with a strong
body, alert mind, balanced personality and a sense of national pride. It is
desirable that mother-craft or art of child care must be taught during school
years.
June 1986
129
eproductive life is associated with considerable
physical, emotional and social stress. Girls with
serious physical or mental handicaps should take the
advice of a specialist before they get married. The
woman should be healthy and having regular mens
trual periods before marriage. Child bearing should
be restricted between 20-30 years of age which is asso
ciated with best reproductive efficiency and lowest risk
of developmental defects. Young mothers are inex
perienced and have greater risk of giving birth to a
low birth weight baby. Marriage among first degree
cousins should be avoided to safeguard against gene
tic defects in the offsprings. Girls must be effectively
immunized against tetanus and rubella (German
measles) before marriage to prevent congenital defects
due to rubella syndrome and deaths due to. tetanus
in the newborn babies.
R
Care of unborn baby during pregnancy
The foundation of the baby is laid in-utero. Heal
thy mother produces a healthy baby while a sick
mother may produce a high-risk infant. Growth of
the fetus is dependent both upon the seed (genetic
endowment) and the soil (maternal health). Mother
must maintain an accurate record of her “dates” (men
strual flow) which provides the most useful and accu
rate parameter regarding duration of pregnancy and
gestational age of the fetus. The expected date of deli
very is calculated by adding 9 calendar months plus
7 days to the first day of last menstrual period. First
three months of pregnancy are most critical and are
characterised by differentiation (organogenesis or em
bryogenesis) of various organs of the unborn baby.
During this period all drugs and diagnostic X-rays
should be avoided due to their effect of producing
possible developmental defects. Self-medication should
be avoided throughout pregnancy. To ensure proper
growth of the fetus, mother must eat at least 15%
extra (balanced food) during second-half of preg
nancy as compared to her pre-pregnancy food intake.
Supplements of iron and folic acid are also essential
during the last 3-4 months of pregnancy to correct
nutritional anaemia. Regular antenatal medical check
ups are mandatory to recognize any problems in the
mother and her unborn child. Steady weight gain (810 kg) during pregnancy is indicative of satisfactory
fetal growth. During pregnancy she must be moti
vated and emotionally prepared for breastfeeding.
Anatomical defects of nipples, if any, should be corr
ected by massage, application of emollients and man
ual eversion.
Basic needs of children
Due to their slow growth and development, human
infants are dependent and are at the mercy of adults
130
for several years after birth. To ensure optimal physi
cal, mental and emotional growth and development
of children, they must be provided with adequate
nutrition, protected against environmental hazards,
and infectious diseases and’exposed to positive, stimu
lating and healthy environment both at home and
School.
Ensure adequate nutrition
Breastfeeding is natural, instinctive and- species
specific. And the human milk is best for the baby.
The infant should be straight away put to breast as
soon as mother has recovered from the rigours of
labour. There is no need to offer any prelacteal feeds.
Infant should be fed on a demand schedule and bur
ped (to break the wind) after each feed. During the
first three months exclusive breastfeeding is advised to
safeguard against risks of bacterial contamination and
diarrhoea. Breastfeeding is economical, . convenient
and emotionally satisfying for the mother as well as
for the baby. It is desirable and best not only for the
baby but for the mother too. Breast milk is best suit
ed for the nutritional needs of the human infant and
is replete with protective cells and antibodies against
microbes. Infants receiving breast milk are less prone
to develop episodes of diarrhoeal and respiratory in
fections which are major causes of morbidity and mor
tality in infancy. There is some evidence available that
breast fed infants are less likely to suffer from allergic
disorders (especially eczema), dental caries, obesity
and high blood pressure during later life. In order
to maintain adequate lactation, the nursing mother
must take nourishing food and eat at least 25% extra
food (as compared to her pre-pregnancy intake) • and
take plenty of liquids to replenish fluids lost through.
milk.
Milk alone is insufficient to sustain physical growth
after six months of age. After four months or so,
semiliquid weaning foods such as egg yolk (followed
by white), curd, cereal, gruel should be given with a
spoon. Rice with vegetables and pulses, ‘halwa’ and
soft seasonal fruits are gradually introduced in the
diet. After the first birthday infant can eat rice with
pulses, bread soaked in pulses or vegetable curry
(without spices), minced vegetables, cheese and meat.
It must be remembered that the one year old infant
needs as much as one-half of food being taken by his
mother. In view of the small capacity of his stomach
Swasth Hind
To ensure optimal physical, mental and emotional growth and development of a child, he!she must be povided with
adequate nutrition, protected againsf infectious diseases and provided with positive, and healthy environment.
he, therefore, needs small and frequent feeds with
additional vegetable oil. Breastfeeding should be con
tinued as long as feasible by the mother. Toddlers
should be offered everything cooked at home and
should not be forced, coaxed or cajoled to eat food
Parents should be relaxed at meal times and should
not show unnecessary concern and anxiety about the
food intake of their child. Excessive intake of can
dies, sweets, biscuits, ice cream, soft drinks and fruits
should be discouraged. During adolescence (12-16
years in girls, 14-18 years in boys) children must eat
at least 50% more than their respective parents to
meet excessive demands for energy to ensure optimal
physical and sexual development.
Prevention of infectious diseases
Avoidance of bottle feeding and maintenance of per
sonal cleanliness and hygiene is essential to reduce
June 1986
incidence of diseases caused by microbes. The house
should be kept clean and free from flies/cockroaches
and food must be kept covered. The infant’s hands
should be kept clean because he constantly put every
thing into his mouth. Children must be taught the
habit of washing their hands with soap and water
before every meal. They must receive various immu
nizations at appropriate times as mentioned in the
following schedule:
Immunization can protect your child from such dread
ful diseases as neonatal tetanus, poliomyelitis, diphthe
ria, whooping cough, tetanus, tuberculosis and measles.
