ECOLOGY AND HEALTH
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swasth hind
In this Issue
Page No.
Ecology and Health
June 1987
Jyaistha-Asadha
Vol. XXXI, No. 6
Saka 1909
OBJECTIVES
Swasth Hind (Healthy India) is a monthly journal
published by the Central Health Education Bureau,
Directorate General of Health Services, Ministry of
Health and Family Welfare, Government of India,
New Delhi. Some of its important objectives and
aims are to:
129
Dr B.N. Ghosh
Sound and fury
133
Adverse health effects of environmental
pollutants
136
Dr Dinesh Chandra
Dr Mangesh Shukla
The man-made environments
health and behaviour
Dr R.D. Shanna
141
Women, Water and sanitation
142
Dr (MS) T.V. Lilong
REPORT
and interpret' the policies; plans, pro*
grammes and achievements of the Union Ministry
of Health and Family Welfare.
ACT as a medium of exchange of information on
health activities of the Central and State Health
Organizations.
Water supply for villages
M.L. Kapur
146
Tribal women and their health problems
148
Dr. (Smt.) Prabha Ramalingaswami
Planning for a sound housing
152
Dinesh Chand
FOCUS attention on the
major public health
problems in India and to report on the latest trends
in public health.
World Health Day-1987
Vaccines production being geared
156
M.L. Mehta
KEEP in touch with health and welfare workers
and agencies in India and abroad.
REPORT on important seminars,
discussions, etc., on health topics.
conferences,
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Articles on health topics are invited for publication in this
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EDITOR
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The contents of this Journal are freely reproducible.
acknowledgement is requested.
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The opinions expressed by the contributors are not neces
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,
ECOLOGY AND HEALTH
Dr B. N. Ghosh
The exact impact on health, resulting from environmental change may be
correctly assessed only by careful experimental epidemiological studies. But
it has become increasingly clear in recent years, that environmental degra
dation, if allowed to proceed unchecked, could result in serious and some
times irreversible damage to life on this planet.
June 1987
129
Lj* oology is that biologic discipline which has to
•*—9 do with mutual relationship of various living or
ganisms in an environment, and their reaction to ani
mate and inanimate surroundings. In short, it is the
influence of the total environment on the behaviour,
health and wellbeing of living things. The ecological
system is always a dynamic one, tending towards a
state of balance or equilibrium but not attaining it.
The ultimate state of equilibrium is known as the
climax state. Ecology is rapidly developing into a
quantitative science with predictive potential.
The study of ecology or, bionomics, as it is some
times called is one of the branches of biology. Ecology
has numerous practical applications in the health of
the people. It is concerned with conservation and
investigation of all natural resources, whether they are
soil, minerals, oil, gas or water, or plants, man or
other animals.
Theoretically, overall development should lead to
progress and an improved quality of life; however,
there are some negative effects. In many parts of
the world, social and economic development has
resulted in unregulated* growth and the creation of
vast urban and industrial complexes, that pollute the
atmosphere and affect the health of the people. One
of the striking changes in the ecology of man has been
the growth of cities. The resulting overcrowding and
squalor in parts- of some industrial cities have pro
foundly affected the psychosocial foundations of so
ciety contributing increase in disease, crime, alcoho
lism, etc.*
Conflicts
Conflicts arise between the desired development and
the preservation of environmental quality. These con
flicts may arise in number of situations as between the
need to use pesticides for food production and the
need to protect natural resources and the community
from the harmful effects.
Poor sanitary conditions and the accompanying
communicable diseases are the greatest cause of mor
bidity and mortality in the developing countries
where the majority of the world’s people live. Such
conditions are characterised by water supplies that are
inadequate both in quality and quantity, poor or non
existent waste disposal system, abundant animal and
insect reservoirs and vectors of disease agents and
insufficient health education, to which is often added
the resistance sapping factor of malnutrition.
130
These conditions have been largely eliminated in
the economically advanced and industrialised coun
tries, but other environmental hazards to human health
often exert their effect more subtly than do communi
cable diseases, and take their toll in both industrialised
and developing countries. They include physical and
chemical factors and psychosocial influences, and to
gether with microbiological agents, they make up the
part of the ecosystem most directly affecting man’s
health;
Quality of water may be degraded* by various pollu
tants, starting, from biological to various physical and
chemical agents.
Biological Contaminants
Biological contaminants mostly affect after ingestion
of the contaminated water and result in different bac
terial, viral, protozoal, helminthic infections and infes
tations. India loses 73 milion man-days a year as a
consequence to water-borne diseases. Diarrhoea is
by far the major killer of children in the developing
world—being responsible for 4 to 5 million childhood
deaths per year or 1 death every 5 to 10 seconds. In
India alone, 1.5 million children die annually from
diarrhoea.
Besides these direct effects, water also
helps in breeding of different vectors and thereby help
in those water-borne diseases ranging from malaria,
filaria, guineaworm.
About 12.6 million people in
11,736 villages in 82 districts of Andhra Pradesh,
Gujarat, Karnataka, Madhya Pradesh, Maharashtra,
Rajasthan and Tamil Nadu are at risk from guinea
worm infection. Presence of naturally occurring che
micals also make water unsafe for human -consump
tion.
Systematic hydro-geological surveys made by
the Central Ground Water Board have shown that
fluoride bearing waters are widespread* in 10 States in
India—Andhra Pradesh, Bihar, Gujarat, Haryana, Kar
nataka, Kerala, Punjab, Rajasthan, Tamil Nadu and
Uttar Pradesh.
Man-made pollutants
Oil fouls the shoreline. The most productive and
potentially useful areas of the sea are in the vicinity
of coastilines with the greatest human activity. They
are thus the most susceptible to destruction by man
made' pollutants. Pollution of River Ganga is another
extreme example in India.
The decibel hell: The extreme limit of human noise is 140
decibels, and the pain threshold 120 decibels.
—>
(Source—World Health, May 1972)
Swasth Hind
June 1987
131
Physical and chemical pollutants, besides affecting
the potability of water, adversely affect the growth
of useful aquatic species and also harm the growth of
vegetations nearby. These physical and chemical con
tamination of water and vegetation is totally man
made, either due to discharging untreated industrial
wastes in water or due to unregulated uses of pesti
cides.
The problem of low level exposure to pesticide ap
pears considerable in India. Data have shown ex
cessive amount of pesticides in various commodities
analysed in Hyderabad, Punjab, Pantnagar (U.P.).
Delhi and Mysore. Even samples of wheat obtained
from F.C.I. godown of Ludhiana and Poona showed
excess of malathion1. Survey conducted by author in
Calcutta revealed that 30% of the animal products
(meat, milk and fish), 26.3% of cereals and 24% of
vegetables of the city showed the presence of pesti
cide (DDT, Lindane and/or malathion).2 Fat, kidney,
liver, spleen and brain tissues from 100 individuals
who died* of fatal accident in Calcutta, when examin
ed revealed the presence of pesticides in 27 subjects?
Air Pollution
Air is another component of the ecosystem without
which man cannot survive more than a few minutes.
Studies in Europe, U.S.A, and Japan have confirmed
that an abrupt rise in concentrations of smoke and
sulphur in the ambient air is positively associated with
excess mortality.* Aggravation and/or causation of
chronic bronchitis, asthma and pulmonary emphysema
have all been considered in association with community
air pollution. Several recent studies have shown
that both overall mortality and mortality from res
piratory diseases are higher in areas of high atmos
pheric pollution than in otherwise similar areas of
low atmospheric pollution5,6. Dead birds and float
ing fish have come to symbolize the environmental
hazards that surround us.
Deaths from cancer of the stomach and intestine
are significantly related to levels of snfoke pollution
in 30 English country boroughs? The level of air
pollution in our big cities has been increasing at an
alarming rate—perhaps 10% each year. A study
carried out recorded the level of SO2 in air as
271/mg/m8 in Calcutta and 0-223/mg/m8 in Delhi while
in the U.S.A, it is not allowed to exceed 0.1 /mg/m3.
The dust fall in Delhi was 811 tons/sq. mile in
132
January 1971 and in Calcutta it was 590 ton/sq. mile
in December 1970. It proves that the problem is
already home.
Noise pollution
Of all forms of pollution, no doubt the most
insistent is the constant background of aggressive
noise in airport, in the street, in factories and even
inside buildings. The city dweller is thus subjected
to “the decibel hell”. Let us look at some facts.
A rocket, when launched- into space, produces a
noise of 170 decibels, a siren 150 decibels, pneumatic
drill 120 decibels (the pain threshold) and a motor
cycle 110 decibiles. An alarm clock produces about
80 decibels, which is also the level of domestic
quarrel. For a sound sleep, noise level should not
go more than 30 decibels. Noise adversely affects
hearing system. It is recognised that the organism
as a whole is adversely affected by excessive noise
particularly its cardio-vascular system, secretion of
hormones, particularly adrenaline, pituitary, thyroid
and the gonals (“Sonic” pathology). Noise can also
have a serious effect on the central nervous system.
Against a background of found noice (a steady 85 de
cibels) immediate memory is adversely affected.
Soil pollution
Another’ important constituent of the human eco
system is the soil. Soil is becoming increasingly pol
luted as a result of insanitary habits, various faulty
industrial and agricultural practices, incorrect method
of disposal of soild and liquid wastes.
In developing countries, soil pollution with patho
genic micro-organisms is still of major importance. In
such countries, intestinal parasites constitute the most
important soil pollution problem. It is estimated that
about l/3rd of the world’s population is infected with
hookworm whereas 1/4th are infected with A. lumbripodies8, *. Vegetables grown on these contaminated
soil are very common source of helminthic and para
sitic infestation of man.
Contaminated soil also plays an important role in
spreading a number of zoonotic diseases like leptos
pirosis, anthrax, Q. fever, and cutaneous larva migrans.
(Contd on
Page
134)
Swasth Hind
SOUND AND FURY
and
generally unre sound and noise. Noise is an un
Industry, airports and social ma
UNSEEN,
cognised, noise has become a acceptable level of sound accord vericks are not the only ones to
pollutant and a nuisance. Overall ing to them. Sound is a form of
noise in urban
conglomerates is energy measured in units
called
doubling in every ten years.
decibels (dB). It is a unit for mea
Studies conducted in major cities suring relative loudness of sound.
of the world show that more than The decibel scale is logarithmic.
70 per cent of neuroses is caused A noise level of 90 decibels would
by airport noise and traffic howl. be ten times as loud as 80. Nor
Overexposure to such sounds da mally, the lowest audible sound on
mages ears and can result in deaf the scale forms one decibel, the
ness. Noisy machinery in facto highest in the scale being 130. In
engineering, textile
mills
ries and mines can make men deaf. heavy
Animals are known to migrate and bottling factories noise levels
from dam sites and bridge sites sometimes go up to 115 decibels,
where iron monsters clatter and causing great harm to workers.
clamour day and night doing their
Take a bridal party going to
assigned jobs.
attend a marriage using powerful
That noise can wreak destruc microphones to broadcast all types
tion is an age-old theory now being of music at night with bands, bug
proved true.
The Bible says that les and drums in a peaceful neigh
the sound of bugles can raze a bourhood where children try to get
fortress to dust. Lord Krishna ready for the next day’s examina
sounded his Panchajanya to para tions, where sick babies have been
lyse the furious court of Suyodhana. put to sleep with great difficulty,
Even now,
soldiers break
step where men and women who had
when they march across a bridge. rushed back from their office try
In fact, sound is like a knife in the to snatch a few moments of rest
hands of a surgeon it heals, a kill ful sleep before rushing off for to
morrow’s work. Who enjoys such
er uses it to kill.
‘music*? Not even the signers. Pro
Scientist's engaged in the study bably the fiery water in them boils
of this disastrous
problem have over. Or take a religious function
made a fine distinction between in a home or a place of worship.
June 1987
blame. In homesteads loo this un
seen danger lurks.
