UNCONTROLLED URBANISATION : A MATTER OF GLOBAL CONCERN
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COMMUNITY HEALTH CEU
326, V Main, I Block
Koramhngala
y
Bangalore-560034 '
India
In this issue
swasth hind
Jyaistha-Asadha
Saka 1915
June 1993
Vol. XXXVTl', No. 6
Page
Uncontrolled urbanization:
global concern
Swasth Hind (Healthy India) is a monthly journal
published by the Central Health Education Bureau,
Directorate General of Health Services, Ministry of
Health and Family Welfare, Government of India,
New Delhi. Some of its important objectives and
aims are to:
REPORT and interpret the policies, plans, pro
grammes and achievements of the Union Ministry
of Health and Family Welfare.
ACT as a medium of exchange of information on
health activities *,of the Central and State
Health Organisations.
FOCUS attention on the major public health pro
blems in India and to report on the latest trends in
of
125
Growing
129
sustainable
134
matter
Dr (Col) A.C. Urmil
Dr PA. Somaiya
Dr. A.K. Urmil
Health and
Challenge
OBJECTIVES
A
Environment:
Population, environment
society
Dr S.C. Gupta and
Dr Deoki Nan dan
The
and
Protecting environment—everyone’s duty
137
Air pollution—a serious health risk in some of
the world’s biggest cities
139
Health problems with fluoride in water: a
reality
Dinesh Chand
141
Community and environment
145
Dr Manjit Singh and
Harbir Kaur
public health.
A universal environmental ethic: The ultimate
goal of environmental education
147
KEEP in touch with health and welfare workers
and agencies in India and abroad.
Launching the environmental revolution
153
REPORT on important seminars, conferences,
discussions, etc. on health topics.
Environmental terminology
155
Health services in urban slums1—need for a
micro-planning approach
Dr A.T. Kanan, Dr S. Venkatesh and
158
The Sth June is observed as the World Environment
Day since 1972 as designated by the United Nations
Organization. Each* year, since then, the World
Environment Day focusses people’s attention
towards protection of our environment.
Swasth Hind devotes this Issue to the World
Environment Day with a focus on Health and
Environment: The Growing Challenge.
Editorial and Business Offices
Central Health Education Bureau
Kotla Marg, New Delhi-110 002
Lester R. Brown
Dr K Pandit
Articles on health topics are. invited for publication in this
Journal.
State Health Directorates are requested to send in reports of
their activities for publication.
The contents of this Journal are freely reproducible.
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
in for publications.
Edited by
Assisted by
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M. S. Dhillon
G.B.L. Srivastava
Cover Design
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Madan Mohan
O.P. Kataria
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UNCONTROLLED
URBANISATION :
A matter of global concern
Dr (Col) a. c.urmil
RBANISATION has been rightly
described as one of the most
characteristic features of the 20th
century. The unimaginable fast
pace of unplanned and uncon
trolled urbanisation has already
become a matter of global con
cern. A direct consequence of
Population Explosion, it is already
being referred to as “Urban Crisis”
and “Urban Explosion”. Like
U
“Population
Explosion”
the
“Urban Explosion” is therefore a
self-inflicted malady which the
mankind has brought upon itself.
Consequently, numerous problems
are becoming more and more dif
ficult to tackle with the existing
resources. An unpredictable in
flux of migrant population from
rural to urban areas in search of
means of livelihood, is also respon
sible for this crisis. The urban
authorities and local bodies are
finding it extremely difficult to
solve this problem due to several
constraints. As a result, slums
and shanty towns have been crop
ping up at an unbelievable,
unprecedented rate. Besides this,
the migrant population have also
JUNE 1993
Dr p. a. Somaiya
dr a. k. urmil
The fast pace of uncontrolled urbanisation or “urban crisis”
portrays a gloomy picture at present. It is already being
regarded as a problem of growing international concern since
there is no single/simple solution in sight.
been using roadsides, pavements
and footpaths for their temporary
shelter. The fast pace of urbanisa
tion, in its wake, has given rise to
problems of housing, transport,
health and medical care, water sup
ply and sanitation, education and
other public services, environmen
tal pollution and also psycho
social problems leading to dete
riorating law and order situation.
A study carried out by the Po
pulation Crisis Committee (PCC),
a USA based voluntary organiza
tion, devoted to promote family
planning, reveals that in respect of
more than 50 per cent of the cities
studied all over the world, the pro
blem of urban population explo
sion has surpassed their capacity to
tackle it effectively since their pop
ulation is getting doubled in every
12 to 20 years. A recent study by
Habitat shows that even the local
bodies like municipalities are now
finding it increasingly difficult to
ensure proper disposal of garbage
(75% of total solid wastes) collected
from households with the result
that most of it is being dumped
openly leading to insanitary con
ditions favouring breeding of many
disease vectors. It creates nui
sance by attracting birds and
animals including stray dogs and
by producing foul odour while
undergoing decomposition. Be
sides garbage, the proper disposal
of other community wastes—sul
lage, sewage, human and animal
excreta etc—is also becoming more
and more difficult Cities in the
developing world are the worst
affected. According to WHO, it
has already become a major
challenge for “Health for All” by
2000 AD since according to current
projections, 50 per cent of the
125
world’s population will be living in
urban areas by the turn of the cen
tury. There will be 60 megacities
of over 5 million population each,
of which no fewer than 45 will be in
the developing world, compared
with just one in 1950. Population
projections (based on population
size in 1985) for the year 2000 in res
pect of world’s 49 largest cities indi
cate that 24 of them will cross 10
million mark. This includes 3
Indian cities also, namely Calcutta
(15.94 million). Greater Bombay
(15.43 million) and Delhi (12.77
million). At the beginning of the
19th century, only 3 per cent of the
world’s population
lived
in
towns. By the beginning of the
next century, more than half will be
living in cities. More than 1000
million men, women and children
are now living in shanty towns
where living conditions and
hygiene are appalling. Urban
poverty is consistently on increase
and likely to outstrip rural poverty
in next 10 years time. The mean
salary has already gone down by at
least 25 per cent in many develop
ing
countries. Although
the
demand for health care has never
been so high in the past and is con
sistently on increase, the health
costs are getting covered less and
less. More than 50 per cent pop
ulation of the Third World cities is
living in conditions of obvious
poverty. The proportion in Africa
is 70 per cent and likely to get worse
in future. The improvement in
health and nutritional status in res
pect of these populations has either
slowed down or totally stopped in
many African and Latin American
countries. UNICEF has already
126
warned that millions of children
among these populations who are
growing up today under such hor
rible conditions, are not going to
realize their full mental and physi
cal
potential. Among
these
children,
diarrhoeal
diseases
account for 25 per cent deaths in
the
least
developed
coun
tries. Respiratory infections and
malnutrition, the 2 major causes of
morbidity and mortality in young
children, have become part and
parcel of life in urban fringe
areas. With increasing urban
poverty, the situation is not likely to
improve—may become worse.
The population of aged people is
also registering an increase in
urban areas. There are 300
million people aged 65 and above
in the world today. In the next 10
years time, their number is going to
surpass 400 million mark. It has
been projected that by 2025 AD, 70
per cent of them will be living in the
developing countries, a majority of
them in the urban areas, where they
will be facing deplorable living
conditions, struggling for survival,
looking for employment in the
absence of any guarantee of their
social
security
and
family
support.
New area of Concern
A new area of concern is also
emerging due to poor residential
environment in the urban areas.
New or previously unknown dis
eases such as Legionnaire’s disease,
are now coming to light. Room
humidifiers, air ventilation sys
tems, cooling towers as well as hot
and cold water supply ducts have
been found to nurture Legionella
bacteria and transmit them
throughout the indoor, environ
ment or discharge them into the
immediate vicinity of buildings.
Disheartening Urban Scenario
As regards India, the fast chang
ing urban scenario is also dishear
tening. Slum areas and shanty
towns are cropping up at un
precedented rate with no prospects
of control or proper planning in
future. Although
a
Supreme
Court judgment of 10 July 1985,
empowered the civic administra
tion from 01 Nov 1985 to removfe
encroachments on public places, it
has not helped much since people
displaced from one area have no
option than to settle down in some
other new area where this problem
again comes up. As a result, half
of the population of Bombay con
tinues to live in slums. During
1985, nearly 78 per cent of the
families were found to be living in
single room tenements and sharing
a lavatory. Bombay still has the
dubious distinction of housing
more than 40,000 people in Asia’s
largest slum-Dharavi. However,
the problem is not peculiar to Bom
bay alone. It has already afflicted
all major/mega cities and even
towns of our country. Madras was
supposed to be having 21.08 lakh
slum dwellers, Ahmedabad 11.33
lakh, Hyderabad 11.12 lakh,
Bangalore 10.37 lakh, Kanpur
8 lakh, Pune 5.15 lakh and
even a relatively small city of
Bhubaneshwar about 30,000 slum
dwellers during 1990 according to
one official estimate. Provision of
housing to solve this problem is a
Swaste Hind
formidable task due to increasing
financial constraints. Even con
struction of 16.2 million targetted
housing units during the 7th Five
Year Plan, ata minimum cost of Rs.
30,000 per unit required an invest
ment of Rs. 486 billion for this pur
pose alone!
Environmental health problems
Several environmental health
problems are intimately associated
with urban growth. Air pollution
has assumed an alarming increase
in several cities around the
world. According to the World
Watch Institute of Washington DC,
engaged in environmental re
search, mere breathing of air in
Bombay now equals to smoking of
10 cigarettes per day. Every day in
Bombay, over 1200 metric tonnes of
pollutants are released by vehicles
which is 60 per cent of the total load
of pollutants. The annual cost of
treatment of pollution related
ailments in Bombay has been
worked out at Rs. 400 crores,
according to Dr. S. R. Kamat, the
vice-President of the National
Society for Air Pollution Con
trol. The growing number of
automobiles, in all urban areas, has
now become a matter of major con
cern all over the world. Their
number, which is 400 million today
is going to cross 700 million mark
over the next 20 years. Much of
that increase will occur in the
(Con id. from Page No. 144)
and smaller cells dealing with
colour and detail. Research has
shown that in glaucoma patients
most damage occurs in the large
cells. After considerable inves
tigation, the group has designed
software that measures sensitivity.
to small movements. As it can be
used on a personal computer, peo
ple would be able to undertake the
tests at an optician’s premises as
part of a routine examination.
JUNE 1993
developing countries which curren
tly own only 12 per cent of the
global car fleet In Delhi city, the
number of motor vehicles in
creased to more than double and
air pollution registered a ten-fold
increase during the period 19701989. Besides automobiles, indus
trial and domestic sources are also
responsible for increasing air
pollution in urban areas where res
piratory infections and chronic
lung irritation are predisposing
more people to lung cancer. The
first 2 factors are also responsible
for increasing noise pollution in
urban areas. Although WHO has
fixed 45 dB as the “safe noise level”,
cities like Bombay, Calcutta and
Delhi register over 90 dB. Bom
bay infact holds the dubious dis
tinction of being the third noisiest
city in the World. The noise levels
have also been found doubling
every 6 years or so therefore by 2000
AD (target year for Health for All),
it is possible that no one above the
age of 10 will hear nor
mally. Depletion of greenery is
causing increase in. level of carbon
dioxide and adding to Greenhouse
effect and global warming. It has
been found that the dust content of
the air drops by 40 per cent in green
spaces which also absorb and dis
sipate sound energy and are a good
means of protection against noise
pollution.
The fast pace of uncontrolled
urbanization or “urban crisis” thus
portrays a gloomy picture at pre
sent. It is already being regarded
as a problem of growing inter
national concern since there is no
single/simple solution in sight
“A global human development.
pact is desired to safeguard the
planet and to ensure the survival of
humanity, reverse the current
trends responsible for present suf
ferings and promote harmonious
development that can restore dig
nity and hope to everyone”—
according to Dr Fredj Stambouli,
Professor of Urban Sociology,
University of Tunis, Tunisia.
In a way, carrying out the test is a
bit like playing a gentle version of
many computer games. Sitting in
front of the screen, a patient fixes
his sight on a cross in the centre of
the screen. All around the cross
are fine short bars which move
slightly from side to side, one at a
time, and at random. Every time a
patient perceives a bar moving, he
presses a button. These res
ponses—and any bar shifts that
have been missed—are recorded by
the computer. It is able to dis
tinguish between real reactions and
false ones by assessing the time bet
ween bar movements and button
pressing. Based on the patient’s
reactions, the computer can then
evaluate how much sensitivity has
been . lost Full trials are now
underway involving more than 500
people, some of whom may be at
risk from the disease for here
ditary reasons.
REFERENCES
1.
WHO. Urbanization and Health in
Developing Countries : A Challenge for
Health for All. World Health Statistics,
Vol. 44, No. 4, 1991.
2.
WHO. Cities ofTomorrow. World Health
(Special issue), Mar-Apr 91.
3.
Gupta S. C. Transport and Environmen
tal Pollution. Swasth Hind, Vol. XXXV,
No. 6, June 1991.
4.
Maharashtra Herald dated 22 Feb 90, 02
Nov 89,29 Jul 90,03 Oct 91,07 Oct 91,27
Apr 90, 08 May 91, 12 Nov 91, 21 Nov
91.
5.
Indian Express dated 06 Sep 85, 23
Sep 90.
6.
Times
90.
of
India
dated
11
Mar
—Spectrum, March-April 1993
127
Message
Health & Environment:
The Growing Challenge
The close links between health and the environment are universally acknowledged. It
is, for example, well accepted that a degraded environment, devasted largely by man-made
endeavours leads to ecological imbalance and very adverse effects on human health. The
Earth Summit held last year in Rio de Janeiro spelt out these concerns most eloquently and for
cefully, calling urgently for measures to curb the mindless destruction of the ecological system in
the name of development
As in other developing regions of the world, the countries in WHO’s South-East Asia
Region are now realizing the importance of paying attention to maintaining the ecological
balance. Already, rapid urbanization in some developing regions has brought in its wake
untold misery in the form of overcrowding and the rapid spread of water-and-vector borne dis
eases, not to mention the diseases related to lifestyle, which seem to proliferate in urban
settings.
Fortunately, however, enough is known about what needs to be done to ensure clean air,
water and land resources. What we must ensure is timely action to make the environment
clean so that coming generations inherit a healthy planet where blue skies, clear, bubbling
freshwater streams-and clean air are a reality and not just wishful dreams.
—Dr U. Ko Ko
Regional Director WHO, South-East Asia Region
(Contd. from Page No. 157)
forth by India and like minded
developing countries. The De
claration is expected to provide
basic framework for the position
to be taken by the developing
countries in future negotiations.
Kuala Lumpur Conference
Another ministerial level con
ference of 55 developing countries
look place in Malaysian capital
Kuala Lumpur in May 1992. The
Declaration adopted at the con
ference is far reaching in several
directions. One of them is the
demand for new and additional
funding for serious environmental
problems faced by developing
countries, including desertification
and drought The conference
called for additional financial
resources and transfer of techno
logy to developing countries on
128
preferential and economical terms.
It called for evolving a partnership
leading towards the goal of sus
tainable development in both
developing and developed coun
tries. The Declaration called for
new funding arrangements which
should be in addition to and
separate from the official develop
ment assistance (ODA) target
commitments by developed count
ries.