Bring your child at the right age for the full course of
the vaccines to the nearest primary health centre,
dispensary or hospital where free vaccination fecilities
are available.
131
Immunization Schedule
Age
Development of behaviour and personality of child
Vaccine
No. of
doses
Disease
Prevented
TT (Protects
both mother
and child)
2*
Tetanus
n Pregnant Women
16-36 weeks
n Infants
3-9 months
9-12 months
18-24 „
DPT
3
Polio
BCG
Measles
DPT
Polio
3
1
1
1 (booster)
1 (booster)
Diphtheria,
whooping
cough, Tetanus
Poliomyelitis
Tuberculosis
Measles
♦Give one dose, if vaccinated previously.
Note:
The interval between 2 doses should not be less than one
month, Minor coughs, colds, mild fever and diarrhoea
are not considered contra-indications to vaccination.
Immunization should be given when the child is
well although minor illness is no contra-indication. If
a dose is missed due to any reason, there is no need
to restart the whole schedule. The vaccine must be
stored in a refrigerator otherwise it may become in
effective. Antipyretic (aspirin or paracetamol) is re
commended in conjunction with DPT, measles and
TAB vaccines to provide relief against fever and dis
comfort. Most vaccines are safe and do not produce
any side effects.
Harmful cultural practices
Mother-craft is taught by mothers to their daughters
through generations. There are several rituals or cul
tural practices regarding rearing of children which
may be harmful and should be avoided. Colostrum
(milk secreted during first 2-3 days of lactation) is
often denied to the infant with the mistaken belief
that it is unclean and unsafe. In fact colostrum is most
beneficial and.best suited for the needs of infant by
virtue of its low fat and high protein (protective anti
bodies) content. Application of dirty dressing or cow
dung over the umbilical cord is fraught with the risk
of development of tetanus. The umbilical stump should
be painted with antiseptic lotion and kept open and
dry. Application of ‘kajal’ or ‘surma’ is associated
with the risks of eye infection and possible lead in
toxication. Teething ‘medicines’ and ‘janam ghuttis’
are unnecessary and unsafe. During early life, medi
cations should be avoided as far as possible and taken
only on the advice of a physician. The child should
not be starved during febrile or exanthematous illness
(measles, chicken pox, typhoid fever, etc.) and instead
he should be given nutritious diet.
132
Behaviour and personality of the child is dependent
upon interaction between his genetic endowment (in
herited characteristics) and environment. The inherent
personality traits or characteristics can be altered or
modified by appropriate environmental stimulation
and proper handling by the parents, siblings and tea
chers. Every child is unique and no two children are
alike. The personality characteristics, attributes, limi
tations and aptitudes, etc., of an individual child must
be clearly known to his parents. Love is a basic or
fundamental emotional need which must be .fulfilled.
Child must be given comfort and security. Child is
never ‘spoilt’ by being loved but overprotection, over
anxiety (in case of the only child or the only male child)
and over indulgence may lead to food fussyness, tem
per tantrums and conduct disorders. Over-protected
children are often shy, timid, dependent and indeci
sive in life. They are unable to face realities of life.
Rejection and neglect of child by constant nagging,
scolding and reprimands may lead to defiant, disobe
dient and delinquent behaviour in the child. Disci
pline must be taught with love, appreciation and tole
rance instead of constant criticism and corporal pun
ishment. Behaviour of the child must be viewed in
relation to his age and developmental status. Parents
should not be unduly concerned by various emotional
developmental phases in children like putting every
thing in mouth,-eating mud, thumb sucking and play
ing with genitals, etc. The rules must be consistent
to avoid any confusion in the child’s mind. Children
are best imitators and adults must set an example re
garding good habits, truthfulness, honesty and mora
lity, etc., for children to emulate. Hypocrisy, smoking,
drinking, etc., among parents are likely to bread simi
lar traits in their children. Maladjusted parents pro
duce maladjusted children who^grow up to become
maladjusted adults. The child is the barometer of
family’s emotional climate. It is futile to treat symp
toms of ‘problem children’ but instead it is essential
to find out the genesis of their behaviour. Above all,
it is essential for all parents to know the capabilities
and limitations of their children and no child should
be pushed beyond his or her capabilities. During ado
lescence, considerable tact is needed to handle chil
dren. Parents must avoid rudeness and threats during
this phase and they should establish rapport with their
adolescent child and explain to him/her the signifi
cance of body changes for smooth transition from
childhood to adulthood. During this period, the par
ents must keep a close watch on the company of their
children so that they do not fall into the trap and
temptation of various addictions.
•
Swasth Hind
METAL TOXICITY
—A slow poison of our environment
Vinod Singh
The major factors responsible for pouring toxic metals in the air, water and soil are our
industries.
Metallic pollutants, released in the air, are brought either with the rain or
due to gravitational force to the soil and pose a danger to the health of the people. There
fore, it is time that precautionary measures are taken to check it.
Increasing use of metals has resulted iu a variety
of problems. Some metals like mercury, cadmium,
nickel, chromium, lead and manganese, etc., arc being
used and discharged into the environment by the
modern industries and are posing a great danger to
{human life.
on the area where a person lives, yet the general
awareness of their harmful effects is lacking in our
people.
This being the reason, even our food articles have
retained excess of these toxic mel'als and their hazard
ous effects remain unnoticed mostly due to the non
availability of facilities to detect them.