Dishwashers,
vacuum cleaners, blenders,
lawn
mowers and even air-conditioners
produce noise more than 93 deci
bels. One of the most unexpected
source of noise pollution is rock
music in a discotheque, where noise
level goes beyond 110 decibels. A
study conducted in Leeds Polytech
nic showed that more than 10 lakh
teenaged rock music addicts suffer
ed from some degree of hearing
loss and other impairments.
In our country we burst crackers
for every occasion. Apart from
fire hazards, it can create hearing
and mental disorders even in chil
dren.
At o decibel nothing can be
heard. Up to 20 decibels sound
won’t disturb your sleep. Awake in
your living room, up to 40 dB will
not be noticed. A noisy office will
have 60 dB and you will have to
be very careful to avoid mistakes
and getting fits. Mechanical saws,
airplanes, etc., vary between
100
and 130 dB. They are dangerous.
Nature itself produces noise.
Sometimes it exceeds the permissi
ble level.
Volcanic eruptions,
133
Thomas Alva Edison recorded a benevolent gift and not a male
human voice on a revolving cylin volent destroyer.
der covered with tinfoil. Despite all
Thousands of urban communities
the harmful effects it acquired with
across
the world are threaterted by
time it has also given the human
race immense benefits. We catch noise assaults. Noise pollution is
more fish, we survey ocean beds, something that can be controlled.
we explore interior of the earth to We have the know-how. All that
get more oil, gas and minerals, we we need is the will to apply that
detect metal fatigue, and we dia know-how before it is too late.
O
Science of sound or acoustics gnose diseases and cure them with —PIB.
began on that day in 1877 when sonar. But this gift should remain
earthquakes and hurricanes show
nature at its worst. But they are
few and far between. But they are
also reminders that the faculty of
hearing is essential for our survi
val. Noise can deafen, it* can
madden. We have to control it as
we control the defilation of our
land, water and air.
(Contd. from page No. 132)
The soil pollutant of recent consideration are the
radioactive materials accummulating in the soil from
nuclear fall-ouls or from the release of liquid or solid
radioactive wastes produced by industrial or reasearch
establishments.
Insects and rodents comprise a major part of biolo
gical environment of man.
Many times, they had
been responsible for major outbreaks of epidemic and
pandemics like Black death pandemic of plague in
Europe in the 14th century which killed a quarter of
the population of Europe and similarly in the recent
past when 200,000 cases of denque occurred within
a spell of 2-3 months in and around Kanpur11. Unfor
tunately. the multiplication of many of the important
vectors and reservoirs of diseases- is often the result of
man's own actions. As human population increases
beyond the capacity of municipal services to dispose
of wastes, more and more bodies of water become
suitable for the breeding of Culex fatigans with a con
sequent increase in filariasis transmission. Flies and
rodents multiply on accumulating solid wastes, sett
ling the stage for transmission of enteric diseases and
often ratbome infections.
Besides transmitting diseases, rodents adversely affect availability of food-grains.
On a world wide
basis, 33 million tons of breadgrains and rice in storage
are estimated to be lost to rodents each year, and the
loss to insects is at least as great, if not greater12.
urban areas. Rapid and uncontrolled urbanisation
generates a whole series of complex problems, of which,
besides basic sanitation and environmental pollution,
housing is important one.
More than one thousand million people throughout
the world live in substandard housing conditions, and
this situation is likely to worsen in the years to come.
Poor housing is usually associated with lack of ade
quate water supply and basic sanitation facilities. It
also facilitates entrance and harbouring of rodents and
insects, with the resultant spread of diseases like mal
aria, filaria, trachoma and also an excessive number
of rat and scorpion bite cases.
It has been stated that the design and construction
of the house may help to produce mental unrest and
thus exacerbate mental disorders already afflicting the
occupants. The gloomy bleak and unattractive rooms
and surroundings may accentuate mental depression.
The effects of rehousing was shown to be varying
due to many other variables. But finally, certain stu
dies have indicated that the morale and general ad
justment of slum dwellers did not improve on rehous
ing and that neuroses and death rates increased after
slum population were moved to better housing12.
Ionising radiation
Housing
During the present century, mankind has been sub
jected to increasing levels of ionising radiation from
man made sources such as x-ray equipment, nuclear
weapons, controlled nuclear explosions, the nuclear
fuel cycle and artificial radio-isotopes used for
medical and other purposes.
The most intimate environment of man is the home
and so this home environment affects his life in many
ways. The problem of derangement of home en
vironment is universal but the problem is more overt in
Genetic effects of radiation hazards relate to the
hereditary materials in the germ cells. The damage
to genn cejls may consist of (a) Lethal mutations or
genetic death or (b) Non-lethal mutations which may
134
Swasth Hind
lead to an increased rale of genetic disorders in sub
sequent generations. As many of the non-lethal mu
tations are recessive in character, their somatic impli
cations may become evident only after many genera
tions. That is when the frequency of a specific muta
tion in the gene pool is sufficiently high so that there
a reasonable probability that two genes that have
undergone the same mutation may meet in the im
pregnation process.
Another matter of fundamental importance in pre
venting undesirable changes in environment and con
ditions detrimental to public health is regional plan
ning with reference to various activities of the com
munities, such as work, education, rest and recrea
tion, keeping in mind all the social and cultural factors
that affect community health. The Environmental
(Protection) Act, enacted by Indian Parliament in
May 1986, is a positive step towards it.4
Not only the physical, chemical or biological com
ponents of environment are crucial to our health but
also the social environment, i.e., the people around
us.
UNESCO’s MAB (Man and the biosphere) pro
gramme attempts to bridge this gap between disci
plines by mobilising applied research efforts all over
the world on major man—environment—resource
interactions.15
Infant mortality rates have been shown to be more
sensitive to socio-economic and cultural characteri
stics of the population, than to variations in the pro
vision of medical care.
Poverty—Hie greatest pollutant
Considering the ever-increasing impact of socio
economic factors on health, Mrs. Indira Gandhi, the
late Prime Minister of India, in 1972 Stockholm Con
ference on the Human Environment, very rightly in
troduced the concept that “Poverty is the greatest
pollutant of all”*111.
It is now widely recognised that most of our en
vironmental problems start from a narrow single pur
pose approach in public or • private actions, that
affect human environment, whether in agricultural,
industrial or urban development. There are perhaps
too many examples of enterprises undertaken with
more zeal than foresight, and of technical experts who
are competent in their own environment but comple
tely inadequate in a different milieu where they are
unfamiliar with the total ecology of the area.
The exact impact on health, resulting from environ
mental change may be correctly. assessed only by
careful experimental epidemiological studies, but it
has become increasingly clear in recent years, that
environmental degradation, if allowed to proceed un
checked, could, result in serious and sometimes
irreversible damage to life on this planet.
To remedy such unfortunate situations, it is now
current jargon to advocate an integrated approach
where all aspects of a given problem are looked at
from all angles, and where, ultimately, decisions
affecting the environment and its resources are not
taken independently of decisions affecting people.
REFERENCES
1. Bindra, O.S. & Kalra, R.L. (1973) A review of work done
in India on Pesticide residues—Progress and problems in
pesticide residue analysis. (Punjab Agricultural Univer
sity and JCAR, Ludhiana) P. 1.
2. Mukherjee, D., Roy, B.R. Chakravorty, J. and Ghosh,
B.N.
(1980) Pesticide residues in human fods in Cal
cutta. Indian J. Med. Res. 72. pp. 577-582.
3. K. Mukherjee, D., Ghosh, B.N., Chakravorty, J. and Roy,
B.R. (1980) Pesticide residues in human tissues in Cal
cutta: Indian J. Med. Res. 72, pp. 583-587.
4. The Environment (Protection) Act (1986), Ministry
of
Environment and Forests, Govt, of India. New Delhi.
5. U.S. National Air
Pollution
Control
Administration
(1969): Air quality criteria for particulate matter, Washing
ton, D.C., U.S. Public Health Service (Publication No.
AP-49).
6. Winkelstein, S.H.
(1967)
Archives of Environmental
Health, 332-363 162-167.
7. Zeidberg, L.D. et al
(1967) Archives of Environmental
Health, 15, 237-248.
8. Stocks, P. (1960) Brite J. of Cancer, 14, 397-418.
9. CCTA/WHO African
Conference on
Ancylostomiasis
(1963). Report, Geneva, WHO (WHO TRS No. 255) P.
5.
10. WHO Expert Committee on the Control of Ascariasis
(1967). Report, Geneva (WHO TRS No. 379) P. 6.
11. Chaturvedi, U.C. et al (1970). Bull, of WHO 43, 281287.
12. Healtli hazards of human environment (1972).
WHO,
Geneva, P. 110.
13. United Nations Conference on the Problems of
the
human environment (1972). Planning and management
of human settlements for environmental quality (Docu
ment A/Conf. 46/6).
14. U.N. Conference on the Human Environment. Stock
holm, 1972, N.Y. UN 1973 (Document A/Conf. 48/
14 Rev. 1).
15. Michael Batisse, (1978). Man and the biosphere, World
Health. June 1986, P. 4.
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June 1987
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135
ADVERSE HEALTH EFFECTS OF
ENVIRONMENTAL POLLUTANTS
Dr Dinesh Chandra
Dr Mangesh Shukla
Better sanitation and therapeutic agents have shifted the concern about death
and disability from infectious diseases to the risks which accompany exposure
to certain chemical and physical agents. It may take several years before the
toxic effects of some of these agents can be noticed. This article reviews some
of the known pollutants and their adverse health effects.
T he memory of Bhopal disaster is still fresh in
1 our minds, on a cold December night in 1984,
the world’s worst industrial disaster struck the city.
Forty thousand kilograms of lethal Methyl Isocya
nate gas leaked out from a pesticide plant leaving
2500 dead and several thousand crippled.
136
In a less dramatic manner, but surely and steadily
various pollutants, mostly originating from human
activities, are threatening our wellbeing. Hundreds
of chemical plants across India are polluting their
environments and leaving their workers exposed to
health hazards. Gas leaks-chlorine, ammonia, oleum
Swasth Hind
or others—are being reported frequently, Naturally,
there is increasing public awareness and concern, about
environmental protection and industrial safety.
Tt is no surprise that The World Health Organization
(W.H.O.) has found Delhi to be the world’s third
unhealthiest city to live in.
Better sanitation and therapeutic agents have shift
ed the concern about death and disability from infec
tious diseases to the risks which accompany exposure
to certain chemical and physical agents. Tt may take
several years before the toxic effects of some of these
agents can be noticed. This article reviews some of
the known pollutants and their adverse health effects’.
Sulphur dioxide forms sulphurous acid on contact
with moist membranes which acts as an irritant.
Thus, exposure to SO2 can cause cough, broncho-con
striction, irritation of the eyes and lacrimation. It
gives rise to ‘acid rain* when mixed with water, which
affects marine and plant life and interferes with food
chains. The standard exposure limit is five parts per
million (PPM) as a time weighed average for an eight
hour workday.
?
i
Environmental pollutants can be classified accord
ing to the mode of exposure, e.g., air, water and food.
This approach is useful in a practical way to regu
latory agencies. However, humans can be exposed to
substances like pesticides, heavy metals and ionizing
radiation through all the three modes of exposure.
.Air pollution
The major part' of air pollutants is produced by
burning of fossil fuels. The burning of coal in thermal
power plants and factories produces flyash and oxides
of sulphur and nitrogen. Automobile exhausts pol
lute. the air with carbon monoxide, oxides of nitrogen
and a complex mixture of intermediate combustion
products. Moreover, a number of agents like lead,
arsenic, cadmium and asbestos have been observed in
industrial and occupational settings. Exposure to
some of these agents may occur in non-industrial sett
ings also. For example, it may be seen with the use
of asbestos as roofing material or of lead as a petrol
additive. A large proportion of the world’s popula
tion lives in urban areas where the impact of these
pollutants is the greatest.
The respiratory tract is the major route of entry
and is affected most frequently, resulting in diseases
like chronic bronchitis, emphysema and bronchial
asthma.
The important air pollutants are:
Sulphur Dioxide (SOS): Sulphur dioxide is a colour
less, pungent gas released on burning coal and other
fossil fuels. Next to flyash it is the commonest pol
lutant from thermal power plants. The Indraprastha
power plant located in the heart of Delhi spews out
27 tonnes of SO2 and 100 tonnes of flash every day.