SAARC Conference
Environment Ministers from the
seven SAARC Member countries
also met in New Delhi in April
1992 to deliberate upon the issues
related to UNCED. The Minis
ters from Bangladesh, Bhutan,
India, Maldives, Nepal, Pakistan
and Sri Lanka hoped that the
Earth Summit could lead to a
genuine meeting of minds. In
their joint communique, they said
the Summit should give true
recognition to the needs of
environment and development,
without resulting in additional
burden on the developing coun
tries. It said the right of develop
ing countries for an equitable
global partnership and prosperity
must
be
fulfilled
at
the
deliberation.
Earth Charter
The Rio Summit held in June
1992 adopted the Rio Declaration
on Environment and Develop
ment, a voluminous programme of
action entitled “Agenda 21”; and a
“Statement of principles on the
Management, Conservation and
Sustainable Development of All
Types of Forests”.
(Also see
Swasth Hind, July 1992).
—Courtesy : PIB
Swasth Hind
1
HEALTH AND ENVIRONMENT :
The Growing Challenge
STATE OF THE ENVIRONMENT
IN SOUTH-EAST ASIA
The WHO South-East Asia Region has eleven developing countries of which Jive (i.e., Bangladesh,
Bh utan, Maldives, Myanmar and Nepal) are least developed countries (LDCs). The present population of
the Region is about 1300 million which is expected to double in less than 50 years. More alarming is the
trend of urban population growth (which is at present more than three times the average national growth
rate) and the rapid growth of squatter settlements—at twice the rate of growth of the urban pop
ulation. The increase in the level of consumption of renewable and nonrenewable resources is causing a
faster degradation ofthe environment due to an increase in demandfor water and arable landforfood and
energy. As a greater number of people are moving to urban areas, services such as water supply and
•sanitation, drainage ofstorm and waste waters, management and disposal ofsolid and hazardous wastes,
supply of adequate and safe food, and housing etc., are unable to keep pace with the rapid and massive
urban growth. Many countries in the Region arefaced with an accelerating decline ofthe quality oflife as
a result of environmental degradation due to surface, ground water and marine pollution, deforestation,
desertification and destruction ofwild life andflora. Thesefactors in turn lead to various types ofphysical
degradation, spread of diseases and poor health.
URBAN ENVIRONMENT
Urbanization and Land Use
The total urban population of
the Region in 1980 was about 340
million and constituted nearly 22%
of the total population. Between
1980-1990, the urban population in
the Region increased by about 110
million which was almost 50%
more compared with the figure in
1980. Demographic trends indi
cate that by 2020 almost half of the
population in the Region will be
JUNE 1993
living in urban centres and the
urban population will double in
the next 10-20 years. There is a
pronounced trend of population
concentration in metropolitan
cities like Bombay, Calcutta,
Bangkok, Jakarta, etc., and it is
likely that the number of smaller
cities with populations of one
million and above will increase
rapidly. Large areas of prime
agricultural and forest lands in the
vicinity of these urban centres are
therefore being lost every year due
to urban encroachment.
Housing
Due to the population influx
from rural to urban areas the shor
tage of housing has been increasing
and in most cities squatter set
tlements are growing rapidly.
Presently, slum dwellers constitute
30-50% of the urban population
with very poor housing struc
tures.
The deterioration of shelter and
basic infrastructural services affect
129
mostly the urban poor. A signifi
cant number of these urban resi
dents have no shelter at all and
many sleep on pavements or in
public parks in many metropolitan
cities in the Region.
Water Supply and Sanitation
The evaluation of the Inter
national Drinking Water Supply
and Sanitation Decade (1981-1990),
indicates that urban water supply
and sanitation services in most
cities in the Region could not keep
pace with rapid urbanization. In
spite of significant investments
during the Decade, only about 75%
of the urban population had ade
quate water supply, while over 50%
of them did not have adequate
sanitation facilities by 1990. The
water supply and sanitation ser
vices in slums and squatter set
tlements are virtually non-exist
ent. People therefore-have to use
unsafe sources of water and open
land and water bodies for defeca
tion, thereby polluting surface and
ground water.
Solid Wastes
Cities in countries of the Region
are unable to cope with the collec
tion. transport, treatment and dis
posal of solid wastes resulting in
unsanitary conditions with vector
proliferation and related dis
eases. With rapid urban popula
tion growth, solid waste from
domestic, commercial and indus
trial sources has been increasing,
placing a major burden on munici
palities.
considerable significance in the
Region due to the enormous pop
ulation growth and the rapid and
haphazard urbanization in most
countries. The absence or inade
quacy of drainage is directly linked
to the resurgence of malaria, filaria
and diarrhoeal diseases and also
causes damage to housing and
property.
The provision of drainage in
human settlements has assumed
Industrial, Toxic and Hazardous
Wastes
Air Quality
Most cities in the Region are
experiencing mild to severe air
pollution caused mainly by motor
vehicles, burning of fossil or
biomass fuel, increased industrial
activities and power generation
either within or on the fringes of the
cities. In most countries the per
capita increase in energy consump
tion and the number of vehicles
have been quite dramatic. While
the transport sector contributes
most of the carbon monoxide and
lead emissions, the power genera
tion sector the particulates and sul
fur dioxide emissions, the indus
trial sector is mainly responsible
for hydrocarbon and carbon mon
oxide emissions. The WHO ass
essment of air quality in the
megacities of the Region in 1991
indicates that air quality has
deteriorated over the past decade.
Unless legislation and enforcement
are strictly followed for the control
of industrial/power and motor
vehicle emissions, air quality in
these cities will worsen significan
tly in the next decade.
Water Quality
Drainage
domestic sewage and industrial
wastes has resulted in the deteriora
tion of river and surface water as
well as ground water in most
cities. Typical examples are the
Klongs in Bangkok, the Brantas
River in East Java, and the Ganges
and Yamuna rivers in'India.
Increased solid and liquid wastes
and particularly the discharge of
%
As most industries are located in
and around urban areas, the
adverse effects of emissions and
effluents from factories are often
more acutely felt by urban and
peri-urban populations. Chemi
cal accidents have also become
more frequent, leading to extensive
toxic impact.
Vehicular Traffic, Noise and Vib
ration
In most cities noise and vibration
levels have increased considerably
due to motor vehicles (commercial
and private), railway traffic, air
craft, industrial machinery, con
struction, air conditioners and
loudspeakers, etc.
In parts of
Delhi city, for example, the noise
level is well above the threshold
limit of 85 decibles (db).
RURAL ENVIRONMENT
Population Pressure on Land
The rural population in the
South-East Asia Region in 1990
was 926 million and was growing
by nearly 2% per year. Rapid
rural population growth in many
countries of the Region has
SWASTH HIND
130
COMMUNITY HEALTH CELL
326, V Main, I Block
Korambngala
Bangalore-560034
India
resulted in severe pressures on
agricultural land and the destruc
tion of tropical forests to meet the
growing food, fuel and fibre needs.
Overgrazing and undesirable farm
ing practices have caused land
degradation as well.
There is a phenomenal decrease
in agricultural land per capita in
densely populated areas of the
Region and the number of landless
rural households is increasing in
countries such as Bangladesh and
India. Population growth more
over results in subdivision of land
holdings into smaller units.
When land holdings are smaller
than 0.4 hectares, they are usually
unable to support a family. It is
estimated that about 40% of all
rural households in many coun
tries of the Region now barely
subsist.
The quality and quantity of rural
shelters is also declining. A large
part of the rural population live in
extremely bad conditions under
leaking, makeshift shelters with
poor ventilation.
Rural Water Supply and Sanitation
While much progress was ach
ieved in the provision of water sup
ply in rural areas in the 1980s
during the International Drinking
Water supply and Sanitation De
cade, nearly 30% of the rural pop
ulation remained unserved in
1990. Sanitation facilities in rural
are^s are hardly available to 11% of
the population. It was estimated
that in 1990 over 800 million rural
people did not have adequate
sanitation facilities.
JUNE 1993
Energy Consumption
The problem of energy re
quirements in rural areas is of the
same magnitude and urgency as
food needs. Two-thirds of the
energy demand in rural areas is
met from wood for cooking pur
poses. Wood is therefore being
used faster than it is being replaced.
tn addition to wood, people use
coal, cowdung cakes, crop residues
etc., resulting in diversion of soil
nutrients.
Indoor Air Pollution
Poor ventilation coupled with the
use of poprly designed cooking
stoves, cause severe indoor air
pollution and health problems in
women and infants who are par
ticularly exposed to high concen
trations of suspended particulates
and carcinogens in smoke.
Agro-chemicals
The occupational health hazards
of agricultural practices affect more
than half of the economically
active population in the Region.
Exposure to agro-chemicals and
the health risks they pose to both
farmers ar\d consumers of the pro
duce is a major health con
cern. The problem of pesticide
poisoning among agricultural wor
kers is also quite common.
Region. In many countries, while
the tropical forests have been a
major basis of development, they
have been disappearing at an
alarming rate. In Sri Lanka and
Thailand the loss is 5% annually.
Commercial logging, fuelwood
collection by rural people, slashand-bum cultivation, human set
tlements and pasture farming are
destroying the forest environ
ment At this rate the tropical
forests can disappear in a relatively
short time and the environment
can be deprived of an important
agent which converts atmospheric
carbondioxide to oxygen. The
newly opened forest canopies also
disrupt the biology of the forest
floor and interrupt the life cycles of
organisms in this habitat
Desertification and Degradation of
Soil
Man’s intervention in land use
for developmental activities, like
constructing highways, railways,
canals, etc. have brought about
drastic changes affecting hydrology
and wildlife. Massive landslides
have been precipitated by cutting
into hills for construction. In
addition mining operations result
ed in adverse topographical chan
ges. The consequences of these
interventions are loss of good
agricultural land, destruction of
forests, wildlife and even man’s
habitat and his health.
LAND ENVIRONMENT
Deforestation
This is one of the most serious
environmental problems in the
Soil erosion precipitated by the
above-mentioned factors, par
ticularly rain, is considered to be
the second important land-related
environmental problem in the
131
Region. A major contributor to
soil erosion is livestock herding
which is a traditional use of land in
dry areas. Nepal is estimated to
lose 240 million cubic metres of soil
annually as a result of grazing,
etc.
Salination caused by mis
management of irrigation systems
also leads to soil degradation.
Irrigated land which is not properly
drained acquires salinity nearer its
surface because of salt built-up
during the dry season. In Bangla
desh, Indonesia and India roughly
3, 10 ahd 20 million hectares are
lost annually respectively due to
salinity. Chemicar degradation of
soil caused by natural leaching of
nutrients is another problem fre
quently faced in the Region.
Destruction of Wildlife and Plant
Habitat
South-East Asia’s tropical zones
which contain some of the most
diverse forms of wildlife in the
world, are under significant pres
sure as a result of hunting and
habitat destruction, threatening the
extinction of many animal and
plant species. In India alone
between 3000-4000 plant species
are presently endangered.
Water Resources
With the expanding demand for
water for industrial and agri
cultural development, increasing
attention is given to surface water
and groundwater development pro
jects such as dams, reservoirs and
irrigation systems. These projects
invariably have an environmen
tal impact
Already scarce water resources
are being polluted by agricultural
and industrial development acti
vities. The discharge of domestic
and municipal waste water is mak
ing these water resources unsuit
able for drinking water supplies
and some times even for agri
cultural and industrial use. Pollu
tion from human excreta due to
open air defection is probably the
Region’s most serious surface water
pollutant resulting in a high
incidence of diarrhoeal diseases.
In many countries of the Region
where rapid population and eco
nomic growth have taken place,
surface water no longer satisfies the
demand and thus groundwater is
being
increasingly
exploited.
With excessive groundwater with-
drawals, salt water intrusions affect
large parts of the Region’s coastal
population as, for example, in
Bangladesh, India, Indonesia,
Thailand and Maldives. At pla
ces the groundwater which con
stitutes the largest source of drink
ing water supply is also getting con
taminated by pesticides and fer
tilizers used in agriculture and
from insanitary landfills, garbage
dumps, etc.
Marine Environment
Eight countries of the Region
have a marine environment of
coastal waters, estuaries, wetlands
and high seas. Though the mar
ine environment meets a large part
of the food and energy needs in the
Region, it is often being degraded
by oil pollution from tankers and
wastewater effluents from refi
neries, land-based pollution from
municipal sewage and other was
tes, sediments and chemicals from
agricultural practices, logging, min
ing and construction. These acti
vities as well as industrial dis
charges, have led to the destruction
of mangroves, sea grasses, coral
and fish life and threatens the life
of many marine mammals.
NATIONAL CAPABILITIES FOR THE PROTECTION OF HEALTH AGAINST ENVIRONMENTAL
POLLUTION HAZARDS
The awareness of the need for
environmental protection in the
Region has continued to increase
during the last decade. In most
countries of the Region, insti
tutions for environmental policy
formulation, implementation, and
evaluation are now in place.
Many countries have developed
comprehensive national control
programmes based on preventive
approaches involving land-use
planning, environmental impact
assessment, waste management,
pollution control, and production
processes in agriculture, industry
and energy development to mini
mise waste and reduce pollution.
132
While some progress has been
made in strengthening institutional
capability to address environmen
tal issues, policies and programmes
in many countries are still too weak
to protect human health from en
vironmental hazards. Technical,
organizational,
financial
and
human resource constraints are
major problems faced by countries
in responding effectively to pollu
tion hazards. Due to the multidis
ciplinary- nature of environmental
management, effective implemen
tation requires integration and hori
zontal coordination of all govern
ment
institutions/departments.
This, however, is often missing.
Although all development acti
vities tend to increase pollution
hazards, countries undergoing ra
pid industrialization tend to have
the greatest problems. According
to the 1989 assessment, four contries
in the Region—India, Indo
nesia, Sri Lanka and Thailand—
had the basic infrastructure to
monitor and control environmental
hazards. The assessment, how
ever, indicated that there is substan
tial scope for strengthening insti
tutions in these four countries, and
in developing institutions and their
capabilities in monitoring, assess
ment, enforcement and labo
ratory support in the remaining
countries of the Region. —WHO
SWASTH HIND
ENVIRONMENT AND HEALTH:
CREATING COMMUNITY AWARENESS
HE lives of people are inex
tricably related and dependent
upon the environment in which
they live. The quality of what is
available to them to breathe, eat
and drink are largely influenced by
environmental factors. And it is
not that people are unaware of this
link. Most people do believe that
‘air’ is responsible for a number of
illnesses and that ‘water’ and ‘food*
can make people sick.
T
But a certain helplessness pre
vails, helplessness bom out of a
sense of dependency, even despon
dency. What is worse, some indi
viduals and communities regard
less of the consequences continue
to manipulate the environment in
search of so-called comfortable
living.
The concern for building a
healthy environment is not new.
It has been felt and expressed for
several years on both national and
international platforms. Its politi
cal, social and economic impli
cations have been meticulously
analysed, the health hazards have
been documented and the study of
environmental sciences has emerg
ed as an academic subject in many
schools and universities the
world over.
But this academic and researchoriented approach has had a
marginal impact on action pro
grammes at the country level.
This is largely because there is little
involvement from individuals and
communities. Today we know
that to achieve their objectives,
policies and programmes must
JUNE 1993
2—5/DGHS/93
involve the people for whom they
are meant.