The major factors responsible for pouring these
toxic metals in air, water and soil are the industries.
Metallic pollutants released in the air are brought
either with rain or due to gravitational force to the
soil. Drained water from the factories, if poured in
rivers, pollutes the adjoining soil, vegetables and
habitations.
In India, various isolated studies have proved the
increase in the contents of these toxic metals in water,
soil, food articles and even in human body depending
Organic wastes, refuse burning, transport, and
power generation arc some of the factors responsible
June 1986
133
for adding metals in our environment. Sewage, sludge,
application of metal, containing pesticides, seed dres
sings, even permitted colours, metallic objects, paints,
varnishes, fuelash municipal compost, domestic rub
bish, use of electro-plated utensils, steel utensils, vege
table ghee, and tea contribute to these toxic metals.
Affects of nickel
Bhabha Atomic Research Centre (BARC), Bom
bay, has carried out investigations to analyse the con
tents of metals in food samples, water, vegetables, etc.,
in and around Bombay. Blood and urine samples of
city dwellers were analysed for the contents of zinc,
manganese, cobalt, nickel, copper, chromium, and lead
for assessing the baseline levels for the general popu
lation. Nickel content in blood was found to be quite
high and this was supposed to be due to composition
of vegetable ghee or use of stainless steel utensils in
cooking. Besides producing systemic poisoning, nickel
is also known to cause cancers in the human. Nickel
also produces skin diseases and ulcers.
Manganese toxicity
The toxicity of manganese usually has been repor
ted in Industrial workers. However recently the effect
of manganese on the nervous system has been repor
ted to occur in a number of families consuming well
water containing high contents of this metal, in a
village in Japan. In 1975-76, in a village in Unnse
district, people developed paralysis and neurological
disturbances and these were attributed to the con
sumption of well water having excess of magnes. Even
cereals and legumes were found to contain an alar
ming amount of this metal.
Lead poisoning
Lead is widely used for various purposes. It has
been found to be present in the. water flowing through
lead pipes, paints, varnishes, pigments, fine glass, lead
glazed potteries, exhausts of motor vehicles, vermilion
and even in surma. Lead has also been reported to
be present in various vegetable and animal food stuffs.
Though certain food stuffs do not contain lead, after
cooking with oil, ghee, salt, turmeric, pepper, and
other spices, they get enriched with lead.
Lead reaching in food stuffs kept in glazed pottery
and its accumulation in the body due to the appli
cation of surma, or spraying of gulal powder has also
134
been reported. Chewing of coloured coatings or prin
ted paper may also lead to its absorption in children.
Different tea samples have also been reported to con
tain appreciable amounts of this metal.
s.
.'V.“i
It has been pointed out that the modern man is
having 100 times more lead than pre-historic man
(Report: Singh V., Gupta A., KNK Institute of Life
Sciences, Kanpur). In cities like Kanpur and Lucknow
the presence of this metal in water has been reported.
Since lead is a non-essential metal, its presence may
produce symptoms like fatigue, sleep disturbances and
constipation in early stages, and colic, anaemia and
neuritis-like symptoms in chronic stage. Children are
more prone to it than the elders, as hypertension and
irritability-like symptoms develop in them due to this
metal.
Toxic affects of mercury
Mercury poisoning was reported in inhabitants of
Minerals Bay due to consumption of fish containing
discharged methyl mercury from the adjoining fac
tories. Exposure to this metal produces toxic effects
in the nervous system which include anxiety, depres
sion, lack of concentration and tremors.
Cadmium
Many cases of food poisoning from the contami
nation of food and drink by cadmium plated contain
ers have been reported. Drinking water may also be
polluted as a result of this metal from solders con
taining this metal in fittings of water heaters and
taps. By swallowing tobacco, this metal has been
found to reach the body. This metal causes protein
uria due to kidney damage. The most serious disorder
of cadmium-toxicity is known as Itai-ltai disease
which occurred after world war II in Japan. Testicular
damage, chronic bronchitis, hypertension and cardio
vascular diseases have been reported.
Dietary factors like iron deficiency, alcoholism, vita
min deficiency, protein deficiency and also stress en
hance metal toxicity to a great extent.
Such reports give a clear picture of the danger these
metals have started posing to public health. Such harm
ful effects of these metals are creeping on us gradually.
Therefore, it is time that precautionary measures are
taken to check it.
A
Swasth. Hind
ENVIRONMENT AND
PUBLIC ADMINISTRATION
V. K. Sreenivasan
The job of different arms of public
administration is to foresee the environ
mental hazards, weave into the plant de
sign as many preventive measures as
possible and to ensure later on unrelenting
vigil on the daily operation at the Units.
June 1986
rotection of environment and control of pollu
tion became topics for raging debates after the
Bhopal gas tragedy. Though the Union Carbide affair
was mere a terrible accident in a chemicals unit, the
pace of policy planning and imperceptible results of
environment protection got a shot in the arm after the
tragedy.
P
135
The world of the blind. For whom there is
no night or day. For whom opening the
eyes is as good as closing them.
*
The world of those who have never seen
the sun rise or set. Their mothers’ face or
their own. Laughter or tears. A world that
knows only one colour. Black.
Think of the hopelessness-and frustration
of such a life.
Today, fortunately there is hope for the
blind. There is a remedy that’s simple,
doesn’t cost anything and is effective.
Only it needs you.
A cornea transplant can restore sight.
The useless cornea, replaced by a healthy
one. And the healthy one could be yours.
Fye removal leaves no scar or
disfigurement. And once you’ve pledged to
donate, you’ll live with the gratifying
emotion that your eyes will live much
longer than you. And that some blind
person will sec ... through them.
