PREVENT VIOLENCE AND NEGLIGENCE
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- Title
- PREVENT VIOLENCE AND NEGLIGENCE
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In this issue
Page
swasth hind
Phalguna-Vaisakha
Saka 1914-15
March-April 1993
Vol. XXXVII Nos. 3—4
WORLD HEALTH DAY—1993
Disability — physical, mental locomotor, hearing.
speech_ accounts for about 12 million victims as per
National Sample Survey of 1981. This means 1.8 per cent of
the total population suffers from one or the other form of
disability. This could not he very accurate as Sample Sur
veys usually arc. but presents an anticipatory view of the
problem. About 10 per cent of the disabled had more than
one physical disability. When broken down by types it
shows that 5.43 million had locomotive. 3.43 million visual.
3.42 million hearing and 1.75 million speech disability.
Being a country of villages, where 80 per cent of the popula
tion lives, the prevalence of disability is higher in rural
areas where more males are victims of disability than
females.
In urban areas, traffic accidents account for 0.4 to 0.8
million disablcd/scriously injured; domestic accidents
besides being responsible for 2 to 4 million disabled/
seriously injured and occupational accidents are respon
sible for 1 to 2 million disabled/seriously injured claiming
nearly 0.1 million lives.
The accidental rate among industrial workers would
surely be rising in the years to come as there is greater
industrialization and more locomotives are coming to
market.
To get an idea of the enormity of economic loss to the
nation because of the disabled we may quote the figure
available for blindness-related economic consequences.
Maintenance of the estimated 9 million blind and- the
estimated 45 million visually handicapped if calculated at
the rate of Rs. 75 pcr person costs about Rs. 8100 million
and the loss of production at the rate of Rs. 5 per day
amounts to Rs. 10.000 million annually. Any figure worked
out in the same refrain for the disabled through accidents,
domestic handicaps and industrial hazards will only be
mind-boggling and spine-chilling. These figures speak of
the disastrous consequences for individuals and society of
accidents and acts of physical violence, which may often
are preventable.
It is possible to prevent accidents if every individual
feels responsible and considers safety is prime concern.
Keeping this in view Swasth-Hind devotes this issue
to Accident Prevention—the theme of the World Health
Day—7 April, 1993. Its slogan being:
Handle life with care: prevent violence and
negligence—World Health Day, 7 April 1993
(Backgrounder)
57
Physical violence and Health—an area of growing
concern
—Dr A.C. Urmil, Dr PA. Somaiya and Dr A.C.
Magdum
61
Road accidents
—Maxwell Pereira
64
Action to reduce road casualties
—Ian Johnston
66
Industrial accidents—their impact on physical and
mental health of the people
—Dr (Mrs) Rekha Thakre and DrA.L. Aggarwal
71
Air pollution—a serious health risk in cities—how to
prevent it
—Dr A.L. Aggarwal, Dr A. Kumar and Ms. P.S.
Rao
74
Eye injuries: their impact on community
-Dr PK. Khosla
77
Alcohol consumption and violence—their implications on individual and family health
—K. Balan
79
Drug abuse—its impact on violence and public
health
H.K. Sharma
83
Housing and settlement
—Dr Bhakt Prakash
85
Accident prevention—role of the community
—Dr Manjit Singh
News
Book Review
87
Articles on health topics are invited for publication in this
Journal.
State J-lcalth Directorates are requested to send in reports of
their activities for publication.
The contents of this Journal are freely reproducible. Due ack
nowledgement is requested.
The opinions expressed by the contributors are not necessarily
those of the Government of India.
SWASTH HIND reserves the right to edit the articles sent
for publications.
Editorial and Business Offices
Central Health Education Bureau
(Directorate General of Health Services)
Kotla Marg, New Delhi-110 002
Handle life with care; prevent violence
and negligence
Edited by
M. L. Mehta
M. S. Dhillon
Cover Design
Madan Mohan
89
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Backgrounder
HANDLE LIFE WITH CARE
prevent violence and negligence
• WORLD HEALTH DAY • 7 APRIL 1993 •
Most accidents are caused by unsafe conditions and unsafe acts or both. In such events
safety rules have either been ignored/forgotten or misunderstood. The World Health
Day, 7 April 1993 therefore has been devoted to the prevention of accidents. Its slogan
is : Handle Life with Care—Prevent Violence and Negligence.
ith the industrialisation and unbanisation of
W
the country the vehicular population has regis
tered about seventy-fold increase to that of vehicle
population at the time of Independence. The vehi
cle density (vehicle per lakh of population) has also
shown an increase of about 30 times since 1950 and
is about 2,600 vehicles per lakh of popu
lation. Alongwith this increase, it has also registered
a ten-fold increase in road accidents and more than
10 lakh persons have lost their lives in road accidents
during the last forty-five years. On an average, 155
persons die per day in road accidents in the country
in addition to 700 people getting injured. During
1991 more than 2.94 lakh accidents were reported
which resulted in the loss of 57,000 lives in road
accidents.
There is an accident every second minute and a
fatality on road every ninth minute in India. Illdesigned and ill-maintained roads and or vehicles
coupled with their poor maintenance, negligent or
drunken driving are the chief factors fqr
accidents. Maximum brunt of injuries are borne by
pedestrians and two-wheeler users including
cyclists?
Everyday hundreds of people succumb to the ills
of growing pollution of environment, to die a slow
and steady death while others die in a catalystic way
as thousands died in Bhopal in 1984. India’s
March-April 1993
Chemical Industry with 4,000 factories is the most
hazardous one.. In 1980, ten thousand workers were
injured and 100 killed in accidents, at the rate of 33
for every one million employed.
India uses nearly one lakh tonnes of pesticides
annually. At least 70% of these consist of the pes
ticides which are banned or severely restricted in the
western countries. A WHO study, which analysed
food samples across India, found that 50% of them
were contaminated with pesticide residues with 30%
exceeding permissible limits.
Thousands of workers die every year because of
occupational hazards. Besides, a number of risks
are involved around us may be it is the house we live
in, the. surrounding environment, the workplaces, the
vehicles we are travelling by or even during walking
on the road, the materials we are handling—almost
in all the activities. With the modernization of our
agricultural Sector, a number of risks have crept in
this profession also which was considered as the
most safe and simple one. The modem agricultural
equipments such as tractors, threshers, fodder
machines, etc., pose a serious threat of accidents and
have rendered a sizeable population of agricultural
workers disabled. There is a serious threat to the
health of the people by the use of pesticides and her
bicides in agriculture, by way of poisoning or long
term side-effects leading to various diseases.
57
* Studies in Nepal have shown that minor cuts are
as frequent as diarrhoea; bums and scalds as fre
quent as dysentery and parasitic diseases; and
more common than infectious diseases and
malnutrition in India, four times as many years of
life are lost to injuries than to cancer.
♦ In South-East Asia, 12-22 per cent of all hospital
admissions are linked to injuries.
* Those who are under the influence of alcohol and
other intoxicants are at greater risk of
injury. They are more, likely to hurt themselves
by falls, by bums or scalds, more likely to over
dose on medicines, and are more likely to drown
and to commit homicide and suicide. There is
enough information to suggest that it is too much
of drinking that trigers acts of violence, deaths on
road-houses etc.
* There is a threat to health from “injuries and
death” that are a consequence of violence par
ticularly in the developing world where traditional
family authority is disintegrating. Urbanisation,
drugs, crime, over-crowding, unemployment has
increased the death rates. In India, rallies and
bandhs are becoming a symbol of violence.
* Family violence such as wife abuse, battered
children, sexual abuse,, coupled with increase in
homicides, suicides and acts of violence have led
to injury induced deaths becoming the third killer
reported besides cardiovascular diseases and
cancer.
Handle Life With Care: Prevent Violence and
Negligence
Major cause of injuries is the carelessness on the
part of the individual to handle different objects or
carelessness in the house, on the road, in the
workplaces, etc. Since this carelessness results in
injuries or injury related deaths, there is a need to
handle life with care.
Most accidents are caused by unsafe conditions
and unsafe acts or both. In such events safety rules
have either been ignored/forgotten or mis
understood.
58
Situations and conditions that need precautions
to be taken to avoid accidents are:
Home and its Unsafe Environment
People at home can very often be absent-minded,
careless and may create an unsafe environment for
the family members as well as for the visitors to
the house.
Falls from an elevated surface in the house as a
result of stumbling, slipping or loss of balance are the
result of plain carelessness. Objects left on stairs,
spilled oil, grease or water, fruit peels may also cause
falls. The following precautions may make the
home and environment safe:
* Ensure that furniture in the house does not have
sharp corners or edges.
* Toys with sharp edges and comers are liable to
hurt children.
* Falls from ladders have disabled many. Stairs
with many landings are preferable to a long con
tinuous flight of stairs. This may help break the
fall after a short distance. Make .stairs safe for
children by blocking spaces under the railing to
avoid their accidental slipping.
* Rugs and carpets are very effective in reducing the
severity of injury due to falls. Use them in areas
where children are likely to encounter risk of
falls. Due care is to be taken in their fixation
otherwise they can cause tripping.
* Keep chemicals such as pesticides, herbicides, etc.
or medicines locked or in places that are inacces
sible to children and old people.
* Cigarette smoking is the biggest cause of domestic,
and forest fires. Discourage smoking of cigarettes
in the house to reduce the probability of fires.
* Keep children away from reach of the kitchen
since they are most liable to get hurt with the fire,
hot water, hot utensils and cooked food.
Kitchens today with LPG cylinders and gas stoves
and other electric gadgets is the most dangerous
place if necessary precautions are not taken.
* Unused electric sockets often tempt youngsters to
poke at them with anything they have in their
hands. Hence these outlets should be taped over
Swasth Hind
or covered with blank switches when not in
use.
* Be extremely careful of pets in your home. Make
certain that they are periodically checked by a
veterenarian and are duly immunised.
( Safety on the Road
Some fundamental traffic tips for road safety
are:
1.
Keep to the left, allow traffic in the opposite
direction to pass you on the right
2.
Overtake only on the right
3.
Overtaking on the left is permitted only when
the car in front is about to turn right
4. Overtaking is not permissible, if it is likely to
cause inconvenience or .danger to the other traf
fic or where the road ahead is not visible.
5.
When being overtaken or passed by another
vehicle do not increase your speed or try and
prevent the other vehicle from passing you.
6. Slow down when approaching intersections,
road junctions or road comers. Enter the
intersection of junction, if it does not
endanger anyone.
7.
8.
When entering a main road from a junction
give way to the vehicles proceeding along the
main road. Give way to all traffic approaching
the intersection on your right hand. If there is
a “Dead slow—major road ahead” sign, yield
right of way to the vehicles on your left
also.
Drive slowly when passing a procession or
when passing road repairs. In any case, your
speed should not exceed 25km p.h.
9.
When turning to the left, drive close to the left
hand side of the road.
10.
When turning to the right draw to the centre of
the road, stop, if necessary, at the intersection,
then move to the left hand side of the road you
are about to enter.
Besides, the emphasis should be placed on the
following target groups:
♦ School children need to be imparted road safety
education specifying the various safety measures
to be adopted while on the road.
March-April 1993
* Motorists should be- constantly reminded of the
need to take special care of children on the roads,
near the schools, etc.
* Several measures to enforce the use of zebra
crossings by the pedestrians should be initiated
and motorists have to be told to give right of way
to pedestrians. There is a need to enforce a sence
of discipline on the pedestrians.
The Govt, of India and State Govts, have under
taken the programmes of road safety. Some pro
gress has been achieved and the rate of accidents has
started slowing down during the last couple of
years. The objective is to reduce the number of
fatalities to 25,000 and the number of accidents to be
brought down to 2 lakhs per year by the year
2000. It is certain that with the active involyement
of the public this target can be achieved.
Safety while Handling Chemical Agents
Many pesticides and herbicides are being used in
farming operations to improve the fertility of the
soil. The chemicals though used for a good cause can
become dangerous. The operator must be fully aware
of the dangers involved and of safety measures. Sim
ple basic rules are :
* Read the label and follow the directions on
the label.
* One must know the contents of container, what it
is for, how to use it safely, what equipment may be
needed, how to store it, how to dispose of the
unused portions and the container, and what to do
if toxic chemicals get on or in the body.
* Use only the amount recommended on the
label.
* Use special protective devices during operation.
* Avoid contact or inhalation, while using these
chemicals.
* After the use of chemicals wash your hands, wear
separate clothes when using chemical spray,
change these clothes before return to your
home.
* Chemicals should be -stored in the original or
approved container, label intact in a suitable
storage area beyond the access and ingenuity of
children and unauthorised persons.
59
* Unused chemicals and empty containers of
chemicals should be buried. Burial is the best
method to dispose of toxic material. These
should not be burned since they might give off
harmful fumes, leaves poisonous ashes, cause
intense fire. .
♦ Toxic chemicals should never be poured on the
ground or into a stream.
Occupational Safeguards
Occupational injuries are common in most
industrial establishments resulting from accidents
that occur either due to carelessness or because of
unprotected machinery. Protection of the industrial
worker from adverse health effects resulting from his
work environment can be done through personal
protection by the workers, control and safety
measures undertaken by the industrial management
and also* through workers education.
Personal protection is used to safeguard workers
from contact with harmful agents and includes pro
tective clothing as well as equipments like eye and
hearing protectors and respirators. Protective
clothing includes boots, gloves which need to be
worn by the workers while handling a wide
:ange of substances.
A safe work environment can be achieved
by:
* Elimination or reduction of risk.
* Total enclosure processes which can ensure that
the workers do not come in contact with toxic
materials.
♦ Segregation of a process by isolating hazardous
jobs from the rest of the production line.
♦ Suppression of dusts by water sprays and
welting agents.
None of these measures can be totally successful
unless occupational health education is imparted to
workers. Hence all industrial set-ups should pro
vide occupational health services and education.
These are but a few situations. There arc many
more areas that require attention for safety measures
in our day-to-day social interaction, changing life
style and developing technology. The desired results
cannot be achieved without the involvement of the
people who need to be enlightened through informa
tion and education about the importance of safety in
life and about what can be done to improve it. The
leaders in health, both medical and paramedical,
need to work with people, accepting them as
partners.
—M.S.Dhillon
A universal problem
It was long believed, and still is believed by some, that accidents occur only in developed countries,
being the price that has to be paid for industrialization, technology, urbanization and
motorization. This is not true. In the developing countries, accidents are perhaps just as com
mon, and their consequences are often more serious.
—CJ. Romer & M. Manciaux. Accidents in childhood
and adolescence.the role of research, Geneva, World
Health Organization, 1991, p. 1.
60
Swasth Hind
PHYSICAL VIOLENCE AND HEALTH
—An Area of Growing Concern
Dr A.C. Urmil
Dr p.a. Somatya
Dr A-C. Magdum
Throughout the 20th century, the physical violence has been a cause of major concern.
It is a paradox that despite the bitter experience of two jvorld wars—and experience
of nuclear and chemical warfare first time in human history—no lessons have been
learnt to prevent these self-created catastrophes. The potential threat of future largescale wars still looms large. And violence has already gripped many countries, includ
ing ours. Its ill-effects are being felt in all spheres of life, including health.
“The seventeenth century has
been called the Age of Enlighten
ment; the eighteenth, the Age of
Reason; the nineteenth, the Age of
progress and the twentieth, the
Age of Anxiety. Although the
path to a meaningful and satisfy
ing way of life has probably never
been an easy one, it seems to have
become increasingly difficult in
modem times”.