This indicates the need for
massive community awareness
compaigns and programmes. It is
not enough to tell people what
illnesses are caused by adverse
environmental factors. It is also
important to tell them what price is
paid in terms of human ill-health
when the environment is mani
pulated, when resources are ex
ploited by the not-so-needy and
when programmes are planned
without regard to their sus
tainability or are poorly moni
tored. Awareness building in
communities involves drawing
attention of the prople to the pro
blems that exist, their seriousness
and, above all, their social and
economic costs. Facts and figures
must be provided as a basis for
action, a potential for solution must
be pointed out and people must be
involved in problem-diagnosis and
in finding solutions.
A carefully designed com
munications strategy that involves
people at every stage is the. begin
ning of creating community aware
ness. A communications strategy
must include a dialogue with com
munities on action that can be
taken at the individual, family and
community levels. This cannot be
left to the environment activists
alone. The government sectors
concerned with environmental
issues must become more com
munication-oriented and must
include communication strategies
in their programmes. Simul
taneously, nongovernmental or
ganizations, youth and women’s.
groups and consumer bodies must
form alliances between themselves
and with government sectors to
promote a common cause.
At a global consultation on
Water Supply and Sanitation held
in New Delhi, India, in 1990, the
New Delhi statement issued at the
concluding session asked for
“intensive efforts to raise awareness
through
communication
and
mobilization of all sections of
society”. Participants of this con
sultation requested that com
munities be involved “by intensive
mobilization through sharply fo
cussed communication and educa
tion efforts at all levels of oper
ation”.
It is now generally recognized
that most water and sanitation
related problems can be tackled by
people both in urban and rural
areas provided they are empowered
to take action themselves. There
are also examples of community
action to prevent deforestation and
monitor
air
quality. Several
groups and agencies can be in
volved in such efforts.
The schools, the media, non
governmental organisations and
several other groups and agencies
can be and are involved in creating
community awareness. Religious
leaders have an important role to
play in some countries. Em
ployers and business leaders can
also be mobilized for creating com
munity awareness through their
employees. Finally,
enlisting
health workers in creating com
munity awareness must not be
ignored in helping to create a
healthy environment
133
POPULATION, ENVIRONMENT
AND
SUSTAINABLE SOCIETY
Dr S.C. Gupta and Dr Deoki Nandan
It is clear that demographically divided world is divided economically also and this
dividing line may become deeper and deeper if present trend is continued. It is also
noted that if the relationship between rapidly multiplying population and their life sup
port systems is not stabilized, all our development policies are likely to fail.
oday, we are facing the pro
blem of population explosion.
The increase in population of the
world is reaching a stage beyond
the Earth's limited capacity to sus
tain it. Around 1830, the world
population was one billion and it
took approximately 2 million years
to reach this stage. The population
was doubled in the next 100 years
(1930) and redoubled in the next 45
years. Another billion was added in
only 11 years and it is expected to
become six billion by the year 1995
(Table-1).
Table 1—Increase in World Population
T
Demographically and Economically
divided World
In one group of countries in this
world, the fertility is at or below the
replacement level and they have
either established a balance bet
ween births and deaths or they are
in the process of doing so. In the
other half of the world, where birth
rates remain high, rapid popula
tion growth is beginning to over
whelm local life support system
leading to ecological deterioration
134
Population
First billion
Second billion
Third billion
Fourth billion
Fifth billion
Sixth billion
and declining living standard. On
this basis, the world can be divided
into two groups viz. slow growth
regions and rapid growth regions.
The slow growth regions are Wes
tern Europe, North America, East
Europe, Australia and Newzealand
and East Asia, whereas rapid
growth regions include South East
Asia, Latin America, Indian Sub
continent,
Middle-east
and
Africa.
In slow growth category the Wes
tern Europe is on the verge of
reaching zero population growth
Years required to add
one billion
"Ybar
2,000.000
100
30
15
11
9
1830
1930
1960
1975
1986
1995
(Estimated)
and East Asia grows on the rate of
one per cent annually. This group
has collective growth rate of 0.8 per
cent per year. In these countries,
rising living standard and low fer
tility rate reinforce each other. The
rapid growth group contains about
2.6 billion people, over half the
world’s total* This group is growing
at the rate of 2.5 per cent per year,
three times as fast as the slowly
expanding half. Thus rapid growth
regions add 64 million people every
year while slow growth regions add
19 million only. Because of this
Swaste Hind
vapid growth, some countries in the
second category are showing a fall
in their per capita income.
However, some countries like India
are still showing increase in the per
capita income, but with the risk of
reversal in this trend, if the popula
tion growth is not slowed down.
It is clear that demographically
divided world is divided eco
nomically also and this dividing
line may become deeper and
deeper if present trend is con
tinued. It is also noted that if the
relationship between rapidly mul
tiplying population and their life
support systems is not stabilized,
all our development-policies are
likely to fail.
Population : Carrying capacity and
sustainable development
The objective of population ecol
ogy is to study the environmental
factors and biotic characteristics
intrinsic to the population which
interact to determine the number of
individuals of different species at a
given place. And a population
structure is reflected in such
dynamic aspects like birth-rate,
death-rate, immigration and emi
gration. These factors are in turn
influenced by age structure, sex
ratio and distribution pattern.
Since our wellbeing rests on the
balance with other populations, we
must learn to consider the impact
that our activities have on our
fellow inhabitants of this planet
The ‘carrying capacity’ for a par
ticular region is defined as the
maximum population of a given
species that can be supported there
without degradation of the natural
resource base. In other way, it is the
measurement of a region’s ability to
support its human population.
Through technological advances
and trade, we can certainly increase
the carrying capacity of that region,
JUNE 1993
but not for continued unlimited
growth. We can increase it tem
porarily through environmental
mismanagement to increase the per
capita supply of goods but it is not
sustainable in the long term and
may ultimately cause irreparable
damage to the natural resource
base in the form of deforestation,
desertification, loss of biological
diversity and pollution.
There are many views regarding
the carrying capacity of earth. In
1983, the Food and Agricultural
Organisation (F.A.O.), in collabor
ation with the International Insti
tute for Applied Systems, con
ducted a study analysing the pop
ulation sustaining capacity .of land
in 117 countries. The study con
cluded that 65 countries with a pop
ulation of 1.1 billion would not be
able to provide even the minimum
level of nutrition to its people.
Hence, there is a great need for a
vigorous drive for population con
trol, specially in developing coun
tries, which are already having
problems of environmental and
natural resource degradation.
THE SITUATION IN INDIA
(i) Population
India is the second largest pop
ulous country of the world with a
population of about 860 million
and it is projected that by 2000
A. D. the population will be close to
one billion (between 945 and 1053
million, according to the RegistrarGeneral of India) while by 2010
A.D., India is likely to become the
world’s most populous country,
surpassing China. In India, there
was sharp increase in population
after 1951. During 1901-1921
there was an increase of only 30
million population while during
1971-81, 13 million people were
added every year. The population
growth per decade was not more
than 14% up to 1951, while during
1971-81, a sharp rise of 25% was
noted. Thus by 2010 A. D., with
1.2 billion population, India will
have double the population com
pared to the year 1975.
(ii)
Availability of Land
India accounts for 15% of the
world’s population while land area
constitutes only to 2.4%.
(iii)
Availability of Food
The average per capita calorie
intake in India is 2189, well below
the standard from nutritional point
of view. The situation is not fair
in the neighbouring countries also,
viz.,—Pakistan—2199,
Kenya—
2151, Nepal—2034 and Bangla
desh—1899. In the beginning of
our plan era, it was proposed to
increase the per capita food intake
by 2% per annum but we could
achieve an increase of 0.5%
only. Availability of pulses has
been sharply decreasing which are
the principal sources of protein for
our people. Despite the signifi
cant achievements in the field of
agriculture, India faces serious
challenges due to increasing pop
ulation, depleting land fertility,
building up of pollutants in soil
due to industrial discharges, in
creasing use of agro-chemicals and
shrinking
of
non-renewable
energy sources.
(iv)
Water Supply, Sanitation, hous
ing and uncontrolled urbanization
More than half of our population
is still to be provided with the basic
need of potable water. The situa
tion is still worse in our neighbour
ing countries like Pakistan, Nepal,
Bangladesh, Srilanka and Kenya.
Regarding adequate sanitation
facilities in our towns and cities, it
is estimated that up to 1985, only
one-third of the Indian urban pop
ulation could be provided with
these facilities. Even in Met
ropolitan cities like Bombay,
Calcutta, Madras, and Delhi all
135
people do not have access to ade
quate drinking water supply and
sanitation facilities. On housing
situation, it was estimated that
(v)
housing shortage in the country
This
to
5. Developing renewable energy,
was 24.7 million during 1985 and it
may be around 29 million in
1995. With the increasing popula
tion we also have the problem of
rapid urbanization. India has the
third largest urban population in
the world with 156 million people
living in urban areas, about 24% of
the total population. It is expec
ted to reach 350 million by 2000 A.
D., doubling the present figures.
The important impacts of the
urbanization are creation of slums,
over-crowding, squatter settlements
and Unauthorised colonies. The
characteristic feature of slums is
the very poor availability of
amenities
and
public
ser
vices. During 1961 and 1981, the
urban population was doubled.
However in Bombay, the squatter
population grew from 4 lakh to 40
lakh, a tenfold increase. The pro
portion of urban population living
in slums is: Bangalore—10%,
Kanpur—37%, Bombay—38% and
Calcutta—42%. Today the squat
ter population of urban India is 30
million and is expected to increase
to 80 million by the end of this
Century.
atmospheric pollution, acid rains,
water pollution, radiation pollu
tion. deforestation and denudation
of vegetal covers.
and
Moving beyond the throw
away society.
Others
With the growing population,
consumption will also increase.
will
in
turn
lead
There is no definite answer to the
actual sustainable limit of the pop
ulation on the Earth, still it is clear
that our present exponential
growth is associated with serious
risks. This is also clear that
irrevocable depletion of resource
base for technological develop
ment has already begun. Keeping
the above in view it can be con
cluded that a sustainable society
can be built if the threat to our
environment is recognised and
appropriate
action
is
taken
immediately. In this regard the
‘World Watch Institute* in 1982
published a short pamphlet
entitled ‘six steps to sustainable
society'. According
to
this
pamphlet, the following six steps
are necessary for smooth transition
into the twenty-first century—
1. Stabilizing world population
2. Protecting cropland through—
(i) The use of cropland in the
most efficient manner,
and
(ii) reducing soil erosion.
Reforesting the earth
Conserving energy
3
4.
6.
‘Throwaway society’
means
whose members use the goods and
throw them away frequently,
thereby increasing the pollution.
Such type of waste can be reduced,
if manufactured goods arc durable
in the first place and if the discar
ded goods are recycled.
REFERENCES
1.
Lester, R., Brown and Pamela Shaw
(1982): Six steps to a sustainable society,
world watch paper; World Watch
Institute, Washington, D. G. March, 1982,
p. 63.
2.
Registrar General and Census Com
missioner (1984): Population projections
of India, paper 1 of 1984, New Delhi.
3.
Population reference Bureau (1986):
World Population data sheet, Washington,
D.C. 1986.
4.
Govl of India (1987): Annual Report
1986-87, Ministry of Health and Family
Welfare, New Delhi.
5.
W.H.O. (1987): Seventh report. World
Health Situation, Vol. 1.
6.
Park, J. E. and Park, K (1989): A text
book- of Preventive and Social Medicine,
13th Edition, Banarasi Dass Bhanott,
Jabalpur.
DR NAKAJIMA APPOINTED FOR
SECOND TERM AS DIRECTOR-GENERAL OF WHO
Dr Hiroshi Nakajima was appointed on 5 May 1993 by the Forty-sixth
World Health Assembly to a second five-year term as Director-General of the
World Health Organization. His current five-year term of office ends on 21
July 1993.
Dr Nakajima was* nominated for the position by the WHO Executive Board
at its Ninety-first session in January 1993. (See S.H., Feb. 1993 for details).
136
Swaste Hind
Protecting Environment
—Everyone’s Duty
The Challenge
Environmental management in India is a major
guiding factor for national development. It is
realised that environmental issues arise in every
sector of the economy and that each sector
should evolve its own solutions. This process
of integrating environmental considerations into
development activities is promoted through a
system of environment impact assessment of the
project before it gets a clearance.
arth, is the only planet, so far
E
known, with an environment,
necessary for sustainable life.
Land, water, air, plant and
animals are the main components
of the global environment. Sus
tainable development is a process
of social and economic well
being. But, to meet this end we
should ensure that the demand on
the environment, does not exceed
its carrying capacity for the pre
sent as well as future gene
rations.
Indian Tradition
India, with its geographic,
climatic and biological diversity,
has an unique environmental
heritage. For the people of India,
environmental conservation is not
a new concept Historically, the
protection of nature and wildlife
formed an ardent article of faith,
reflected in the daily lives of the
people and also enshrined in
myths, folklore, religion, art and
culture. According
to
the
Upanishads “this universe is the
creation of supreme power meant
for the benefit of all his
creation. Each individual life
form must, therefore, learn to
enjoy its benefits by forming a
part of the system in close relation
with other species. Let not any
one species encroach upon the
other’s rights.”
Even in modem times, as is evi
dent in the constitutional pro
visions. environmental legislations
and planning objectives, cons
cious efforts have been made for
maintaining environmental secu
rity
alongwith
developmental
advances. The national conser
vation strategy and the policy
statement on environment and
development are in response to
the need for laying down the
guidelines that will help to weave
environmental considerations into
the fabric of our national life and
development process.
The vast majority of Indians is
directly dependent on the natural
resources of the country for their
basic needs of food, fuel, shelter,
and fodder for their cattle. The
challenge of prevention of erosion
and, indeed, of restoration of
India’s land resources is inti
mately related to the strategies for
the management of land, water
and vegetative cover.
A massive programme of Was
telands
Development through
afforestation and tree planting
with people’s participation was
initiated in
1985. The pro
gramme attempts to restore,
through natural regeneration or
appropriate intervention, the forest
and tree cover in the country both
for ecological security and to meet
the fuelwood and fodder needs of
rural communities. It also seeks
to raise green cover on non-forest
and private wastelands in order to
reduce the pressure on the
forest areas.
The role of forest communities in
restoring and conserving forests is
now being increasingly recognised.
The need is to integrate modem
knowledge and skills in the area of
forestry with the traditional
knowledge and experience of the
local communities and to evolve
more effective strategies for the
joint management of forests.
JUNE 1993
137
COMMUNITY HEALTH CEIA
326. v M'in. I Block
Bangalor«-t>60034
|pdit
With the constant inflow of
municipal wastes and industrial
effluents, most of the rivers and
water bodies have become pol
luted. Restoring the water quality
of the rivers and other water bodies
such as lakes is another important
environmental challenge facing
India.
A major programme to improve
the water quality of the
river
Ganga has been undertaken and it
includes a total of 261 schemes
covering interception and diver
sion of industrial waste and sewage,
sewage treatment plants, low-cost
sanitation and development of
river front facilities including tree
plantation on river banks. A
National River Action Plan is also
being formulated to cover other
major rivers of the country.
The threat to the biological diver
sity of India due to over exploita
tion and habitat destruction, is a
major challenge. Realising the
fact that many species of animals
and plants have become endange
red, several initiatives have been
taken in India for their conser
vation.