If your heart goes out to the blind during
your lifetime, let your eyes go out to them
after death. It’s the most precious gift you
can give them.
To know more about eye donation, and
what kinds of blindness can be cured,
send us the coupon for a detailed brochure.
Do it today. Remember, miracles can’t
cure the blind. You can.
Sight. A gift only you can give.
Reproduced by the Central Health Education Bureau, Directorate General of
Health Services, in the interest of eye donation programme.
136
Swasth Hind
Atmosphere and water pollution and damage to the
nature and ecology cannot be prevented entirely. This
is the physical “cost of living” we have to pay for
rapid industrialisation and the cornucopia of comforts
and gadgets it provides. For example, as long as we
use more and more automobiles of all sorts, working
on diesel or petrol, our streets are bound to be pollut
ed with exhaust fumes. As long as we have giant
manufacturing units using complex chemical processes
we will have the problem of pollution of air and
water.
The job of different arms of public administration
is to foresee the environmental hazards, weave_ into
the plant design as many preventive measures as
possible and to ensure later on unrelenting vigil on
the daily operation of the units.
our reserves of seeds will be very high yielding varie
ties only and then will start the* journey downhill.
In this context it 'is important to think of preserving
the vast forest reserves which can provide new genres
that are healthy and disease-free so that our life sys
tem can be supported and sustained.
No Fire-Fighting
Another example where anxiety about environ
mental degradation came ‘after the completion of the
•project’ is ■ the Mathura Refinery Project and the
effect of the fumes on the Taj Mahal. Only after
trial production started, did monument enthusiasts
and environmentalists make a hue and cry and only
after the newspaper reports and Parliament questions
did the authorities think of ordering a Committee to
go into the question of the refinery vis-a-vis the Taj.
Different Interests
In ‘administration’ can be included different deci
sion-making bodies right from the highest echelons of
the Cabinet and the various departments and. mini
stries of the Government of India, through the State
Governments, city and municipal corporations and
panchayat and village level bodies. Where the ques
tion of environment is concerned, most often it is a
local issue left to be taken care of by the State and
regional administration.
There appear also areas of centre-state interaction
where a high-level policy decision is to be taken about
a cost-benefit analysis of a hydro-electric project for
comparative considerations of ultimate economic and
developmental benefit accruing from the proposed
project, and the possible damage to the environment
the project would entail. The most recent instance
was that of the Silent Valley Project of Kerala. After
a prolonged ding-dong battle between environmenta
lists and hydel power specialists, the Government at
the Centre came strongly in favour of abandoning the
project.
As part of the Green Revolution we had introduced
a large number of high yielding varieties of food
grains, pulses and oil seeds in the country. No doubt
production went up by leaps and bounds but it re
mains a fact that high yielding varieties are more
prone to diseases than traditional varieties. There
may soon come a stage when all our crops and all
June 1986
Administration at all levels, has to adopt a perspec
tive and systematic approach in place of ‘fire-fighting’
methods of environmental protection. Just to cite
one example, for long years forests were used, to be
cleared by farmers for extensive cultivation. In some
States the government departments themselves had al
lotted forest land for terraced cultivation of a variety
of items including cash crops. After two or three
decades they awoke to the need of avoiding wood as
fuel and the need to protect trees.
Similar was the case with rapid, industrialisation.
Over the last twenty years we forged ahead with
small-scale industries, industrial estates, district in
dustries centres and the like. We did not include
pollution control measures in these schemes.
Administrations have to take measures with vision.
All industrial undertakings should, indicate at the
time of applying for licence the scope for expansion
and diversification in addition to their ensuring
pollution control measures in the first instance. The
local, administration should work out projections of
population growth for coming decades and segregate
habitation areas strictly from industrial areas. It is
well-known that when Union Carbide set up their
plant in Bhopal, the surrounding areas were uninha
bited.
The zeal for industrialisation should not overlook
environmental needs. Recently it has been reported
that the Government’s policy is to have at least one
137
major industry in every district. Great discretion in
choice of site and care in planning and implementa*
tion are required here as in outlying and hilly districts
it will be a sheer impossibility to monitor day-to-day
implementation of pollution control measures.
Projects for sewage and waste disposal have to be
given priority by city and town councils with a view
to minimising the pollution of water courses. Osten
tatious expenditure should be kept to the minimum
and enough funds diverted for pollution control pro
jects.
DR M.D. SAIGAL IS THE NEW
DIRECTOR GENERAL OF
HEALTH SERVICES
Dr M. D. Saigal has taken over as the Director
General of Health Services in the Ministry of Health
a id Family Welfare on 11 April, 1986.
Earlier Dr Saigal was the Additional Director
General of Health Services (Public Health).
Practical Approach
The decision-making in the higher units of public
administration will have to gear themselves up the
threshold of confidence to fix priorities and to go for
perspective planning. It is high time we come to
grip with the fact that the two main areas of environ
ment protection, viz. pollution control and preserva
tion of nature are inexorably linked to the energy
use pattern that we will be adopting. We have wood,
coal, oil, electricity, biogas, solar and wind energy.
It is well-known that when the Netherlands people
found that they have enough reserves of natural gas
they took the bold step of closing down all their coal
mines.
Let us now consider two type situations from two
different parts of the country to show how environ
ment is being eroded because of the administration's
lack of priorities and measures to keep close watch
on people’s lifestyle. In the north Indian villages—why
in most of our villages for that matter—the main house
hold fuel is wood. The administrations now tell
people that wood is scarce and they should switch
over to alternate energy soufces. People know this
very well. Often they have to forage in search’ of
firewood or do poaching on private reserves.