June 1987
Carbon Monoxide (CO) : An odourless, colourless
gas produced by incomplete combustion of carbona
ceous material. The major source of general environ
mental pollution is vehicular exhaust. However, the
commonest cause of personal exposure is cigarette and
bidi smoking.
Carbon monoxide combines with haemoglobin to
form carboxyhaemoglobin. Since the affinity of CO
for the haemoglobin binding sites is nearly 200 times
greater than that of oxygen, it reduces the ability of
haemoglobin to bind with oxygen, resulting in tissue
anoxia. The brain and heart are most affected by
CO. The myocardium is very sensitive to CO when
the coronary circulation is impaired. CO can worsen
the prognosis in patients with acute myocardial in
farction, may aggravate anaemia, peripheral vascular
dispose to infections), cough, headache, eye and nose
chomotor performance. The current standards limit
exposure to maximum, of 50 PPM for an eight hour
workday.
Nitrogen Oxides : Nitrogen oxides include nitric oxide
(NO), nitrogen dioxide (NOo), nitrous oxide (N2O),
etc., that are principally released from internal com
bustion engines and during the manufacture of ferti
lizers and textiles. At low concentrations, they cause
damage to respiratory tract mucosa (which may pre
dispose to infections), cough, headache, eye and nose
irrigation, etc. With higher exposure, acute pulmo
nary oedema, bronchiolitis obliterans and methaemoglobinaemia may occur.
Chlorine: It is a highly .toxic gas used in the manu
facture of paper, plastics textiles and chlorinated che
micals. A concentration of 30 PPM can induce
137
coughing and higher concentrations may lead to
breathlessness, haemoptysis, tracheobronchitis and
bronchopneumonia;
Ammonia: It is used in the manufacture of fertilizers
and explosives. It can cause respiratory tract irrita
tion, pulmonary oedema and chronic bronchitis.
Hydrocarbons: A major fraction of the urban air
is composed of organic compounds. These include
many known carcinogens like polynuclear aromatic
hydrocarbons, e.g., benzpyrene and methylchloranthrene.
Other examples arc benzene, which is extremly toxic to the bone marrow and N-hexane, an
aliphatic hydrocarbon which produces peripheral neu
ropathy.
Methyl Isocyanate and Hydrogen Cyanide: These
compounds are used in manufacturing of pesticide.
Cyanide salts are used in metal pTating operations.
Symptoms of acute cyanide poisoning are headache,
.giddiness, breathlessness and unconsciousness. Chro
nic exposure leads to skin ulceration, nasal irritation,
headache, tremors, etc. The antidote for cyanide poi
soning is amyl nitrite inhalation and intravenous
sodium nitrite or sodium thiosulphate.
Smoke from Domestic Fuels: In the developing
countries, there is a high incidence of chronic bron
chitis and pulmonary heart disease in women exposed
to the fumes of firewood, cowdung or kerosene inside
their homes. The smoke generated by these fuels
contains almost all of the toxic components found in
the smoke emitted when fossil fuels are burnt, but in
concentrations far exceeding the permissible limits.
Such exposure can be prevented by using smokeless
‘chulhas’.
Tobacco Smoke: While the risks associated with
tobacco smoking are well known, not many people are
aware of the environmental consequences of exposure
to tobacco smoke. Breathing in the vicinity .of smokers
in enclosed areas can cause lung cancer and other
illnesses in healthy nonsmokers. Children of parents
who smoke have more respiratory infections than
children of nonsmokers. Infants in families having
smokers have a greater risk of getting bronchitis
and pneumonia. It is time we imposed more restric
tions on smoking in the workplaces and in public
buildings.
138
Particulate air pollutants
So far we have seen the effects of gaseous substances
that pollute the air. But there are also solid particles
of different substances, dust, etc., suspended in the
air, which can cause diseases.
Dust : Dust particles of different sizes produce
different reactions in the body. Particles larger than
3 microns are coughed out. However, those between
0.5 to 3 microns reach the alveoli and give rise to
dust diseases, also known as Pneumoconiosis. Some
important dust diseases are discussed:
(i) Silicosis: It is caused by free silica in the form
of quartz, theodolite or cristobalite. Occupational ex
posure occurs in mines and quarries, in the ceramics
and glass industry, ‘iron and steel industry, during
sand blasting and constructions work. In the mica
mines of Bihar 34% of the miners were found to have
silicosis in a survey. In the stone quarries along the
Delhi-Haryana border, silicosis is especially common.
Entry into the body is by inhalation. Particles
between 0.5 to 3 microns reach the alveoli and give
rise to nodule formation. The nodules maiy aggregate
and massive pulmonary fibrosis may develop later
leading to emphysema and impaired lung function.
Symptoms include cough, dyspnoea on exertion and
chest pain. An X-ray of the chest shows ‘snow storm’
appearance in the lung fields. The disease is gradually
progressive and death occurs from right heart failure
or from pulmonary tuberculosis which the silicotics
are prone to develop.
(ii) Anthracosis: The disease results from prolong
ed inhalation of coal dust. It occurs in two phases,
Simple pneumoconosis, a non-progressive condition,
and Progressive Massive Fibrosis (PMF). PMF causes
severe respiratory disability and shortens life expec
tancy. It is a notifiable disease under the Indian Mines
Act.
(iii) Byssinosis : Byssinosis is due to inhalation of
cotton fibre dust and afflicts 7 to 8% of the textile
workers. It produces generalized air flow obstruction
and chronic cough.
(iv) Asbestosis: The term asbestos is used for
naturally occuring fibrous minerals containing silicates
of varying composition. Asbestos enters the body by
Swasth Hind
inhalation and fine dust may get deposited in the
lungs which causes .pulmonary fibrosis leading to a
‘small tight hung’. This may lead to respiratory in
sufficiency and even death.
Asbestos has been implicated in carcinoma of the
bronchus, intestinal tract and mesothelioma, a rare
cancer of the pleura and peritoneum. The risk of bron
chial cancer is exceptionally high if exposure to
asbestos is combined with cigarette smoking.
Clinical signs in patients of asbestosis include se
vere dyspnea, cyanosis, clubbing and cardiac dis
tress. The lungs have a characteristic ground glass
appearance on a chest X-ray.
The disease is pro
gressive once it is established, even after removal
from further exposure. Asbestosis can be prevented
by substitution with safer insulants, rigorous dust
control and periodic examination of workersMETALLIC POLLUTANTS
Exposure to these can occur through air, water or
food. The common metallic pollutants are:
Lead :
It is the commonest metallic contaminant
in the air. The largest source of environmental pol
lution is automobile exhaust which contains lead
derived from tetraethyl—lead which is added to pet
rol to prevent knocking. Lead exposure may also
occur through drinking .water from lead pipes or
chewing of lead paint on toys by children.
Lead
glazed earthenware and flaking lead paint are other
possible sources.
Over 200 industries use lead, e.g., glass manufac
ture, storage batteries, printing, ceramics, rubber in
dustry, etc.
Most of the lead in the body is found in the ske
leton. Blood contains about 1%. Blood levels , of
40 micrograms per 100 ml are considered excessive.
Inorganic lead compounds cause anaemia, abdominal
symptoms (colic, constipation) and blue line on the
gums.
Organic lead compounds are primarily neurotoxic,
and their effects can range from fatigue, headache
and irritability to behavioural disorders, mental re
tardation and even severe encephalopathy.
June 1987
Mercury : Metallic mercury due to its volatility,
has long been on industrial hazard. In 1953, in the
village of Minamata, Japan, an outbreak of what
became to be known as Minamata disease occurred
for the first time. The origin of this disease was traced
to contamination of the fish with methyl mercury in
Minamata bay resulting from mercury discharged
from a factory nearby. This occurred due to a pro
nounced tendency of mercury to bioaccumulate.
The symptoms of mercury poisoning include sto
matitis, parasthesiae, tremors, (the hatters shakes) and
emotional disturbances.
Renal damage is
well
known and CNS damage can lead to cerebral palsy,
ataxia and other symptoms mentioned above.
Cadmium : Poisoning affects the proximal rubules
of the kidney and produces proteinuria. Cadmium
concentration in air is positively correlated with hy
pertension and heart disease. It is carcinogenic to
experimental animals.
Arsenic : It is a cumulative protoplasmic poison.
Environmental pollution may arise from agri
culture (weedkillers, fungicides, insecticides) and in
dustry. Chronic poisoning leads to loss of appetite
and weight, gastrointestinal disturbances, peripheral
neuritis and skin lesions. It may produce bronchitis
and lung cancer.
Water Pollution
Polluted water contains any foreign substance—
organic, inorganic or biological—that tends to de
grade its quality so as to constitute a hazard or im
pair its usefulness.
Historically, consideration of the health effects of
water pollution have been focussed on water borne
diseases such as cholera, gastroenteritis, typhoid, etc.
However, in recent years, chemical pollutants derived
from industrial, agricultural and domestic wastes have
assumed a greater importance.
The water pollutants of public health importance
are organic compounds such as polynuclear aromatic
hydrocarbons, Polychlorinated biphenyls, phenols
139
and pesticides, inorganic compounds like nitrites, nit
rates, fluorides and metallic pollutants like lead, mer
cury, chromium, etc. Estimates of health effects are
complicated by latency and the lack of definite data
on dose response relationship.
Organic Pollutions'. Over 400 organic chemicals
have been identified in drinking water supplies. Chlo
rination, the most widely used water treatment me
thod, is being questioned due to the possibility of
harmful chlorinated compounds resulting from the
reaction of chlorine with organic materials in water.
Organic contamination of drinking water results
from agricultural and urban runoff, discharges from
industry and chlorination practices. DDT is a typi
cal example of pesticides that persists in the environ
ment.
It tends to accumulate in the body fat.
Peripheral neuropathy, CNS toxicity and liver da
mage may occur due to DDT. Many of the orga
nic chemicals listed above have been identified in
laboratory studies as having carcinogenic, mutagenic
and teratogenic properties.
Inorganic Contaminants : Studies on lead and cad
mium levels in drinking water have underscored the
importance of corrosive water in introducing these
metals at levels exceeding current drinking water
standards.
Inorganic fluorides found in subsoil water can cause
fluorosis. Nitrites combine with tertiary amines to
form nitrosamines, a class of potent chemical carcino
gens. Other inorganic pollutants such as asbestos,
arsenic and selenium may also act as carcinogens.
Ionizing Radiation
loniznig radiation is present normally in man’s
environment. The annual dose of natural ionizing
radiation is about 100 millirem of which 40% comes
from radioactivity in the eath’s crust, 40% from
cosmic rays and 20% from radionuclides within the
body itself.
The manmade sources of radiation contribute 75
millirem per capita every year.
They are medical
(diagnostic X-rays), occupational exposure and ex
posure from radioactive fall-out due to nuclear ex
plosions.
140
A variety of cancers are associated with radiation
exposure.
They include leukemia, cancer of the
breast, lung, thyroid, stomach selivery glands, bone
skin, liver and various intracranial neoplasms.
Besides cancer, radiation causes damage to DNA
leading to mutations, and to rapidly dividing cells in
the gonads, skin, hemopoietic tissue, and gastroin
testinal mucosa.
1
Workers exposed occupationally to ionizing radia
tion include those employed in medicine, in nuclear
reactors and in various manufacturing and industrial
activities. The maximum permissible dose is 5 rem
per year. Protective measures like lead shields, leadrubber aprons, other safeguards and periodic me
dical. examination can help reduce the ill effects.
There has been a worldwide interest in preparing
safety standards and codes of practice for the safe
operation of nuclear power plants and enunciating
the basic principles of radiation protection. This
work has received a sense of urgency alter the shock
ing accident at Chernobyl and the radiation leak
at Three Mile Island.
Conclusion
Environmental pollution causes disease and death
and makes life less joyful.
The sorry aspect of
pollution is that it is created by human’ activity.