Today, India has a wide network
of 69 National Parks, 392 Sanc
tuaries and 7 Biosphere Reserves
located in different parts of the
country. Among the special pro
jects taken up for the protection of
threatened species, Project Tiger
has been a phenomenal suc
cess. Separate projects have also
been estabilished for the protection
of the Gir Lion, Crocodiles,
Kashmir Stag, Himalayan Musk
Deer, Indian Swamp Deer, the
Browantlered Deer and Snow
Le.opard. Some zoos are also
engaged in captive breeding pro
grammes successfully.
Guiding Factor
Environmental management is
now accepted in India as a major
guiding factor for national develop
ment. It is realised that environ
mental issues arise in every sector
of the economy and that each
sector should evolve its own solu
tions. This process of integrating
environmental considerations into
development activities is promoted
through a system of environment
impact assessment of the project
before it gets a clearance.
In the area of formal education,
the National Policy on Education
(1986), emphasises that, there is a
paramount need to create con
sciousness about the environ
ment It must permeate all ages
and sections of the society, begin
ning with the child. The policy
gives unqualified priority to universalisation of elementary education
and substantial improvement in
the quality of education. Detailed
school mapping exercises have
been planned under a Master Plan
for universal provision of facilities
for environment education. The
National Council of Educational
Research and Training (NCERT)
has been assigned priority to
environment as a subject in the
model syllabi and instructional
packages.
—PIB
Preparations for Conference on Population
Tventy-year goals should* be set
for all states in such areas as mater
nal mortality, infant mortality and
family planning, Nafis Sadik
(Pakistan), Secretary-General ’ of
the 1994 International Conference
on Population and Development,
told the Conference’s preparatory
committee on 10 May. The recom
mendations made by the Con
ference should be comprehensive,
operational
said.
and visionary, she
Jean-Claude Milleron (France),
Under-Secretary-General for Eco
nomic and Social Information and
Policy Analysis, said socio-eco
nomic development thinking at the
United Nations should be at the
forefront of new global trends.
Citing the increasing gap between
the world’s developed and develop
ing regions, he said peace could
only be guaranteed by develop
ment
During its two-week session, the
preparatory committee is expected
to agree on the final document to
be adopted by the conference,
which will take place in Cairo from
5 to 13 September.
—U.N. Newsletter
“First of all our young men must be strong. Religion will come afterwards. Be
strong my young friends, that is my advice to you. You will be nearer to heaven through
football than through the study of Gita. You will understand the Gita better with your
biceps, your muscles a little stronger”.
—Swami Vivekanand
138
Swasth Hind
AIR POLLUTION—A SERIOUS
HEALTH RISK IN SOME OF THE
WORLD’S BIGGEST CITIES
IR pollution is posing increas
ingly serious health problems
in some of the world's biggest cities,
and is now an almost inescapable
part of urban life everywhere,
according to a new report
published jointly on 1 December
1992 by the World Health
Organization (WHO) and the
United Nations Environment Pro
gramme (UNEP).
A
The report, “Urban Air Pollution
in Megacities Of The World”, is the
result of a scientific study of pollu
tion levels in 20 such cities—those
that already have populations of
ten million or more, or are expected
to reach that total. by the year
2000. The
United
Nations
estimates that by then, 47 per cent
of the global population will be liv
ing in urban areas.
The cities are: Bangkok, Beijing,
Bombay, Buenos Aires, Cairo,
Calcutta, Delhi, Jakarta, Karachi,
London, Los Angeles, Manila,
Mexico City. Moscow, New York,
Rio de Janeiro, Sao Paulo, Seoul,
Shanghai and Tokyo. In some of
them, air pollution contributes to
premature death and serious dis
ability, the report says, adding that
these cities are not necessarily the
world's most polluted.
JUNE 1993
Urgent Action Recommended
The report’s recommendations
include the urgent implementation,
where necessary, of measures
such as:
•
air quality
programmes;
•
energy conservation;
•
motor vehicle examination
and
maintenance
pro
grammes;
•
management
phasing out lead in petrol;
• promotion of mass transit
systems;
•
alternatives to open burning
Of refuse;
•
the introduction of “clean”
technologies
In an example of how history can
repeat itself, the report shows that
some of the megacities have
approached the same massive air
pollution levels of the notorious
London smogs of 40 years
ago. But while London and other
cities in developed countries have
cut their air pollution dramatically
since then, expanding cities in the
developing world face slow suffoca
tion as their air quality dete
riorates.
Dr Hiroshi Nakajima, DirectorGeneral of WHO and Dr Mostafa
K. Tolba, Executive Director of
UNEP, say in their foreword of the
report: “By studying past and pre
sent air pollution problems and air
quality management stategies,
UNEP and WHO believe that
many of the problems currently
faced by megacities can be avoided
by the megacities of the future”.
Hazards Will Increase
The report says that because
many of the world’s major cities are
growing rapidly, with few if any
pollution control measures, the
hazards will increase and the
quality of life for millions of urban
residents will continue to fall. “It
is clear- that air pollution in many
of the world’s megacities, as well as
in other cities, is a major health and
environmental
concern. This
concern is increasing and should
command high priority for action,”
it says.
The study investigated levels of
six major pollutants in 20
megacities. The pollutants are
sulphur dioxide (SO2), mainly
from power generation and indus
trial emissions, suspended particu
late matter (SPM), largely from
domestic fires, power generation
139
and industries; lead (Pb), chiefly
from petrol engine exhaust; carbon
monoxide (CO) also from motor
vehicles; and nitrogen dioxide
(NO2) and ozone (03), due to a
combination of heavy traffic and
high levels of sunshine.
Of the 20 megacities examined,
Mexico City emerges as among the
worst-affected. Levels of SPM
also rates a serious problem in
eleven
other
cities-Bangkok,
Beijing. Bombay, Cairo, Calcutta.
Delhi, Jakarta. Karachi, Manila,
Seoul and Shanghai. Cairo and
Karachi have a similar rating for
lead, Beijing and Seoul have
serious problems with
SO2,
Karachi has the highest lead level
among the 20, and Los Angeles,
Sap Paulo and Tokyo have serious
ozone problems.
London, New York and Tokyo
come out as the least-polluted
megacities,
normally meeting
WHO guidelines on four or five of
the six pollutants.
Impact on Health
The report says that the direct
human health effects of air pollu
tion vary according to both the
intensity and duration of exposure
and also with the health status of
the population exposed. Those
who may be at greater risk include
the young and the elderly, those
already suffering from respiratory
and cardiopulmonary disease, and
those taking exercise.
Most of the air pollutants directly
affect the respiratory and car
diovascular systems. Increased
deaths, disease and disability have
been associated with elevated levels
of SO2 and SPM. Nitrogen diox
ide and ozone also affect the res
piratory system, irritate the eyes,
nose and throat, and in addition,
ozone can cause headaches. Car
bon monoxide is able to displace
oxygen in the blood which in turn
can result in cardiovascular and
neurological effects. Lead affects
bone tn arrow, impairs liver and
kidney function, causes neurologi
cal damage, and limits mental
development in children.
The report continues: “For the
megacities, motor vehicle traffic is
a major source of air pollution; in
nearly half of them it is the single
most important source.” The pre
sent total number of vehicles in the
world—about
630
million—is
expected to double within the next
20 to 30 years, with much of the
growth occurring in developing
countries and in eastern Europe.—
Courtesy: HFA 2000
HOW TO PREVENT CHOLERA
—DO’s AND DONT’s
The incidence of cholera and
other diarrhoeal diseases takes
place during the monsoon period.
They occur basically due to
polluted contaminated water. They
are preventable, if we follow these
Do’s and Dont’s:
Do’s
—
—
—
—
—
—
—
Use only potable water.
Add chlorine tablets in case
drinking water is unsafe.
Always wash your hands
before taking meals.
Keep
the
surroundings
clean.
During an episode of
diarrhoea, use Oral Rehyd
ration Therapy (ORT) at
domiciliary -level.
Garbage should be pro
perly disposed.
Drain out water from Air
Coolers periodically at re
gular intervals to avoid
breeding of mosquitos.
Dont’s
Do not take exposed and cut
fruit and food articles.
— Do not allow water to collect
and stagnate in the sur
roundings.
— Do not use shallow water for
drinking and cooking.
Cholera and other diarrhoeal
diseases are basically due to
polluted/contaminated
drinking
water. A large incidence of such
diseases takes place almost all over
the country during the monsoon
period. Water-borne diseases are
generally transmitted through oral
route due to contamination of
drinking water sources and food
with feacal matter and poor per
sonal hygiene.
The steps taken to prevent such
outbreaks include surveillance and
monitoring of these diseases, sup
ply of safe drinking water and
chlorination of unsafe drinking
—
140
water sources, safe disposal of
human excreta, garbage and refuse,
improvement of food and personal
hygiene, promotion of ORT in case
of dehydration due to diarrhoeal
diseases and providing health care
facilities by strengthening health
infrastructure in rural and urban
areas.
Other measures include
strengthening of health education
measures, giving detailed informa
tion about various water-borne diseases.and their prevention to the
people giving guidelines to the
health personnel for prevention,
improvement of environmental
sanitation and training of medical
staff engaged in the activities to
impart knowledge and skill for
house management of diarrhoea.
—PIB
SWASTH HIND
COMMUNITY HEALTH CEU
326, V Main, I Block
Koramt>ng?!a
Bangaloro-5GOC34
Indie
HEALTH PROBLEMS WITH
FLUORIDE IN WATER :
A REALITY
Dinesh Chand
Limited fluoride in water may not be a cause for worry and it may play havoc
in human life if taken in excess for long periods continuously. To provide
fluoride-free water to save the population of endemic areas, a combination of
hardware and software have to be opted to achieve the desired results.
XCESS fluoride
in water
causes fluorosis (dental and
skeletal) and is considered a dis
ease which has no cure. Thus, the
preventive measures are the only
solution. Apart from the above, it
may also cause gastro-intestinal
complaints, viz., loss of appetite,
nausea, vomitting, pain in the
stomach, constipation and inter
mittent diarrhoea and flatulence
due to fluoride toxicity. The expec
tant and lactating mothers and
children are most vulnerable
groups. Fluoride free water may be
provided by chemical treatment
processes like Nalgonda, Prasanthi, A ion exchange etc. Provid
ing fluoride free water alone in the
endemic areas is not ade
quate. Together with it, informa
tion, education, communication
should also be an essential part of
the control of fluoride programme.
E
JUNE 1993
3 — 5/DGHS/93
In India, about 85% of rural as
well as urban population are solely
dependent on ground water as the
drinking water source. This is
desirable as ground water sources
are economical and can be depen
ded upon.
The earth’s cnist being extremely
rich in fluoride bearing minerals,
the ground water contains high
fluoride content in some parts of
the country. The maximum fluo
ride content so far detected is 38.5
ppm (mg/litre) in ground water
used for drinking purpose.
This has caused severe health
problems since the last 50 years.
Initially, the health problems were
known to exist in only 4 States of
India. But today, an estimated 25
million people are leading a pain
ful, crippled and vegetative life in
about 150 districts spread over 15
states of the country who have been
associated with health problems as
a result of drinking fluoride con
taminated water. It has become an
urban as well as a rural health pro
blem; affecting the young and the
old alike.
Since early 1930s, the major
focus had been to promote basic
research, epidemiological studies
and clinical research to understand
fluoride action on body tissues
and the health problems in its
totality. Researches in this field are
still being promoted by various
national and international agen
cies. In the recent past, Canada has
supported fluorosis research in
India.
In the year 1986, the Government
of India had set up a Technology
Mission in the Ministry of Rural
141
Development as the nodal agency
to tackle the drinking water pro
blem bn a war footing. The strategy
adopted for visible results is to
focus* on Sub-Missions, coun
trywide. Water quality assessment
and defluoridation installations,
both at the domestic and com
munity levels as one of the major
activities are dealt with.
India is possibly the first country
to launch a National programme
on Control of fluorosis.
Sources of Fluoride
The origin of fluoride, like most
other minerals, is associated with
volcanic and plutonic activities in
the crust of the earth. Fluoride
occurs as calcium fluoride. In the
acid plutonic rocks like granites, it
occurs in the form of fluorapatite.
It also occurs in micas and calcium
phosphate deposits. Basalts con
tain 100 ppm (parts per million),
whereas granites contain as high as
500 to 850 ppm of fluoride. Shales
and deep sea clay deposits contain
740 and 1300 ppm of fluoride res
pectively. Alkaline rocks contain
the highest percentage of fluoride
(1200 to 8500 ppm). Alkaline water
also shows high enrichment of
fluoride.
Fluoride
concentration
in
ground waters may range up to 50
ppm or more but more than 10 ppm
is rare and surface waters seldom
contain more than 1.0 ppm.
Health problems
In fact, in major parts of the
globe excess fluoride is a problem.
142
China has reported to have nearly
32 million people affected with
dental fluorosis and 1.75 million
people affected with skeletal
fluorosis. In the developing coun
tries to prevent dental caries, the
need of the hour is not fluoride but
adequate awareness on the impor
tance of oral health and hygiene
besides improving adequate cal
cium and vitamin-C in the diet
Fluorosis is considered as a dis
ease which has no treatment or
cure and its preventive aspects are
often neglected. It is also true that
the disease was very often mis
diagnosed as arthritis, spondylysis
or joint pain. We are not surprised
to note the statement in Chemical
Engineering News (Page 37, Aug
ust 1988) that most doctors in U.S.
have not studied the disease and do
not know how to diagnose it.
In India, the data are available to
suggest that 0.4 ppm of fluoride in
drinking water is causing mild,
moderate and severe forms of den
tal fluorosis.
It is also a fact that due to
atrophy of fibre and connective
tissue of the body including the
oral cavity caused by the use of
fluoride, people living in endemic
areas for fluorosis, become eden
tulous (loose teeth) at an early age;
look much older and many (who
can afford) resort to the use of
dentures.
People may also have health pro
blems with excess ingestion of
fluoride associated with kidney
function which has been confirmed
by leading Nephrologists in the
country.
Muscular weakness, loss of mus
cle power and neurological mani
festation leading to excessive thirst,
tendency to urinate more frequent
ly, although the volume of urine is
not too large, are common among
the afflicted individuals.
Severe and widespread gastroin
testinal problems, viz, anorexia,
pain in the stomach, intermittent
diarrhoea, chronic constipation,
gas formation and bloated feeling
in the stomach (Non-Ulcer Dys
pepsia) caused due to drinking
fluoridated water have been con
firmed. Changing the source of
water with low levels of fluoride
(below 1 ppm) provides relief from
the
gastrointestinal
problems
within a period of 2-3 weeks.
Some developing nations are
now reporting on the unsuitability
of WHO guidelines for fluoride
concentration in drinking water. A
recent report from The Nether
lands, based on a study in Senegal
has shown dental fluorosis in
children where fluoride in water
ranged from 1.0 to 7.4 ppm, pre
valence of mild dental fluorosis is
68.5% at 1 ppm of fluoride in drink
ing water. When fluoride exceeded'
to 4 ppm, the prevalence of dental
fluorosis reached 100%. It has been
suggested that the WHO guidelines
for fluoride concentration in drink
ing water in Senegal is unsuitable*
and the upper limit should be
reduced to 0.6 ppm (Lancet:
11,223—225, 1988).