What is the alternate fuel? They can’t afford
kerosene, electricity or cooking gas, the latter two in
any case not being available in most villages. Solar
cookers? The village lifestyle demands an early
meal with a packed lunch for the workplace. The
villagers might be returning to their huts by sundown.
Of what use are solar cookers to them?
Take the case of the building boom in Kerala
created by the flow of the ‘gulf money’. Paddy fields
are being raised with earth work to build homes and
shopping centres. Coconut groves are being wiped
out to build lodging houses and industrial units. Now
the administration that created an Overseas Employ
ment Development Corporation never thought it
worthwhile to impose any restrictions on the conver
sion of farmland into built-up areas.
A well-conceived plan for environment, protection
of farms, factory or roads cannot only save life and pro
perty later but can prevent closures of units leading to
inconvenience for employees.
A
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138
Swasth Hind
WATER AND SANITATION
—Investment in Human Potential
Jesus answered and said unto her. If thou knowest the
gift of God and who it is that sayth to thee: Give me to
drink*, thou wonkiest have asked him and he would have
given thee living water. The women saith unto hini thou
hast nothing to draw with and the well is deep*, from
whence then hast thou that living water.
— Gospels. St. John IV, 10, 11
Where is that living water that is the great sustainer of life? But today, it is a great destroyer as
well. It covers 81 per cent of this earth’s surface. It
is salty and of no use to most earthlings. Another
1.9 per cent of fresh water covers the earth—the
rivers, the lakes, the ponds, etc. We use only 5
per cent of it to drink. From what is known, the
June 1986
consequences of having no safe drinking water are
astounding. By using water that should not be used,
coupled with poor sanitation,
* 50 crores are afflicted with trachoma and blind
ness
* 25 crores suffer from swollen limbs
*16 crores shiver with malaria
* 20 crores have blood in urine
*10 Crores have diarrhoea
* 3 crores discharge blood with urine
*105 crores under-5 children die every year from
water borne disease
* 50 per cent of world hospital beds are occupied
by these patients
* India loses 730 lakh mandays every year as
workers fall sick
* Approximately Rs. 450 crores are spent for their
treatment every year. •
139
To put it in another way, it is as if the entire
western Europe has gone blind with trachoma, as if
each Russian has filarially swollen limbs, each
American was having bilharzia and the entire people
of Japan, Malaysia, and Philippines shivering with
malaria.
It is astonishing that in spite of these terrifying
facts, the problem did not receive the serious atten
tion of public health experts till the middle of the
current century.
Recent Awakening
A concerted effort to deal with the colossal pro
blem emerged in 1976 when the UN Conference on
Human Settlements (HABITAT) in Vancouver laid
down the specific proposal “fresh water for all by
1990”. Later the UN Water Conference (1977) in
Mar del Plata, Argentina, recommended that the In
ternational Drinking Water Supply and Sanitation
Decade be observed from 1981 to 1990 by which time
potable water was to be made available to each and
every human being. The Conference did not draw
up any guidelines or programmes, but exhorted all
States to achieve this aim. Next year International
Conference on Primary Health Care, held in Alma
Ata (USSR) declared safe drinking water and basic
sanitation as essential for primary health. The World
Conference on the International Decade for Women
stressed that absence of potable water and proper
sanitation imposed a special burden on women. The
International Drinking Water Supply and Sanitation
Decade was finally launched by the United Nations
General Assembly in New York on 10th November
1980. It stressed the importance of good water and
sanitation on economic productivity, increased pur
chasing power, and better health. Effort of the De
cade was termed as “investment in human potential,
a moral imperative and sound economics”.
Children are the most vulnerable to water and sani
tation deficiencies. About 1000 million children have
virtually no access to potable water in Third World
countries. Of the 25 million under-5 children who
do not survive, almost 9 million fall prey to diarrhoea.
Even those who survive are permanently impaired phy
sically and mentally.
Magnitude of the Job
To give safe drinking water to every human by
1990 is a gigantic task, the magnitude of which is
seldom fully understood* It means that every day
during the Decade, water and Sanitation should be
made available to five lakh new individuals. The
cost of this venture is calculated to be 600,000 crore
dollars (roughly 600,0000 crore rupees). The United
140
Nations and the World Bank have taken up this
challenge very seriously. When we consider that the
annual arms bill of the world is around 800,000 crore
dollars, the decade aim does not look impossible.
The world spends about 4380 million dollars on
smoking and 365 million dollars on non-essential
painkillers every year.
The UNDP is funding many research projects on
low cost sanitation. We are all learners in th’s es
sentially new field of low cost sanitation. Whatever
is evolved has to be feasible and acceptable to millions
who do not know well what it is all about.
One factor may make all the endeavour of the UN
and world nations in this regard look futile. The
explosive growth of population in the poor countries
is this imponderable. Today, there are more people
in the world* who need water and sanitation than there
were in 1975. Yet to make it an issue and to make it
work is the motto of the UN and its members, in
cluding India. With an annual river flow of 1360
million acre feet, we have enough water to reach our
aims.
‘Habitat’ had passed special resolutions, the United
Nations Water Conference and the World Conference
on UN Decade for Women adopted special resolu
tions recommending women’s incorporation in the
Water Decade Programmes. All this was in recogni
tion of the impact which women can have on the
success of water and sanitation programmes. An
Inter-Agency Task Force for women and water has
already been established. The strategy envisages in
volvement of women in policy making, management
and technical levels for programming, monitoring and
evaluation of the decade activities.