There is, therefore, an urgent need to
introduce
standards and control measures on these activities.
A recent W.H.O. report shows that the developing
countries need to take stricter control measures be
cause their populations are more vulnerable to the
effects of pollution due to factors like malnutrition,
unhygienic living conditions, infectious diseases and
genetic predisposition.
Development without sufficient consideration for
health and environmental safeguards can prevent the
improvement of living conditions for the very people
for whom the development was undertaken. It is the
time for the Government and the society to take
long term steps to protect our people from the threat
of pollution.
O
Swasth Hind
THE MAN-MADE ENVIRONMENT,
HEALTH AND BEHAVIOUR
Dr R. D. Sharma
fast industrialization and general trend to
wards urban living has been one of the major facts
of life in most Asian countries during- the present
century. This growth has been accompanied by un
desirable changes in the pace and conditions of life
of the inhabitants of cities. It is not infrequently
asserted that these changes have produced an in
crease in the overall amount of stress which city
dwellers must endure—an increase which is in turn
held to reflect itself in the growing numbers of the
people who seek psychiatric treatment. Most of the
studies conducted so far make only passing reference
to those conditions which are associated with beha
vioural, psychological, and emotional stress.
As
research in behavioural
toxicology and industrial
Psychology expends into a more direct application
to the people and their working conditions, the link
ages between physiological and biochemical effects
and the currently subjective measures of job dissatis
faction and stress should become clear. Smith et. al.
have reported three incidents of industrial
mass
psychogenic illness in which the majority of work
ers affected were women. The locations were an
electronic assembly plant, an aluminium furniture
assembly plant, and a dozen fish packing plants. Symp
toms included weakness, sleepiness, nausea, bad taste
and dry mouth and breathing difficulties—all symp
toms which may be associated with exposure to
toxic substances.
be measured in terms of its relation to something
else. Under various circumstances this ‘Something
else’ may be the health and survival of the natural
systems that are part of the environment, the inte
grity of the natural physical features of the environ
ment, the beauty of the landscape, or the appro
priateness of the man-made parts of the environment
to the activities for which they are used. However,
•most of the time this
“Something else” is the
“equality of human life” in the environment. The
need that is most often remarked upon is a need
for a way of evaluating how the “quality of human
life” is affected by the environment, as by a part
of the environment.
It is widely recognized that there is need for bet
ter means of measuring what is often called the ‘qua
lity” of the environment. The word ‘quality’ as it
is used in this context, has an evaluative sense—it
implies that there is a relative “value”, “goodness”,
or “appropriateness” of the environment, which can
{Abstract of the paper entitled “The Man-Made En
vironment, Health and Behaviour” presented by -the
he
T
June 1987
This paper is man-oriented. It is .directed at the
problems of measuring the effect of the environment
upon the health and' behaviour of the people. It is
not primarily concerned with the effects of people
upon the environment, nor is concerned with the
effect of the environment upon human social groups
as such. It is directed to the question of how to
make measurements upon individuals which may
reflect the effect of the environment upon their health
and behaviour. It is concerned with the matter of
how people are affected by their .interaction with
the environment in which they live.
author at the ‘1st Asian Conference on Behavioural
Toxicology and Clinical Psychology* held at
Kanpur, from 9—11 January, 1987.)
O
141
WOMEN, WATER AND SANITATION
Dr (Ms) T. V. Luong
Various strategies for enlisting women’s participation in promoting water and sani
tation activities have been tried out successfully on a small scale. However the
mechanisms to enlist their active, participation for wide-scale Application are yet to
be developed and tried out. The present attention should, therefore, be directed at
evolving strategies for scaling up women’s participation.
ater is vital to life. Yet, over one billion people
Win the developing countries do not have easy
access to safe drinking water. It is estimated that this
section of population will reach two billion by the
end of this decade. In India about 300 million ru
ral population are to be provided with safe water
by 1990.
Fetching water for their families from whichever
available source at whatever distance is a way of
life for hundreds of millions of women, particularly
in rural areas. In India, many women in some pla
ces spend daily as many as six hours and use up
more than half a day’s energy for fetching water.
A substantial amount of the water these women
‘bring home, is neither safe nor adequate. Accord
ing to WHO, approximately 80% of all sickness and
/diseases can be attributed to inadequate water and
poor sanitation. For example, diarrhoea directly
kills six million children in developing countries
each year and attributed to the death of up to 18
million people yearly. In India alone, 1.5 million of
children below the age of five die of diarrhoea every
year.
Clean water is easily contaminated in insanitary en
vironment. This problem is further compounded by
the inadequate care taken in storing the water at home
due to a combination of ignorance and careless at
titudes.
142
It is now realized that providing safe
drinking
water alone will not achieve the health benefit un
less it is integrated with the improvement of sani
tation. Hence, United Nations launched the Inter
national Drinking Water Supply and Sanitation De
cade (IWSSD) with the objectives of promoting safe
and adequate drinking water and better sanitation.
Low cost and appropriate technologies are cur
rently largely available in the context of water
supply and sanitary facilities.
This naturally re
duces significantly the financial burden of a govern
ment and/or the community. However, the success
of the water and sanitation programme also depends
ito a large extent bn the human elements as it in
evitably involves the planners, the implementors and
most importantly, the users. The facilities provided,
regardless of their excellence of construction and
function, cannot achieve their objectives if they are
not being used, or when used, they are not being
properly maintained.
Women, health and the decade programme
Women, as wives and mothers particularly in rural
areas, bear the responsibility of collecting the domes
tic water supply and firewood and cooking the food.
Furthermore they feed and care for the children, the
elderly and the sick. In addition, the majority of
them spend many hours in the field for cultivation.
These long hours of hard work leave them little time
to care for themselves, their children and nomes. Yet,
Swasth Hind
sanitation both at household and community level.
They will appreciate the benefits of improved water
and sanitation. However, they should be involved
right from the planning stage in identifying problems
and suggesting likely solutions. Their effective in
volvement in the activities would enhance proper
usage and maintenance facilities.
For example,
women can suggest a convenient location for a public
tap or a handpump in their village. Recognising the
importance of the link between women, water and
sanitation, a World Conference of the United Nations
Decade for women recommended full participation of
women in planning, implementation and application
of technology in the decade programme.
Education, community
ment of women
participation
and involve
- While it is important to promote women in the pro
cess of planning, implementing, educating the com
munity in the water and sanitation programme, the
involvement of rural women in these developmental
activities is by no means easy. Considering the wo
men’s status in the community, low literacy rate, po
verty and social and cultural milieu in which women
live, if they are to actively participate in these
schemes, they need the support of their men, their
community, tljieir leaders and their governments.
U.K .
Woman of Memari Block, chlorinates the family
drinking water at home.
the level of hygiene in millions of these families is
largely dependent on these women who are quite
often over worked and malnourished. As a result
they can be the agents of disease transmission.
Equally they can be the change agent for improved
sanitary practices. Their potential role in improving
sanitation to reduce mortality and morbidity rate of
infants and children is undeniable.
Naturally, the prime users and beneficiaries of
these improved facilities are women. They should,
therefore, be considered not as passive recipients but
as active* participants in the use and management of
domestic water, personal hygiene, food and home
June 1987
Awareness of the needs and benefits of these
schemes should be created among both men and wo
men in the community including all levels of com
munity leaders and government functionaries.
In
addition, appropriate training and orientation should
be given to women to motivate them for effective par
ticipation. Training and education will help to build
up the confidence of the rural women and to equip
them with the knowledge to gain the support ofi their
menfolk and the community.
Having to shoulder domestic responsibility, it is
quite often assumed that women would be acceptors,
users, and agents of behavioural changes.
While it
is true that the influence of wives and mothers are
more effective on.the hygiene and behaviour of their
family members, the full support from the other half
of the population—men—are vital to enable women
to carry out their tasks effectively.
143
Our experiences indicated, for example:
— Women often need the permission from their
husbands or fathers td carry out promotion,
education and motivational activities in the
community.
— Contribution in cash or in kind comes from
their men for such matters as the construction
of family latrine and for buying soap for fa
mily handwashing.
able to spread simple health and sanitation messages
correctly in spite of their illiteracy.
Furthermore, it is evident that village elderly wo
men . can motivate their junior village womenfolk
more effectively. As a grandmother and mother-inlaw she has. authority in the family. Once she is
motivated herself to adopt sanitary practice, she
can supervise their daughters and daughter-in-law
to do so.
Women handpump caretakers
Women’s contribution
2.
In the past decade, UNICEF has been supporting
the Government of India (GOI) to provide improved
water supply to rural areas. More recently, in its
collaborative effort with the GOI to fulfil its decade
objectives, UNICEF has contributed in uplifting sa
nitation as a priority issue both at the government
and the community level. In promoting sanitation as
a package of health-related activities requiring beha
vioural and attitudinal changes, rather as a purely
latrine scheme, the role of women is, therefore, evi
dent. Some strategies adopted giving emphasis on
enlisting women participation are outlined below:
Selected village women and men were trained side
by side as village handpump caretakers. In Andhra
Pradesh, more than one thousand women handpump
caretakers are operating in a large number of villages.
1.
Illiterate rural women reduce significantly children
diarrhoeal incidence
Women in many villages of Memari block, West
Bengal, collect their drinking water from unprotected
water sources namely ponds and shallow wells with
handpumps. The women were trained in the tech
nique of adding chlorine to their drinking water pit
chers in addition to adopting various sanitary habits.
By consuming disinfected water, a reduction of 80%
of children diarrhoeal incidence was achieved within
12 months of intervention.
Deworming of children in these communities' won
the confidence of mothers and the community. This
activity proved to be an effective educational tool to
promote better personal hygiene (i.e. washing hands
with soap before eating and after defecation) and the
use of the sanitary latrine.
Selected village women were trained as motivators.
These women are illiterate. More than half of them
are grandmothers. These women motivators were
144
Handpump caretakers are volunteers. To qualify
as a handpump caretaker, the villager should live near
the handpump site and be willing to devote some time
to work for the community. They are selected by the
block functionaries and the village leaders.
Prefe
rence is given to capable women.
Handpump caretakers are given two-day’s training
on simple handpump maintenance as well as some
sanitation and hygiene knowledge so that they can
educate and motivate the handpump users.
They
attend to simple routine maintenance.
HoweVer,
when the handpump breaks down due to major faults
he or she reports’ the problem to the block mechanic
for repair by sending a prepaid postcard.
3.
Anganwadi and Sanitation
Under the Integrated Child Development Service
(ICDS), the network of anganwadi centres covers huge
area in the country. It is a vast readymade infras
tructure which could exert a profound influence on
many pre-school children, mothers and community.
The anganwadi centres are run by female workers
from the villages- The integration of sanitation pro
gramme in ICDS not only has the direct benefit to
women and children but also takes advantage of the
availability of a huge number of trained grass-root
women, as sanitation educators, trainers and moti
vators.
Swas th Hind
As a part of their pre-service training, the anganwadi workers are exposed to the importance of water
and sanitation as a measure for child health. With
the aims of more intensive promotion of sanitation at
the anganwadi centre, UNICEF is implementing sani
tation schemes on a small scale. The scheme em
phasizes on educating and promoting habit changes
and good personal hygiene. The construction of sani
tary facilities in selected anganwadi centres aims at re
inforcement of behaviour changes. The anganwadi
workers, their supervisors, and the child development
officers (CDPO) are given two-day orientation on sani
tation.
‘
4.
Women income generation scheme and sanitation
The Development of Women and Children in Rural
Areas (DWCRA) .programme implemented by Rural
Development Department (RDD) covers activities such
as income generation schemes and non-formal literacy
classes, etc., for rural women. In villages under such
scheme, RDD provided training centres where women
come daily to learn certain skills for a period of six
months. Female group leaders from RDD are res
ponsible to organise th’ese activities in these centres.
DWCRA scheme offers yet another readymade in
frastructure for promotion of sanitation by women.
UNICEF supported rural sanitation schemes are to
be taken up in selected DWCRA areas using the
women’s groups as the entry point to the community.