It is unfortunate that the use of
fluoride for prevention of caries
although formulated and brought
out 50 years ago by U.S.-based den
tists, is still being promoted the
SWASTH HIND
world over without questioning, the
health hazards which have been
emerging due to fluoride poison
ing. It has been shown by the
Indian dentists that by use of
fluoridated toothpaste forbrushing
the teeth, in young and old, the
serum fluoride levels are enhanced
within minutes (Rajan et al.
Fluoride in toothpaste:'Cause for
Concern, Fluoride 21:4 1988; Rajan
et al. Serum and Urine Fluoride in
Toothpaste Users, Jr.. Ind. DennL
Assoc. 59.137—142 1987). The oral
mucosa rich in blood vessels do
absorb fluoride ions rapidly. The
sublingual blood vessels (the one
below the tongue) drains the stuff
directly to the superior venecava
and then to the heart. It is not (rue
that toothpaste never enters the
body unless it is swallowed/ingested. Fluoride does enter the circula
tion directly from the oral cavity
through the fine blood vessels of
the mouth. Fluoride being a per
sistent bio accumulator, even small
amounts that enter through-fluori
dated toothpaste is a guaranteed
entry not only in children but even
among the adults and the cumula
tive or additive effects of fluoride is
causing serious concern.
Not free from fluoride
It has been discovered in India
recently that there is no toothpaste
marketed which is free from
fluoride whether labelled or other
wise. The amount of fluoride aris
ing as a contaminant from the raw
materials used viz. chalk, talc and
calcium carbonate, may be as high
as 80 ppm. Over and above the
contamination, different manufac
turers add fluoride to the extent of
2000-2500 ppm. It has also been
observed in India as a result of
extensive laboratory investigations
that the fluoride is not mixed
homogeneously in the paste.
In none of the so called fluori
dated brands of the toothpaste, the
quantity of fluoride in the paste is
revealed on the tube. It is also a fact
that, when sodium monofluorophosphate (SMFP) is added to the
paste, it is known to decompose
and. the expiry date of the tooth
paste is never revealed either.
It has been shown that excess
ingestion of fluoride leads to the
accumulation of a particular
chemical substance viz. dermatan
JUNE 1993
sulphate, both in the bones and
teeth. The substance on accu
mulation tends to demineralize the
area around, both in human teeth
as well as in the bones. Such
demineralized zones in the teeth
get pitted and perforated in dental
fluorosis Resides being discoloured
(Susheela et al, Arch. Oral Biol., 33,
10, 765, ' 1987). The belief that
cavity -formation occurs only in
dental caries is an outdated infor
mation. In fact, cavity formation
may be aggravated in some cases
due to excess ingestion or use of
fluoride, leading to dermatan sul
phate formation and ensuing demi
neralization of the tooth matrix.
In reality the statement that
using fluoride for caries preven
tion only makes the enamels
strong, no longer holds good,
because fluoride also causes
demineralization of the teeth and
they get pitted, perforated and
chipped off.
In addition to the above, it has
also been reported that fluoride
may induce cholesterol production
in males and can also lead to
blocking/calcification of blood
vessels, specially in the region of
the main vessel leading from the
heart, viz., the aorta, causing car
diac problems. This certainly
means that the toxic effects of
fluoride far outweigh its benefits in
the Indian situation.
There are reports on high
incidence of cancer due to fluoride
in U.S. (Cancer Mortality in Rela
tion to Fluoridation and Popula
tion Changes, Data from 140
largest U.S. cities from 1940-1980,
Burgstahler, Int. Conference of the
Fluoride Society, Utah, 1986).
Animal experiments from Japan
and other parts of the world, also
suggest that fluoride is cancer
causing (Mutation Research, 139,
193-198, 1984 : Cancer Research,
44, 938-941 : Science of Total
Environment 68, 79-96, 1988).
Excessive fluoride in drinking
water causes dental fluorosis (Mot
tled enamel) which increases in the
intensity of its effect with increas
ing
fluoride
concentrations.
Following observation of this con
dition, Dean suggested that the
mineral composition of drinking
water might have an important
bearing on the incidence of dental
caries. His examination of nineyear old children with continuous
exposure showed a higher percen
tage of children to be caries-free in
those communities where the
domestic water supplies contained
a higher concentration of fluorides
in comparison with communities
using water having a lower
concentration.
Hodge has reported that 13 of 114
residents of Bartlett, Texas (U.S.)
where the drinking water contained
8.0 ppm of fluoride showed osteos
clerosis, and that 21 of 178 of those
living in a specific South American
area and who were drinking water
having in it 16 ppm, gave evidence
of bone changes by X-ray exami
nation. A single dose intake of
fluoride in the range of 2,250-4,500
mg can be lethal.
Preventing dental caries
The effectiveness of fluoride in
preventing dental caries was con
firmed by the 10-year observation
of participants in a study in
Michigan.-201. Here the adjust
ment of the fluoride content of the
communal water supply to 1.0 ppm
produced a reduction of the caries
rate for the deciduous teeth in 6year-old by 54 per cent and, in
children bom subsequent to the
start of the fluoridation pro
gramme, the caries rate in perma
nent teeth was reduced by 60 per
cent
With the initiation and extension
of the practice of supplementing
fluoride intake to the optimum
level, using drinking water as the
vehicle, Galagan-200 pointed out
that water intake—and hence the
fluoride intake increased directly
with increase in air temperature
under normal living conditions in
the United States.
The U.S. Public Health Service •
Drinking Water Standards specify
that when fluoride is naturally pre
sent in drinking water, the concen
tration should not average more
than the appropriate upper limit as
indicated in table-1 and if average
concentrations are greater than
twice the optimum values in that
table, water should be rejected
straightaway. When
controller!
amount of fluoride compounds are
artificially added for fluoridation,
the average concentration should
be kept within the upper and lower
limits of table 1 :
143
COMMUNITY AND ENVIRONMENT
Dr Manjit Singh
AND
Harbir Kaur
Air, water and soil pollution has resulted in global warming. Community can play a major
role in preventing a catastrophe taking place as a result of this global warming. To live in
clean surroundings is the right of every individual and to make it clean is the duty of
everyone. Community can do it with strong will, legislation and through resources made
available to it, say the authors.
uman demands are many but
Hresources are limited.
Developing countries face many
problems; pollution is becoming a
threat to them. Millions of people
die every year from illness caused
by environmental pollution and
millions more suffer chronic dis
abilities in the form of diminished
physical strength, lower intelli
gence and lack of alertness.
Environment pollution is in the
form of pollution of AIR, WATER
and SOIL.
Air Pollution is as a result of over
use of energy. more demand of food
leading to deforestation, vegetation
and grassland being burnt to clear
land for more food. Fuel pol
lutants add to air pollution.
Whereas industrial plants, power
generating stations, refineries, tan
neries and hospital wastes all con
tribute towards air pollution. Air
pollution can increase risk of can
cer. respiratory diseases, heart and
lung defects, genetic defects and
mental retardation.
JUNE 1993
Water Pollution is as a result of
increased congestion in the cities,
industrial expansion, lack of popu
lation control measures.
Increased human demands ex
ceed the rate of renewal of land,
forests and fresh water. Out of the
available fresh water, approxi
mately 70% is used for irrigation
purposes which can be better
utilized with the help of modem
techniques, 20% to 25% of this water
is utilized by industries. The
industries add all its pollutants to
the water sources. Only 8 to 10%
of the water is used for household
purposes which can be better used
by plugging leakage, better sanita
tion means and storage facilities.
Faecal wastes are added to water
sources. Nitrogen and phosphorus
wastes deplete oxygen supply in the
water, thereby killing fish, animals
and plants in water. Most of the
urban sewage is discharged un
treated in waterways. Heavy met
als, toxic chemicals and solid
wastes are added to water wastes.
Cleaning of water is most cost
effective in improving the nutrition
of the people. We know “Clean
Gut” leads to increased digestibility
and assimilation of food, thereby
increasing and improving nutrition
of people and preventing them
from getting diarrhoea, typhoid,
infective hepatitis, amoebiasis,
giardiasis, intestinal infection,
trachoma, scabies and yaws.
Seventythree million work-days
are lost every year because of water
related diseases all over the world.
India has taken a step towards con
servation of water supplies and to
prevent pollution through control
waste facilities.
The Ganga cleaning Project is a
step towards cleaning of water.
This river travels through 1500
miles and supplies water to million
hectares of land and serves as a
drinking source of water to millions
of people, in India.
Soil Pollution;— Soil erosion is due
to pressure of population to grow
more food for increased popu
lation. The Metropolitan1 Cities
face problems due to increased
congestion, industrial expansion,
lack of pollution control measures;
145
all contributing towards unhealthy
air and water pollution. Rapid
population growth bums nature's
candle at both ends generating
generating awareness amongst the
countries to limit the pollution,
thereby making life of their people
comfortable and for the overall
more consumers while reducing
well-being of human beings.
natural productivity. Population
has direct relationship with pover
ty. This is due to more demand
for food and water. The demand
for land and more food is met by
destroying vegetation and burning
the grassland to clear more land to
grow more food to meet more
demand. As a result, top soil is
lost
There has been a stress on not to
blame each other and to make joint
effort in limiting population
growth, a step towards pollution
control—because growing popula
tion demands rising standards of
living, increased demand of water
and land together multiply en
vironmental problems.
Loss of trees, native plants and
animals contribute towards soil
pollution and air pollution.
Grassland takes a year to grow
back after over-grazing. Fish
stalk may take five years to return
to previous level after moderate
over fishing.
Ever increasing human demands
exceed the rate of renewal of land,
forest and fresh water.
Depletion of coal and oil from
the crust of earth, carbon dioxide
emission from the energy used and
reduction in Ozone layer from the
stratosphere, all are becoming evi
dent and alarming.
Wastes are dumped in the waste
land which are limited and control
measures cannot cope up with the
fast growing wastes. Earth Sum
mit at Rio focussed mainly on pre
servation and protection of en
vironment This has resulted in
Soil depletion and erosion, acid
rain, air and water pollution, loss of
wet land and other natural habitat
all are as a result of overpopu
lation.
Role of Community:—Air. water
and soil pollution has resulted in
global warming. Community can
play a major role in preventing a
catastrophe taking place as a result
of global warming by taking
steps towards:
1.
Afforestation, i.e., restoration of
forests. Chipko Andolan is an
example towards such step.
2. Retaining and protection of top
soil by restoring grassland, pro
tecting native plants and habi
tats.
3. Prevention of polluting air and
water by limiting automobile
emissions
and
industrial
wastes.
4. Use of natural resources (sun,
air and water energy).
5. -Renewable energy sources and
developing more energy effi
cient devices.
6. Conserve water supplies by
preventing pollution through
controlled waste facilities and
water treatment plants.
7. Recycling and
of energy.
conservation
Women can play an important
role. They are the users of resour
ces. They can help in limiting the
use of these resources and in con
trolling population growth by plan
ning and implementing the Govt
programmes on Family Welfare.
Their involvement and desire in
preventing unwanted pregnancies
shall help in limiting population.
People give environmental pro
tection high priority. The need for
achieving this is through strong
political will and acceptable solu
tion to problem.
To live in clean surroundings is
the right of every individual and to
make it clean is the duty of
everyone. Community can do it
with strong will, legislation and
through resources made available
to it
Resource conservation and pol
lution control can help in protect
ing the natural system and life thus
safeguarding the rights of the future
generation.
A
Treatment is more than just technology
No treatment is simply a technology. In practice, the effectiveness of
treatment depends upon the skills and attitudes of the person applying
it, the diagnostic and other characteristics of the patient, and the
sociocultural context.
—Evaluation of methods for the treatment of mental
disorders. Report of a WHO Scientific Group. Geneva,
World Health Organization, 1991 (Technical Report
Series. No. 812), p. 2.
146
Swasth Hind
A Universal Environmental Ethic
The Ultimate Goal of
Environmental Education
An ethic may be thought of as an ideal of human behaviour, an environmental ethic as
ideal human behaviour with respect to the environment, natural and built. One senses a
newly emergent environmental ethic in the growing concern about the environment, in
swelling movements to save the Earth, indeed in current and encouraging national and
international environmental laws and regulations. Yet, we know that, as in the more
familiar context of social interaction, strict obedience to the letter of the law must be com
plemented and supplemented by individual moral sensibility and conscience, by
environmentally-ideal human behaviour, an ultimate goal of environmental education.
The examples are simple and homely. Many countries, a vast number of towns and
communities, have enacted laws and established rules to prevent the littering of public
roads, lands and gardens. Such laws and regulations reflect an often newly acquired
collective moral sensitivity to the environment. However, we know, even guiltily, that one
may legally litter one’s own home and one’s backyard, if one owns one. An environmental
ethic, created or reinforced, would discourage one from doing so, even if one were
alone. We may never perfectly achieve harmony with nature, but the existance of an
environmental ethic, partly encoded in laws, but largely a matter of sensibility and con
science, can draw individuals in the direction of that ultimate goal of environmental educa
tion, namely, environmentally-ideal personal behaviour.
Think globally, act locally has
become the universal slogan of the
environmentally
concerned. It
implies a universal environmental
ethic towards which, one feels, we
are massively moving. What are
the principles in common in that
movement and its varieties, how
can they be educationally streng
thened,
developed,
univer
salized? The beginning may lie in
a .comparative study of environ
mental cultures and ethics across
the borders of time and space.
JUNE 1993
Chronologically one might com
mence with Hinduism, whose ori
gins reach into the dim historical
past and resist facile doctrinal
definition. Roughly
contem
porary with the Greek epics of
Homer and Hesiod are the Vedas,
composed by Aryans who brought
them to India and in which we find
a pagan polytheism with clear
affinities to the pagan polytheism
of the Greeks, who were from the
same Indo-European linguistic,
cultural, and racial stock. The
gods, identified with and manifes
ted by features, forces and pro
cesses of nature (Sky, Earth, Thun
der, and so on) were propitiated
with animal sacrifice, entreated
with prayer, and commanded by
magical incantation.
Hindu thought gravitated to
ward belief in an inner, unseen,
abstract reality, underlying the
manifest world disclosed to the sen
ses. For man (and other living
things) it was Atman, the spirit or
147
inner self, in contrast to the
body. More expansively and
abstractly still, all things in the
divided, articulate world disclosed
to the senses are manifestations of
inner Being, Brahman. Atman
and Brahmam, in turn, came to be
conceptually united so that the
inner Being or essence of all things
is soul, spiritual being, or con
sciousness. Objective knowledge
and subjective knowledge thus
coalesce. To know one’s self, not
one’s personality or empirical self,
but one’s transcendental self, is to
know the nature of all things.
The empirical world is both
unimportant, because ultimately
unreal, and contemptible, since it
seduces the soul into illusion and
bad karma. It distracts the soul
from finding itself, attaining libera
tion, and merging with the one
essential, transcendental self, i.e..
from achieving nirvana. On the
other hand, since the essential or
transcendental self of each person
is the same, “same” in the strongest
sense, literally identical with the
Self or Being per se in everything
else, one is led to empathy and
compassion. Other forms of be
ing, particularly other forms of life,
are victims of the same deceit, frus
tration, and suffering as oneself
and should be pitied. Indeed,
there is no real distinction between
self and other. One cannot, thus,
profit at the expense of others,
either other human beings or other
natural, environmental beings
since, ultimately, there are no
“others”—all are ephemeral mani
festations of one indivisible
Being..