Women’s Role
Experience has shown women as primary users of
water resources and the primary influence on family
habits. So it is evident that they can contribute subs
tantially to progress of the decade programmes.
Since women are traditional water carriers, they
spend a lot of time upto six hours a day—hauling
water. By virtue of their predominant functions at
home, women are particularly vulnerable to water
borne diseases, which amounts for 80 per cent of all ill
nesses according to WHO studies. Also to be taken
into account is the fact that it is women who mostly
take care of the children and any ageing housebound
relative. Unfortunately, wherever poverty is persua
sive, the perception of priorities becomes a male pre
rogative. This has to be changed by education and
increased social awareness.
A
Swasth Hind
CLEANING OUR RIVERS
—Anti-pollution measures for all major rivers
R. S. Mathur
initiative and dynamism of Prime Minister
Shri Rajiv Gandhi has given a start for “cleans
ing” the Ganga waters of all pollution throughout its
course. Priority, however was given to the HardwarRishikesh sector because of the Kumbh Mela of
1986.
T
rivpr, are to be covered. What is proposed is to pro
vide pumping stations for sullage and effluent dis
charge from the city drains and inlets, for being trans
ported to sewage treatment plants to be installed.
After treating, the water would be made available for
irrigation, while the ‘solid* remnants would be used
as manure.
A “crash” two-and-a-half months programme to
chem pollution of the Ganges waters was launched
by the Uttar Pradesh' Jal Nigam alongwith the State
Pollution Control Board to implement a programme
of the Central Ganga Authority. It included plugging
of te.n inlets at Hard war and six at Rishikesh which
brought sullage. Through pipes the sullage water
flow has been diverted to pumping stations, which in
turn pump it on to agricultural fields in the area for
irrigation purposes.
Each of the 29 first class I cities, including Hardwar
and Rishikesh, would have separate long-term
schemes for preventing pollution on a permanent
basis. An outlay of Rs. 242 crores is earmarked for
the first phase, to be completed during the current
Seventh Plan Period. Varanasi would perhaps get
the major chunk estimated at Rs. 42 crores accord
ing to a project report prepared for the city.
he
Similarly, effluent discharge from the industrial
units, flowing through channels, have also been plug
ged and the water diverted away from falling into the
river Ganga.
Pollution of the Ganga waters near the twin cities
of Hardwar and Rishikesh was ‘temporarily’ control
led for the Kumbh Mela of 1986, as a start. Steps
were also taken to check any sewerage flow from the
camping sites and townships got readied for the
Kumbh pilgrims.
Tackling Major Towns
The ‘crash’ programme to check pollution was only
for the Hardwar-Rishikesh region and for the Kumbh
Mela period alone.
The Central Ganga Authority has drawn up a twophase programme for cleaning the Ganga, to be im
plemented during, the Seventh Plan Period as also
during the Eighth Plan.
In the first phase, apart from the action taken for
the Kumbh Mela, 29 class I cities along the river in
the three States of UP, Bihar and West Bengal, which
account for as much as 86 per cent pollution of the
June 1986
Second Phase
In the second phase, the remaining 71 cities and
towns along the Ganga in the three States are to be
taken up. This programme will be implemented
during the Eighth Plan.
An outlay of Rs. 50 crores would be available for
the second phase of the operation. The Central
Ganga Authority would provide funds and approve
scheme which are to be excecuted by the State
Government agencies.
AU India Programme
During the Eighth Plan Period it is proposed also
to undertake pollution control schemes on the pattern
of that for the Ganga, for all the major 12 rivers of
the country. Surveys and studies are to be conduct
ed and project reports submitted for each river.
Funds would then be allocated from the Centre.
And happily all these anti-pollution measures for
the nation’s rivers—sacred in their respective areas—
shall make the dip on sacred occasions or really
holy! Clean and wholesome water to drink for man
and beast, would lead to a new ‘awakening’ and im
proved health for those for whom filtered
water
supply is still a distant dream.
A
141
Who will suck
venom to seek
Pleasure?
No one.
Yet, that's what some do.
Carried away by the viles
of the Marijuana Medusa.
And taken in by its tangles—Charas,
davp 85/455
142
i
Swasth Hind
LOW COST DRINKING WATER FOR RURAL AREAS
Conference of State Ministers and Secretaries
in charge of Rural Water Supply and Sanitation,
at its meeting held on 12-13 February, 1986. have
noted with satisfaction the physical achievements
during* the Sixth Plan truly impressive as 1.92 lakh
out of a total of 2.31 lakh identified problem villages
had been provided with at least one safe source of
drinking water.
,
he
T
The Conference arrived at the consensus to make
an all-out effort to provide adequate and safe drinking
water supply to the entire rural population of the coun
try. The highest priority would be given to cover the
hard-core 39000 problem villages spilled over from
the Sixth Plan period followed by problem villages
identified subsequently and coverage of partially
covered problem villages.
The Conference was of the opinion that the cove
rage of Scheduled Caste and Scheduled Tribe habita
tion should be given the highest priority and the sour
ces meant to benefit SC/ST population should essen
tially be located within their habitations for providing
them easy accessibility.
The Conference was of the view that there was
urgent need to develop low cost options for provision
of safe drinking water in rural areas as an alternative
to the capital intensive schemes.
Regarding the launching of Techonlogy Mission on
Drinking Water Management the Conference felt that
the Mission would aim at finding low cost treatment
for problems of fluorides, salinity and brackishness,
bacteriological contamination, improving the recharg
ing of ground water through proper micro-level eco
logical planning and developing the traditional water
retention structure in hill, desert and tribal areas
through the use of appropriate technology. The
Conference .felt that developing low cost science and
technology will help to expand coverage with the avai
lable resources and achieving the goal of providing
drinking water to the entire rural population.