The female group leaders will be given two-day sani
tation orientation. They would educate and motivate
those women participating in the income activities and
also help to organise sanitation promotion activities
in the villages.
Conclusion
Safe water supply and sanitation relating to change
of sanitation habit and personal hygiene should be
promoted as a way of life.
A woman Iiandpump caretaker at work.
Various strategies for enlisting women’s participation
in promoting water and sanitation activities have been
tried out successfully on a small scale. However, the
mechanism to enlist their active participation for widescale application are yet to be developed and tried
out. The present attention should, therefore, be dir
ected at evolving strategies for scaling up women’s
participation. A
WORLD ENVIRONMENT DAY—5 JUNE
June 5 very 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 wastes, management of hazardous wastes, the protection of flora, fauna and their habitats
and questionsjTo combat [environmental pollution.
This issue of Swasth Hind is devoted to Environment, Sanitation and water.
June 1987
145
WATER SUPPLY FOR VILLAGES
M. L. Kapur
P otable water is
one of the
fundamental needs of life on earth.
While polluted water is a carrier
of diseases and has been always
causing havoc in the form of ende
mic diseases like cholera and diar
rhoea, lack of safe and clean drink
ing water affects the quality of
life particularly in rural areas. That)
is why in all the health programmes
of the country, stress has always
been laid on the supply of safe
water to the people. Planning pro
cess has also given it the due im
portance and more and more funds
have been allocated for water sup
ply in the successive plans.
While situation in larger cities
and towns lias improved considera
bly in the last forty years of plann
ed development large parts of rural
India still feel neglected and do
not have adequate drinking water
facilities. Despite the constraints of
resources the Government is com
mitted to provide drinking water
to all the villages by the turn of
the century if not by the end of
the current Five Year Plan. The
Twenty-Point Programme
1986
aims at providing safe water for
all villages, assisting local commu
nities to maintain sources of such
water supply in good condition and.
ensuring special attention to water
supply for Scheduled Castes and
safe drinking water to the entire
Scheduled Tribes.
rural population the subject was
To attain this priority objective kept as a part' of the Minimum
of the Government of providing Needs Programme in the Sixth
146
Five Year Plan and nearly Rs. 4,000
crores was spent on it both in the
Central and State sectors. To acce
lerate the rate of growth there has
Swasth Hind
been a quantum jump in investment
in this sector and an allocation of
6522.47 crore rupees has been made
for the next five years.
Work in the States
Funds have been provided in the
State budgets right from the start
of planning era in 1951. Though
schemes for rural water suply were
implemented initially under Com
munity Develdpment Programme,
in 1954 the State Governments start
ed entrusting the work to separate
departments to tackle the .problem
of water supply and sanitation.
It was found in the mid-sixties
thalt rural water supply schemes
were being implemented in the vil
lages which were easily accessible
and could be tackled without much
technological skills neglecting the
rural areas which had problems in
getting the much needed water for
domcstice purposes.
Taking into account the magnitude
of the problem and in order to
cover speedily the problem villages
the Central Government! introduced
the Accelerated Rural Water Supply
Programme in 1972-73 and assisted
the States with 100 per cent finan
cial assistance to implement the sche
mes in villages. With the introduc
tion of the Minimum Needs Pro
gramme the ARWSP was with
drawn in 1974. However, it was
re-introduced in 1977-78, when it
was observed that the progress in
the provision of drinking water to
the identified problem villages was
not at the expected rate.
Problem villages
A ‘Problem Village’ is one where
there is no safe source of drinking
water within a distance of 1.6 km
or where water is available at a
depth of more than 15 meters and in
the hilly areas where the elevation
difference is more than 100 meters
or where water sources has exces
sive salinity, iron, fluoride and other
toxic elements hazardous to health
or where water is exposed to the
risk of water-borne diseases like
cholera or guineaworm.
June 1987
The Seventh Five Year Plan will
attempt covering all those villages
which do noti have an assured source
of water supply wiithin a distance of
0.5 km. The present norm of avai
lability of forty litres per capita per
day will be enhanced to seventy
litres per day.
operation and maintenance of
created sources. States have been
allowed to spend 10 per cent of
the plan funds under MNP for
maintenance.
Under the Peoples Action for
development, voluntary agencies
would be involved in the execution
Various States and Union Terri and maintenance of water supply
tories had identified about 2.34 lakh schemes. Emphasis will also be
problem villages by 1978. The num given to community participation
ber later 'increased to 3.265 lakhs and health consciousness through
in 1980. At the same time it was extension work and mass media.
observed that 94 thousand of these
villages had already been provided
Special efforts will be made to
with safe water supply leaving 2.31 develop low cost option for
pro
lakh villages to be tackled as on viding safe drinking water to the
1 April, 1980.
rural areas as an alternative to capi
tal intensive schemes.
With this
objective a Technology Mission
As a result of the intensive efforts on drinking water in villages and
and investment 1.92 lakh problem water management has been laun
villages and 0.437 non-problem vil ched. It aims at finding lowcost
lages were covered during the Sixth but! effective alternative solutions
Plan and 0.39 lakh villages spilled to capital intensive schemes and
over to the Seventh Plan. Further development of traditional sources.
survey to identify villages that have It will also (involve a multi-disci
become problem villages under the plinary approach, conjuctive use
revised norms is being undertaken of water sources, periodic testing
of water besides development of
by the States.
appropriate technology.
Seventh Plan Strategy
Quality of work
Experience has shown that faul
The salient features of the Seventh
Plan strategy for rural water supply ty or incomplete execution of
include a high priority to coverage schemes defeats the very objective
of the spillover problem villages fol of .providing potable water. Atten
lowed by coverage of problem vil tion has to be given to mainten
lages identified subsequenty and then ance of the water supply points to
partially covered problem' villages. maintain continuous' supply of
Coverage of SC/ST habitations drinking water. Involvement of
funds will be earmarked for SC/ST womenfolk in selecting the water
under Accelerated Rural Water supply points and their mainten
Supply Programme in the same pro ance can help because they are the
portion as earmarked for SC/ST prime users of water. Users of
under the State Sector Minimum water could be imparted training
Needs Programme for SC under the to undertake simple repairs and to
Special Component Plan and for safeguard the environment. Simi
larly, there has to be a proper and
ST under Tribal sub-plan.
effective coordination between the
village and district authorities for
State Governments and local regular check-ups.
bodies have by and large not been
able to make adequate provisions
As resources are limited it is
and arrangements for maintenance, necessary that we look around
e.g., keeping the surroundings of for new ideas but also think in
water sources clean, construction of terms of using once again the tra
drains, soaking pit’s and prevent ditional methods after improving
ing water-logging. Special attention them to suit local needs.
—PTB.
will therefore be given towards
O
147
TRIBAL WOMEN AND THEIR
HEALTH PROBLEMS
Dr. (Smt) Prabha Ramalingaswami
To understand the impact of government health programmes, a study was conducted on
< women from economically weaker section especially the tribal women. The sample consisted of
■ 372 tribal women in 15-45 age group living in Paderu Block of Visakhapatnam district in Andhra
Pradesh. Although these women were illiterate and were living in a remote place away from
urban influence, they showed awareness about these Health programmes. About 50% of the
women have liked to have their babies delivered by Auxilary Nurse Midwives and trained dais.
However, it was aporoximately 17% °f women who could avail the services of the dais and
Auxilary Nurse Midwives. Unfortunately the health programmes have not benefitted them.
The author discusses reasons for this in this article.
in India have always enjoyed a unique
position. On one hand they have been deified,
have been praised as being the corner-stone of Indian
society and have been depicted as the very personi
fication of moral force that binds the family toge
ther. On the other hand women in real life have been
denigrated and have been subjected to many hard
ships. (Report of the Committee on the Status of
Women in India. 1974).
are done by women. The wages that are paid to them
are very low in comparison to the work of their male
counterparts and in comparison with the quantity and
quality of work they do. A lot has been written on
this. To quote a few: (Anita Dighe 1985); (Kalpana
Bardhan 1985), (Vimal Balasubrahmanyam 1985),
(Leela Gulati 1981). (Murali Manohar et al 1981).
(Saradamoni 1982), (UNICEF Report on Women in
Development 1980), (Vina Mazumdar 1982).
The polarisation that exists between the privileged
sections of society and the masses, influences the pro
blem of women. It is the women from economically
weaker sections especially the tribal and rural women
that arc adversely affected.
Women who are the
prime producers of the necessities of life; women, on
whom the society depends so heavily for economic
support and family health care are the prime targets
of these inequalities and injustices- These women are
poor and illiterate. They are working not by choice
but by force of circumstances. They arc working as
agricultural labour, as construction workers, and in
agri-based industries like tobacco and cotton. All the
back-breaking jobs in agriculture, all the jobs which
are health-hazardous—in tobacco and other industries
Added to these are other problems which these
women face.
They have to fetch drinking water
(sometimes from very long distances) and fire-wood
and cow dung for cooking- The result is that in addi
tion to work outside the house and inside the house.
they arc spending more time and energy for getting
cooking fuel and drinking water. The work at home
is itself not regarded as important or remunerative.
The work she does outside is hard and wages are
usually very low. She is usually in a poor state of
health. Repeated pregnancies, chronic under-nutri
tion. hard work, lack of health care and basic ameni
ties have sapped all her energies. Yet she is the key
person jn the family—it is she who takes care of the
children and every member of the family. Among
omen
W
148
Swasth Hind
this economically weaker section it is the tribal women
who are most disadvantaged. Often one hears about
tribal medicines and the preference of the tribals to
follow their own system of medicines. What is the
reality? Are the tribal women aware of government
health services? What is their knowledge about some
of the communicable diseases that affect their health?
A study was conducted in order to understand the
above issuesObjectives of the Study
(1) Are the tribal women
Health Centre?
aware of the Primary
(2) Are these women aware of maternal and child
health services rendered by auxiliary nurse midwives?
If so, have they utilized their services.
(3) Are these women aware of family planning ser
vices and utilised them?
(4) Are these women aware about TB, leprosy and
malaria?
times that was fixed by pre-arrangement. After esta
blishing rapport and after collecting identifying data
and background information, questions were asked
about childbirth, the persons who helped them during
childbirth and the persons they would like to have
during childbirth, whether they were aware of the
tetanus toxoid injection (part of the immunization pro
gramme of the government and which an ANM is sup
posed to give) which reduces maternal mortality, their
knowledge about family planning programme, and
their knowledge about diseases like T.B., leprosy,
malaria and goitre (which is prevalent in this region)
and awareness about primary health care (PHC). The
attempt here has been for understanding- the existing
factual knowledge they have about these problems.
Analysis of data
Content analysis was done on the responses. Here
the most important features of the results are pre
sented in the following Tables.
Table /—CHILD BIRTH
Area of the study
Six villages near Paderu Block in Visakhapalnam
District of Andhra Pradesh arc included in this study.
Paderu has 93% tribal population and is completely
rural. It has a female literacy rate of 3.05%. It
is the headquaters of the tribal division and is about
150 km. from the district headquarters. The nearest
town (which has a population of 21,000) is about
74 km. Out of the six villages, one village is about
10 km distance from Paderu, another village 8 kmanother village 6 km. and two villages are 4 km. and
two villages are 3 km. from Paderu.
Sample
A total of 372 women in 15-45 age group were
included in the study. For each household one woman
was interviewed. Fifteen women were literate with
out educational- level, 20 women had about two to
three years of schooling. All of them were married
and had at least one child. They are all tribal womenThis group was selected for the study because of their
illeteracy and poverty and were living far away from
urban areas.
Deliveries Persons who actually Persons who pre
conducted had their deliveries ferred to have this
by
_________________
category_____
Number Percentage Number Percentage
Family
Members
304.
81-72
188
50*54
A.N.M.
4
1-08
107
28-76
Local Dais
58
15-59
20-69
Hospital
5
1.34
77
—
The above Table clearly indicates that although the
services of ANM have not reached these people
they are aware about them and nearly 29% have said
that they would have preferred to have an ANM
attend on them. Although the present group cf
women are tribal women living in a remote area away
from urban influence their responses are similar to
those of rural women studied by Banerji (1982).