Lastly, there is a correspondence
between the ecological world view
and the world view of Hindu
thought. Ecology also represents
the world as a unity, that is,
holistically—the unity of oneself
and one’s surroundings. Thus,
148
there are two major elements in
Hinduism which contribute to the
development of a universal en
vironmental ethic: empathy and
compassion regarding all living
things and a sense of harmony with
the environment, therefore its pro
tection and enhancement.
In Jainism, more than in Hin
duism, or Buddhism, one finds an
explicit environmental ethic. Jai
nism, in contrast to the core
philosophy of Hinduism as dis
cussed, is dualistic rather than
monistic. There is a fundamental
dichotomy between souls and
body, mind and matter. Each
soul, moreover, maintains its own
integrity. It is not a manifestation
of the universal soul. Every living
thing is endowed with such a
soul. And, although in each living
thing the soul is, as it were, crusted
over with flesh and its conscious
ness dimmed and confused with
sensory perceptions of various
modes and degrees of clarity, all
souls are equally pure and perfect
in and of themselves.
At the moral core of Jainism is
the doctrine of ahimsa, .the deter
mination not to kill or harm any
living- thing which contains a soul
as perfect or complete as one’s own
and which is as liable to suffering
as oneself. The Jains are famous
for the extreme lengths to which
they go to honour this doc
trine. Of course, the eating of
meat especially is prohibited since
animal empirical consciousness is
more acute than plant conscious
ness. Mahavira, the founder of
Jainism, himself, only ate leftover
food, prepared for someone else, so
as not to have personally caused
injury even to the plants, or their
seed, from which it was made.
Moreover, food must be inspected
before eating to assure that insect
eggs or mites. are not consumed
inadvertantly. Similarly,
water
must be strained, not to protect
one’s health, but to avoid consu
ming any organisms in the water.
One ought even to sweep one’s path
before walking so that one’s footfall
does not injure or kill any living
thing. Ahimsa is a doctrine of
extreme concern for other living
things. It is in this respect a kind
of environmental ethic contribut
ing to the universal environmental
ethic aimed at
Buddhism stems from the teach
ings of Siddharta Gautama, who
lived in India during the sixth cen
tury B.C. Buddhism, however,
today flourishes less in India than
in countries to the south and east of
India, namely, Sri Lanka, Myan
mar, Thailand, Kampuchea, Laos,
Vietnam, China, Korea, Japan,
Tibet and Mongolia.
Core moral values in Buddhism
are to be found in the five pre
cepts : abstention from killing liv
ing creatures, abstention from
stealing, abstention from lying and
abstention from taking intoxi
cants. While these precepts em
body the basic requirements for the
living of a good life and the
establishment of a good com
munity, some of these are relevant
to a conservationist ethic. The
respect for life and property, the
rejection of hedonistic life styles
and the notion of truthfulness
emphasizing
consistency
in
thought and action are all ethical
premises relevant for the develop
ment of environmental ethics.
The Buddhist precept concern
ing abstention from killing living
creatures focuses attention on the
ethical premise concerning the
value of life. The Buddha asked
people to abstain from destroying
the life of human beings and
animals and also condemned the
infliction of suffering and pain on
living creatures. He was also criti
cal of the pleasures of hun
ting. The kings were expected to
SWASTH HIND
provide protected territory not only
for human beings but also for the
beasts of the forests and birds of the
air. The principle of ahimsa, non
harming and non-injury to life, was
a concept found in the Jains and
other Indian sects and the Buddha
(though he did not go to the
extremes of the Jains) was alive to
the concept and preached against
taking life. All this shows great
feeling of sympathy for living
creatures.
What can be inferred from the
philosophy of Buddhism is a pro
conservationist (sound manage
ment) conception towards nature,
which is critical of an aggressive
attempt to exploit the environment
for short-term benefits and gene
rate gigantism, and a life style
based
on
limitless
con
sumerism. In short, a non-violent
and gentle attitude towards nature,
animals and fellow people provides
the essence of the environmental
stance—the environmental ethic—
of Buddhism.
Zen Buddhism provides an
especially fitting philosophical and
experimental basis for an environ
mental ethic: the phenomenal
world is affirmed as the delightful
expression, the artifice and play, of
the benign and loving common
essence in all things. There is,
moreover, a very strong tradition,
evident in Zen poetry and art, of
nature esthetic. The contempla
tion of the fleeting yet eternal
moment of satori are all elements
of an esthetic attitude towards the
environment. And the esthetic
value of nature has long served as a
powerful human motive for its
conservation.
Zen Buddhism has certain
affinities with Taoism, since Zen is
a version of Buddhism which evol
ved in China, where Taoism is
native. The word << tao >>
literally means a way, or a road. It
June 1993
is the way of the universe, the
orderly and harmonious unfolding
of phenomena, the developmental
tendency of things. If allowed to
take its course, it results in natural
fulfilment ar\d perfection.
Taoism stresses the perfection of
harmony between humanity and
nature. It also provides the basis
for a philosophy of technological
development. The
traditional
Western forms of << high >> and
<< hard >> technology should be
abandoned, from the Taoist point
of view, for forms of < < low > >
and <<soft>> technology or
what is sometimes called an
<< appropriate >>
technology.
An appropriate technology is
essentially adaptive' and coope
rative. It does not attempt to com
mand or control nature, rather, its
approach is to bend natural pro
cesses to human advantage and
adapt human ways of life to the
environment
Like Zen Buddhism, Taoism
conceives the environment as an
articulate unity, a unity among
natural things and these things
with humanity. This picture of
nature as an autonomous and
dynamic whole, in which humanity
has its fitting and appropriate
place, fits well the world view of
ecology which has been descri
bed.
Confucius also accepted the Tao,
but focused on the order of human
society. Just as nature is an
orderly and harmonious realm so
ought human society to be equally
orderly and harmonious. Con
fucianism supports an anthropo
centric environmental ethic. En
vironmental destruction, degrada
tion and defilement would in most
cases impose deleterious effects on
other people and thus violate the
first two Confucian virtues, regard
for others and justice. A third vir
tue being wisdom, it would also be
plainly unwise, because imprudent
or profligate, and violate a fourth
virtue, namely, faithfulness to one’s
children or one’s children’s
children or to one’s more remote
posterity. The contribution to a
universal environmental ethic is
clear.
During the past fifteen years of
heightened environmental con
sciousness there has been intense
controversy about the environmen
tal attitudes of the Judeo-Christian
tradition. Most of this con
troversy has centered on the
relationship between God, Man,
and Nature in the book of Genesis
in the Bible.
Environmentalist
critics
of
Genesis have claimed that since,
according to Genesis, Man is
created in the image of God and
given dominion over nature and
commanded to subdue the Earth,
Genesis clearly awards Man a
God-given right to exploit the
Earth without moral restraint
(except insofar as environmental
exploitation may adversely affect
Man himself). Man’s unique
essence among creatures, con
stituted in the image of God, con
fers upon Man unique rights and
privileges
among
creatures.
Further, God seems to have inten
ded Man to be his viceroy upon the
Earth. Man is to the rest of crea
tion as God is to Man. Thus, if
God is the lord and master of Man,
so Man is the lord and master of
Nature. This may be called the
mastery interpretation of Genesis.
Judeo-Christian apologists have
contested both this interpretation
of Genesis and the untoward
environmental ethical implications
drawn from it. Man’s unique
essence, to have been created in the
image of God, confers, it is argued,
not only special rights and privi
leges upon Man, but also special
duties
and
responsibilities.
COMMUNITY HEALTH CELL.
V
I Block
Korambng^a
z
Bangalore-560034 /
India
149
Paramount among Man’s respon
sibilities is his responsibility to
wisely and benignly rule his domi
nion, the Earth. To abuse, degrade,
or destroy the Earth is to violate the
trust the regent (God) placed upon
His viceroy (man). This inter
pretation may be called the
stewardship
interpretation
of
Genesis.
There are two separate Creation
myths in Genesis: (1) The account
which begins (rather than ends)
with the creation of Man and the
Garden of Eden in a single day and
is centuries older than (2) the
account which begins with the
creation of light and the division of
waters on the first day and ends
with the creation of man on the
sixth. The older, even more ambi
guous. myth also is subject to two
conflicting interpretations about
the proper role of Man in relation
(o nature. It is in this myth that
one finds that the role assigned to
man by God is to dress the garden
of Eden (which might be inter
preted to mean Nature as a whole)
and keep it. This injunction
together with Man’s naming the
animals and thus establishing a
kind of power over them and pre
rogative respecting them suggests
the kind of responsible, benign
vice-regency of the stewardship
interpretation.
There are, as well three possible
environmental ethics consistent
with the Judeo-Christian world
view, depending upon its inter
pretation: (1) an indirect anthro
pocentric. utilitarian environmen
tal ethic associated with mastery;
(2) a more direct biocentric en
vironmental ethic associated with
stewardship: and (3) a direct
biocentric environmental . ethic
associated with citizenship. While
both the environmental ethics
associated with stewardship and
citizenship are direct and biocen
tric, they differ in their practical
implications. The former would
permit benign management of
Nature and wise use while the latter
would imply a laissezfaire, live-andlet-live approach, incompatible
with the present more positive
attitude toward environmental pro
tection and improvement The
environmental ethic associated
with stewardship is thus both the
most practical and the most accept
able interpretation consistent with
the
Judeo-Christian
tradition.
Further, since it is a possible inter
pretation of the role intended for
Man by God in both the creation
myths of Genesis, it seems the most
plausible interpretation of the
overall gist of the text as it has come
down to us, and its most effective
contribution to a universal en
vironmental ethic.
Indeed, current teaching on the
environment—as exemplified by
Pope John Paul H’s Encyclical on
the Environment (1990)—stresses
humanity’s stewardship of nature.
People are the guardians, the pro
tectors, of the environment, not it
owners. A way of loving one’s
fellow human beings as oneself, the
Encyclical states, is to protect the
environment and natural resources
on which they depend.
The other primary source of Wes
tern culture and civilization is
Greek mythology and, later, philososphy, which was disseminated
throughout the Mediterranean
basin by the Macedonian and
Roman empires. A fairly rational
account of the world, initiated early
in the sixth century B.C., is the liv
ing legacy, due to its revival during
the European Renaissance, which
was followed directly by the rapid
development of Western science,
and is thus essentially Greek in
both origin and fundamental
character.
The dominant strains were
Pythagorean, Platonic and Democ-
150
ritean. Some see a nascent en
vironmental ethic in Pythagoras’
belief in the transmigration of souls
from human beings to animals and
from animals to human beings,
extending ethics beyond the sphere
of human relationships to non
human natural beings. However,
the pythagorean ethic has closer
affinities to the contemporary
animal liberation/animal rights
ethic than to an ecological/environmental ethic. Moreover this
concept of the soul as con
taminated by its bodily and earthly
prison or tomb and thus alienated
from the natural environment is
profoundly antithetical to an
environmental ethic preaching the
harmony of humanity and the
environment
This dualistic concept—a divine
soul in an alien, mortal body—
became a cornerstone of the later
philosophy of Plato, and thanks to
whose
enormous
influence,
became virtually institutionalized
in Western culture and civilization,
both religious and secular. Mean
while Greek philosophers were
also occupied with the physical
world, the nature of nature, one
might say. It reached a culmina
tion with Leucippus and especially
Democritus, who developed the
atomic theory of matter—atoms as
indivisible, solid particles compos
ing all material objects.
The resulting concept of nature
as materialistic and mechanical,
and of Man, because of his soul, as
essentially divine and both sepa
rate from and superior to nature,
has reinforced the notion of incom
patibility rather than harmony with
the environment In this respect
the Greek philosophical tradition
of Pythagorean-Platonic dualism
and Democritean atomism can be
said to lie more heavily at the roots
of present environmental problems
than contribute to an environmen
tal ethic. However, the other
SWASTH HIND
GALTH CEU
aspect, namely, the Greek stimulus
to a scientific attitude, while result
ing in a technology which has so
often had negative environmental
impacts, can also develop approp
riate, environmentally conceived
technology to prevent and correct
the problems created by the
former.
In this sense, too, Greek
philosophical tradition can con
tribute an essential component of
an environmental ethic—scienti
fically sound environmentalism,
that is, the rationale of a secular
environmental ethic.
Although the culture and civili
zation of the Middle East and
North Africa are rooted in the
Judeo-Christian
and
GrecoRoman traditions, there is a third
major element which spread world
wide, Islam. During the Euro
pean Dark Age, Greek science was
preserved and developed by
Islamic scholars and Mohammad,
(he Prophet of Islam, regarded
himself to be a prophet of the same
God and in the same prophetic
tradition as Jesus, Moses, and
Abraham before him. The Islamic
cultural tradition, therefore, has
been substantially influenced by
Judeo-Christian
and
GrecoRoman ideas, although it con
stitutes a distinctive historical and
cultural context for environmen
tal ethics.
The Koran is less ambiguous
than Genesis about the relation
ship of human beings to nature. It
makes explicit certain themes
which are only suggested implicitly
in the more ancient account in
Genesis. According to the Koran,
Allah created the first man and
woman, Adam and his wife, from a
clot, or clay, or dust, and breathed
into His creation the breath of
life. All other things are explicitly
created by Allah for the sake of, the
use of. and the benefit of man.
June 1993
Adam and his seed are explicitly
made to be the viceroy of God on
Earth. According to Islam, then,
man is at the moral center of crea
tion and is, indeed, the very pur
pose of the creation. As in Genesis,
so also in the Koran, it is man’s
right to have dominion over and to
subdue the Earth and all its non
human denizens. Indeed, in the
Koran, not only are animals and
plants subjected to man, the rivers,
the sea, even the sun and moon are
subjected to and subservient to
man. Man’s dominion over the
earth and the subordination of the
creation to man is spelled out in no
uncertain terms.
Man’s role is viceroy or agent on
earth should not, however, be con
fused with tyranny. Man’s domi
nion over the Earth should be
benign, not wantonly destruc
tive. The doctrines of Islam are
equally explict and emphatic that
man’s relation to nature should be
one of stewardship not mastery.
The creation of Allah is, as it
were, a divine work of art. The
whole world and all of its parts are
understood
in
Islam
as
<< signs >> to man indicative of
the greatness, the goodness, the
subtlety, the richness, and so on of
the creator. To deface, defile or
destroy nature would be an im
pious or even blasphemous act
Although man is accorded the
usufruct of the Earth, he is not
given the right to abuse it with
impunity.
The sanctions on environmental
abuse (direct abuse of the natural
.environment, setting aside, for the
moment, the indirect effects on
people) are of two kinds. The
Earth is a temporary abode for
man, and Allah, according to
Islam, rewards and punishes deeds
done on Earth in the next life.
Persons, therefore, who blaspheme
against God by defacing, defilling,
or destroying His creation will be
punished accordingly in the next
life.