The Conference was of the view that there was
urgent need for integrating the drinking water supply
programme with Health Education and promotion of
health consciousness amongst the rural population.
Health Education pertaining to drinking water supply
and sanitation should be made an integral part of for
June 1986
mal primary education and non-formal education pro
gramme for children and in all adult education pro
grammes.
The Conference expressed the need for mobilising
local resources for supplementing the governmental
efforts in the rural water supply sector.
The newly launched integrated programme for pro
vision of sanitary latrines in the rural areas during the
Seventh Five Year Plan was welcomed by all the
States. They assured that necessary efforts would be
made for the implementation of the integrated pro
gramme of sanitary latrines. The close integration of
the rural sanitation programme with the health edu
cation programme and involvement of the community
and the voluntary organisations in the implementation
of the programme was emphasised by all the States.
Under the new rural sanitation programme, Rs. 30
crores would be provided under each of the pro
grammes of Rural Landless Employment Guarantee
Programme and National Rural Employment Pro
gramme for construction of five lakh sanitary latrines
in rural areas during the Seventh Plan.
Sanitary latrines would also be provided as an inte
gral part of the housing programme for one million
Scheduled Caste and Scheduled Tribe families under
the Rural Landless Employment Guarantee Pro
gramme.
Construction of sanitary latrines would be taken up
in village level institutions like health sub-centres,
schools, ‘anganwadis’ etc. and, to the extent possible,
sanitary latrines would be provided to all rural hous
ing projects sponsored by State Governments.
Under the new sanitation programme, the States
could draw up projects under RLEGP for complete
coverage of those villages where the population of
Scheduled Castes and Scheduled Tribes exceeds 25%
of the total village population.
The programme would involve voluntary agencies
and mass media for health education and promotion
of use of sanitary latrines in the rural areas. A mas
sive drive would be undertaken to train masons in
construction of low-cost sanitary latrines.
—PIB
143
ICMR NATIONAL AWARDS FOR BIOMEDICAL RESEARCH
he Indian Council of Medical Research (ICMR)
has selected 24 scientists for its various national
awards in the Biomedical research for the year 1985.
These scientists have been honoured for their out
standing contributions in their respective fields of re
search.
T
The scientists who have received awards are: Dr
N. Kochupillai, Associate Professor of Medicine, De
partment of Endocrinology & Metabolism, All India
Institute of Medical Sciences, New Delhi; Dr N. C.
Misra, Department of Surgery, K. G. Medical College,
Lucknow University, Lucknow; Dr S. N.
Saxena,
Director, Central Research Institute, Kasauli; Dr S. K.
Bhargava, Former Head, Department of Paediatrics,
Safdarjang Hospital, New Delhi; Dr V. K. Gupta,
Lecturer in Preventive & Social Medicine, University
College of Medical Sciences, New Delhi and Dr Raj
Kumar, Senior Research Officer, (Epidemiology) De
partment of Preventive & Social Med (cine, All India
Institute of Medical Sciences (AIIMS), New Delhi; Dr
Soumen Kumar Mitra, Associate Professor of Paedia
trics Surgery, Post Graduate Institute of Medical Edu
cation and Research (PGIMER), Chandigarh; Dr C. V.
Bapat, Emeritus Medical Scientist (ICMR), Depart
ment of Microbiology, Grant Medical College, Bom
bay; Dr Pradeep Seth, Associate Professor, Depart
ment of Microbiology, AIIMS, New Delhi; Dr M. V.
WATER AND WASTE DISPOSAL
SYSTEMS
The number of rural inhabitants in the developing
world served with water supplies increased by 150
million between 1980 and 1983, according to figures
in the World Health Statistics Annual, 1985, released
recently by the World Health Organisation.
In absolute numbers, this represents a rise from
430 million to 580 million, or from 30 to 38 per cent,
in the three years since the launch of the International
Drinking Water Supply and Sanitation Decade.
That is “probably the most significant achievement
of the Decade so far”, WHO says in an assessment of
progress and problems to date, and adds that “increas
ing attention is being given to areas of real need—
namely, rural and urban fringe populations.”
• The aim is to cover 85 per cent of populations pro
jected for 1990. The provision of safe water to rural
populations is just one of the four goals set for the
Decade. The three other goals are: rural sanitation;
urban water and urban sanitation.
—W.H.O.
144
R. Rao, Prof, of Chemistry, Delhi University, Delhi;
Dr Digamber Behera, Lecturer, Department of Chest
Diseases, PGIMER, Chandigarh; Dr S. P. S. Teotia,
Prof, and Head, Chief Consultant Physician, Post
graduate Department of Human Metabolism & Endo
crinology, LLRM Medical College, Meerut; Prof.
L. K. Kothari, Prof. & Head, Upgraded Department
of Physiology, SMS Medical College, Jaipur; Dr Leela
Raman, Deputy Director, National Institute of Nutri
tion, Hyderabad; Dr R. C. Mahajan, Prof. & Head,
Deptt. of Parasitology, and Dr N. K. Ganguly, Assoc.
Prof., Deptt. of Experimental Medicine, both of the
PGIMER, Chandigarh; Dr N.N. Wig, Regional Ad
visor (Mental Health) WHO, Eastern Mediterranean
Regional Office, Alexandria, Egypt (UAR); Dr. J. B.