» 7/—TETANUS TOXOID INJECTION
Techniques used
The women were interviewed with the help of an
interview schedule consisting of open ended questions.
The interviews were conducted in their houses and at
June 1987
—
Those who received
Those who did not
’
Number
Percentage
58
314
15-59
84.41
149
Table III—AWARENESS ABOUT DISEASES
Number
Percentage
T.B.
111
29-84
Leprosy
105
28-23
Malaria
368
98-92
Goitre*
121
32-53
♦While they were aware about - Goitre as swelling
near the neck, it is only 121 who knew it was a
disease and could be prevented by changing th'e
salt, z.e., iodised salt.
Table IV—FAMILY PLANNING PROGRAMME
Number
Percentage
Persons who were aware
of government Family
Planning programme
345
92-73
Persons who used this
programme
249
66-94
Persons who said there
should be only two or
three children
289
77-69
Persons who said that
there should be 3 years
of difference between
children
286
76-88
Table V—AWARENESS ABOUT PHC AND OTHER
GOVT. PROGRAMME
' AWARE
Programme
USED
Number Percentage Number Percentage
P.H.C.
249
66-94 .
249
66-94
Develop
mental
186
50-00
1.86
50 00
Adult
Education
25
6-72
5
1-34
Discussion
The Tables presented here bring out one point very
clearly that these people are aware of the government
programmes. The programmes have not yet reached
them. For instance, it is only 4 out of 371 women
who had the luxury of having their babies through the
150
hands of an ANM. Yet 107 out of 371 (nearly 29)
were aware about ..ANM as a trained person and pre
ferred to have her attend on them.
Likewise almost everyone . was aware of malaria
worker and associated him with fever tablets and
blood smear. It is indeed interesting to notice that
malaria programme reached these villages and every
one knew’ about malaria.
Although this area is an endemic area for leprosy,
TB also is quite common. It is approximately 29%
of the women who could mention the important symp
toms of these diseases and were aware of the possibili
ties of treatment- Considering the illiteracy of these
women it is interesting to note that so many were
aware of these diseases and the possibilities of treat
ment.
Family planning/welfare programme reached these
women. They were approached by family planning
workers and were motivated for going in operation
and dutifully mentioned to us that the number of
children one should have is two or‘three and that
there should be a gap of 3 years between children,
thus reflecting the publicity of the family welfare pro
gramme. These women have heard about PHC and
have made use of the PHC at times when a family
member was acutely ill or at the time of an accident.
However they look upon PHC as hospital and though
they are hot aware of the preventive work supposed
to be carried, out by. PHC they identify ANM and the
malaria workers with PHC.
The most basic health service which a women
needs is during maternity. A proper care during this
crucial period will substantially help the women to
maintain a reasonable health. The emphasis on family
welfare has taken away most of the time of ANMs.
In addition in a forest area where most of the villages
do not have access to bus, where walking a two mile
distance means walking through an uphill forest path
will pose even more problems for ANMs to reach the
women in their areas and render MCH care- It is
in such places the most deprived among the disad
vantaged live. One of the solutions could be increase
in the number of ANMs and trained dais in such re
gion. MCH care is most important for women.
ANMs who are supposed to give this care are not
able to effectively render this. Instead of finding fault
with them the approach should be to see their difficul
Swasth Hind
ties, solve their problems and ensure that they are
able to discharge their duties without much physical
strain to themselves. For instance, in this region most
of the villages are beyond 3 miles from a bus stop
and this would definitely be a lot of strain even to
reach one village lot alone cover a number of villages.
It is here that consideration for the problems of ANM
will help. It is only an increase in the number of dais
and ANM that will make MCH care a reality. While
this is often talked about, it is one of those areas’ that
is not implemented- A four-fold increase in the num
ber of ANMs and demarcation of an area which they
can cover without much physical strain and a reason
able amount of time for MCH work within, the cons
traints of working for family welfare programme will
improve the MCH services for these women. This
in turn will improve their health.
REFERENCES
Anita Dighc (1985) : “Women’s employment in the urban
informal sector—Some critical issues”, Social Change,
. vol. IV, no. 2.
Bancrji, D. (1982) : Poverty, class and health culture
India, vol. I, Prachi Prakashan, New Delhi.
in
Kalpana Bardhan (1985) : “Women’s work, welfare
and
status : Forces of Tradition and change in India”,
Economic and Political Weekly, vol. XX, no. 5.
Leela Gulati (1981) : Profiles in Female Poverty : A study
of five poor working
women in Kerala, Hindustan
Publishing Corporation, India.
Mundi Manohar, K., Shobha, V., and Janardhan Rao (1981):
“Women Construction Workers of Warangal”, Economic
and Political Weekly, vol. XVI, no. 4.
Saradamoni, K., (1982) : “Women’s Status in changing Agra
rian Relations : A Kerala Experience”, Economic and
Political Weekly, 1982 vol. XVII, Jan. issue.
Towards Equality : Report of the Committee on Status of
Women in India (1974), Published by Government of
India.
UNICEF (1980): Board Report on the integration of women
in the development process and its impact on
the
well being of children Part I, UNICEF, New Delhi.
Vimal Balasubrahmanyani (1985) : “Biology and
gender
bias : Some issues in discrimination against women at
the work place”, Economic and Political Weekly, vol.
XX, no. 20.
WHO REGIONAL OFFICE BUILDING
A “NO SMOKING” AREA
As of 7 April, celebrated as World Health Day, smoking
is no longer permitted anywhere in the building of the
WHO Regional Office for South-East Asia. The only ex
ception will be a room on the fourth floor which has been
specially modified for
the. purpose. A similar curb
on
smoking in WHO Headquarters in Geneva also came into
effect from 7 April 1987 while Regional Office buildings in
Brazzaville, Washington, Alexandria and Manila have been
“no-smoking” areas for some time.
In announcing the measure, the Organization cited mount
ing evidence that “passive smoking”—involuntary exposure
to tobacco smoke—is harmful to the health of non-smokers.
According to a 1985 report of WHO’s International Agency
for Research on Cancer (IARC), “passive smoking gives rise
to some risk of cancer”.
The Organization’s statement on the new measure notes
that “the workplace is recognized by health authorities as
being usually the place where the most substantial exposure
to passive smoking occurs. 4t has been calculated that a
non-smoking office worker sharing the office with a smoker
could inhale the equivalent of a few cigarettes per day in
smoke particles”.
In many countries, an increasing number of health and
non-health institutions, commercial and business undertakings
are adopting non-smoking policies on their premises based
on considerations of personnel health and comfort.
The curb on cigarette
smoking in the Regional Office
building, it is hoped, will help protect the health of staff
members (a majority of whom are non-smokers) as well as
visitors, to the building.
Further, it will serve as an exam
ple of ensuring a smoke-free working environment to nation
al institutions such as schools, factories, government and
business premises and hospitals as well as other international
organizations.
This is all the more important in view of
a 1986 WHO report which described cigarette smoking as
“the major avoidable cause of ill health and pre-mature
mortality in the countries where it is widespread”.
The
report estimated that the world pandemic caused by tobacco
use results in at least one million premature deaths each
year.
Vina
Mazumdar (1982) : “Another Development with
women : A view from Asia”, Development Dialogue.
June 1987
151
International Year of Shelter for the Homeless—1987
PLANNING FOR A SOUND HOUSING
Dinesh Chand
A serious threat to physical and mental health of the population and their social
well-being has been felt by most countries because of the over-crowded housing
and the resultant unhealthy environment. The author feels over half of the
diseases of the metropolitan areas could be eliminated through proper understan
ding of the factors effecting health of community and sound environmental pla
nning of housing. In this article he highlights housing environics, planning in
accordance with the minimum standards and role of various groups of interest,
education media and public health engineers.
HOUSING IS A BASIC and indispensable need
of the human beings. The country at present is facing
a colossal housing shortage. The estimated housing
shortage of about 21.3 million dwelling units have
been assessed by the National Buildings Organisation
on the basis of 1981 census data in urban and rural
sectors. For gradual eradication of a country’s hous
ing problem, the United Nations recommended the
construction of atleast 10 new houses per 1000
population annually. Against this, our annual rate
works out to be less than one unit per 1000 popula
tion. Now almost all possible efforts and financial
assistance are being provided by our Government for
promotion of housing programmes. Our planners
ignore to incorporate the environmental factors in
their housing programmes. Fortunately, it is now
being increasingly realised that adequate housing as
well as healthy and hygienic environment are not only
the pre-requisites for a balanced and harmonious
growth of economy but they also increase the produc
tivity of people, raise their morale and standard of
living
The first report of the WHO Expert Committee on
the Public Health Aspects of Housing has defined
housing as, ‘‘The physical structure that man uses
for shelter and the environs of that structure includ
ing all necessary services, facilities, equipment and
devices needed or desird for the physical and mental
health and social well-being of the family and indi
vidual.” This report further points out that the im
152
mediate surroundings of residential buildings should
be included in housing environment. Thus the resi
dential environment, as it may more explicitly be
termed, should be considered not as an isolated sub
ject of study but as one of the several environmental
health problems associated with planning and deve
lopment, and having economic and social aspects.
What over-crowded housing does
The present study will indicate the high incidence
of maior crimes, delinquency and fires and the high
costs of services of slum areas. Data have been gather
ed elsewhere which indicate that over half the
diseases of the metropolitan areas are found within
the so-called ‘Slum districts’ of the cities.
The
incidence of tuberculosis bears a close relationship
to the degree of crowding in dwellings. The other
diseases like penumonia, influenza, rickets, plague,
typhus, tularaemia, trichinosis, rat-bite fever, infec
tious jaundice and home accidents are far more
prevalent in these areas of poverty and congestion,
unhealthy housing.
In view of above Indian environmental engineers
and planners can play not only a major role but can
also take a lead in the field of housing activities
through their considerable knowledge and understand
ing of environmental problems affecting community
Swasth Hind
health. In collaboration with public work departments,
the planning departments and city and regional
authorities, they may practically influence the deci
sions and approval of plans relating to water supply,
sewerage and drainage systems, overcoming runoff
and flooding hazards of surface water, etc. These
services are so -important for protection of public
health that uptodate and complete information about
them js essential for the operation and activities of
public health engineering departments.
We need planning and regulations
About 45 years ago, C.E.A. Winslow, with his
commentary on Hygiene of Housing of the American
Public Health Association (APHA), established the
basic principles of healthy housing. These have cover
ed four major areas of concern: (1) the fundamental
physiological needs, (2) the Psychological needs,
(3). protection against contagion, and (4) protection
against accidents. In its first report, the WHO Expert'
Committee has outlined the similar principles covering
four levels of planning: (1) the prevention of pre
mature death, (2) the prevention of disease, illness
and injury, (3) the attainment of efficiency of living,
and (4) the provision of comfort.
The planning of healthful housing should include
following major aspects:
(1) Provision of space for light, air and recrea
tion;
(2) Provision of adequate water supply and pro
per sewerage, drainage solid waste disposal
facilities;
(3) Freedom from accident hazard;
(4) Clean air:
(5) Freedom from unnecessary* noise and dis
turbances;
(6) Insect, rodent and nuisance control; and
(7) A land use plan.
.Presently, in some areas of development there has
been a tendency to place many dwellings on small
plots of- ground, without any provision for children's
play, space nor sufficient room for adequate natural
lighting, proper air circulation between dwellings and,
more important, protection from fire hazards.
Every community needs space for small parks, play
grounds, etc., for children to play, for adult recreation,
for mental stimulation and relaxation and for other
community activities which aid the total health of
individual and the family.
Potable water, must
It has long been recognized that an adequate, safe
potable public water supply is esesntial for public
health and thus needs careful planning apd designing.
Generally, the lack of adequate quantity of water at
various peak demand periods is one of the difficulties
in a number of the big metropolitan areas. The lack
June 1987
of adequate water pressure in the municipal distri
bution system can cause 'inconvenience as well as
serious health hazards due to contamination in the
system by back-siphonage.