—James C. Coleman in
“Abnormal Psychology and
Modern Life”.
cal and health services, too. It
diverts, for example, the existing
hospital services for tackling the
medical emergencies consequent
on it, thus depriving the other
needy persons of these facilities
particularly when curfew continues
to be imposed for long durations as
a precautionary measure. Special
“high risk” groups, e.g., seriously/
critically ill individuals and those
in need of urgent health care, have
to unnecessarily suffer during such
periods for no fault on their part
Physical Violence : Present Concern
Throughout the 20 th century—
the century of material progress as
well as of social turmoil—the
physical violence has been a cause
of major concern. It is a paradox
that in spite of having the bitter
experience of two World Wars—
and experience of nuclear and
chemical warfare first time in
human history—no lessons have
been learnt to prevent these self
created catastrophes. The potential
threat of future large-scale wars still
looms large and violence in its
various forms has already gripped
many countries of the world
including ours, during the recent
past.
Its ill-effects are being
increasingly felt in all spheres of
life, including health. It is therefore
not only appropriate but of crucial
significance for the W H O to select
“Handle Life with Care: Prevent
lthough ihe dictionary mean
ing of the word “Violence” is
A
“Swift and intense force; injury”,
the term is now used in a broader
sense in physical, mental (psy
chological) and social contexts.
Unlike negligence which is regar
ded as an act of “Omission”,
violence is regarded as an act of
“Commission”. It has its wide
repercussions on all aspects of life,
including health of the people,
actively or passively involved in it
For example during riots, not only
the active participants or pro
pagators suffer from injuries and
may succumb but even the non
participants, the accidental victims,
meet the same fate. Besides dis
rupting the social life, it imposes a
tremendous load on existing medi
March-April 1993
Negligence and Violence” as the
Slogan for the World Health Day to
be observed on 7 April, 1993.
Vigilance: The Need of the Hour
The root cause behind large
scale physical violence is the
social discontentment/disharmony
among various population groups/
communities. Besides these, politi
cal rivalries, religious and ethnic
conflicts have also been respon
sible for its genesis as is evident
from the past and current global
scenario in many parts of the world.
Eruption of violence (date and
time) remains unpredictable in
most cases where it is of sudden
onset, although in certain situ
ations such as ongoing rivalry/
conflict, it may be anticipated with
high degree of certainty. However,
in order to tackle the situation and
its consequences effectively, ade
quate prior preparation on all
fronts, including medical and
health, is required. It therefore
calls for keeping an adequate
vigilance at all times and at all
places, playing paticular attention
to those areas/regions which have
already been recognized as
“Violence prone” in the light of
past experience. It also calls for an
effective monitoring/information
system for timely warning to all
concerned—including medical and
health authorities—about its anticipated/actual
eruption
and
61
susbsequent progress.
Police/
intelligence department should be
competent to play this role and
bear this responsibility. This is one
area where inter-sectoral coopera
tion is of crucial importance.
Responsibility for Vigilance and
Control
The reponsibility of vigilance
and control lies with every
individual, every community (poli
tical, religious, socio-economic etc),
administrators (enforcers of law
and order) and providers of medi
cal and health care—govern
mental and non-govcmmental.
The success to achieve this aim
entirely depends upon proper
understanding of one’s role and
devotion to duty and also upon
intersectoral cooperation. Com
munity leaders in various fields
(politics, religion, etc) and all
categories of prominent citizens
whom the society respects (writers.
poets, actors, artists, doctors,
industrialists etc) can play a very
vital role in preventing and con
trolling it and must come forward
when situation calls for their help.
Mass media (newspapers, T.V.,
radio, etc) should be fully utilized
to make people change their mind
and attitude and give up the idea
of resort to violence.
During
actual period of disturbances such
as riots, the safety of medical/
paramedical
personnel
and
ambulances must be ensured
through liaison with police/army
authorities. Members of voluntary
organizations/voluntary
health
workers can play a very crucial
role in mitigating the human suf
ferings. They should, however, be
easily recognized through separate
uniform/cap/badge/rib and etc.
People should be ;told well in
advance (in case of anticipated
violence) through mass media and
after eruption of violence also
through loudspeakers on police
vans—whom to contact, how to
62
contact and where to contact in
case of an urgent help required.
Care and Management of Victims
It is indispensible to treat all
kinds of violence as an emergency
at par with “man-made disaster”.
Emergency first-aid arrangements
and provision of ambulances
should be made at suitable places
preferably in consultation with
police/military authorities detailed
for violence control. The ideal
would be to train in advance, the
young people and mothers, in the
art of first aid in violence prone
areas. The victims in the violence
affected area should be tackled by
the medical/paramedical staff pre
sent there, according to priority
when their number is large,
following the “Principle of triage”
as followed in respect of war/
disaster victims when mass
casualties occur so that the loss of
life could be minimised and com
plications prevented to the max
imum possible extent
The
hospital authorities should keep
fully prepared to deal with
large and unexpected number of
casualties
ensuring adequate
accommodation, beds, equipment
and medical stores, adequate
manpower (doctors, nurses, X ray,
laboratory and blood bank
technicians, compounders, dres
sers, other administrative and
general duty personnel), mortuary
ambulance services and com
munication (telephone, telex, wire
less etc).
In case of any
deficiency/constraints,
higher
authorities/voluntary
organi
zations must be immediately
approached for necessary help/ A
Control Room should also be
opened to provide feeding of
information to all concerned. In
nutshell, the action plan for
managing the casualties should be
on the same lines as followed dur
ing a disaster.
Prevention of Physical Violence:
Some Considerations
It is unfortunate that physical
violence is becoming more pre
valent in our society as one way of
dealing with certain problems at
various levels. The instinctual ten
dency of humans to aggress under
frustration, disputes and argu
ments is evident everywhere. The
seeds of violence are laid in early
part of life when children are
exposed to 3 key conditions which
influence their level of aggressive
potential and/or behaviour—their
family, their peers and the broader
socio-cultural environment. The
parental models mainly influence
during the early part of their
development and the peer groups
during adolescence.
During
recent years focus has been shifted
to- role of socio-cultural environ
ment, particulalry mass media in
development of aggressive be
haviour.
Violence has now
become a standard fare in films,
TV, newspapers and magazines to
which youth are getting exposed
more and more. “Children begin
to absorb the lessons of TV before
they can read or write-----------------. In a fundamental way, TV
helps to create what* children
expect of themselves and ■ others
and what constitutes the standards
of civilized society------------------- .
Yet we daily permit our children
during their formative years
to enter a world---------------- of
routine demonstrations of killing
and maiming” according to
National Commission on Causes
and prevention of violence (45,
1969). These considerations bring
out the importance of crucial role
the parents, the peer groups and
the mass media have to play in
laying the seeds of non-violence in
the minds of children from the
very beginning.
Children and
SWASTH HIND
youth should be particularly
motivated:—
A To believe in the maxim
“love one another” and other
basic ethical tenets of the
world’s religious philoso
phies and a belief in the
worth of an individual and
of human survival.
B. To believe, in the present
context, that recourse to
violence of any kind is not
the answer to sort out dis
putes of various nature, at
various levels since violence
is not only an anti-social but
an inhuman act History has
made it amply clear that the
final outcome of violence is
always unpredictable.- The
need of the hpur is therefore
to settle all disputes and
revalries in a peaceful man
ner, in a humane way,
through
talks/negotiations
across the table, rather than
resort to violence.
C. Not to fall prey to alcoholism
which is also associated with
automobile accidents and
violence. In the USA, it was
found associated with over
50% of all deaths and major
injuries due to automobile
accidents, about 50% all mur
ders, 40% of all assaults, 35%
or more of all rapes and 30%
of all suicides. About 1 out
of every 3 arrests in US
results from abuse of alcohol.
Due to rising trend of
alcoholism among teenagers
during 1970s, it was called
the “teenage tragedy of the
seventies”.
Teachers* role is important in
preaching non-violence to their
students. They should however
practise what they teach and never
resort to violence in any form as
punishment to a student at fault
The United Nations observed
1986 as the International Year of
March-April 1993
Message from Dr Hiroshi Nakajima
Director-General of the World Health Organization
on World Health Day 1993
At least three and a half million people on our planet die
every year as a result of injury caused by violence, acci
dental or intentional.
Whether on the roads, at home, at work or at play, the risks of
injury to individuals have been neglected for too long, and the need
to reduce them has so far received little public attention.
I
'
Today, public health is improving in many countries, and life
expectancy of birth is increasing everywhere. Therefore, it is less
acceptable than ever that so many people should meet a violent
and premature death, or that millions of others should become per
manently handicapped.
More than half of deaths of young people are due to injuries,
and injuries represent the main cause of potential years of life
lost.
As a result of negligence, indifference or foul play, millions of
people each year require medical care after accidents or acts of
physical violence.
At a time when economic crises are jeopardizing efforts to
improve the health of mankind, injuries of all kinds cost the world
community almost US$500 thousand million a year in medical
care and lost productivity.
In devoting World Health Day 1993 to the prevention of
accidents and injuries, the World Health Organization wishes to
draw attention to the sometimes disastrous consequences for
individuals and society of accidents and acts of physical violence,
which very often can be prevented.
It is time to show that in contemporary society safety is a matter of individual and collective responsibility. Far from being a
marginal concern, it should form an integral part of health promo
tion policies.
Leading a healthy life, only to lose it through carelessness, is
a tragic waste. Accidents and acts of violence happen easily, and
not just to other people. The safety of each is the respon
sibility of all.
|
|
“Handle life with care; prevent violence and
negligence”
Peace. There is a perpetual
necessity of having similar cam
paigns and observe “International
Year/Decade of Non-violence”.
Public opinion should also be
mobilised through the UN in the
endeavour to put an end to all
types of conflicts, wars and build
ing up of nuclear and bio
chemical arsenals. Lastly, it is
worthwhile to recollect what late
John F Kennedy had to say in this
respect---------------- . “Each man
can make a difference, and each
man should try”.
63
vROAD ACCIDENTS
Maxwell Pereira
More than 60,000 human lives are lost in road accidents each year................. The economic
cost of a fatal accident is Rs. 2 lakhs, that of an injury accidents Rs. 1 lakh and the
average cost of a minor non-injury accident, Rs. 3,000. This shows the kind of
economic loss we are confronted with on account of road accidents each year.
ire traffic accident has come to
be considered as among the
T
deadliest of killer diseases. This
disease is a problem that the motor
age has created and we arc sluggish
in our attitude to adapt ourselves to
the hazards of the motor vehicle as
compared to our concern and
adaptability to the maladies
attached to other killer diseases.
The problem of traffic accidents
is more acute in developing coun
tries. Thus .in respect of safety on
toads, our own country’s position is
far from satisfactory. More than
60,000 human lives are lost in road
accidents each year. In a study
conducted in 1990 for the Planning
Commission, the economic cost of
a fatal accident has been placed at
Rs. 2 lakhs, that of an injury acci
dent at Rs. 1 lakh and the average
cost of a minor non-injury acci
dent, al Rs. 3,000. This should
give us an idea of what kind of
economic loss we are confronted
with on account of road accidents
each year.
Cities are accident-infested areas
with high-risk of involvement in
some sort of accident or the
other. Though only about 20 to
25% of the population of the coun
try lives in urban area, about 75% of
accidents occur in cities and
(owns. The big cities of our coun
try, thus contribute the major share
in road accidents. The reasons for
such high rate of accidents are
64
Road Safety Education
courtesy to others on the road.
These are all factors that tend to
cause road accidents. Lastly, the
prevention of road accidents in any
given city directly depends on the
knowledge of its road users. Thus
road safety education is an area
that assumes paramount importan
ce. The quality of road users pro
duced, directly depends on the
quality of traffic education that the
user has been exposed to. One
would normally expect that a per
son who has secured a driving
license would do so after being
fully conversant with the road rules
and regulations and road safely
norms. This, however, is a nega
tive fact. In a recent survey con
ducted by the Delhi Traffic Police,
the parents of school children visit
ing the school fete were subjected to
a traffic knowledge quiz. While
most children of the same school,
because of their interaction with
road safety officers, could secure
more than 40% marks in the quiz,
not more than two of the parents
from among the 170 tested could
secure above 40%. The driver
licensing procedure, as such leaves,
much to be desired.
Most drivers in our country,
irrespective of the vehicle mode,
have invariably taken to reckless
driving, with blatant disregard to
behavioural norms such as signall
ing when changing traffic lanes,
yielding the right of way to fellow
drivers, and of displaying normal
Accidents today are among the
leading causes of deaths in our
country. There are many causa
tive factors involved in road traffic
accidents which makes it difficult
to assess accurately the effective
ness of any particular preventive
many,-------- including urbanisa
tion, economic growth, tremendous
vehicular growth, traffic conges
tion, poor and inadequate enforce
ment of traffic rules, lack of road
safety sense and so on.
The phenomenal increase in the
two-wheeler traffic in the last
decade, the inadequacy of a mass
rapid transport system, a greater
complexity and heterogenity of
vehicular traffic among various
other factors, have all contributed
to push up the number of accidents
in our country. Despite the steady
toll on death and injury on our
roads, it often appears that most
people are apathetic, often feeling
that such tragedies cannot he pre
vented. But they can be. The
problem of road safety in our coun
try has not been approached with
the same urgency and earnestness
as in the more affluent coun
tries. This, due to the fact that our
limited national resources have
commanded higher priorities for
economic development as com
pared to social requirement.
SWASTH HIND
measure
directed
specifically
against one of them. Improved
performance by road users would
probably be the most important
factor
in
accident
preven
tion. Proper maintenance of a
motor vehicle is the responsibility
of the owner of the vehicle and
would be a factor in reducing road
traffic accidents. Efficient acci
dent services, if promptly available,
would save lives and more frequen
tly, may prevent the worsening of
injuries received in road accidents.
Modern accident surgery can make
a valuable contribution to reducing
fatalities, as prompt and efficient
treatment by an experienced surgi
cal team considerably increases the
patient’s chances of recovery in
many cases and shortens the period
of incapacity in most others.
Active Coordination
The prevention of mortality and
injury in road accidents is essen
tially a public health pro
blem. Public conscience should
be developed to make every indi
vidual automatically think preven
tively above road accidents. The
multiplicity of circumstantial and
environmental factors concerned
in the causation of accidents sug
gests a need for multiple preventive
measures. Preventive action in
volves the co-operation of experts
in many fields—town planners,
traffic engineers, medical prac
titioners, teachers, police officers,
publicity experts, media persons,
automobile manufacturers and
representatives of the public as
road users, etc. Thus there is need
for more active co-ordination.
Education in road safety mea
sures offers one of the most promis
ing possibilities for accident pre
vention. Road safety education is
of paramount importance in to
day’s context. It is essential that
public opinion should hold widely
and strongly to the view that safety
is more important than speed or
added convenience. When it is
safety versus convenience, we
should learn to put safety first, even
March-April 1993
2— l/DGHS/93
Message from Dr U Ko Ko
Regional Director
WHO South-East Asia Region on World Health Day
1993
In the long struggle for survival, humankind has successfully
overcome formidable odds. Though disease, hunger, strife,
natural and man-made calamities have made the road to progress
rough and uncertain, much has been achieved on several
fronts.
Undeniably, life expectancy is now better than ever before
but what merits serious consideration is the avoidable suffering
and deaths due to accidents and violence.
It is indeed a sad paradox of modern-day life that, while on
one hand, breakthroughs in health science have made it possible
for people to live longer and healthier lives, on the other, this very
life preserved and protected at such cost, is cut short by accidents or
violence—at home, at work, on the road or at play. Millions
become partially or fully handicapped as a result. What is even
more tragic is that more than half of deaths of young people are due
to injuries. Contrary to general assumptions, accidents have now
become a leading cause of morbidity and mortality in developing
countries as well.