However, even though the Earth
is only a temporary abode for man,
and meant to be at the service of
man, man is very much at one with
the Earth, at least while living on
it Man is made of the stuff of the
Earth, dust or clay, and he is, albeit
exalted above all others, a creature
among creatures. There should,
thus, be a kind of fellowship bet
ween man and other creatures,
according
to
Islam. Islam,
moreover, values scientific know
ledge of the environment, whose
study is encouraged and supported
by the doctrine of signs. As we
learn more about the natural world,
through the geological arid biologi
cal sciences, it has become abun
dantly clear that the natural
environment is systemically inte
grated, a seamless whole. Hence,
'the destruction of one part of the
environment
will
reverberate
throughout the whole. Now as
man, according to Islam, is, after
all, made of the stuff of the Earth, a
creature among creatures, environ
mental destruction is necessarily
self-destruction. This too is a kind
of sanction against environmental
abuse—*■ a this-wordly, not otherwordly, type of sanction.
The Islamic tradition clearly
supports, perhaps even more une
quivocally than the Judeo-Chris
tian tradition, a direct biocentric
environmental ethic of the steward
ship
type. The environment,
though given over to man’s role
and subservient to man, is the
direct object of respect and care,
because it is the handiwork of God
and a sign of His power and
majesty. The Islamic tradition also
clearly supports an indirect
anthropocentric
environmental
ethic.
151
According to Islam, all human
beings are descended from Adam
and Eve. Hence all human
beings, regardless of race, colour, or
national origin, are equally mem
bers of one extended family; no
people are privileged or chosen; no
one is inherently better than any
one else. In Islam, moreover,
there is a strong emphasis on jus
tice. Justice, indeed, is one of the
cornerstones of the Moslem reli
gion. Since environmental abuse
and/or destruction are, more often
than not harmful to people, they
are a form of injustice. To ruin or
destroy the environment is tan
tamount to either bodily injury or
the destruction or theft of property
or both. Further, ignorance of the
complex or delayed effects of
action in the environmental arena
is no excuse, since Islam stresses
the moral importance of know
ledge, no less than of jus
tice. These are all truly elements
of an environmental ethic with
universal implications.
Reviewing the foregoing tradi
tional cultures and religions to find
what they have in common with
regard to humanity's relationship
and responsibility vis-a-vis the
environment—in other words, the
common ingredients of a universal
environmental ethic—is the his
toric role of environmental educa
tion. An ethical attitude toward
the environment personally and
professionally, individually and
collectively, and universally valid,
is both the assumption and the goal
of this new great field of education,
making EE the principle, indispen
sable instrument for its develop
ment.
Indeed the aim of this article has
been to provide the cultural and
religious background and elements
for just such an EE programme
activity. The nascent environ
mental ethics demonstrated in the
various traditional beliefs may be
developed in two complementary
ways. Firstly, both inside and out
side the formal school system, by
contemporary
cultural
custo
dians—priests, rabbis, mullahs,
scholars, and religious and secular
educators generally, who are
environmentally aware, who speak
with authoirity for their respective
intellectual traditions, and who
realize that living bodies of belief
change and evolve in response to
the vital needs of the times.
Secondly, they may be developed
through alliance with contem
porary scientific concepts and
research findings of the biological
and
environmental
sciences.
Some modem scientists even
argue that they are often simply
rediscovering concepts intuitively
grasped in traditional cultural
world views. For example, Taoism
appears to have understood the
cyclical nature of biological pro
cesses, the American Indians
ecological interdependency, Hin
duism and Jainism the continuity
of life. Animist religions, as well,
strongly emphasize the link bet
ween humanity and the environ
ment And so on. Traditional
environmental attitudes, resting
upon such intuitively grasped
ideas, can frequently be reinforced,
enriched and developed by means
of the more detailed theories and
findings of the contemporary life
sciences.
In turn—and as a conclusion—
environmental education and its
ethical component not only find
their roots in these world cultures
and religions, but their sound
development requires that they be
solidly anchored in them—with
due regard for the requirements of
changing, evolving and differing
civilizations.
(The above article is based on
several studies prepared in the
framework of the UNESCO-UNEP
International Environmental Edu
cation Programme).
—Courtesy: Connect, June 1991.
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152
Swasth Hind
Launching the Environmental
Revolution
LESTER R. BROWN
health of the planet has
deteriorated dangerously dur
ing the last few years. As a result,
the world faces potentially con
vulsive change. The cnicial ques
tion is. will the change come from
strong worldwide initiatives that
reverse the degradation of the
planet and restore hope for the
future, or will it come from continu
ing environmental deterioration
that leads to economic decline and
social instability.
T
he
Muddling through will not
work. Either we turn things
around quickly or the self-reinforcing internal dynamic of the
deterioration-and-decline scenario
will take over. The policy deci
sions we make in the years
immediately ahead will determine
whether our children live in a
world of development or decline.
Building an environmentally
sustainable future depends on res
tructuring the global economy,
major shifts in human reproductive
behaviour, and dramatic changes
in values and lifestyles. Doing all
this quickly adds up to a revolution,
one defined by the need to restore
and preserve the earth’s environ
mental systems. If this Environ
mental Revolution succeeds, it will
rank with the Agricultural and
Industrial Revolutions as one of
the great economic and social
transformations in human his
tory.
JUNE 1993
People facing starvation today are not likely to worry about
the effects of climatic change tomorrow. The situation
has come where we can no longer separate the future
habitability of the planet from the current distribution of
wealth. Unless a strong net flow of capital from rich
countries to the poor is restored, international environmen
tal effort is doomed to be a failure. Lester R. Brown in this
article talks about the issues that are to be solved for the
smooth ushering in of the Environmental Revolution —the
only action that can save this planet from the
impending disaster.
A Faster Pace
The pace of the Environmetal
Revolution will be much faster
than that of its predecessors. The
Agricultural Revolution began
some 10,000 years ago and the
Industrial Revolution has been
under way for two centuries. But
if the Environmental Revolution is
to succeed, it must be compressed
into a few decades.
to. Between 1950 and 1984, the
historical peak period, world grain
production per person climbed by
nearly 40 per cent Since then it
has fallen roughly one per cent a
year, with the drop concentrated in
poor countries. With food im
ports in these nations restricted by
rising external debt, there are far
more hungry people today than
ever before.
Already the planet’s degration is
damaging human health, slowing
the growth in world food produc
tion and reversing economic pro
gress in dozens of countries. A
scarcity of new crop land and fresh
water plus the negative effects of
soil erosion, air pollution and hot
ter summers on crop yields is slow
ing the growth of the world grain
harvest. Combined with con
tinued rapid population growth
this has reversed the steady rise in
grain output per person that the
world had become accustomed
On the economic front the signs
are equally omnious: soil erosion,
deforestation and overgrazing are
adversely affecting productivity in
the fanning, forestry and livestocks
sectors, slowing overall economic
growth in agriculturally based
economies. Converting to an
environmentally sustainable eco
nomy in the time available depends
on accelerating the process of
change.
Our choice now is either to rally
behind the Environmental Revolu
tion or to continue on the current
153
path, moving towards, a world
where famine expands beyond the
capacity of international relief
agencies, where cancer reaches
epidemic proportions, and where
the decline in living conditions
now under way in some 40 coun
tries continues to spread, dropping
more and more of the world’s poor
below the survival level.
Redistribution
Social and economic change
always starts with individuals, even
when it occurs within large
organisations. Some of the con
ditions of sustainability can be
satisfied' by individual lifestyle
decisions or by local community
action. Individuals
can
use
energy more efficiently. But phas
ing
out
Chlorofluorocarbons
(CFCs), replacing fossil fuels with
solar energy, or protecting the
planet’s biodiversity depends on
national Governments and inter
national
agreements. Without
clear policy
guidance
from
Governments, corporations, which
control a large share of the world’s
investment capital, are not likely to
make the required changes in
investment pattern.
Barber Conable, the former
World Bank President has, noted
that “as the 1990s unfold, success in
reducing poverty should be the
measurement of global economic
progress”. It is difficult to imagine
an effective international environ
mental effort if a strong net flow of
capital from rich countries to poor
ones is not restored. As others
have noted, when we reach the
point where half the world watches
the other half starve to death on
television, the civilization will have
come to an end.
If deepening poverty continues
to threaten the survival of part of
humanity in the short run, the
Environmental Revolution will
fail. People facing starvation
today are not likely to worry about
the effects of climate change
tomorrow. We can no longer
separate the future habitability of
the planet from the current dis
tribution of wealth.
To Succeed
In the years ahead, environmen
tal influences can be expected to
increasingly dominate the evolu
tion of the global economy. Phas
ing out fossil fuels, shifting to a
reuse-recycle economy, protecting
the stratospheric ozone layer,
reducing air pollution and acid
rain, minimising hazardous waste
generation and adapting to water
scarcity are among the environ
mental' influences shaping the
economic future.
Local limits on the earth’s waste
absorptive capacity are forcing
industries
to
redesign
their
manufacturing
processes
to
generate
less
waste. Already
doing this in response to Govern
ment regulations, firms will find an
even greater incentive to cut waste
as environmental taxes are levied,
such as those recently adopted on
plastic bags in Italy and nonreturnable beer and soft drink containers
in Finland.
Unless more of us become
environmentally active, both as
individuals and in organised
groups, the Environmental Revolu
tion will not succeed. Success
depends on overcoming human
inertia, vested economic interests
in the status quo and some of the
structural impediments of society.
Although the Environmental
Revolution has been described
here largely in environmental and
economic terms, it is in the most
fundamental sense a social revolu
tion, the product of changing
values, of seeing ourselves again* as
a part of nature rather apart from
nature, of recognising our depen
dence on the earth’s natural sys
tems and resources and on the
goods and services they provide.—
(Courtesy: State of the World
Report, 1992)
The urban crisis
The world is at a turning point. It is faced both by the massive
degradation of the natural environment and by the accelerating decline
in the quality of life of many of those who live in the built environment
of cities. The two crises are related. The consequences of
urbanization make a major contribution to the global environmental
changes that threaten the very existence of life in the future, while
changes in the biosphere increasingly affect health and social
conditions in the cities. Dealing with this twofold crisis calls for
unprecedented cooperation among the people of the world and their
governments.
— Environmental health in urban development Report
of a WHO Expert Committee. Geneva. World Health
Organization, 1991 (Technical Report Series, No. 807), p. J.
154
SWASTH HIND
ENVIRONMENTAL TERMINOLOGY
Environment
Environment is the surround
which includes all external con
ditions and influences affecting the
life
and
development
of
organisms. It is broadly divided
into two parts biotic and abiotic for
ecological purposes.
Biotic Environment
The biotic environment consists
or living organisms, which both
inter-act with each other and are
inseparably inter-related with their
abiotic environment.
surrounds which
biosphere.
comprise
the
Ecological systems powered by
solar energy are known as eco
systems. These are basic to sup
port life on the planet earth.
Conservation
Conservation is the management
of human use of the biosphere so
that it yields greatest sustainable
benefit to mankind. It includes
preserving,
maintaining,
sus
tainable
utilisation,
restoring
and enhancing of the natural
environment
Abiotic Environment
The physical or abiotic environ
ment includes all those physical
and non-living chemical aspects
which exert an influence bn living
organisms. Among these are soil,
water, the atmosphere and the
influence of energy from various
sources.
Biosphere
Biosphere is the surround which
is of direct relevance to the living
beings inhabiting the planet It is
thin layer of soil, rock, water and
air that surrounds the earth which
we utilise for our living. In short
it is the life zone of the earth.
Ecology
Ecology is the scientific study of
the relationship between orga
nisms and their environment
Ecological Systems
Ecological systems are the
intimate relationship between liv
ing organisms and the non-living
JUNE 1993
Development
Development is the modification
of the biosphere and the applica
tion of human, financial, living and
non-living resources to satisfy
human needs and to improve the
quality of life.* For sustainable
development,
socio-economic,
ecological, living and non-living
resource base, choice between
alternative decisions, short-term
and long-term advantages/disadvantages are crucial factors in
the process.
Desertification
Desertification is a process of
any piece of living habitat becom
ing a desert due to vegetation being
so scanty so as to be incapable of
supporting
any
considerable
human population. Apart from
prolonged drought, large scale
human activity including overgraz
ing and over exploitation of natural
resources are the principal reasons
for desertification. Experts at the
UN estimate that 10 percent of the
earth’s population have already
been affected to some extent by
desertification.
Resource *
The resource is a constituent of
each element of the surroun
dings. Natural resources include
air, water, land, biotic components,
fuel and raw materials. Man
made resources include cultural •
heritage, human population and
socio-economic
infrastructure
among other things.
Social Forestry
Social Forestry programmes
were started in the late 1970s.
These include raising rural fuel
wood plantations and village wood
lots, starting tree nurseries, dis
tribution
of
tree
saplings,
encouragement of plantations
around agricultural fields as well as
promotion of farm forestry and
strip plantations on roadsides and
canal banks.
Acid-Rains
The presipitation of rain-clouds
and the resultant shower are
exposed to unnatural atmospheric
oxides due to industrial pollu
tion. These gases are generated
due to manufacturing activities and
disperse into the atmosphere.
Consequently, the rain has to pass
through an atmosphere polluted
with two poisonous gases namely
sulphur dioxide and nitrogen diox
ide. These gases are mostly emit
ted from power plants and
factories. The falling rain and
snow react with these oxides and
presipitate new chemical proper
ties. This mixture, often of sul
phuric acid,,nitric acid and water is
155
being described as “Acid Rains” by
scientists. This
causes
wide
spread harm to the environment.
Greenhouse
Warming
Effect
&
Global
A part of the sun’s rays pass
through the atmosphere into the
planet earth which we inhabit
Some portion of these rays are
absorbed by plants, soils and the
atmosphere. These
rays
are
necessary for maintaining the
minimum temperature to sustain
human life in the planet The
word greenhouse is derived from
the phenomenon of the sun-rays
easily passing through transparent
plastic and glasspanes enclosing
vegetation. In the larger context
of the earth, it means penetration of
the sun-rays into the planet and its
ecology. A part of the heat
received is reflected by the earth in
the infra-red range of long
wavelength. This is trapped by
clouds, dust particles, carbondiox
ide and water vapour in the lower
layers of the atmosphere. This
combined with large scale human
activity are changing the earth’s
atmosphere. The increase in the
earth’s temperature is being des
cribed as large scale global war
ming. The consequent accelera
tion in the melting of glaciers and
snow-fields could raise the level of
oceans by 70 cms.(more than 2 ft)
per century to begin the drowning
of most of the sea-ports in the
earth. This whole effect is known
as the greenhouse effect
CFCs
Popularly known as Chloro
fluorocarbons, CFCs are Chlorine
compounds extensively used for
refrigeration,
air-conditioning,
foamed plastic and as aerosol
propellants.
Ozone Layer
The ozone gas is caused by the
action of the sun’s ultraviolet radia
156
tion with ordinary oxygen in the
upper atmosphere. It is found as a
band of gas in the atmosphere
about 15 to 50 kilometres above the
surface of the earth. This zone is
called Ozondsphere. Near the
ground level, ozone is an undesir
able pollutant a constituent of
smog that irritates the eyes and
impairs breathing. But in the
upper atmosphere it acts as a
screen against harmful ultra-violet
rays which would otherwise reach
the earth. These rays can cause
extreme sunburn, skin cancer and
damage to the body’s proteins and
nucleic acids.
the river and sea beds. A global
ban on all such dumping at the
sea by 1995 had been pro
posed. Alternatives are available
for scientific and harmless disposal
of toxic waste. These are building
better dumps which are leak proof,
breaking down the poisons and
eliminating output of toxic wastes
in the production process itself.