Every effort should be made in all metropolitan
cities to develop a water carried sewerage system,
with a provision for suitable treatment. Moreover the
dangers of contamination of surface and ground water
sources is frequent in the case. of septic tank system.
The domestic solid wastes disposal is also an impor
tant factor in metropolitan cities due to a rodent
problem, fly and mosquito breeding, and other nui
sance. Too often surface drainage problems are over
looked expecting the original drainage channel to
perform this function.
Remove hazards
The planners should endeavour to see that for
dwellings, especially those on highways and streets.
such patterns are designed as minimise accidental in
jury or .death. The programmes of overcoming exist
ing hazards in substandard dwellings should be pre
pared by them because structural deficiencies arefound in many of our older as well as newer dwell
ings. Consideration should also be given, to the re
moval of accident hazards for children in residential
streets.
ana nuisance
New habitat should be located possibly in the far
off places to protect people from industrial odours,
gases, dust, and fumes. Existing air pollution pro
blems should be tackled with the help of state pollu
tion control boards or by shifting either industries or
habitants, whatever is easy and economical in such
cases.
.Industrial noises particularly those from railroads,
motor traffic and other sources which disturb com
fort are all potential health hazards. For new housing
programmes these aspects should be considered and
corrective measures taken such as altering timingof various industrial operations in areas where dis
turbance is of serious character. Necessary steps for
control of insects and rodent should also be taken to
minimize the nuisance.
For a best! housing environment, the environmental
engineers/planners should cooperate in developing
master plan or land-use plan for the entire area, stipu
lating future land-use for various public purposes.
After housing plans have been completed by a deve
lopment authority, it is essential that regulations and
zoning methods are adopted which assure implemen
tation of the recommendations for land! use; thorough
fare, and community-facilities. Its enforcement can
assure proper protection of housing areas from the
factors detrimental to the community which may
vitiate the utility of an area for housing purposes. In
notifying industrial areas, the planners should ob
serve Me additional regulations and consult other
concerned government authorities.;
153
Minimum standard should be adopted based upon
principles of hazard-free housing as indicated in the
WHO Expert Committees Report on Public Health
Aspects of Housing. In the Soviet Union the mass
housing programmes are carried out in accordance
with All-Union Building Standards and Regulations
which are revised periodically. All-Union Building
and Hygienic Standards of the Soviet Union provide
that the total noise levels of dwelling houses and
public buildings should not exceed 35 decibels in the
day time (8 A.M. to 10 P.M.) and 30 decibels at
(10 P.M. to 8 A.M.). In all such cases the special
abilities, experience and training of the environmental
engineer can play an important role in the develop
ment of new codes, ordinances and enforcement pro
cedures. It would be of great advantage if a clearing
house could be established whereby a more effective
enforcement could be assured.
Further, code enforcement can prevent the de
terioration of housing facilities because of unapprov
ed and substandard remodelling of dwelling units.
Care must be taken, however, that all the principles
of proper housing are fulfilled in such remodelling
operations.
Appraisal
The appraisal of existing housing facilities and the
need for improvement, can well be accomplished
through the concentrated efforts of various govern
mental agencies under the leadership of well qualified
and experienced environmental engineers. Census data
are an important tool and key to understand the
metropolitan housing problems. For an all out attack
on the blight' and the spread of deterioration of exist
ing housing, a thorough analysis of entire community
and its neighbourhood must be made.
The US
Housing and Home Finance Agency has recommen
ded following four steps for developing a programme
for an attack on the blight:
1. Delineate the residential areas of the com
munity by neighbourhoods for study and
planning purposes.
2. Determine the location, extent and intensity of
blight in each neighbourhood.
3. Analyse each neighbourhood in terms of its
condition and need for treatment.
4. Make
recommendations
for
action-pro
gramme required to meet neighbourhood needs,
such as code enforcement, public improve
ments, conservation, reconditioning, clearance
and re-development.
It is essential that' neighourhoods be analysed as
a whole and the condition of housing in terms of
the general environment be considered. Also the.
pattern of land-use, traffic-flow, street arrangement
and. neighbourhood facilities and services may also be
considered. Further, the APHA housing appraisal
methods and techniques and the modified appraisal
methods of the city of Detroit may also.be consulted
for valuable guidance. Such a study and analysis of
154
data will sometimes indicate the need for complete
removal of substandard housing in situations where
corrective measures are found inefficacious. This
practice may provide an opportunity to appraise the
value of housing facilities of a community and to
determine on a long-term basis the total liability in
terms of substandard or dilapidated housing condi
tion,
7
Corrective steps
Appraisal of existing housing conditions is followed
by suitable long-term planning for solution. In most
communities, following four basic types of housing ,
area are found:
(1) Areas which are essentially • satisfactory and
will require protective action only.
(2) Areas which show incipient blight or which
are subject to adverse effects from conditions
beyond their borders. These areas will re
quire protective and corrective action.
(3) Substandard areas which are basically sound
enough to be brought upto an acceptable
standard by a comprehensive approach to
their problems.
(4) Areas which are unsuitable for continued use
and cannot be elevated to an acceptable
standard economically because of poor qua
lity of dwellings and environmental conditions.
These areas will require redevelopment.
Programmes of improvement involve following three
types of approach:
(1) Conservation: It requires retaining and protect
ing all satisfactory elements of the dwellings
and their environments.
(2) Rehabilitation: It requires repairing, remo
delling, renovating or supplementing basically
sound dwellings and. their environment.
(3) Redevelopment: It requires demolition of in
dividual or groups of structures and planned
reuse of individual premises.
Education and publicity
The key persons in each neighbourhood of com
munity should be approached and their enthusiasm
and interest aroused for correction of existing hazards.
Civic organisations, groups of parents and citizens,
clubs, etc., should be educated and exposed to the
problems existing in the community. Simultaneously,
the planners should be in close contact with the
government bodies which are responsible for provi
sion of public facilities. Another group of interest is
of those who have a strong economic interest in such
development, for example, businessmen, builders,
real estate interests, mortgage houses, banks, etc. In
the Detriot Metropolitan Area, the Governor’s office
formed a so-called ‘task force’ composed of repre
sentatives of all interested groups. This task force,
with officials from the various organisations have
worked together and found most successful in its
Swasth Hind
More assistance for rural housing
RURAL HOUSING is an integral
part of the Minimum Needs Pro
gramme of the Government. During
the Sixth Plan a scheme for Rural
House Sites-cum-Construction Assis
tance was in operation as a part of
the Minimum Needs Programme.
The total number of landless fami
lies which were provided house sites
under the Sixth Plan is estimated at
13.07 million. However, the analysis
has revealed that there are still 0.72
million landless families to be pro
vided with house sites. As regards
construction assistance, 19 lakh fami
lies were assisted against the tar
get of 36 lakh.
would be made to provide constru
ction assistance to those families al
ready provided house sites. A tar
get of 2.71 million families has been
fixed for provision of construction
assistance at a total cost of Rs. 541
crore. The amount of assistance
per family has also been revised up
wards : it is proposed to provide
assistance to the extent of Rs. 500
per family for provision of deve
loped house site of 100 sq. yards
each, against the current provision
of Rs- 250. Similarly, for construc
tion assistance, it is proposed to in
crease the amount to Rs. 2000 per
family against the provision, of Rs.
500 at present
During the Seventh Plan the re
maining 0.72 million landless fami
lies will be covered on a priority
basis* For this a sum of Rs. 36
crore has been earmarked. Along
with allotment of house sites, the
sckeme also provides assistance for
construction. During the Plan, efforts
Besides the provision .of Rs. 577
crore made in the Plan for Rural
Housing under Minimum Needs Pro
gramme, an amount of Rs. 240 crore
would also be made available dur
ing the Seventh Plan from institutions
like HUDCO and General Insurance
Corporation.
Q
mission under the leadership of Chief Engineer of
Environmental
Health Division of the Health
Department.
The application of health education techniques of
housing can play an important role in the same
manner as in the field of communicable disease
control. For thorough understanding of problems of
the people within an area, the sociologist and the
educator may play an important role.
Mass education
The Mass education activity should include the
production of numerous simply-worded, well-illustra
ted pamphlets, brochures and- bulletins related to
problems of rubbish disposal, rodent control, building
maintenance, gardening, improvement of yards, open
spaces, etc., which can encourage an individual for
improving his home and its surroundings. The publi
city must be coupled with demonstration of ideal
dwelling units and providing information relating to
June 1987
the efforts which can easily be made by themselves
and financial aspects of improvements. Enthusiasm
for community improvement may be developed
through area-wide publicity, institution of awards,
public recognition of individual efforts and inclusion
of environmental studies in the schools syllabi.
There is an ever-increasing concern on the part
of public health authorities about the need for rapid
and effective action to stem the spread of blight which
is constantly extending into neighbourhood particu
larly in metropolitan areas. The numerous examples
can be noticed indicating the direct interaction bet
ween sub-standard housing and communicable disease,
mental health, chronic disease, etc. Great rewards can
be realised from improved housing programmes stated
herein, through improved health, economic status
and dignity of large number of the people of the
country.-^-Courtesy: Yojana, Vol. 13, No. 18
Q
155
World Health Day—1987
VACCINES PRODUCTION BEING
GEARED
M. L. Mehta
HE Central Health Education
Bureau organised a function on
the eve of the World Health Day
on 6 April, 1987 at its office build
ing in New Delhi.
The venue, in
fact bore a festive look. The theme
was—“Immunization : A chance
for every child”.
A large number
of functionaries of the Central
T
Health Education Bureau, Directo
rate General of Health Services,
Ministry of Health
and Family
Welfare attended the function. Re
presentatives from
international
agencies like WHO,
UNICEF,
Voluntary agencies and a cross sec
tion of the public participated in
this function.
Photo above: A view of the World Health Day function
held at the Central Health Education Bureau, New Delhi.
Photo shows Dr V. P. Kimati, Programme Officer (Health),
UNICEF, Regional Office for South Central Asia, addres
sing the gathering. Sitting on the dais from left to right
are: Dr (Smt.) V. K. Bhasin. Director, CHEB; Dr A. K.
Mukheree, Addl. Director
General of Health
Services;
Shri S. S. Dhanoa, Secretary, Ministry of Health and Family
Welfare; Smt. Rami Chhabra, Adviser (Media), Ministry of
Health and Family Welfare; Dr Mahendra Dutta, Deputy
Director General (Planning); Dr B. Popovic, WHO Repre
sentative to India, and Dr V. M. Bagley, Deputy Assistant
Director General, CHEB.
156
Inagurating the function, Shri
S. S. Dhanoa, Secretary, Ministry
of Health and Family Welfare, ex
pressed the confidence that India
could meet the challenge of cover
ing 100 per cent children under the
immunization programme by 1990.
The programme of Universal Immu
nization was launched on 19 Novem
ber 1985, the birthday of late Prime
Minister Smt. Indira Gandhi.
The programme aimed at immu
nizing children at birth against com
municable diseases and reducing
the infant mortality rate.- While*
India had the highest childbirths it
also shared the dubious distinction
of reporting the largest child deaths
every year.
Swasth Hind
The challenge taken may be
“premature”, but “we have taken
it at the highest level”, that is the
level of the Prime Minister of India,
Shri Rajiv Gandhi, the Secretary
said.
Organization and UNICEF could
assist to find out if a special type of
refrigerator called island refrigera
tor could be made for installation
in villages. Shri Dhanoa said that
the Government was committed to
In fact, every month the Prime establishing a primary health centre
Minister reviews the progress of for every 30,000 population and a
the programme.
And “we have sub-centre for every 5,000 people
not been able to satisfy him”, by the end of 1990.
because a programme of the magni Intensive programme
tude of immunizing all the child
Dr B. Popovic, WHO representa
ren of India, that too, by 1990
tive to India, said: “Immunization
“needs mobilization of the commu
is one of the most powerful and cost
nity and creating awareness about effective weapons of modern medi
it,” Shri Dhanoa said.
cine.