It is therefore most appropriate that this year’s World Health
Day theme focusses attention on the threat to health and life itself
from injuries and violence and the urgent need for preventive
measures. As the WHO Director-General, Dr Hiroshi Nakajima,
has said, “leading a healthy life, only to lose it through carelessness,
is a tragic waste. Accidents and acts of violence happen easily,
and not just to other people. The safety of each, is the respon
sibility of all.”
It is sincerely hoped that World Health Day this year will lead
to greater attention being paid on how we. can better handle life
with care by preventing violence and negligence.
at the cost of convenience. The
strengthening of public opinion in
the direction of safety needs to be
pressed,
and
pressed
con
tinuously. The creation and deve
lopment of a social climate which
is conducive to the cultivation of
good and sound manners should
be a natural effort for a cultured
community of mature citizens.
Good manners are life-savers on
the road.
65
Road Safety
Action to reduce road casualties
IAN JOHNSTON
Progress in road safety is reviewed with particular reference to radical measures that
have proved beneficial in Australia. Community involvement in decision-making is
vital if gains are to be made and sustained in this field.
HE casualty rate per unit distance of road travel
indicates how safely a road transport system
operates. Fig. 1 shows the records of four countries in
this matter between 1965 and 1987. All of these coun
tries now have much the same level of safety—between
1.5 and 2 deaths per 100 million vehicle-kilometres—
despite ’very different safety programmes. This
indicates that the precise nature of the action taken is
less important than its amount, provided that the
individual measures are selected scientifically. It
should also be noted that these countries formerly dif
fered greatly in their levels of road safety, Australia
and Japan having undergone particularly rapid
improvement in this respect
T
With regard to the number of casualties per head
of population, which indicates the level of personal
risk, the rate of improvement has been comparatively
slow (Fig. 2). Furthermore, Japan and the United
Kingdom present a much more favourable picture
than Australia and the USA The explanation, of
course, is in the very different levels of motorization
(Fig. 3). Clearly, for countries with similar safety per
unit distance of travel, the number of casualties per
head of population will vary with the volume of
travel. This is often overlooked in the road safety
debate, particularly when international comparisons
are being made. It shoiildbe borne in mind that the
mobility provided by road transport has danger as a
by-product, which has major implications for stra
tegic planning.
Government intervention
Why do most highly motorized countries have
remarkably similar levels of safety per unit distance of
travel? As a country motorizes it gradually im
proves its infrastructure to cope with additional
traffic.
Dr Johnston is Executive Director of the Australian Road
Research Board Ltd., P.O. Box 156, Nunawading 3131, Ausiralia. This article is based on the Second Westminster Lecture on
Transport Safety, delivered in London on 25 November 1991.
66
l ig. 1. Deaths per 100 million vehicle-kilometres, 1965-1987
The vehicle industry matures and the quality of
its products improves; the mechanisms for controlling
traffic flow develop and the behaviour of road users
becomes safer.
Much of the advance is safety has come from
general improvements in road transport systems,
specific measures having given additional gains.
Such measures have to be tailored to each country's
problems. In Australia, nearly 70% of the people who
becomes casualties in road accidents are vehicle
occupants, whereas in the United Kingdom the corres
ponding figure is just over 40% and in India it is only
5%; consequently, measures directed at the protection
of occupants can be expected to have impacts on
overall safety which differ considerably between
these countries.
Swasth Hind
In Australia there has been a tendency for direct
government intervention to control individual be
haviour on the roads. The success of this approach is
partly attributable to the powers held by the State
governments in matters relating to road transport
Almost all of the country’s major interventions com
menced in one State and were later adapted by the
others once success had been demonstrated. Most of
these measures originated in Victoria, where an all
party parliamentary committee on road -safety,
established in the 1960s, paved the way for what many
people consider to have been quite draconian
measures.
There are two particularly effective road safety
strategies. One is to seek to reduce levels of injury by
means of protective devices. The other is to reduce
the frequency of the forms of travel with the highest
degrees of risk. Both require legislation and enfor
cement.. In Australia, legislation on self-protection
began in 1961 when Victoria made it compulsory for
motorcyclists to wear crash helmets. The compulsory
wearing of scat belts was introduced in Victoria in 1970
and in 1990 the same State introduced the compulsory
wearing of helmets by cyclists. Victoria set a limit of
50 mg/100 ml for blood alcohol in 1966, required a
blood sample to be obtained from every accident vic
tim taken to hospital as from 1974, and introduced
Where improved behaviour is needed the
authorities should promote it by every possible
means.
random breath testing in 1976. In 1984 Victoria
introduced a zero blood alcohol limit for drivers with
an initial, probationary licence. Learner motor
cyclists are restricted to machines with a.n engine
capacity of 250 cc or less, research having demon
strated that this category of road user has an especially
high risk of crashing on powerful motorcycles.
Fig. 2. Deaths per 100,000 population, 1965-1988
Why have other countries with similar legisla
tion not had the same success as Australia? And why
do Australians tolerate a high level of government
intervention? In Australia the public receive unam
biguous messages. Thus in 1970 it was laid down that
in all seating positions for which a belt was available it
had to be worn. Even today there are very few coun
tries in Europe which require seat belts to be worn in
rear seating positions. In some countries, seat belts
have to be worn only on high-speed roads. The
clearer and simpler the message sent by governments,
the higher is the probability of compliance.
Random breath testing, when introduced.in Vic
toria, was not successful. It was not until several years
later in New South Wales that legislation on random
breath testing became effective. Random testing
being a controversial issue, Victoria had proceeded too
cautiously with only a low level of enforcement.
The public debate surrounding the introduction
of random testing legislation led to a short-term reduc
tion in alcohol-related crashes as motorists overes
timated their chances of being apprehended. Within
about six months this effect disappeared. The
authorities then embarked on evaluation program
mes. In 1978 and 1979 the Melbourne police conduc
ted intensive random testing on a rotational basis in
the four sectors into which the city was divided.
Alcohol-related crashes were reduced only during and
for two to three weeks immediately after tes
ting. What mattered was not the actual experience of
providing a breath sample but the intensity and
visibility of enforcement. At a time when casualties
in New South Wales were especially high, intensive
random breath testing was introduced: a million peo
ple are tested annually in a population of just under
three million licensed drivers, and the frequency of
alcohol-related crashes has fallen markedly.
As regards the acceptance of so much government
intervention, the explanation lies in the fact that
legislative action is but one link in an integrated chain
of measures. Let us consider Victoria’s legislation
requiring cyclists to wear approved helmets. Al
though it was introduced in 1990 the story begins in
1983. Most of the cyclists .who suffered injury or
death on the roads were children, and among the most
serious casualties about three-quarters were found to
have significant head injuries. However, a roadside
survey revealed that less than 4% of child cyclists and
only 15% of adult cyclists wore helmets. Few people
accepted that helmets were necessary or effective and
(he available helmets were expensive, uncomfortable,
inconvenient and unattractive.
A major educational campaign was conducted
over five years. A concerted effort was made to get
schools both to encourage the wearing of helmets and
to provide secure storage for them. Publicity on
March-April 1993
67
television and radio was directed principally at
parents, they being in the best position to. influence
children's behaviour. Victoria implemented a rebate
scheme whereby the purchaser of a helmet could get a
25% rebate from the government. Within about three
years, roadside surveys revealed that the wearing of
helmets had risen dramatically. For young children
the wearing rate between home and school exceeded
50%; for older children it was about 20% and for adult
commuters it was about 40%. Two years later, even
though the intensity of the educational effort had been
maintained, the wearing rates had not improved, sug
gesting that no further progress could be achieved
voluntarily.
A further significant development helped to pave
the way for the legislation. The major obstacle to
helmet wearing, shown by market surveys, was that the
helmets were heavy, hot and unattractive. The enor
mous increases in wearing rates generated by the
educational campaign created an expanding market
which led manufacturers to redesign helmets so as to
improve their competitive position.
When the legislation was introduced there had
been five years of intense educational effort This
had led the public to rfecognize the value of helmets in
reducing injury, had brought to the market a range of
helmets acceptable to the consumer, had reduced their
cost, and had produced an atmosphere in which the
majority of parents favoured the legislation because it
simplified their own attempts to ensure that their
children were adequately protected.
The success of the measures was due to the atten
tion paid to inducing supportive social change. This
Fig. 3.
Vehicles per 1000 population (circa 1985)
model is fairly typical of Australian road safety inter
ventions. Legislation normally only follows edu
cational efforts aimed at encouraging the desired
behaviour and other efforts designed to remove
obstacles to a sustained change in behaviour. The
legislative approach has created a willingness among
Australians to mandate self-protection and to limit the
forms of travel carrying the highest risks.
Road safety strategies
Road safety did not come into its own until the
late 1960s. Ereviously, separate authorities had been
responsible for road building, traffic control, traffic
law enforcement and public education. There was
little integration of activity and no joint strategic
planning.
William Haddon, the inaugural head of the
Road Safety Agency in the USA, pointed out that road
accidents were associated with numerous problems,
each of which needed to be addressed separately
(J). He also demonstrated the value of comprehen
sive and reliable accident data systems. Without ade
quate data the problems and solutions can only be
matters of speculation. If, on the other hand, reliable
data arc available, the problems become identifiable
and sensible decisions can be made about the
priorities to be given to them.
The importance of distinguishing between the
magnitude of a problem and the level of risk involved
is now understood. It is known, for example, that an
inexperienced motorcyclist on a powerful motorcycle
is about 20 times more likely to be killed in a crash
Ilian is the driver of a car. However, almost 70% of all
crash casualties in Australia are car occupants,
whereas less than 10% are motorcyclists. It is
It is necessary to increase community awareness of
the key problems and to provide opportunities for
wider participation in decision-making if road
safety is to obtain an adequate share of
resources.
necessary to consider the likely effectiveness of the
measures under consideration and then to decide, in
terms, of the estimated total casualty reduction, which
problems and measures should have first call on
funds.
Fig. 4.
68
The Haddon matrix
The Haddon matrix (Fig. 4) indicates all the
options available for dealing with any particular safety
problem. Let us examine the question of crashes
involving vehicles running into roadside power
poles. In Australia this type of crash accounts for
about 10% of deaths in urban areas. Let us look
initially at the road user in the pre-crash phase (see
Fig. 4). How might such accidents be prevented
through behaviour change? Most of them involve
skidding, so it might be advantageous to have a train
ing programme in which people are taught how to cor
rect a skid. Such training is unlikely to be completely
successful, but injuries might be reduced further if
legislation is passed requiring the wearing of seat
belts. In the post-crash phase, if most of the popula
tion has had first-aid training it might be possible to
keep accident victims alive until paramedical help
arrives. Let us now look at vehicle-based measures.
We might prevent crashes by fitting vehicles with anti
skid brakes. We might minimize injury by having
collapsible steering columns. We might insist on
burst-proof fuel tanks to prevent post-crash fires. As
regards the road traffic environment, crashes might be
prevented if road. surfaces were skid-resistant; the
severity of impacts could be reduced if frangible poles
were used; and identifying numbers might be placed
on poles so that a passer-by could indicate the exact
location of a crash when telephoning for an ambulan
ce. It is not difficult to devise two or three solutions
for each cell in the matrix. This kind of approach
brings discipline to the analysis of each identified
safety problem. After the identification of potential
solutions the likely effectiveness of each has to be
assessed. This is a function not only of the value of
the measures but also of the probability that they can
be implemented in a given sociopolitical climate. A
single measure should nevet be selected to deal with a
problem; instead a package of measures should be
chosen with the intention of implementing them in an
integrated manner.
Haddon’s matrix provides guidance on the fun
damental strategies of accident prevention, injury
reduction and enhanced post-crash treatment. Each
strategy can be implemented through behaviour mod
ification and/or environmental change to either the
vehicle or the road and traffic system. The concep
tualization of strategies is very, useful but has
shortcomings. It fails to give prominence'to one of
the most effective strategies, namely the reduction of
high-risk forms of travel. Restricting learner motor
cyclists to the less powerful motorcycles, imposing a
zero blood alcohol limit on learner drivers, prohibiting
cyclists on-motorways, imposing high fuel taxes to dis
courage the use of powerful cars, and prohibiting the
sale of alcohol to people under the age of 21, are exam
ples of measures that seek tQ control high-risk
behaviour. Furthermore, the Haddon matrix has the
drawback of focusing attention on the micro level. A
specific problem is examined, only the immediate
March-April 1993
causes are considered, and an attempt is made to iden
tify potential solutions. It is relatively uncommon for
the broad picture of safety to be critically analysed,
something that has become urgently necessary. As
previously indicated, most motorized countries have
achieved roughly the same level of safety in the opera
tion of their road transport systems. Road infrastruc
tures are now mature in these countries. At the same
time an anti-car movement has developed in response
to congestion on the roads and to the emission of
greenhouse gases. These questions are constraining
investment ig road infrastructures but seem to be hav
ing little effect on the growth in traffic. In Australia
the number of cars in use continues to grow at around
3% per annum, while the number of lorries grows
We arc beginning to recognize that road safety does
not exist in a vacuum and that pressures against it
have to be countered.
at more than double that rate. A 30% reduction in the
death rate per 100 million vehicle-kilometres is needed
in Australia just to hold the total number of deaths in
the year 2000 at today’s level.
Safety and environmental goals are sometimes in
conflict. - In order to reduce greenhouse gas emissions
and to conserve fuel, smaller cars are coming to the
Core. In the USA it has been estimated that an
improvement of a mile per gallon (35 km/1001) in fuel
efficiency resulting from the use -of smaller vehicles
translates into a 4% increase in the death rate per
vehicle. It is often suggested that the compulsory use
of car lights during daytime would improve safety, yet
such a move would run counter to the aims of fuel
efficiency and restriction of greenhouse gas
emission.
As motorization proceeded, advances in safety
were derived in considerable measure from steady
improvements in road and traffic systems. Today,
governments consider that it is no longer feasible, to
match demand by increasing supply, and are talking
about restricting demand in accordance with the
Independent bodies could be established to conduct
regular safety audits of the institutions involved in
road construction, traffic management, traffic law
enforcement, land-use planning, public health
and education.
availability of road space. Road pricing is the new
hope for combating congestion. However, little is
known about the impacts on safety of the broader
transport decisions taken with a view to environmental
protection or the better management of mobility
requirements.
New trends
Strategic planning for road safety at the macro
level is beginning to take its place in Australia, New
69
Zealand, the USA and many European countries (2—
7). While this is a good trend, such plans must not be
accepted uncritically. Some of the strategic plans
that have been produced have had the following dis
appointing aspects.
Q While most plans make passing reference to the
need for trade-off decisions to balance safety,
mobility and environmental objectives, none con
siders these issues in detail.
* Some plans propose numerous specific measures
without considering the barriers to implementation
or how they might be overcome. In the European
Community, for example, differences in practices
between Member States create a major difficulty in
the way of harmonization. It is important that
harmonization should not result in acceptance of
the lowest .common denominator.
• In the United Kingdom it has been proposed that,
wherever possible, the strategy should avoid legisla
tive controls on people (5). Yet if the Australian
experience has any single message it is that legisla
tive interventions can be both successful and
widely accepted without any perceived loss of
freedoms.
* Reference is made in several strategic plans to
involvement of the community and consultation
with affected institutions and organizations. To
be effective, consultation and institutional integra
tion should be accompanied by the acceptance of
meaningful accountability for the achievement of
goals. In New Zealand, a country with under four
million people, no fewer than 28 public and 45 non
governmental agencies were identified as essential
to the networking process, yet there was no discus
sion as to how each could become accountable for
its contribution (6).
• There is a tendency to place the onus for safety on
the individual road user. Of course, the indi
vidual's behaviour is a critical determinant of her
or his safety, and communal behaviour likewise
has a vital influence on the community's safety.