Dilawari, Assoc. Prof, and Head of Hepatology,
PGIMER, Chandigarh; Dr Om Prakash Ghai, Prof.
and Head, Deptt. of Paediatrics, AIIMS, New Delhi;
Dr W. Selvamurthy, Principal Scientific Officer, Defence
Institute of Physiology and Allied Sciences, Delhi
Cantt. Delhi; Dr S. S. Hasan, Reader, Faculty of Life
Sciences, Rohilkhand t University, Bareilly; Dr Deepak
Anant Gadkari, Senior Research Officer, National
Institute of Virology, Pune; Dr R. B. Narayanan, Re
search Officer, Central Jalma Institute of Leprosy,
Agra; and Dr (Mrs.) Vinod Kochupillai, Assoc. Prof.
Medical Oncology, IRCH, AIIMS, New Delhi.
A MILLION DEATHS EACH YEAR
FROM TOBACCO
The world pandemic caused by tobacco results in
a million deaths each year and health authorities may
be losing the fight they are waging against tobacco to
protect health. This is clearly stated in a report pre
sented to the Seventy-seventh Session of the WHO
Executive Board held in January 1986 in Geneva.
Although the damage tobacco causes has been
known for a long time the latest report is particularly
hardhitting: “Cigarette smoking is the major avoida
ble cause of ill health and premature mortality in
countries where it is widespread. It is responsible for
about 90% of all cases of lung cancer, 75% of chronic
bronchitis and emphysema, and 25% of cases of
ischaemic heart disease, as well as for a number of
other types of cancer, pregnancy complications, and
respiratory diseases in children exposed to passive
smoking”.
Swasth Hind
AUTHORS OF THE MONTH
BOOKS
Primary prevention of coronary heart disease: report
on a WHO Meeting. Copenhagen, WHO Regional
Office for Europe, 1985, 96 pages (EURO Reports and
Studies, No. 98) ISBN 92 890 1264 I.
Coronary heart disease is still the major killer in
many countries of Europe. Yet the number of deaths
from coronary heart disease has declined sharply in
some countries, because people are now living healthier
lives—eating better, drinking and smoking less and
exercising more. Experts meeting at the WHO-spon
sored Conference on the Primary Prevention of Coro
nary Heart Disease, reported in this book, believe that
the “epidemic” of coronary heart disease in most
European countries could be stopped if people would
follow the example of their healthier neighbours.
In this book the public, the health services and
governments can find many practical ways to prevent
coronary heart disease. It shows that, to start with,
they must accept two Fundamental ideas: that we know
enough to be able to .cut the incidence of coronary
heart disease; and that individuals have a substantial
responsibility for their own health.
The way forward is then clear:
t i(l) Everyone should know the, main causes of coro
nary heart disease and the main ways in which they
can reduce the risk.
I
Dr B.O. Osuntokun
Professor of Medicine (Neurology),
University of Ibadan,
Nigeria
Shri K. C. Samikkannu
Junior Executive/Health Education,
National Model Centre for
Occupational Health Services,
Bharat Heavy Electricals Limited,
Tiruchirapalli-620014
Shri Pritarn Lal
C/o Information Department,
USSR Embassy in India,
Barakhamba Road,
New Del hi-110001
Dr Meharban Singh
Associate Professor of Paediatrics,
Chief Neonatal Unit,
All India Institute of Medical Sciences,
New Delhi-110029
Shri Vinod Singh,
D-2, GSVM Medical College,
Kanpur-208002
Health Care Expenditures in a Rural Indian Commu
nity. Parker, RL Social Science & Medicine" 1986;
22(1) : 23-7.
This book should be read by all physicians and
nurses—who, as they have demonstrated with their
effective antismoking advice, have a vital role to play
in changing people’s life-styles. It should also be read
by health researchers and by health administrators and
politicians concerned with the health, food, alcohol,
tobacco, sports and other sectors affecting our daily
lives and our health.
Financing health services is an increasing concern
that looms as one of the major obstacles to achieving
an equitable distribution of primary health care > in
developing communities. An important step in sol
ving this problem is the assessment of current levels
of health care expenditures in these communities' in
order to determine the extent to which local resources
are being used for these purposes. Ways to maxi
mize the effectiveness of these resources * can then, be
sought. Village level studies carried out
between
1968 and 1974 in Punjab, India, revealed that at least
80% of all health care expenditures in this rural area
were for services of traditional practitioners or private
‘modern’ doctors.
This paper explores various as
pects of these expenditures including the source of ser
vices and the effect of individual characteristics such
as caste on the amount spent on health care. Outof-pocket expenditures are contrasted to expenditures
in the government system.
Assessment of the im
pact of ‘free’ village level primary care services in this
setting revealed that the poor reduced their expendi
tures on\health care more than the wealthy, but both
groups took almost equal advantage of the ‘free’ ser
vices.
The results raise the possibility of mobilizing
some of the savings accruing to the community to help
support the ‘free’ services as well as the potential of en
couraging private traditional and modern practitioners
to cooperate in achieving primary health care goals.
—WHO Chonicje
—National Medical Library
(2) To act on this knowledge people, must be able
to create a healthier life-style, and they may need pro
tection from the powerful interests that resist such
changes.
(3) Success calls for a broad-based approach invol
ving the medical services, many departments of .govern
ment, the food and agricultural industries, and a wide
range of agencies and skills in the community.
The Conference’s recommendations are based on
scientific and public health evidence, common sense
and practical examples. Its report includes chapters
describing the present situation, outlining what is
needed from governments and international organiza
tions and going into the behavioural changes needed
if we are to reduce the incidence of coronary heart
disease.
ISSUED BY THE CENTRAL HEALTH EDUCATION BUREAU, (DIRECTORATE GENERAL OF HEALTH SERVICES), KOTLA
NEW
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