Diseases like measles, diph
Under the Technology Mission theria, pertussis or whooping cough,
for Immunization, Shri Dhanoa said, tetanus, polio and tuberculosis,
production of vaccines was being which mostly strike children can be
geared and the country would be in checked by getting vaccinated against
a position to manufacture all the them.
vaccines required by 1989.
Dr Popovic said since the Ex
High drop-out
The high drop-out rate was one
of the major challenges being en
countered in the immunization of
the programme.
The child was
supposed to be vaccinated three
times and by the third time the drop
out was as high as 30 per cent.
There was a clear-cut link between
high mortality rate and drop-out
rate.
It is here that the “CHEB has
taken up the task of health educa
tion and mobilization of the com
munity. The^need is to share the
problems with the people and not
putting them under the carpet”, he
said.
Another problem was preserva
tion of the potency of polio vaccine
which required to be kept at a low
temperature.
Efforts were being
made to devise methods to maintain
the potency even without adequate
power supply.
The World Health
June 1987
panded Programme of Immuniza
tion (EPI) was launched by the
WHO in 1974, intensive national
programmes were established in the
countries of the South East Asia
Region.
Efforts were under way
to improve the existing vaccine he
said.
Shri S.S. Dhanoa, Secretary, Ministry of
Health and Family Welfare
delivering the inaugural address
at the function.
in India? The answer is obvious.
We may like to remind ourselves
that although India’s childhood
population is about 22% of the total
third world population, India’s
share of the global childhood deaths
•is about 30%, i.e, 1.4 times the pro
portional share. Of about 3 million
infants dying annually in this coun
try, nearly a third of them die of
immunizable diseases.
Another
one million infants every year get
crippled by immunizable diseases.
This is certainly bad news”.
There are however some very
good news for India, he said. “India
Child survival
leads the world not only in num
“There is too much propensity in bers but also it leads the third world
the world today to kill, than to pre in several development and econo
serve life. This is reflected in the mic fronts.
India is self-sufficient
obsession shown by many develop in food production and production
ing countries to spend more and of essential industrial goods. Cur
more on arms than on social, eco rently India stands to be the seventh
nomic and human development. most industrialized country of the
Incidentally only 500 crores of world. The country has enormous
rupees (i.e., 0.0005% of total global trained manpower, the fourth lar
annual military expenditure), is gest in the world and potential
needed to fully immunize all the material resources.
India’s econo
infants bom in the third world my has always had an upward trend
annually”, said Dr Valerian P. as opposed to many of the third
Kimati, Programme Officer, Health world countries which have been
Services, UNICEF.
caught in the trap of almost unre“Why is it that immunization is payable debts. A mere 100 crores
being given such a high publicity of rupees which is the current dost
157
Smt. Rami Chhabra, Adviser (Media), Ministry of Health and Family Welfare, releasing the special numbers of
monthly journals, Swasth Hind (English) and Arogya Sandesh’’(Hindi) on the World Health Day
theme: “Immunization: a chance for Every Child”, at the function
of 3 modem fighter planes, can im
munize every child born in this coun
try each" year.
In short, India has
the capability to save its children
and let them develop to their full
potential”, Di Kimati said.
Family planning has been one of
the highest priority programmes in
India.
Currently a two-children
family norm is- being advocated.
Here too there is some good tidings,
helpful to the immunization pro
gramme.
The recently revised Family Wel
fare strategy, which aims to reduce
158
the birth and death rates dramatical
ly, to slow down the population
growth rate and to stabilize India’s
population at a level of 1300 million
by the year 2050, accords high prio
rity to the EPI as well as to the
National Diarrhoea Management
Programme.
This reflects a new
recognition of the synergistic rela
tionship between fertility control,
child mortality reduction and im
proved quality of life.
sal immunization through the Uni
versal Immunization Project) (UIP)
which was specially set up 2 years
ago as a strategy to achieve this
goal.
India has given priority to child
survival in its national development
and is committed, to achieve univer
Smt. Rami Chhabra, Adviser
(Media), Ministry of Health and
Family Welfare, released the special
“This year, India intends to im
munize 16.9 million infants and 18.6
million mothers, the largest number
in any country of the world”, said
Dr Kiimati.
Mobilising all media channels
Swasth Hind
number of Swasth Hind (English)
and Arogya Sandesh (Hindi) brought
out on the theme of the World
Health Day by the Central Health
Education Bureau.
Commenting on the speical issue
of these two magazines she said,
they have been “brought out well”.
There was a need to make the
EPI a “people’s movement”, And
“how can we do it?” she asked.
Television stations throughout
the country have been persuaded
to screen one minute messages on
various aspects of family planning
including immunization at prime
time and closed-circuit television
and public address systems at rail
way stations are also being brought'
into use. We need to mobilize all
the media channels at our command,
said Smt. Chhabra.
We already
have a fairly vast media net-work
supporting health and welfare direc
tly, but we are now getting support
from practically all media channels
in the country.
Message
WORLD HEALTH
DAY-7 April, 1987
Shri Rajiv Gandhi
Prime Minister of India
In a message on the World Health Day, the Prime Minister, Shri Rajiv
Gandhi, has made an appeal to all to support the Immunization Programme
iso that our children have a better and brighter future. The World Health
Day was observed on 7 April, 1987. The message says:
“Health for all” is one of the basic tenets of our
human resources.
“As a vital component of this approach, the Universal Immunization;
Programme was launched in November 1985 in the memory of the late
Prime Minister Smt. Indira Gandhi who firmly believed in securing a better
future for our children.
“By covering expectant mothers and infants against six dreaded diseases,
the Programme aims to protect millions of our people from death and disa
bility and the wasteful effects of illness and poor growth.
“Such a stupendous task cannot be undertaken without the involvement
of the community and the required awareness and motivation on the part of
parents.
It is significant, therefore, that this year the underlying theme of
the World Health Day is “Immunization”.
On this occasion I appeal to all
to support this challenging venture so that our children can have a better
and brighter future.”
But this movement has to be
taken further.
Apart from tele
vision and radio there was a vast
army of field, publicity, including
song and dance troops, as well as in his presidential address said
the widespread extension channels “India is self-sufficient in the produc
of the health and family welfare tion of vaccines” under EPI except
system. But more importantly we polio and measles.
are now bringing in the development
functionaries dealing with agricul
Polio vaccine is being imported
ture, women and child development
at present, but is likely to be pro
and other fields.
We are getting
across the understanding that the duced in the country shortly.
family welfare message including Efforts are being made for indigen
immunization is central to other ous production of measles vaccine
development concerns, said Smt. through imported technology, said
Dr Mukherjee.
Chhabra.
Involvement of voluntary agencies
Dr A. K. Mukherjee, Additional
Director General of health Services,
June 1987
approach towards
ment” and education of mothers for
immunization, said Dr Mukherjee.
Another significant feature of
EPI was involvement of voluntary
agencies.
They could contribute
a great deal in mobilizing people
for immunization of children, he
said.
Health education programme
Earlier, Dr V. K. Bhasin, Direc
tor, Central Health
Education
Bureau, in her address of welcome
There was need to “lay tremendous said that the Bureau was observing
emphasis on community involve in its modest way the World Health
159
Message
WORLD HEALTH DAY-7 April, 1987
Authors of the month
Shri P. V. Narasimha Rao
Dr B.N. Ghosh
Director
All India Institute of Hygiene and Public
Health
110, Chittaranjan Avenue
Calcutta-700 073.
Union minister for human resource development and
Health and Family Welfare
Shri P.V. Narasimha Rao has appealed to all members of the commu
nity to actively involve themselves in the fight against vaccine-preventable
diseases and attain the goal of Universal Immunization by 1990. Excerpts of his
message on the occasion of the World Health Day, observed) on 7 April, 1987,
are reproduced here:
“Out of the approximately 3.8 million deaths taking place in the world
due to these vaccine-preventable diseases, it is estimated that India's share in
the deaths and disabilities caused by polio, tetanus, pertussis and measles is
about 44 per cent, 31 per cent, 41 per cent and 39 per cent respectively. This
contributes in considerable measure to the still high infant mortality
rate
prevailing in India.
“To combat these diseases and help reduce the infant mortality rate,
Programme for Universal Immunization of pregnant women and infants has
been launched since 1985.
It is India’s living memorial to the late Prime
Minister, Suit. Indira Gandhi. Under this programme it is proposed) to protect,
by 1990, all pregnant women against tetanus and all infants with vaccination
against the six vaccine-preventable diseases. Through immunization as well
as other interventions like better nutrition, improved hygiene, etc., it is esti
mated that the infant morality rate would be brought below 60 by the turn
of the century.
“However, this goal cannot be achieved unless a; total and dedicated move
is made by the people involved in the programme, as well as the community
at large. I would, therefore, seek all members of the community to actively
involve themselves in this noble endeavour and, thereby, ensure the survival
and improved health of millions of mothers and children.”
Day each year since 1957.
“The media organisations like AIR &
accent throughout has been on health TV.
education of the people with a view
“Radio and T. V. too, would
to winning their active support and
participation in different health pro brodecast/telecast programmes on
the theme of the Day.
grammes.”
An exhibition was organised for
Suggested guidelines and a Back
grounder to the observance of the different localities for education of
programme against six child diseases the viewers.
brought out by the bureau were sent
out to the health organisations in
Filmshows on immunization were
cluding State Health Education planned for * different localities to
Bureaux, medical colleges, and educate people on the importance
160
Dr Dinesh Chandra
Professor
and
Dr Mangesh Shukla
Junior Resident
Department of Pharmacology
Maulana Azad Medical College
New Delhi-110 002.
Dr R.D Sharma
Project Officer
Adult University
Garhwal University
Srinagar (Garhwal)-246 174.
Dr (MS) T.V. Luong
Project Officer
Water and Environmental Sanitation
UNICEF, 73 Lodi Estate
New Delhi-110 003.
Dr (Smt.) Prabha Ramalingaswami
Associate Professor,
Centre for Social Medicine and Commu
nity Health
School of Social Sciences
Jawaharlal Nehru University
New Delhi-110 067.
Shri Dinesh Chand
Assistant Secretary
U.P. Pollution Control Board
Lucknow (U.P.)
of immunization of infants, children
and expectant mothers.
“In short, a concerted, continued
health education programme has
been planned to help achieve the
target of providing immunization of
infants and children and expectant
mothers by 1990,” said Dr Bhasin.
Dr V. M. Bagley, DADO, pro
posed a vote of thanks.
The function
concluded with a
puppet show on immunization.
Swasth Hind
EXHIBITION ON WORLD HEALTH DAY 1987
Shri Dhanoa Inaugurates
Some 800,000 lives are saved every year by immu
nization in the developing world.
And how can a
mother protect herself, her baby before and after
birth from the six vaccine-preventable diseases were
some of the highlights of the exhibition set up for
the World Health Day 1987.
The exhibition was
organised by the Central Health Education Bureau at
it's building on Kotla Road, New Delhi on the theme
of the Day—Immunization: A Chance for Every
Child.
Shri S. S. Dhanoa, Secretary, Union Ministry of
Health and Family Welfare, while inaugurating the
exhibition, on the eve of the World Health Day on
6 April, 1987, said that the exhibition was informa
tive and entertaining and should prove an attention
getter of the mother for getting her child immunized
against childhood diseases.
Through a series of panels, and telling pictures, the
exhibition highlighted the nutritional requirements of
a mother before, during and after child-birth.
It
also highlighted the significance of breastfeeding for
the healthy growth of her baby.
The exhibition brought out vividly that immunization is truly a chance for every child.
And how
a mother can protect herself and her child against six
vaccine-preventable diseases—measles, diptheria, per
tussis, tetanus, polio and tuberculosis. Through
photographs it spelled out when and how the vaccina
tions should be given to the child and mother and
where such facilities were available.
Indeed, the exhibition, a feast for eyes, was received
favourably by one and all the viewers.
Photo above: Shri S. S. Dhanoa,
Secretary, Ministry of
Health & Family Welfare, going round the Exhibition. Seen
with him are Dr (Smt) V.K. Bhasin, Director, CHEB, and
Dr B. Popovic, WHO Representative to India.
Position: 2680 (4 views)