However, it is not acceptable that governments
should
absolve
themselves
of
respon
sibility. Where improved behaviour is needed the
authorities should promote it by every possible
mean's.
• In general the widespread use of cost-benefit
analysis in decision-making -is to be applauded.
However, it is important to see things in their true
perspective. It is preferable to spend a sum of
money on a major problem with a cost-benefit
return of 2 to 1 than on a minor problem with a
cost-benefit return of 20 to 1. Furthermore, a
70
slavish adherence to cost-benefit analysis tends to
inhibit the testing of innovative solutions.
.Despite the above concerns, the strategic plans
undoubtedly hold promise of progress, as outlined
below.
• There is a clear recognition that the political and
community profile of road safety should be
raised. It is necessary to increase community
awareness of the key problems and to provide
opportunities for wider participation in decision
making if road safety is to obtain an adequate share
of resources and if governments are to be
encouraged to take difficult decisions.
• There is a publicacknowledgement of the need for
integrated efforts across traditional institutional
boundaries. Although there seems to be no clear
plan for implementing institutional accountability,
hopeful signs exist It has been suggested, for
example, that there should be routine independent
safety audits of road networks. This would bring
accountability to the authorities responsible for
road construction and maintenance. Another
possibility would be to require safety impact
statements in .respect of major decisions on land
use planning and liquor licensing. It is now
recognized that institutional fragmentation of res
ponsibility has been the largest single barrier to
progress in the safety field. Integration, coopera
tion and consultation are excellent first steps but
may come to nothing if true institutional accoun
tability is not achieved.
• Formal targets are being set as part of the new
approach to planning. In the United Kingdom
the goal is to reduce the number of casualties by a
third by the year 2000 (5). The European Com
munity seeks to redu’ce the number of serious
casualties by 20-30% by the same date (4). In Aus
tralia, Victoria has set itself a target of a 30% reduc
tion (2) and New South Wales aims to achieve a 25%
reduction (3), again by the year 2000. All of these
targets have been expressed in terms of absolute
numbers of deaths and serious injuries, which is
what the public is most interested in. However, in
the USA the target is given as a reduction in the
fatality rate per 100 million vehicle-miles (7); in.
other words, mobility is put first and the aim is to
have the safest possible transport system on that
basis. The Europeans, in contrast, are talking
about limiting mobility as a means of improving
safety. Target-setting is the first step towards
achieving accountability. Thus in the United
Kingdom the Department of Transport has to sub
mit an annual report on progress in achieving the
targets that have been laid down (8). At present
the institutions setting targets in various countries
(Contd. on page 76)
swasth Hind
INDUSTRIAL ACCIDENTS
—THEIR IMPACT ON PHYSICAL AND
MENTAL HEALTH OF THE PEOPLE
Dr (Mrs) Rekha Thakre & Dr A. L. Aggarwal
The adverse health effects of industrialisation range from those caused by relatively
high exposure of small populations within particular factories to those of the general
public usually lower levels of exposure. The hazards can be acute or chronic
depending on the levels of exposure and duration for which the humans are subjec
ted. During accidental incidents the toxic containments are released in large quan
tities and the effects are drastic and instantaneous.
has made
many positive contributions to
health, among them increased per
sonal income, greater social wealth
and improved services particularly
transport and communication. But
industrial activities carry the
inherent risk of adverse health con
sequences for the workforce and
die general population, either
directly, through exposure to harm
ful agents or practices, or indirectly
through environmental degrada
tion. Industrial emissions and
products also threaten the global
environment
The term industry covers a great
range of activities, each with the
potential to affect the health of
workers, their families and the
wider public. The industries can
be classified according to .the pro
duction capacity, processes in
volved or workforce involved. As
per the international norms the
classification of industries is shown
in the Table-1.
Industrial Activities and Health
Hazards
The health hazards associated
with industrialization include not
only those of the production pro
cess but also those of the raw
materials, fuels and wastes as they
J
ndustrialisation
March-April 1993
are obtained, transported, handled
and the effects on the health of the
products and wastes.
The adverse health effects range
from those caused by relatively
high exposures of small pop
ulations within particular factories
(or parts of factories) to those of the
general public usually, lower levels
of exposure. The hazards can be
acute or chronic depending on the
levels of exposure and duration for
which the humans are subjec
ted. During accidental incidents
lhe toxic containments are released
in large quantities and the effects
are drastic and instantaneous.
Occupational Exposures
At the workplace, a variety of fac
tors influence the level of risk for
lhe working population.
Estimates based on the current
occupation injury rates in a num
ber of countries suggest that there
arc 32.7 million occupational dis
orders per year and 146,000 deaths
(WHO 1990). Although no global
estimate can be made at present,
the prevalence of some common
occupational diseases among
exposed population is indicated in
Table-2.
Accidental Releases
Accidental releases of toxic sub
stances often result in health risks
both at the workplace and in the
wider environment The indus
trial accident at Bhopal, methylisocynate emitted from Union
Carbide Plant caused several thou
sand deaths and over fifty thou
sand injuries is one of the best
known example (Rosencranz
1988). The accidental causes are
not only restricted to accidental
release of toxic chemicals in fac
tories but also during the transport
of the chemicals, while they are
being stored as a result of explo
sion, fires, collision or human
sabotage.
Toxic Chemicals and Hazardous
waste
Certain industrial and insti
tutional wastes are very deleterious
and harmful to human beings and
hence are categorised as hazar
dous and toxic. Special care is
needed for their storage and dis
posal to ensure that they are
isolated
from
human con
tact. Their storage and handling
requires utmost precautionary
measures to prevent them from
contaminating the human en
vironment. Most toxic wastes
71
TABLE: 1
Classification of Industries
Industry
Examples
Total workforce
per ha
Nuisance produced
Air Pollution
Noise
Hazards
I. Heavy industry
Oil refineries, chemical
works, fertilizers indus
tries,
metallurgical
&
seaport industries, nuclear
reactors.
< 25
May be great SOs.
Hi S, Hi SO<» HC, NHa,
SPM
Moderate
Explosion
fire risks
2. Heavy industry
Machine manufacturing,
steel mills, ship building,
big harbour industries,
power stations, pulp &
paper mills
50
May be . rather less:
CO, SOi.CLi.HiS,
Mercaptans, SPM
May be consi
derable indudes
traffic noise
Explosion & fire
risk
3. Medium
Heavy
industry with air
pollution
Manufacture of straw
board, artificial fibres,
ceramic products, glass
industry, cement works,
manufacture
of cars,
lamps, foods & textiles
100—200
Comparitively
not
much
SOa, HF, Ci.
SPM, may indude
malodorous
emis
sions
Considerable
traffic noise
fire risk
4. Light industry
Tanneries, textiles & food
processing industry
50—100
Not much but may
include
malodorous
emissions
Moderate
lire risk
5. Service industry
Printing works, bakeries,
film laboratories
10-50
Little
None
None
6. Work-shops, handi
crafts
Fashion studio, photo
printing shops, potteries
1—10
None
None
None
come from the chemical industry
but other industries viz., metal, pet
roleum, transport, pulp and paper
mills, leather and tanning indus
tries also produce significant
quantities of hazardous waste.
The nature of hazardous wastes
varies considerably depending on
the origin and chemical con
stituents. The degree of toxicity is
governed by the physical states
they are being handled, the gas
eous phase is the most toxic while
Solid phase comparatively is
less. Some wastes are inflamm
able, as are many solvents used in
chemical industry, some are
highly reactive and explode or
generate toxic gases on contact
with water specially, water vapour
in the ambient' air or other
chemicals. Some
wastes
are
highly, toxic, for instance cyanide,
arsenic and many heavy metal
72
compounds and many are car
cinogenic, i.e., potentially Cancer
producing.
Examples of careless disposal of
industrial wastes with adverse
impact on biosystem including
humans are found all over the
world. The discharge of mercury
contaminated wastes into water,
received much publicity through
the hundreds of deaths and
thousands of cases of disablement
it caused at Minamata, Japan.
Minamata disease is a chronic
neurological disorder caused by
methyl mercury. The disease first
broke out around Minamata Bay
in South-West Japan and was
officially attributed by the
Japanese Govt, to methyl mercury
in 1968. Mercury oxide was used
in the production of acetaldehyde
by Chisso Co. and discharged in
the plant’s waste water as organic
and
mercury. It was biologically con
centrated in fish and shellfish con
sumed by people. Patients re
corded in accordance with the
Japanese Pollution Related Health
Damage Compensation Law as
suffering from Minamata disease
tptalled 2248 around Minamata
Bay as of March 1990. Of these,
1004 had died by that date (Our
Planet Our Health 1992).
The industrial accidents occur
at one comer of the world and its
impacts are felt thousands of miles
away.
Another example of industrial
accident which is fresh in our
minds is the Cheronobyl disas
ter. There is always a potential
threat in certain industrial pro
cesses and a little act of careless
ness can result in tremendous loss
SWASTH HIND
of humans and other living com
ponents of ecosystem both instan
tly due to high levels of exposures
and chronic due to cumulative
effect of the pollutants recurring
after certain lapse of time.
Health hazards can also arise
from inadequate attention to the
safe disposal of equipment con
taining dangerous materials, such
as, polychlorinated biphenyls in
transformers and heavy metals in
batteries. An extreme example of
this was recorded in Goiania,
Brazil, when an abandoned can
cer therapy machine was broken
up and radioactive Caesium-137
was released. More than 240 peo
ple were contaminated, many died
and those who survived will be at
increased risk of developing
cancer.
Once the industrial accident
occurs and its impact is realised,
the very opinion of general public
to look to the industrial sectors get
altered. This has been experien
ced in the recent soico-economic
survey conducted by NEERI for
establishing a new industrial unit
in Haryana. The women folk
and the old illiterate people
strongly opposed to the new
industrial activity saying that the
offing chemical industry will
result in accidents like Union Car:
bide at Bhopal and a constant
feeling of danger will be looming
in our hearts. Hence, the unit
may not be allowed tp come
up. No one can deny the pro
bability because to a certain extent
this is true also;
How to avoid industrial acci
dents ?
It is essential to understand the
root cause of the accidents if they
are to be avoided. Industrial
accidents are usually more com
mon in countries with relatively
small and undeveloped industrial
base. The reasons cat! be
enumerated as :
♦ Inadequate planning for1
safety
* Lack of skilled arid
experienced manpower to
service. and
maintain
industrial equipments
' ♦ Untrained plant opera
tors
March-April 1993
3—l/DGHS/93
TABLE: 2
Industrial
Diseases
&
Population
Exposed: Global Estimates
. Disease
‘& Population
exposed
Silicosis
Coal Miners
coniasis
33—432
Pneumo83—43.8
Byssinosis
5.0—30.0
Lead Poisoning
1.7—100
Mercury Poisoning
26—37.0
Noise
loss
1.7—17.0
induced
hearing
Skin
Occupational
Disease
1.7—86.0
2.0—5.0
Low Back pain
pollution strength of the source,
prevailing meteorological con
ditions and selection of effective
plant species and their planta
tion pattern.
Siting of the industries
The industrial activity should be
planned away from the commer
cial and residential zones which
will automatically reduce • its
adverse
impacts. However,
in most of the Indian cities there
are no such well defined zoning
and all types of activities are either
centred at one place or diffused
throughout the cities. Accidents
take great tolls of human lives and
natural and personal proper
ties. We must understand the
risks involved, the potential
accidental sites, the impact it can
exert and the strategy to be adop
ted immediately if the accident
engulf inadvertantly. Thus, we
These can be taken care of by
the authorities by employing the
proper personnel at least at the
potentially
accident
prone
points.
TABLE:3
Industrial Emissions and Human Diseases
Chronic lung diseases
Silicosis, Asbestosis, Byssinosis
Kidney diseases
Cadmium, Mercury Pollution
Central Nervous System disorders
Organic
solvents.
Manganese
Lead,
Mercury,
Malignant
organs
Asbestos,
Arsenic,
amines. Benzene
Nickel,
Aromatic
diseases
of
different :
Risk evaluation
To avoid the industrial accidents
before setting up a new industry,
risks involved in each unit process
have to be assessed critically and
the industrial authorities should
be fully aware of the immediate
steps to be taken in case the
accidents occur. The already
existing industrial units and com
plexes should also evaluate the
risks involved in the operational
processes and be prepared for
fighting the disaster, if it takes
place.
Green belts
Development of the green belts
around the industry is one of the
best control measures to avoid the
further spread of accidental
releases directly affecting the inno
cent public residing in the vicinity
of the establishment Width of
green belts should be evaluated
scentifically and systematically
taking into consideration the
can at least minimise the
accidents frequency and the losses
due to the
aftermath of
industrial accidents.
References
• Our
Planet
Our
WHO 1992.
Health.
* Global Estimates, for Health Situation
Assessment and Projections 1990.
Geneva WHO, 1990 (Unpublished
document WHO/AST/902).
• The State of India's Environment
1982: A Citizens Report Delhi, Centre
for Science and Environment
• Rosencranz, A 1988.
Bhopal, Transitional Corporations and
Hazardous Technologies Ambio, 17
(5): 336—341.
• Tsubaki, T. and Takahashi H. eds.
1986.
Recent Advances in Minamata Disease
Studies. Tokyo, Kodanshi Ltd.,
* Rossiter, C. and El Balawi, MA.
1987.
The Working Environment Industry
and Environment 10: 3—11.
'rn
73
AIR POLLUTION:
A SERIOUS HEALTH RISK IN CITIES
—How to Prevent It
Dr a. L. Aggarwal, Dr A. Kumar and Ms P. S .Rao
The presence of substances in ambient air, which are generally resulting from
anthropogenic activities, in sufficient concentration, over a sufficient time, interfere,
under certain circumstances, significantly with comforts, health or welfare of human
population living around. However, use of various control measures can avoid this if
followed rigorously.
N most of the major 'Indian
I cities air pollutants, viz..
Sulphurdioxide, Oxides of Nit
rogen, Carbon monoxide, Hyd
rocarbons etc. are emitted from fuel
burning in industrial, . auto
mobile and domestic/commercial
sources. These pollutants and
many others are toxic in nature and
can impart serious health risk, if
exposed over a prolonged period.
However, their emissions can be
effectively brought down by adopt
ing various control measures.
General characteristics of the
individual air pollutants, their
sources, effect on human health
and
control
are
described
below:
Gaseous Pollutants
1. Sulphur-dioxide (SO2): It is a
colourless gas with pungent
odour, oxidises to form SOa,
which reacts with water to form
Sulphuric acid. It is emitted
74
from combustion of fossil fuels,
smelting of Sulphur bearing
metal ores and natural events
such as volcanic eruptions. Its
effect on health include aggra
vation of respiratory diseases
like asthma, chronic bronchitis
and emphysema, reduced lung
function, irritation of eyes and
respiratory tract. However, use
of low sulphur fuels or scrub
bing of fuel gases with lime or
caustic, catalytic conversion etc.
are the various options for its
control.
2. Oxides of Nitrogen (NO*): NOa is
brownish red gas often formed
from oxidation of nitric oxide
(NO). Various sources of its
emission include motor vehicle
exhaust,
high temperature
stationary combustion, etc. Its
major effect on health include
aggravation of respiratory dis
eases, cardiovascular illness,
and chronic nephritis. However,
catalytic control, of automobile
exhaust gases, modification of
automobile engines or scrub
bing the fuel gases with caustic
substances or urea can effec
tively bring down the emission
levels.
3. Carbon-monoxide (CO): It is a
colourless gas with strong che
mical affinity for haemoglobin
in blood. It is primarily emitted
from incomplete combustion of
fuels and other carbon contain
ing substances such as in motor
vehicles exhaust, natural events
like forest fires or decomposi
tion of organic matter. It can
impart reduced tolerance for
exercise, impairment of mental
function and foetal develop
ment, aggravation of cardiovas
cular diseases. Various methods
to control CO emission from
automobile exhaust include
modification of automobile
engines (proper tuning), re
design of combustion chamber,
control of exhaust gases through
SWASTH HIND
improved catalytic or thermal
devises etc. Improved design,
proper operation and main
tenance of stationary furnaces
effectively bring down the levels
of CO emissions from industrial
sources.
4. Hydrocarbons (HC): These are
emitted from incomplete com
bustion of organic fuels, pro
cessing, distribution and use of
petroleum compounds, forest
fires and in nature through
plant metabolism. Its prolonged
exposure may lead to cancerous
growth. However, it can be con
trolled through proper tuning of
automobile engines, crankcase
ventillation, exhaust gas recir*
culation, redesign of combus
tion chamber and catalytic or
thermal control of automobile
exhaust gases. Operation and
maintenance of stationary fur
naces, improved control pro
cedures in processing and hand
ling of petroleum compounds
are exercised to contain emis
sions from such sources.
Particulate matter
Suspended Particulate Matter
(SPM): Though natural events
such as wind erosion and
volcanic eruption raise the
background dust, the anthropo
genic activities such as combus
tion of solid fuels from statio
nary sources and construction
activities etc. cause SPM emis
sion. The health effects of par
ticulates are classified according
to their size causing aggravation
of diseases like asthama, cough
and cardiorespiratory diseases.
However, it can be conrolled by
cleaning of fuel gases with iner
tial separator, fabric filter,
March-April 1993
3.5 Million die yearly
Not from disease but from injury
N estimated 3.5 million die yearly throughout the globe, the World Health Organiza
tion (WHO) says, not from disease but from injuries that are sustained through
A
accidents and violence.
Equally tragic, just as many may be totally disabled, and as many as ten times more
partially disabled, through loss of limb or eyesight
A million deaths linked to injury are estimated to be caused intentionally. They
are the results of suicides and homicides, but are also the products of violence manifested
through battered children and spouses, rape, gang-warfare, and crime.
The other 2.5 million deaths are unintentional, resulting from accidents on the
road, in the home, in the workplace, on the playing fields; from fires, drownings,
poisonings, falls; and from natural disaster.
“Too often accidents are perceived as acts of fare, as something in the cards, as
unavoidable. That is not so. Accidents are neither unforeseeable nor unpredict
able. However, very little, or not enough, is done to prevent them,” says Dr Claude
Romer, chief of WHO’s injury prevention unit
The following are estimates of yearly deaths for the major causes of injury-linked
mortality based on reports to WHO:
Intentional Deaths
—
—
Developed World: Suicides, 200,000; homicides, 60,000.
Developing World: Suicides, 550,000; homicides, 215,000. China and India,
the two countries with the world’s largest populations, account for 370,000
suicides and 50,000 homicides combined.
According to the latest statistics available in WHO, Hungary has the highest agestandardized rate for suicides, 48.4 per 100,000 males, and 14.6, females.
Unintentional Deaths
—- Developed World: Motor vehicle accidents, 210,000; other accidents
380,000.
— Developing World: Motor vehicle accidents, 515,000; other accidents
1,370,000. An estimated 290,000 motor vehicle accidents took place in China
and India; plus 740,000 other accidents.
Young and Elderly
The young and the elderly are most commonly the victims of injury-linked
deaths.
In the industrialized world:
— Injuries now rank only after heart diseases and cancer, and far ahead of
infectious and parasitic diseases, as a cause of mortality. They are the main
cause of death among males up to age 44, and females to age 34.
— In the United States of America, for instance, 63 per cent of mortality bet
ween ages 15 and 24 and 40 per cent between ages 25 and 44 are caused by
injury, according to the country’s National Centre for Health Statistics.
Furthermore, motor vehicles account for 45 per cent of all U.S. childhood deaths
between the ages of 10 and 14; drowning for 12 per cent; and homicides for 8
per cent
As well, U.S. domestic accidents, namely poisoning and falls, alone account for
three quarter of injuries sustained by those over age 65.
In the developing world:
— Deaths from injury, though still a small part of total mortality, are nonethe
less on the rise. As communicable diseases come under control, deaths
.from injury are already beginning to rank among the five top killers.
Trends show that in virtually all countries, injuries figure among the leading
public health problems.
Nine out of the top ten countries with the highest overall mortality rates report
more deaths from injuries, poisonings and violence than from infectious and
parasitic diseases.
The former Soviet Union, for instance reported 1052 deaths per 100,000, popula
tion, adjusted for age, from injuries, and 182 from infectious diseases.
—WHO
75
scrubbers or Electrostatic Pre
cipitator and safe disposal of
solid waste.
Ambient Air Concentrations
(Annual Average) of SOa NOxand
SPM for various metropolitan
cities like Bombay, Calcutta,
Madras and New Delhi are given
in Table.
TABLE
Ambient Air Quality Status of
Four Indian Metropolitan Cities: 1990
Location/
Metropolitan
Cities
Bombay
Delhi
Calcutta
Madras
Annual Avg. Pollutant
Concentration (ug/m3)
■ ■ ■
SPM
SO*
NOX
201
469
369
105
42
29
48
12
30
47
39
15
Ref: NEERI Report; Air Quality Status
of Ten Cities: 1990.
The best available method to
minimise air pollutants emission
are:
— Use of raw material and fuels
of low air pollution poten
tial and
— Proper design of process and
burning equipment involved
in handling and processing
the burning materials.
(Road Safety—Contd. from page 70)
are monitoring their own performance. It would
clearly be preferable, however, for targets to be set
for each institution and for independent audits of
performance to be conducted.
• There is clear evidence of improvement in the
utilization of limited resources and of more effec
tive management and coordination of safety pro
grammes. The critical factor in the long term will
be the degree to which accountability can be placed
upon each institution.
*. ♦ ♦
Hope comes from -the growing frequency with
which safety measures are being selected scien
tifically. We are beginning to recognize that road
safety does not exist in a vacuum and that pressures
against it have to be countered. There is widespread
acceptance of the critical role played by diverse public
and private institutions and of the need for insti
tutional cooperation, programme integration, and
genuine accountability for performance.
What else could be dope to improve road
safety?
• Vehicle manufacturers could instal speed-limiting
devices, ignition interlocks to prevent drink-drivers
from starting their vehicles, and better occupant
protection systems.
• Independent bodies could be established to con
duct regular, safety audits of the activities of the
76
institutions involved in road construction, traffic
management, traffic law enforcement, land-use
planning, public health and education. This
would allow pressure to be applied for the achieve
ment of targets and for proper attention to be paid
to institutional obligations.
• A systematic long-term programme could be
implemented with a view to changing social
attitudes on car use.
References
1. Haddon, W., Such man, E.A. &. Klein, D.
Accident research—methods and approaches.
New York, Harper & Row, 1964.
2. Government of Victoria. Road safety: challenges and strategies for
the next decade. Melbourne, Vicroads, 1991.
3. Road safety 2000—Strategiesfor road safety in NSWfor the 1990s and
beyond Sydney, Roads and Traffic Authority, 1991.
4. Report of the High-level Group for a European Policy for Road
Safety. London, Commission of European Communities,
1991.
5. Road safety: the next steps. London, Department of Transport,
1987.
6. Official Committee on Road Safety. National., road safety
plan. Wellington, Ministry of Transport, 1991.
7. Safety research for a changing highway environment. Washington
DC, Transportation Research Board, 1990 (TRB Special
* Report 229).
8. Road casualty reduction. Implementation of the road safety review.
annual progress report 1989/90. London, Department of Trans
port, 1990;
Courtesy: World Health Forum Vol. 13, 1992.
swasth Hind
EYE INJURIES
—Their Impact on Community
Dr p. k. Khosla
Most eye injuries can be prevented by taking adequate and simple precautions. People
must realise that nation spends a huge amount on the rehabilitation of blind persons. The
society also has to share the loss of revenue from the special facilities given to the visually
handicapped persons.
HE modem civilization has
The injuries to eye could be due
given us lot of comforts, but
T
to pressure called as concussional
at the same time it has added.
various factors which expose the
eye to injuries by gross or subtle
phenomenon. Eye injuries con
stitute 5-10 per cent of all ophthal
mic patients in developed count
ries. In our country, a survey done
by NSPB-ICMR team had revealed
that of a total of 9 million blind (in
1972-73), 1.25 per cent were suffer
ing blindness due to eye injuries.
The upkeep of blind costs the
government Rs. 75 per month at
1972-73 figure to which- you can
add 20 years of inflation.. Add to
this the costs of economic loss in
term of manpower lost and one can
see the fortune lost. The approx
imate cost in terms of loss of pro
duction is calculated @ Rs. 5 per
man-day.
It is in this context that one must
understand the causes and implica
tion as well as the preventive
measures that must be taken.
March-April 1993
injuries or they could be due to
penetration of eye tissues.
Causes
Causes of Eye Injuries, can be
classified into the following:
1. Festival-related injuries:
During Dussehra, we have bow
and arrow injuries and cracker
injuries while in the Holi season
eye injuries due to water baloons
is common.
2. Injuries specific to rural set-up:
During Farm-related accidents,
leaves or other organic material
while hitting the eye usually result
in corneal ulcers.
Animal-related accidents: Eye
injuries caused by bull horns and
tail flick of an animal are common.
Games like qulli danda are popular
in the rural set-up and are common
causes of injuries.
3-. Injuries related to household sub
stances: Mostly children get eye
injuries while playing sharp edged
objects with knives, scissors, com
pass, pins and other sharp-edged
toys and objects.
4. Injuries related to road accidents
are also common specially when
glass splinters enter the eyes.
5. Injuries related to various sports:
The sportsmen receive eye injuries
from hockey, cricket, golf and
squash balls, besides various types
of raquet, darts, airgun, and boxing.
Also photophthalmia in snow
sports.
6. Occupational injuries: Ammonia
bums in printers; comeal and
intraocular foreign bodies in metal
grinding, stone breaking, persons
working with chisel and hammer,
cataract in glass blowers; photoph
thalmia in welders, and chemical
injuries in students and scientists
working in laboratories.
7. Injuries during fights: The eye
injuries also occur during fights
77
with fists, knives, gun shots and
other explosives used during war.
8. Retinal
eclipse.
bums
due
to solar
Mild degree of blunt injuries
may cause redness and vague dis
comfort in the eye. Severe blunt
trauma can cause swelling of lids
and surrounding area and black
discoloration of the same, redness
due to blood below the conjunctiva
or the front white portion of the eye.
There could be blood in the
anterior chamber, displacement of
lens. Development of glaucoma
(Kala Motia), blood in vitreous and
retina along with detachment of
retina. There may also be injury to
the optic nerve.
various industries on the floor level
should be done.
Health education programmes
should be launched.
All injuries must be immediately
seen by a ophthalmologist Ade
quate and timely surgery of the eye
is important and can avoid pro
blems in the other eye and the
sight-saving for the same eye as
well.
Shows dose up view of a chiI ds eye who got a
perforating injury while playing with bow and
arrows.
Rehabilitation
Prevention
The most important aspect of
these injuries is that most of them
are easily preventable by taking
adequate and simple precautions.
Thus children should be allowed to
play only with blunt objects and
avoid bow and arrow, gulli danda
and such activities. Welders and
lathe workers should be told to use
protective appropriate glasses.
Chemical injuries should be
immediately treated by washing
with copious amounts of water till
all irritation subsides. Sports
injuries can be avoided by wearing
protective head.'and eye gedr. Pro
per illumination should be carried
out in industries. Bold display of
measures for eye protection in
One must realise that nation
spends a huge amount on the
rehabilitation of the blind persons.
The Government runs 150 vocatio
nal training centres, 23 special
employment exchanges, 17 voca
tional rehabilitation centres, 11
District rehabilitation centres, 6
Institutions for women blind, 2
Industrial Homes, 1 home for aged
and blind, 3 Braille and SPL equip
ment production centres, 6 Braille
printing houses and many other
such Institutions.
Educational
facilities have been provided for up
to 7% of visually handicapped
children *as against 84% of
normal children.
It is the duty of all Government
and non-govemment agencies to
carry out eye health education
specially related to prevention of
eye injuries and then we will be
able to take care of the menace of
blindness due to eye injuries.
A case of concussional Trauma with subhyaloid
haemorrhage.
A case of iron particle within the eyeball
while the person was working with chisel and
hammer.
To ensure prompt supply of the Journal quote your Subscriber Number and intimate the change
of address.*.
For all enquiries, please write to:
The Director*
Central Health Education Bureau
Kotlji Marg, New Delhi-110 (102
78
Swasth Hind
ALCOHOL
CONSUMPTION
AND
VIOLENCE—
THEIR
IMPLICATIONS
ON
INDIVIDUAL
AND
FAMILY
HEALTH
K. Balan
Alcohol—a mood changing habit—is slowly and steadily becoming a health destroyer among the
people. When they fall victim of alcohol dependence syndrome, the alcohol takes control of their
health and life.
lcohol is
fast becoming a
degenerating force in our
society, particularly so when it is
combined
with
violen
ce. Violence is widely prevalent
and alcohol, they say, is directly or
indirectly
supporting
it by
motivating the individual to resort
to violent activities. As a result,
the alcohol related health pro
blems cause severe strain on the
life of the individual and social
fabric of the family and the com
munity at-large. Alcohol, when it
is combined with tobacco and
drug, as a trio, becomes a force to
reckon with to achieve narrow
goals. And the weaker sections.
A
March-April 1993
the unemployed youth, the
students and other vulnerable
groups are, knowingly or un
knowingly, falling victims of
alcohol combined violence result
ing in serious setback not only to
their own health but also to that of
their family.
According- to the World Health
Organization, the problems relat
ing to alcohol rank among the
major health problems of the
world. Some years ago, an offi
cial of the World Health
Organization corroborated that
the alcohol related problems even
constitute an important obstacle
for socio-economic development
and will threaten to overwhelm
health services unless appropriate
measures are taken at the right
time. Research studies
have
revealed that a high proportion of
the hospital beds are occupied,
year after year, by physically and
mentally, derailed victims of
alcohol and violence. To these
should be added the uncountable
thousands who are victims of
accidents caused by drinking
and driving.
Implications
The implications of alcohol
combined violence
on
the
79
individual and family health are
many and varied. The individual
loses the direction and purpose of
life. Here is the real life
experience of a factory worker,
who was taught by his friend how
to drink beer. The habit con
tinued as a time passing one and
he bought new varieties of liquors
to satisfy his urge and a lot of
money was spent in company with
his friends. The habit robbed
him off his desire to work, he
neglected his household, beat his
wife and children often. It was
not long before the children went
hungry, suffered malnutrition and
could . no
longer
attend
school. This has created a crisis
and social chaos in his family.
Due to continued absenteeism, he
was dismissed from employ
ment. And finally, he fell victim
of serious ailments. This reveals
the • real implications of the
alcohol
combined
-violent
behaviour in the life of an
individual and family. This is
not an isolated case. Millions of
people are facing such torturing life
situation in our society having
fallen victim of “alcohol depen
dence syndrome”. And again,
thousands of youngsters are com
pelled or fancied to acquire the
habit of alcohol and led into the
violent activities bringing serious
injury to their health and that of
their family.
Research studies have brought
to light that alcohol consumption
and the consequent violence
coupled with rash and negligence
caused a third and a half of all
road deaths. The drinking habit
causes three out of ten accidents at
work and results in loss of pro
duction. In many cities and
rural areas, it is the chief cause of
crimes, which is alarmingly
increasing day by day.
80
Promotes quarrel and poverty
Uncontrolled
drinking
habit
among the bread earners of the
family promotes quarrel and
poverty in the family. Wife and
child beating are common scenes
in rural areas and slums. The
mental health of the individual
goes down in alcoholic drain and
life-long severe emotional scars
are
left
on
spouse
and
children. The growing habit of
drinking takes away the full or
good part of .the income of the
individual. Thus he is unable to
provide the needed support to give
essential food and other neces
sities of life to the family mem
bers. The children of alcoholic
parents are often in a pitiable life
situation. The children caught in
between quarrels of parents and
social conflicts, lose all interest in
life. They also lose proper
guidance and direction. Unbear
able of such torturing situation,
children in sqch families run away
from home falling victims of child
labour or delinquency. Thus the
children of parents who are
habitual drinkers are living under
a number of risks. The risks
being beaten, neglected , or under
nourished. But beyond that they
may risk long-term harm from
memory of terrible or even tragic
scenes. In a nutshell, the in
dividual as well as the family
members suffer serious psy
chological and physiological pro
blems affecting their health and
life.
Negative attitude
Large-scale flow of poor quality
alcohol into the slums and rural
areas make the life of the people
not only miserable and horrible
but also easily susceptible to all
sorts of diseases. Thus alcohol
today is a rising tide eroding the
health of the individual and the
family, and consequently that of
the society. Apart from the risk
of being attacked by diseases
affecting the heart, liver, lungs and
other vital organs of the body, the
children and youth in their family
sometimes face discrimination by
other
people. They
suffer
development of their personal,
family, professional and civic
attitude and qualities of life.
They are often misled and driven
into anti-social and violent
activities. In the absence of pro
per guidance at home, they grow
in an unfavourable living environ
ment and develop negative
attitude and violent behaviour, as
being .widely witnessed now.
Thus the French slogan “where
parents drink, it is children who
pay” is most relevant and true in
our society.
The children and youth who are
forced into the habit of drinking
are long-term sufferers. Research
has revealed that drinking habit
among the children and younger
people below certain age cripples
their future health, as it affects the
formation and growth of vital
(nervous) systems in the body.
That a good percentage of youth
in our country are acquiring this
habit for one reason or the other is
a matter of serious concern to
the nation.
Crimes
Today we are living in an
environment where violence and
crimes are increasing alarmingly;
crime against girls and women,
weaker sections; so on and so
forth. We are also frequently
hearing about wife and children
committing suicide due to unbear
able living conditions at home.
All these violent activities can be
linked to alcohol, which is overtedly or covertedly, playing a role
in promoting these crimes and
anti-national activities.
The number of girls and women
acquiring the habit of drinking is
SWASTH HIND
also
increasing. In
women,
alcohol brings about serious psy
chological and social consequen
ces, particularly so when they are
in the child-bearing age. Alcohol
affects not only the health of the
mother but also that of the
child.
Thus it can be seen that the
alcohol—a
mood
changing
habit—is slowly and steadily
becoming a health destroyer
among the people. When they
fall victim of alcohol dependence
syndrome, the alcohol takes con
trol oT~their health and life. In
our society, the alcohol combined
violent behaviour promotes death
in the streets, and on the roads—in
thousands; ruins one’s own earn
ing capacity, lower the socio
economic status of the individual,
motivate the individual to neglect
wife and children, and acts .as a
stimulator of quarrels, murders,
rapes, assaults, thefts, burglary,
hooliganism and so on. All these
activities, erode the health and
degenerate the moral, social and
other values of life and often des
troy the family culture itself.
The first aim of the World
Health Organization’s alcohol
Programme is to alert the world to
the devastating spread of alcohol
related health problems. The
World Health Assembly on more
than one occasion recognised the
problems relating to alcohol, par
ticularly the excessive consump
tion, are one of the world’s major
public health challenges.*
No nation may be willing to
lose the health and power of the
people,
particularly
youth.
Several nations have already come
forward with concrete plans to
fight the alcohol menace and save
time, health and energy of the
youth. The
World
Health
Organization has set clear-cut
guidelines for the purpose.
March-April 1993
Alcohol and Violence:
Not only on the roads
HE connection between drunken driving and road
disaster is amply supported by police reports and
T
hospital records. But the influence of alcohol on
injury and deaths extends much beyond the havoc on
the roads with which drink is commonly associ
ated.
The kind of alcohol-inflicted injuries that take
place at home, at work, in schools and even on recrea
tion fields, are poorly, if at all, documented. Yet there
is enough information to indicate that it is too much
drink that often triggers acts of violence, World Health
Organization (WHO) experts state.
Though patchy, information from Africa,
Europe, North America, and Australia, shows ade
quately that alcohol-related accidents are not only a
significant cause of human misery, but also represent
major economic losses for all countries.
Because they over-drink, the imbibers are more
likely to hurt themselves by falls, by bums or scalds,
more likely to over-dose on medicines, more likely to
drown, or to commit homicide or suicide—in short,
those under the influence are at greater risk of
injury.
Both in the United Kingdom and the United
States of America, experts estimate that about 45 per
cent of all alcohol-related deaths are linked to acciden
tal injuries and poisoning.
“Domestic and occupational injuries, more often
than not, are associated with over-drinking,” says Mr
Marcus Grant, technical officer of WHO’s programme
on substance abuse.
“But because of little documentation, not much
has been done anywhere in the world against these
alcohol-related injuries,” he adds in calling for better
record keeping as a much-needed first step for preven
tive programmes.
There are as well a range of social problems
caused by excessive drinking: marital discord spouse
and child neglect, absenteeism, and, when pay goes to
drink instead of groceries and rent, even poverty.
Over the last three decades, production of
alcohol has increased world-wide, in some developing
countries even out-pacing population growth. Sup
ply has created demand for wine, spirits, and par
ticularly, beer.
While in the developed world, trends show
drinking levelling out or even decreasing, in the
developing, world, trends are on the upswing—
jumping, according to WHO estimates, over recent
decades by at least 500 per cent in Asia, 400 per cent in
Africa and 200 per cent in Latin America.
Along with this increase, there has been a corres
ponding rise in alcohol-related injury, some of it inten
tionally inflicted, some unintentionally. And the
up-trend is expected to accelerate in the years
ahead.
—WHO
81
There is imperative need to pro
vide education on alcohol com
bined violence from the school
stage itself. There should also be
brain storming sessions meant for
youth and other vulnerable sec
tions. This should also be
included in the National Literacy
Mission Programme. The role of
media, particularly TV, films,
Radio and Newspapers are very
important
in
this
direc
tion. Panchayat Raj institutions,
social clubs, voluntary organi
sations, educational institutions,
hospitals and even educated
individuals can play a positive
role in preventing abuse of alcohol
and saving the health of the
people. There should also be
intensive counselling and treat
ment programmes to the victims
of alcohol dependence syn
drome. Legislative measures pro
hibiting sale of alcohol to younger
people, restricting the timings of
sale of alcohol, introduction of
prohibition,
discouraging
establishing
brewing/distillery
industries etc. are measures that
will help in achieving positive
results.
Baby-Friendly Hospitals
ive years from now, thousands of hospitals throughout the world could have a plaque by the front entrance
designating them as ‘baby-friendly’. To qualify for baby-friendly status, hospitals will have to comply with a
new code of practice drawn up by UNICEF and the World Health Organization. The code is designed to ensure
that all maternity units give babies the best possible start in life by encouraging their mothers to breastfeed.
F
Decline in breastfeeding
The ‘baby-friendly’ idea is the
latest advance*in a ten yeaj cam
paign to reverse the trend towards
the bottle-feeding of infants.
The reason for the decline in
breastfeeding, says UNICEF’s 1992
State of the World’s Children
report, is that more families are liv
ing in cities, more women are going
out to work, and more. adver
tisements are persuading mothers
that bottle-feeding is more modem
and sophisticated.
In fact, breastmilk is the world’s
most sophisticated food, says
UNICEF. It is so nutritionally
complete that an infant normally
needs no other food or drink for the
82
first four to six months of life. It is
hygienic and inexpensive.
It
immunizes infants against com
mon infections. It can protect
mothers against pregnancy. And it
reduces the risk of breast and
ovarian cancer
As a result, bottle-fed babies in
poor communities have been found
to be approximately 15 times more
likely to die from diarrhoeal dis
ease and 4 times more likely to die
from pneumonia than babies who
are exclusively breastfed.
Apart from being inferior in
quality, powdered milk mixes
badly with poverty.
Without
enough money to buy adequate
quantities of powder, and without
enough education to read the
instructions on the tin, nlany
families overdilute commercial
milk powders. And without clean
water or sterilizing equipment,
fridges or fuel, the milk powder is
often mixed with contaminated
water and fed to babies from
unsterile bottles.
Overall, the World Health
Organization .estimates that more
than a million children’s lives
could be saved every year if all
mothers gave their babies nothing
but breastmilk for the first four to
six months of life.
The poorer the circumstances the
greater the risks of bottle-feeding.
But breastfeeding is best for all
babies, says UNICEF. One study
has shown that babies in New York
are three times more likely to be
hospitalized if they are bottle-fed.
SWASTH HIND
DRUG ABUSE
Its Impact on Violence and
Public Health
H. K. Sharma
The alcoliol/drug related violence and its adverse health consequences has manifold
implications. The changing drug scenario calls for drug abuse monitoring system and con
stant surveillance against alien drugs. There is an urgent need to strengthen social control
mechanisms and networks to deal with family violence, child abuse and aggressive
behaviour.
N the last few decades at the
Lnational level, the pattern and
prevalence of drug abuse has
undergone rapid and significant
changes in the choice of drugs and
socio-demographic characteristics
of users. Within the 80’s a new
potent drug, heroin (brown sugar/
smack) was introduced in the illicit
drug market due to geo-political
developments around the country.
The social and chronic users of
other drugs turned to brown sugar
without realising its dependence
potentiality and adverse conse
quences ajid this took an epidemic
form in major cities.
The consumption of ethanol and
nicotine in the urban and rural
areas cannot be oversighted in the
wake of steady rise in the produc
tion of alcoholic beverages and
tobacco products. (1-2) The steep
rise in O—T—C (over the counter)
drugs like tranquillisers and
designer drugs in the urban pop
ulation make this phenomenon
more complex. The profile of drug
users emerging from current drug
scene is that of a male prerogative,
early age of onset (between 10—14
t
March-April 1993
years) and a large majority of them
being experimental/recreational
users. The problematic users arc in
the range of 4-5 per cent of alcohol
users and about 90 per cent of
opiate users.
Projecting these
figures at the national level, about 3
million alcohol users and between
3—5 lakh heroin users need public
health intervention. The steady
increase in alcohol/drug abuse has
its own implications on the socio
cultural fabric of society and
adverse public health including
violence, crime, etc.
Drug abuse and violence
Violence incorporates a wide
range of human activities and
events which can be characterised
by great physical force, impetu
osity, passion or simply injury to
individuals. ‘Alcohol’ out of wide
spectrum of drugs available and
consumed ranks first in a variety of
violent behaviours; felony, cri
minal homicide, violence within
family sexual assaqlt, suicide and
violent accidents. The elevated
blood alcohol concentrations
(BAG) have been linked with petty
crime, quarrels and fights at home
and outside. The prison studies in
the West have shown that between
30 to 77 per cent of the individuals
accused of murder have been pre
sumed to have been drinking
before the offence and likewise 42
per cent of victims drank before
being murdered. (3) It corroborates
the concept of ‘battered alcoholic
syndrome’. The role of alcohol has
also been documented in sexual
assault and rape. The violent acts
and risks are more in the families
with alcohol related problems and
in this respect women, children and
elderly are the silent sufferers. The
role of alcohol could be traced in 17
to 25 per cent of cases of spouse and
child abuse.
Besides alcohol, other drugs
(heroin, barbiturates, ampheta
mines, cannabis and other
hallucinogens) also seem to poten
tiate aggressive behaviour and
occasional violence. (4) These may
be due to direct pharmacological
effects, income generating crimes
and drug trafficking and other
effects. The drug trafficking in nar
cotic (mainly heroin) in the 80’s has
opened a new chapter on violence
83
in the country. The narco-terro
rism link and its security
implications at the state and
national level often appear as
headlines in the print media.
Drugs are ideal commodities for
perpetuating organised crime
across national boundaries. The
operators of these organised crimes
are well disciplined but weaponary
confrontation with law enforce
ment agencies and street level
violence in peddling of illicit drugs
are frequent. The ethnographic
observations of a drug peddling
area of Delhi by the author over the
last five years noticed many major
incidences of violence, including
murder of a youth, heroin users on
noncompliance of ‘street rules’ and
an open confrontation between
street peddlers and their associates
with a Sdgilant* youth group of the
affected community. The orga
nised drug peddling stigmatised the
whole community and the inno
cent people bore the wrath of
neighbouring communities, result
ing into social tension and disrup
tive behaviour. This is a case study
of only one out of hundred drug
affected communities.
Drug abuse and public health
The impact of drug abuse on
public health can be reflected in
terms of morbidity and mortality.
Besides narcotics, socially sanc
tioned drugs like tobacco and
alcohol are emerging as the major
public health issues. It has been
amply demonstrated that tobacco
use is a major factor in causation of
many diseases and deaths that
estimate between 6—10 lakhs in a
year. The relative risk among
tobacco users increases to many
folds for respiratory disorders,
cardio-vascular heart diseases and
cancer in different parts of the
body. Tobacco use during pre
gnancy increases the risk of abor
84
tions and health of unborn child
(premature, less birth-weight) etc.
According to ICMR report (5) there
were about 9 million smokers in the
country and the government was
bearing Rs. 1204 million per year
on treatment of respiratory and
other diseases.
Consumption of alcoholic be
verages and its associated physical
and social problems are equally
burdening the health care system.
The cause of concern is a steady
increase in per-capita consumption
of ethanol and proportionate rise of
problematic users/alcoholics. (One
out of 25 in comparison to one out
of 300 alcohol users in 60’s). The
excessive alcohol use has signifi
cant association with diseases/
disorders of liver, pancreas,
digestive tract, respiratory and car
diovascular systems. They are at
risk of mental disorders, injuries,
accidental poisoning, overdose and
road traffic accidents. The data of
Road Research Institute showed
that alcohol was one of the causes
in one-third of 50,000 RTA deaths
and disabilities. The mortality/
morbidity risks are high among
heroin users, as well as other drugs
like amphetamine, hallucinogens.
The combination of sedatives and
alcohol could prove fatal. The poly
drug use has its toll in respiratory
depression fatalities.
Implications
The above description shows
clearly that alcohol/drug related
violence and its adverse health con
sequences has manifold impli
cations. The gambit of prevention
of these problems lies to a great
extent within the realms of decision
makers, planners and programme
implementers. In recent years
alcohol and tobacco are syn-
onimised with economic develop
ment programmes and sources of
revenue. Prohibition of these may
not be a practical solution.
However, pragmatic approaches
are to be adopted in formulating
‘pricing’ policy, enforcement of
excise laws, sales regulations and
effective
implementations
of
stringent laws like Narcotic Drugs
and Psychotropic Acts, 1985. The
health sector needs further
strengthening towards manage
ment of alcohol/drug related crisis
situations (poisoning, suicide
attempts, accidents etc), and ade
quate provision for treatment ser
vices and after care. The changing
drug scenario calls for drug abuse
monitoring system and constant
surveillance against alien drugs.
The health education program
mes and public campaigns against
drug/alcohol abuse must incor
porate messages on association of
violence with drugs. The risk
situations and settings must be
identified. There is an urgent need
to strengthen social control mecha
nisms and networks to deal with
family violence, child abuse and
aggressive behaviour.
REFERENCES
1.
D. Mohan and HJC Sharma (1985).
Alcohol: Friend or foe. Impact of
Science on Society UNESCO, No.
133, 139—145.
2.
H.K. Sharma and D. Mohan (1989).
Tobacco an invisible foe. Shatayushi,
Oct, 91—95.
3.
Charles M. Evans (1986). Alcohol and
Violence. In Alcohol and Aggression
(Ed) Paul F. Brain, Croom Helm
London.
4.
JR. Tinkenberg (1973). Drugs and
Crime. Drug use in America, pro
blems in perspective. Washington
D.C. US Govl Printing office. Vol. I,
Part-2.
5.
ICMR (1990). Review Committee on
tobacco. New Delhi, (unpublished).
S WASTE HIND
HOUSING AND SETTLEMENTS
Dr Bhakt Prakash
A well-planned, low-cost housing improve the health of the community not so much
because of better accommodation but because of the amenities and facilities—water
supply, employment and education.
a billion
people lack. adequate
dwellings to protect them and pro
vide basic amenities and space for
family functions, and about a
hundred million people lack any
kind of dwelling at all. Makeshift
structured almost invariably fail to
guard them against extremes of
heat and cold; they are highly
vulnerable to flood, wind and
storms, and offer no defence
against noise, dust, insects and
rodents.
pproximately
A
The shortage of shelter in Rural
India is less visible and harder to
assess than in urban area. Esti
mates indicate that in 1981? the
total number of households were
125 million, while the “acceptable
housing stock” was less than 102
million resulting in a shortage of
23 million for both rural and
urban areas {Table I). This gap
(which should be considered an
under-estimate in yiew of the very
low “norm” adopted for accept
able housing) is expected to have
increased to 41 million by 2001
AD. Roughly two-thirds of this
shortage represent the very poor
shelterless and rest one-third by
low-income
groups. Presently,
they are living with some or other
kind of temporary housing.
Several factors have been iden
tified for achieving a substantial
March-April 1993
increase in shelter for the
poor. As the cost of the land is
out of the reach of the poor, alter
native means of providing sites as
well as services need to be
found. Conventional
building
materials should be made avail
able at low cost, innovative alter
natives need to be promoted using
traditional
materials
and
modem technology.
Million Houses Programme in
Sri Lanka is the classical example
in helping socially and econo
mically neglected people to have
decent houses. The government
of Sri Lanka is providing financial
aid to each family. This is poss
ible due to self-help, community
participation and strong political
will. In 1984 alone, 42,213 rural
families were given shelter com
prising of upgraded houses with
latrines in 50% of cases and new
houses with latrines in 31%
cases. The cost to the govern
ment is US $ 202-212 per family
(Tennakon, S. 1988).
Million Houses Programme has
demonstrated that it can bring
progress and development, and
create a friendly and wholesome
living environment
Yet while studying 6 cities of
South-East Asia it is concluded
that it is unrealistic for large coun
tries to expect to solve the housing
problems in present decade
because of alarming rate of popu
lation growth ~and rapid increase
in slum and squatter areas.
In India, some ill-conceived
slum
upgrading
and
slum
improvement programmes have
left the poor in a worst state than
before. Forced movement to a
different site means social disrupt
tion, and often greater distances
from work places and higher
transport cost and waste of
time.
This is not to deny the contribu
tion that housing can make. A
well-planned, low-cost housing
improve the health of the com
munity not so much because- of
better accommodation but be
cause of the amenities and
facilities—water supply, sanita
tion, employment and educa
tion.
Shelter, water and sanitation are
fundamental to health
Shelter, clean water and sanita
tion are fundamental to health.
According to Government of India
estimates, in 1981, only 25.1 per
cent of urban population and only
0.5 per cent of the rural population
had access to basic sanitary
facilities. Even though, the septic
tank was introduced in India
85
about 200 years ago and sewage
some 50 years later, relatively few
houses even in the urban areas
have benefited
from
those
systems.
Studies by the All India Institute
of Hygiene and Public Health
(AIIHPH), Calcutta have revealed
that age specific death rates due to
gastro-intestinal disorders showed
a mark decline with the introduc
tion of water-flush latrines with
safe disposal of excreta. While
safe disposal of waste water and
garbage are major sanitary pro
blems yet to be tackled, proper dis
posal of excreta deserves the first
attention in view of the human
and health implications.
In the. Indian context, another
experience of relevance to the
poor has been community toilets
complexes with bathing and wash-
Shortage in shelter
in million
1981
1986
1991
1996
2001
(i) Total households
(Rural***adjusted urban)
124.8
141.4
160.6
183.0
209.2
(ii) Total housing stock
116.7
131.5
148.8
168.8
192.6
(iii) Acceptable housing stock
101.5
114.4
129.6
147.1
1682
(iv) Housing gap
233
27.0
31.0
35.9
41.0
S. No.
Source: National Building Organization.
ing facilities—for the use by those
who do not have space for
individual
household
lat
rines. These have functioned on
a “pay and use” basis, helping
proper maintenance and con
tinuous operation.
What can be done?
The objective of the health-forall could be powerfully served if
health values were integrated into
the efforts of families and com
munities to improve the con
ditions and use of their houses.
The health* sector cannot by
itself solve the problem of inade
quate housing. But its mission
requires it to serve as adequate
norm setter, teacher, and agent for
development actions that will help
to meet people’s needs.
4
Health and development: inseparable partners
Health is an essential objective of development. The capacity to develop is itself dependent on
health. These two aspects of health and its links with development are now emerging with greater
Force and clarity. Health status cannot be traded off against economic gain. There is a better
understanding of the crucial contribution of health to economic activity, to improvement of the,
human condition and, through these, to all the processes of development.
The achievement of
appropriate health objectives is therefore an important measure of the effectiveness of
development strategies.
—Health dimensions of economic reforms.
World Health Organization, 1992, p. vii.
86
Geneva,
Swasth Hind
ACCIDENT PREVENTION
—Role of the Community
Dr Manjit Singh
A safe life is the basic right of everyone. Safe life leads to a longer and more pro
ductive safe community. Safe community can participate in injury reduction
programme.
HE theme
for
the
World
Health Day—7 April 1993 is :
T“Accident
Prevention”.
falls, poisons, fires, suffocations
and chemicals.
The slogan is :
“Handle Life With Care:
Prevent Violence and Negli
gence”.
Most of the household accidents
can be
minimised/prevented.
How?
There occurs a death every fifty
seconds and injury due to accidents
every two seconds in the world as
per records. Accident is becom
ing one of the major causes of
death after communicable dis
eases,
cancer
and
cardiac
diseases.
“Life is precious, save it” is a
cpmmon saying.
World Health Day is observed on
7th April every year to make people
aware of one of the existing health
problems, mobilise the community
for their own problem and they
take part in removing/minimizing
the problem. It holds true in the
case of accidents, too.
‘Accident’ literally means an
“event without a cause”. Ac
cidents recurrence can be mini
mised by learning more about it.
Accidents can take place at house,
workplace* or community places.
Household accidents are mainly
due to electric appliances, stoves,
March-April 1993
Preventive Measures
Use good quality shock proof
electric appliances;
(b) Use closed stove cooking;
(c) Old people and children
should be escorted to
minimize the risk of meeting
accidents in the form of falls/
suffocations or poisons.
(d) Chemicals should be stored
and kept in special containers
so that children do not have
access to these products.
(a)
(e)
Medicines should be stored in
child resistant containers and
kept away from the reach of
children.
Accidental poisoning in children
is 100% preventable. Accidents
occur only when child is unattended/unsupervised even for a
moment. Toddlers are at risk of
accidental poisoning as anything
they come across theyput it in their
mouth; they should therefore never
be left unsupervised even for a
moment
The household poisoning may
be intentional, too. It is com
monly seen in the adults in the
form of suicides by swallowing pes
ticides and equally toxic substan
ces. In the case of children this
may be unintentional. The com
mon household products, for
example, are detergents/bleaches,
pharmaceuticals, and paints which
are less toxic than the chemicals.
Chemicals have been developed to
be used in the form of preser
vatives, manures to increase food
supply, or to store food pro
ducts. These may lead to illness
or even death, if used im
properly.
Chemicals in the form of phar
maceuticals stocked at home
increases the risk of exposure to
these chemicals. Negligence in
their use can lead to accidental
poisoning.
Safety of Each is the Responsibility
of All
In India, lives lost as a result of
accidents are four ties more than
that of cancer deaths. Accidents
.taking place at workplaces may be
in industrial set-ups or agri
cultural sector.
(i) Industrial Sector: Accidents
at workplaces can be minimized by
87
“conscious, careful colleague”
practising and adopting, the
maxim, “Safety is first”. Possible
hazards that could take place
should be displayed at prominent
places in the industrial house.
Safety manuals/literature related to
equipmcnt/machines
used
at
workplace should be known to
every worker.
Location of
emergency exit/fire fighting equip
ment should be displayed and
made available in case of the even
tuality taking place. Worker must
be aware of the alert signal/all clear
signal. Accidents at workplaces
can be minimized by:
(a) Knowing the work habits/
practice of the employees;
(b)
Knowing the work environment/conditions in or around
workplaces and making the
workers
to
use ' safety
measures and footwears.
(c)
Protecting eyes and res
piratory tract by using mask
and glasses. Many accidents
take place due to ignorance/
inadequate knowledge about
disposal of or handling the
industrial wastes.
In the event of an accident, the
first consideration should be
towards the comfort and treatment
of the injured. Questions should
only be asked after the injured has
received treatment and is comfor
table. There should be an attempt
to fact-finding and not fault
finding. Sarcasm or any attempt
to blame people leads to
withdrawal of community support
and a setback in the preventive
measures. Pertinent facts should
be secured from the witness at the
accident site. Discuss accident
with the injured only after treat
ment and favourable circumstan
ces. Encourage him to contribute
ideas to prevent accidents.
(ii) Agriculture: Accidents
at
agriculture workplaces are com
88
mon. Chemicals used in agri
cultural
sector
are
mainly
pesticides which are neurotoxic
and result in most of the deaths
taking place as a result of mishan
dling or intentional suicides.
Ignorance or negligence in the use
of electrical appliances pr auto
mobiles also add to deaths taking
place in the agricultural sector.
(iii) Community : 12 to 22% of
hospital admissions are linked to
injuries and most of these injuries
are as result of accidents taking
place on the roads, play grounds,
religious places, fair (melas)/
bandhs/rallies.
Road accidents during night
have a direct relation to alcohol
consumption. Driving,
mixed
with drinking, is directly propor
tional to road accidents. Level of
alcohol in the blood has direct
relation with the risk of injuries.
One gram increase of alcohol in
blood increase the risk of injuries
to 23 times.
Alcohol
production
has
increased manifolds all over the
world in the last three decades.
Over-drinking induces a drunkard
to hurt himself by having a fall,
sustaining injuries by developing
over-confidence. Social problems
related to over-drinking are mari
tal discords, hurting, spouse,
neglecting children, absenteeism
leading to poverty and other com
plications.
Alcoholics may
develop cirrhosis of liver, which
results in 20% alcoholic deaths.
Violence in Societies
Violence is on the increase in
the society and has become a blot
on the humanity. Teen-agers have
more inclination towards the
materialistic side of the society
and have not much of access to
the resources. They attempt'theft/
stab/poison or murder a person .to
meet their demands.
Urbanization, drugs, crimes,
overcrowding, unemployment are
the contributing factors towards
increase in violence. Violence is a
public health problem. According
to Dr. Mark Rosenberg, a U. S.
epidemiologist:
(a) Family violence is becoming
a problem which is resulting
towards increase in homi
cides, suicides, acts of
violence
and
induced
deaths.
(b) Child
abuse
reflected
through suicides, murder,
rape, bullying in the schools
is another alarming sign
which should be taken
care.
(c) Sexual abuse—another form
of childhood violence can be
prevented. It is seen that a
child abused turns into a
child abuser which should be
stopped.
Conclusion
A §afe life is the basic right of
everyone. Safe life leads to a lon
ger and more productive safe com
munity.
Safe community can
participate in injury reduction
programmes.
Community par
ticipation can be sought at
(i) Workplaces through labour
unions minimizing or preventing
hazards at workplaces by provid
ing better amenities to the
workers.(ii) Academic institutions, stu
dents and faculty 'participations
through curricular development
and providing safer environ
ment
(iii) Religious functions through
free talks by religious leaders and
people to come forwrd and par
ticipate in safety programme in
day-to-day life supported by
media in the form of newspapers,
radio, T. V.
and
published
material.
For prevention of road accidents
1 Do not mix driving with
drinking. This slogan should
be displayed all along the
highways.
,2. Avoid too long a stay on
wheels without rest.
3. Badly disigned/badly lit/
badly managed/badly de
signed roads lead to more
road accidents. This should
be given due care/proper
attention.
SWASTH HIND
NEWS
form of cancer while in countries such as Egypt it has
become relatively common.
UK TRIALS FOR FIRST ANTI-CANCER
VACCINE
The UK Imperial Cancer Research Fund (ICRF)
says men with breast cancer may not be receiving the
best treatment because there has never been any
clinical trials for the male version.
The first vaccine designed to protect people
against cancer is expected to be ready for clinical
trials in a year’s time.
Scientists at the Paterson Institute in Manches
ter, north-west England, have developed the vaccine
against the common Epstein Barr virus (EBV), which
is strongly linked to at least three types of cancer—
Hodgkin’s lymph gland cancer, nasopharyngeal
throat cancer and Burkitt’s lymphoma, a cancer of
the jaw in children. Glandular fever could also be
eliminated b’acause it too is caused by EBV.
The new vaccine, produced by the Manchester
institute’s Drs John Arrand and Mike Mackett in
collaboration with scientists in two other UK centres,
is based on a protein found on the membrane that
surrounds the EBV virus. This can stimulate the
body’s natural defence system and enables it to
recognise infection by the virus proper and
destroy it
The two doctors have devised a way to produce
the protein both efficiently and safely by using
genetic engineering techniques. Experiments have
shown that injection with the purified protein pro
duces antibodies against EBV.
The first trials will check the vaccine’s safety,
using about 20 volunteers, and will be followed by a
larger clinical trial to test the vaccine’s
effectiveness.
Dr Arrand, a molecular biologist, commen
ted: “If the patient trials repeat the success of the
laboratory work, this vaccine has the potential to pro
tect millions of people throughout the world from
often fatal EBV-related cancers.”—Medical News From
Britain
TRIALS CALL
CANCER
FOR
MALE
BREAST
Doctors in London are calling for an investiga
tion into breast cancer iri men.
Until now, breast cancer has been regarded as a
traditional female problem, but there is evidence that
men are also becoming victims of the disease. In
Britain, 170 men a year are diagnosed as having this
March-April 1993
The fund’s breast cancer unit at Guy’s Hospital
in London now believes there is a need for male
breast cancer to be studied seriously with a trial to
find the most effective form of treatment.
The survival rate of men suffering this cancer is
currently 60 per cent, but ICRF says more could be
saved if they had not waited for an average of 18
months . after finding a lump before seeking
help. Men are said to wait so long because they are
unaware they can get breast cancer or are
embarrassed at having what is normally a female
disease.
Men are treated in much the same way as
women with a variety of surgery, radiotherapy and/or
drugs. However, they mostly have a mastectomy
because the tumours usually appear near or under
the nipple, and because there is less breast tissue.—
Medical News From Britain
£1 MILLION BRITISH AID FOR CANCER
CARE IN INDIA
LONDON, March 1—A cancer care project in
Gujarat, India is to receive £1 million in aid from the
Overseas Development Administration. The project
aims to provide access to cancer care for *1.5 million
women and nearly 5 million men in five districts by
1996-97.
The three-year project will focus on improving
the performance of the Gujarat Cancer Research
Institute in Ahmedabad. It will enhance its com
munity outreach programme for providing cancer
care services for the prevention, early diagnosis and
effective treatment of cancer.
The institute is the only large cancer centre in
the State of Gujarat, which has a population of 43
million. The incidence of breast and cervical, can
cers in women and oropharyngeal (mouth and
throat) cancer in both sexes is rising, particularly
among rural and tribal populations. The emphasis
of the community outreach programme will be on
prevention and early detection in the most disadvan
taged districts.—BIS.
89
COMMUNITY MANAGEMENT IS AN
APPROACH, NOT A FORMULA
Communities have a role to play in the manage
ment of improved water supply systems, but com
munity management is an approach, not a
formula. This was one of the key findings from an
international workshop held at IRC from 4-10 Novem
ber 1992, which reviewed community management
experiences from the field.
Community management can take many forms,
and can reflect a* wide range of “balances” between
community and agency contributions. Whatever the
balance, however, it requires in all cases a substantial
resource input from the community. It also requires
a continuing partnership between communities and
agencies, and communities and other supporting
partners (including the private sector and, very impor
tantly, other communities).
The workshop brought together field-based pro
fessionals and representatives from UNICEF, WHO,
the Water Supply and Sanitation Collaborative Coun
cil, the Directorate-General for International
Cooperation (DGIS) of the Netherlands, and
IRC. Nine of the participants are working in projects
and programmes in the field which are seeking to
develop strong elements of community manage
ment.
Seven community management case studies
were reviewed at the workshop, and additional back
ground papers were provided by IRC and the UNDP/
World Bank Water and Sanitation Program. Case
studies were presented from: Aqua del Pueblo,
Guatemala/Unit for Marginal Barrios of the National
Water and Sanitation Agency (UEBM/SANAA),
Honduras/Aga Khan Rural Support Programme,
Pakistan/Pan African Institute for Development
(PAID), Cameroon/CARE, Indonesia/UNICEF,
Uganda/Support Rural Water Supply Department
Project, Yemen.
KEY FINDINGS
Community management means “putting the community
in charge”.
The workshop avoided an over-specific definition as
this was considered to be too limiting. Community
management is an approach which has certain defin
ing characteristics which distinguishes it from other
approaches, including a relationship based on
partnership between the community and agency.
Community management is something new and
different.
While it has important continuities with, and builds
upon, approaches based on community participation,
90
it has new and wide-reaching implications for both
communities and agencies. Supporting community
management certainly will not mean less work for
agencies. It means a different direction, moving from
provision to facilitation, and demands work of
higher quality.
Many communities arc demonstrating a genuine willing
ness and capacity to take on management roles.
Under the right conditions, community management
works very well. Many communities have consider
able capacity,if properly supported, motivated, and
assisted, to develop suitable tools and methods.
Community management not only helps to solve water
and sanitation problems but can also create an environ
ment for broader developipent benefits.
Putting the community in charge can help solve pro
blems such as the covering of recurrent costs and sus
taining system reliability. It can also build capacity
and confidence for wider development efforts, both
within and beyond the water sector.
Community management not only addresses issues of
sustainability but can also be a way to involve more com
munities in water and sanitation improvement pro
grammes.
The taking up of a larger share of responsibility by
communities frees supporting agencies to move for
ward in supporting more communities, without having
io constantly go back to maintain older systems.
In building up the community management approach,
new indicators are required to recognize and reward the
“process” inputs and outputs which are essential to
its success.
Many agencies in the field are trying to set in motion
process-based approaches which are less easy to
measure than technical outputs, like numbers of wells
installed and so on. Governments and funding agen
cies may contradict these efforts if they continue to
confine themselves to conventional progress in
dicators, and do not reward efforts towards building
' capacity through less tangible processes. New tools
and methods are required to monitor, measure,
recognize, and reward such work.
Advocacy at all levels is required to support the further
development of the community management
approach.
The full meaning and* implications of taking up and
supporting a community management approach must
be clearly spelled out and communicated at all levels,
from the community to global levels. This is essential
io allay fears and misconceptions, and also to support
ihe establishment of appropriate policy and legal
frameworks necessary to create an “enabling environ
ment” in_ which community management can
flourish.
—IRC Newsletter Nov. 1992
Swasth Hind
MORE THAN HALF OF ALL PREGNANT
WOMEN SUFFER FROM ANAEMIA
More than half of all pregnant women suffer
from anaemia and so do a third of non-pregnant
women of reproductive age according to a WHO report
released during March in Geneva. On the evidence
of more than 500 studies worldwide, the report reveals
that anaemia is one of the most widespread, and most
neglected, nutritional deficiency diseases in the world
today. Anaemia affects mainly women, especially
during their reproductive years, and is particularly
severe in those who are pregnant or breast
feeding. In parts of the developing world such as
Southern Asia, three quarters of pregnant women are
anaemic, compared with 17% in Northern America
and Europe, the report, “The prevalence of anaemia in
women” says.
In worst affected parts of the world, 5% of women
suffer from severe anaemia, and may die of heart
failure. As many as four women in ten are less
severely affected but have chronic fatigue. They face
higher risks of death during pregnancy and
delivery? Anaemia is a contributory factor in many of
the 500,000 deaths which occur each year due to com
plications of pregnancy and childbirth, according to
WHO. While a normal healthy woman can survive a
blood loss of one litre or . more during childbirth, for
anaemic woman even the normal blood loss of 250 cc
can be fatal. Anaemic women have lowered resis
tance to infection and are at greater risk of com
plications as result of anaesthesia and surgery.
“No woman should approach the end of pre
gnancy with a haemoglobin level below 11 g/dl,” states
Dr Tomris Tiirmen, Director of the WHO Division of
Family Health.. “In practice, not only do many
women start their reproductive years with inadequate
iron stores, but also, because of closely spaced pre
gnancies they have little time to build up their
haemoglobin levels.” Each pregnancy makes them
more vulnerable to serious ill health and death.
Even mild anaemia is a debilitating condition that
reduces resistance to infection and leaves the woman
weak and breathless after slight exertion. Where
women face the daily task of carrying water and fuel,
and taking goods to market, and where they are the
mainstay of the family, anaemia puts a break on social
and economic development
In anaemia, the haemoglobin content of the blood,
which carries oxygen to the body’s cells is less than
11 g/dl. In the early stages there may be no symptoms
but as haemoglobin concentration continues to fall
oxygen supply to vital organs declines and there is a
feeling of general weakness, tiredness, dizziness and
headaches. Eventually the tissues of the body
become starved of oxygen. The common belief that
anaemic women are pale is only partly true. In fact
noticeable pallor is not apparent until the anaemia is
severe, at less than 7 g/dl.
March-April 1993
Most anaemia is a result of shortage of one or
more vital nutrients, iron, folic acid, vitamins, trace
elements and protein. This can arise from low intake,
poor absorption, chronic blood loss or increased
demands. In many cases nutrient intake is low sim
ply because food intake is low. In addition to those
who go hungry, millions more suffer a lack of specific
nutrients. Women are particularly vulnerable where
their status is low and throughout their lives they eat
last and eat least
Women are more vulnerable to anaemia because
their needs for iron are greater. From puberty until
the menopause they have a high demand for blood
forming. nutrients. An adult man needs a daily
amount of 1.1 mg of iron, compared with over twice as
much for a woman, even when she is not pre
gnant During pregnancy, growth of the fetus and
placenta, and the larger amount of circulating blood in
the expectant mother, lead to an increase in the need
for nutrients, especially iron and folic acid.
Iron absorption is hindered where unrefined
cereals form a large proportion of the diet and by drink
ing tea or coffee with the meal. The problem of nut
ritional anaemia is compounded in many areas by
tropical diseases such as malaria, and parasitic infes
tations such as hookworm, which increase both the
incidence and severity of anaemia.
“The situation is all the more alarming because
anaemia is almost entirely preventable” says Dr Turmen. The long term solution is to ensure adequate
nutrition for girls and young women before they
become pregnant. Women need to eat red meats or
dark green leafy vegetables and dried beans together
with tubers or fresh fruits. They should avoid tea or cof
fee with meals. But it will take a long time to get this
message through to all the women in the world, and
their menfolk, and to change entrenched dietary
habits.
A more immediate and cost-effective solution is
to give all pregnant and lactating women oral iron sup
plements. Research is under way to identify effective
ways of so doing and to overcome problems of unplea
sant side effects which iron tablets may cause. WHO
is working with its many international partners to sup
port such research, to intensify health education and
comniunity involvement in preventing, detecting, and
managing anaemia. Fortification of various foods
with iron is an alternative approach. Equally impor
tant is the need to ensure that women eat a varied diet,
rich in essential nutrients.
Women who have many children, too early and
too closely spaced are at particular risk. Providing
access to family planning methods can help to prevent
anaemia and contribute greatly to improving
women’s health.
“Women hold up half the sky” a Chinese pro
verb says. Working to combat anaemia is an essen
tial support that the world community can offer
them.
— WHO
91
Book Review
Hospitals and the
Health Care Revolution
In nine chapters, this book provides a lively and
compelling account of several major events that are
beginning to revolutionize the way the world looks
after the health of its people. Focused on the place of
hospitals in this health care revolution, the book uses
numerous examples and case studies—from hospitals
in New York City to health units in Bangkok—to illus
trate how changing times and changing circumstances
are revolutionizing the ways in which doctors relate to
patients and hospitals treat their customers.
Throughout the book, an effort is made to help readers
understand how certain specific changes, whether
introduced by design or by force of circumstance, are
now converging to form a noble, humanitarian, and
momentous revolution in health care and world
over.
., .
The opening chapters characterize the main
features of this health care revolution and track its his
torical origins. Readers arc then introduced to the
ideology of the revolution, with chapters explaining
how hospital and primary health care services are
becoming increasingly interrelated and why a system
of care based in health districts needed to be
established. Using anecdotes, examples, and striking
illustrations, the authors portray the role and functions
of the hospital at the first referral level, discuss health
programme coordination, education and training, and
outline requirements for management and administra
tive support. A chapter devoted to the district health
system explains exactly what constitutes such a system
and why it should be considered as essential to the sort
of health care revolution that can -make sustained
improvements in the health of humanity.
Arguing that the new type of hospital is a complex ven
ture requiring good organization, the remaining chap
ters tackle the practical problems of implementation,
discussing the organizational and functional integra
tion of services, questions of attitudes, orientation and
training, and the need for information, financing and
referral systems. The book concludes with a sum
mary of the aims of the health care revolution, the
extent to which these aims have been achieved, and a
guess at where the future will lead.
As inspiring as it is instructive, as readable as it is
convincing, the book will make fascinating reading for
anyone interested in seeing how mankind’s desire for
social equity, its hatred of injustice, and its wish to help
the sick and disadvantaged are finding expression in
an exciting movement to which hospitals the world
over are making a major contribution.
Hospitals and the Health Care Revolution
by L.H.W. Paine and F. Siem Tjam
World Health Organization, 1988
iv+114 pages, (available in English; French and
Spanish in preparation)
ISBN 924 156116 5
Sw.fr.20.—/US $ 16.00
Order no. 1150304
WHO • Distribution and Sales • 1211 Geneva 27 • Switzerland
AIDS Can Spread By
—
SHARING
BLADES & OTHER SHARP PIERCING OBJECTS LIKE TATTOOING NEEDLES
—
DRUG INJECTION NEEDLES
—
TOOTH BRUSH
—
INFECTED BLOOD & BLOOD PRODUCTS
(Contributed by Dr. S. K. Sattfa
and Dr. Maiyit Singh)
92
Swasth Hind
ESSENTIAL
DRUGS: ACTION
GRAMME A PRIORITY
PRO
Meeting at WHO in Geneva on 23 and 24 Feb
ruary 1993, the Management Advisory Committee of
the WHO Action Programme on Essential Drugs
reviewed the activities of 1992 and approved a US S
28 million budget for 1994-1995. The members, rep
resenting 25 countries, a dozen international and
nongovernmental organizations and the phar
maceutical industry, applauded WHO’s reaffirmed
commitment to the promotion of essential drugs as a
means of improving health care and establishing
greater social equity.
Authors of the Month
Dr P. K. Khosla
Chief & Prof, of Ophthalmology
Dr. Rajendra Prasad Centre for
Ophthalmic Sciences
All India Institute of Medical Sciences
Ansari Nagar
New Delhi-110 029.
Maxwell Pereira
Deputy Commissioner of Police (Traffic)
Delhi Police Headquarters
Indraprastha Estate
New Delhi-110 002.
Dr (Mrs) Rckha Thakrc
Scientist
and
Dr A. Kumar
Scientist
APC Division
and
Dr A. L. Aggarwal
Half the inhabitants of our planet have no
access to the most basic drugs and 75% of the world's
population consumes less than 20% of the drugs on a
market recently valued at around 170 thousand
million* US dollars. The Action Programme on
Essential Drugs was set up a decade ago in the wake
of the Alma-Ata Conference and in the light of the
health-for-all strategy, which is still the cornerstone
of the activities of WHO, notwithstanding certain
adjustments dictated by global upheavals. The Pro
gramme is intended to help countries improve access
to essential drugs for their people, and to ensure the
rational use of such products.
In his opening address, Dr Hiroshi Nakajima,
Director-General of WHO, recalled that 16 years ago
he was personally involved in developing the concept
of essential drugs. He praised the donors who had
contributed to the development of the Pro
gramme.
Sixty-four developing countries now have their
own essential drugs programmes, and 28 others are
in the process of developing such programmes.
Dr Fernando Antezana, Director of the Action
Programme on Essential Drugs, pointed out: Since
its establishment, the Action Programme has pre
pared a Model List of Essential Drugs, which now
contains nearly 270 products, covering most health
needs. Since many of those products are no longer
under patent, they can now be produced by different
manufacturers, with due regard for quality control
and at reasonable cost. This is essential if they are
to be accessible to the greatest possible number of
people.—WHO Press
Scientist
and
Ms P. S. Rao
Scientist
APC Division
National Environmental Engineering
Research Institute
Nehru Marg
Nagpur-440 020
Madhya Pradesh.
Dr A. C. Urmil
Professor (PSM)
and
Dr P. A. Somaiya
Professor (PSM)
and
Dr A. C. Magdum
TUtor (PSM)
Krishna Institute of Medical Sciences
Karad (Distt. Satara)
Pin-415 110
Maharashtra.
K. Balan
Puthiyadath Tazha Kuniyil House
Chokli P.O. 670 672
Via—Tellicherry
Cannanore Dist.
Kerala.
Dr Bhakt Prakash
Asstt. Professor
Department of Social and Preventive Medicine
S.N. Medical College
Agra
Uttar Pradesh.
I I. K. Sharma
Sr. Research Officer
De-Addiction Centre
Department of Psychiatry
All-India Institute of Medical Sciences
Ansari Nagar
New Delhi-110029.
Dr Manjit Singh
Chief Medical Officer (Training)
Central Health Education Bureau
Kotla Road
New Delhi-110002.
M. S. Dhillon
Sr. Sub-Editor
Central Health Education Bureau
Kotla Road,
New Delhi-2.
ISSUED BYTHE CENTRAL HEALTH EDUCATION BUREAU (DIRECTORATE GENERAL OF HEALTH SERVICES). KOTLAMARG,
NEW DELHI-110.002 AND PRINTED BY THE MANAGER, GOVERNMENT OF INDIA PRESS, COIMBATORE-641 019.
No. D—-(C) 359
■. R«a- n°- m-n- ««?—;
PREVE
HEALTH D
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