UNEP
Scientists monitoring the ozone
layer had noticed that it became
thinner each spring over the South
Pole. In 1985, researchers from
the British Antartic Survey dis
covered a hole in it The major
cause for this is the breakdown of
ozone by the chlorine compounds
of CFCs. These substances are
estimated to be present in the
atmosphere for a life span of 100
years.
The United Nations Environ
ment Programme (UNEP), was
established in 1972 by the UN
General Assembly as a result of the
Stockholm Conference of Human
Environment. UNEP works on
assessment, review and formula
tion of policies and programmes on
environment protection. It also
administers a fund for this pur
pose. The UNEP world report
published in 1983 is considered to
be a major policy document on the
environment
scene
in
the
world. It
outlines
concerns,
strategies and policies to protect the
environment and to create a safe
planet for human inhabitation.
Toxic Waste Disposal
Stockholm Conference
Niagara Falls in New York,
became the centre of a horror story
in 1978. About 25 years earlier, a
chemical manufacturing company
had disposed of 20,000 tonnes of
highly poisonous wastes by bury
ing them in a landfill at the site of
an old canal. This is only of
thousands of places where the toxic
wastes of industry have been stored
or dumped. Distance from a
dumping site is no guarantee of
safety, because rainwater seeping
through the dump carries con
taminating material through the
soil and may reach wells or rivers
serving as water supplies.
The Global concern for Environ
mental Protection found expres
sion .in the UN Conference on
Human Environment held at
Swedish capital Stockholm in June
1972. The Conference adopted an
action plan relating to subject areas
of human settlements and human
health, territorial eco-systems,
environment and development,
oceans, energy and natural disas
ters. It proposed institutional
arrangements for implementing
the action plan within the UN sys
tems. The recommendations of
the Action Plan were accepted by
the UN General Assembly and
institutional arrangements were
made under the UNEP.
Ozone Hole
Scientists are also finding high
levels of extremely poisonous
chemicals being disposed of into
SWASTH HIND
UNEP Session
Ten years after the Stockholm
Conference, UNEP convener a ses
sion of a special Charter of the
Governing
Council
of
the
UNEP. This Conference was held
in 1982 at Nairobi to commemorate
the tenth anniversary of the
Stockholm Conference. The ses
sion reviewed major achievements
of the Stockholm Action Plan and
recommended action in the field of
environment to be taken by the
UNEP over the next decade. The
Conference adopted a Nairobi
Declaration and a decision on
Environment in 1982—Retrospect
and Prospect The Conference
felt that the principles of the
Stockholm Declaration were as
valid 10 years later as in 1972 and
together with the decisions adopted
in the Nairobi Conference, pro
vided basic guidelines for effective
and
sustained
environmental
progress.
Vienna Convention
The Vienna Convention for the
protection of the ozone layer was
initiated by the UNEP and was
adopted in 1985. It came into
force in September 1988. The
Convention provides for*a general
framework for addressing the
ozone problems at the • inter
national level through coordinated
research, exchange of information,
etc. It also envisages action
through specific protocols to con
trol ozone depleting substances.
Montreal Protocol
The Montreal Protocol on sub
stances that deplete the ozone
layer, adopted in September 1987
has come into effect since January
1989. The protocol in its original
form (prior to amendments at the
recent London Conference) aims at
a phased reduction by 50 percent in
the production and consumption
of some controlled substances in
JUNE 1993
the next ten years and for freezing
the consumption of halons. The
protocol says developing countries
including India which have a low
level of consumption of such sub
stance will follow a similar
schedule, but with a ten year
delay. The protocol also provides
for restriction of trade in the con
trolled substances with non-parties
to the Convention and in general
terms for technical and financial
assistance to developing countries
to comply with it.
Funds for Assistance
Till a multilateral fund is
established, an interim financial
mechanism has been set up under
the protocol for the purpose of pro
viding financial and technical
cooperation, including technology
transfer to the signatories to the
protocol. The fund will meet the
incremental costs of developing
countries for developing alternate
technology and substances for pro
tecting the environment in their
industrial activity.
UNCED
One of the major outcome of the
Brundtland reportis the decision to
organise the United Nations Con
ference on Environment and
Development (UNCED) at Rio de
Janeiro in Brazil in June 1992.
The primary goal of this Summit
level conference is to establish
relationship between environment
and development The UNCED
is likely to cover virtually every sub
ject which is related to both
environment and development
issue and the mechanisms and
modalities by which sustainable
development may be achieved. In
particular, it would seek to identify
the constraints and obstacles which
the developing countries face in
their pursuit of development and
necessary action to ensure sound
and foolproof strategies for
environmental protection. This
includes the nature of the inter
national economic order, trade pat
terns, aid terms, the working of the
international financial institutions
and even the functioning of the UN
systems.
Basel Convention
New Delhi Conference
The Basel Convention on the
control of transboundary move
ment of hazardous substances was
adopted at a Conference in Swit
zerland in 1989.
A preparatory official level con
ference of 21 developing countries
to discuss the emerging global
environment issues was hosted by
India in New Delhi in April
1990. It took stock of the ground
work done for the earth summit
and outlined broad priorities.
Brundtland Report
The linkages between environ
ment and development were clearly
brought out in the report of the
World Commission on Environ
ment and Development chaired by
the former Prime Minister of Nor
way. Ms. Gro Halem Brundtland.
Popularly known as “Our common
future” .1988, this report was pre
pared at the behest of the UN
General Assembly and was presen
ted to it in 1988. Its recommen
dations were endorsed by the world
body.
Beijing Conference
As a follow up to the New Delhi
Conference, a ministerial level con
ference of developing countries was
hosted by China at Beijing in June
1991. It was the first ever such
conference of developing countries
in which 41 of them par
ticipated. An important outcome
of this conference was the adoption
of the Beijing Declaration which
substantially met the concerns put
(Contd. on Page No. 128)
157
HEALTH SERVICES IN URBAN SLUMS
—Need for a Micro-planning Approach
Dr A.T. Kanan, Dr s. Venkatesh and Dr K. Pandit
with
rapidly growing number of
urban slums and slum population
and accompanied health conse
quences, has been a matter of con
cern for urban planners, econo
mists,
environmentalists
and
health administrators alike. The
bulk of the urban poor are living in
extremely deprived conditions with
insufficient physical amenities like
low cost water supply, sanitation,
sewerge, drainage, health care, nut
rition, pre-school and non-formal
education, etc.
NCREASING urbanisation
I
A survey by the Delhi based
National Institute of Urban Affairs
estimated that 50.5 million people
(about 27.7%) of the urban popula
tion were living below the poverty
line in 1984-85 and that another 100
million people would be added to
this in the next 10 years, thus
further aggravating the situation.
The survey also revealed that of the
population below poverty line in
urban areas, women and children
number about 33 million (women
15 million and children 18 mil
lion).
Considering their poverty, living
conditions and usually precarious
nature of work, it is not surprising
that the urban poor are the easy
targets to various illnesses. The
most common illnesses among
slum dwellers are respiratory dis
eases. gastro-intestinal disorders,
skin diseases, fever, worm infes
tations, ENT ailments and tuber
culosis.
158
An I.C.M.R. study covering
slums in three cities in 1984-85
showed that 85% of the people did
not avail of the available maternal
and child health services and that
75% of the births were unattended
by any health functionary. While
the average rate of infant mortality
in urban India is half that for rural
India, the rate in slum sectors of the
larger cities was found to range bet
ween 51 to 93 per 1000 live
births. The prevalence of low
birth weight varied from 25.9% to
56.9%. Around 6,000 urban child
ren become blind annually due to
Vitamin A deficiency. Nearly
three lakh urban children die every
year from diarrhoeal dehydra
tion. Incidence of diarrhoea in
urban areas is estimated to be 500
per 1000 among infants and 299 per
1000 among pre-school children.
82% of the pre-school age children
in urban slums have some degree
of Protein Energy Malnutri
tion. The changing trend . from
breastfeeding to bottle feeding in
urban slums may be contributing
to this increased morbidity in
children below 5 years of. age.
Anaemia and Iodine Deficiency
disorders have also been reported
in these children.
Urban malaria, tuberculosis and
respiratory ailments and leprosy
are important diseases affecting the
urban slum population. The pre
valence rate of leprosy was 22 per
1000 in a slum in Bombay against
the city average of 6.9 per 1000.
The energy intake data of Natio
nal Nutrition Monitoring Bureau
from 15 major cities showed a
lower energy intake for urban slum
dwellers similar to that of the land
less and was lower than the rural
average. Situation in relation to
other indicators was also far from
satisfactory. 30% of live births
were of parity four and above.
Female enrolment in schools was
low with 2/3rd of girls between 10 to
14 years of age in Delhi slums
being out of school.
Mothers in urban slums working
to supplement the family income
face problems relating to child care
facilities during the day. The.
situation as regards sanitation is
also poor with an estimated 93% of
the households having no inde
pendent source of water supply.
Environmental improvement in urban
slums
Rightly recognising the need for
.urgently addressing the problem of
urban slums, the National Housing
Policy enunciated by the Govern
ment of India in 1988 had, as one of
its five important goals, “the crea
tion through housing........... of con
ditions conducive to the achieve
ment of crucial goals in health,
sanitation and education sec
tors”. Health considerations are
also inbuilt in the building regu
lations, public health and urban
planning acts and slum improve
ment legislation. The Policy em
phasises the necessity to keep in
Swasth Hind
sharp focus the needs of the home
less and those living in extremely
poor shelters and unhealthy neigh
bourhoods. Shelter has been
viewed in a broad perspective as
including not only the structure but
also the various physical and social
services which form a part of the
housing environment
Emphasis is 'being given to
environmental improvement of
urban slums (rather than their
massive clearance or relocation)
with provision of seven basic
amenities viz. water supply, sewer,
storm water drains, community
baths and latrines, widening and
paving of existing lanes and path
ways and street lighting.
Health posts have been set up
under Family Welfare programme
for providing out-reach services in
urban slum areas. The present
urban health care delivery system,
which was reviewed in depth by the
Krishnan Committee in 1982, is
being revamped and streamlined
with assistance from international
and bilateral agencies like WHO,
UNICEF, ODA, USAID, etc.
Urban Basic Services for the Poor
The Urban Basic Services for the
Poor (UBSP) Programme is aimed
at convergence of social and physi
cal services rendered by different
specialised
departments
like
Health, Education, Social Welfare
and Industry/Industrial Training in
urban slums with special emphasis
on women and child survival and
development* through immuniza
tion, nutrition supplementation,
pre-school and creche facilities,
training for income generation,
water supply and low cost sani
tation.
Introduced in 1986 as a Centrally
sponsored
programme
with
UNICEF assistance, the Urban
Basic Services programme was
reviewed and enlarged in 1990-91
and came to be called U.B.S.P.
JUNE 1993
The programme presently covers
169 towns of 36 districts. The
revised programme has enlarged
the social services to be provided to
urban poor by including special
inputs for street children, han
dicapped, poor, aged and destitutes
and for solving socio-economic
problems of the slums like juvenile
delinquency, communalism, gam
bling and alcoholism.
The programme encourages
slum dwellers to take the lead in the
developing process by identifying
their obstacles and finding solu
tions appropriate to their needs
and capabilities. Resident com
munityvolunteers —usually women
from the slum themselves—provide
immediate daily assistance and
ultimately creating linkages to the
Government development agencies
responsible for providing ser
vices.
Urban India lacks a structure
similar to the rural health set-up
which has defined territorial res
ponsibilities. Though
U.B.S.P.
Programme tries to fill up this gap
in the areas in which it is function
ing, there is necessity for a well
organized health care programme
covering urban slums all over the
country. There is also a need for
proper coordination and monitor
ing of the various health and
development
agencies—both
Governmental and Non-Govemmental working in urban slums.
Need for micro level action plan
A Micro Level Action Plan
should be prepared for each slum
area which should be available
with all the Departments/Agencies
involved in delivery of health care
services in that area. The Plan
should incorporate the following
elements:
1. Service Delivery agencies pro
viding health care services directly
or indirectly. MCH Services,
including ante-natal, under five
care and immunisation should be
provided on fixed dates and times
at fixed locations. Proper system
of referral should be implemen
ted. Coordination of activities of
the various organisations is
necessary to ensure optimum
delivery of services.
2. Enumeration of the popula
tion where it is not already done
and should be made available
with the Anganwadi workers or
other service agencies. This can
be carried out with the help of
NGOs, NSS Volunteers, teachers,
etc. The trainees of ANM, MPW
Schools could also be involved.
3. Identification
of
Nodal
Officers—The overall respon
sibility should lie with the
Municipal Officers. Some offi
cers may be made responsible
zone-wise after dividing the town
into zones with a population of
50,000 slum dwellers each.
4. Health Coordination Commit
tees should be formed at all
levels—-Community, ward and
town levels—with the involvement
of locally elected representatives
and leaders and volunteers from
the community.
5. Training
and
Continuing
Education
Programme—The
training needs of the various
volunteers involved should be
identified and suitable curricula
and programmes developed and
organised with emphasis, on com
munity orientation, e.g., com
munity based distribution of oral
rehydration salts, conventional
contraceptives and chloroquine.
6. Monitoring
&
Coordina
tion—The responsibility for this
should rest with the local adminis
trative body under control of the
local administrative chief. The
Health Officer may be the Nodal
person who will coordinate and
159
monitor. Members from other
related departments like Educa
tion, Sanitation, Public Works,
etc., should be involved. A pro
per Management, Information &
Evaluation system should be
developed and used for this
purpose.
7. Logistics & Demand Gene
ration—The requirement of health
care equipment, medicines, chemi
cals and other supplies should be
properly estimated in advance
based on the needs of the com
munity, and their supply should
be ensured. Proper maintenance
of the equipment is also essential
for which linkages have to be
established with servicing departments/agencies. Decentralisation
of financial powers to the
periphery would help improve
efficiency. Information, Educa
tion and Communication (I.E.C.)
programmes may be organised to
encourage community participa
tion and increase the demand for
the services.
8. Schedule of activities—A pro
per scheduling of the activities
should be done which should
include time, place, persons,
etc. This would help ensure pro
per implementation of various
phases of activities.
9. Health Systems ResearchResearch on Biological, Psycho
social Environmental and other
factors related to health as well as
on the components of health care
services on the delivery mecha
nism would help identify lacunae
and suggest measures for improv
ing the. efficiency.
Unless such suitable time
bound Microlevel Plans are pre
pared for the urban slum areas, it
may not be possible to ensure
optimum provision of primary
health care services to the vast
population
living
in
urban
slums.
“BREAK-BONE FEVER” INCREASING WORLDWIDE
HE severe viral disease dengue,
which can be fatal to young
children, is spreading and worsen
ing throughout the globe, with tens
of millions affected annually, and
urgent measures must be taken to
bring it under control, the World
Health Assembly—the governing
body of the World Health
Organisation
(WHO)—resolved
on 14 May, 1993 in Geneva.
T
The incidence of “classical”
dengue, called “break-bone fever”
because of the intense pain it can
cause in bones and joints, has
been increasing since the Second
World War—when the disruption
of warfare is believed to have
spread the daytime—biting mos
quito that transmits the disease
throughout Asia. These mos
quitos—principally Aedes aegypti—
breed rapidly in clean water in
tins, abandoned tyres, cement
tanks, drums, water jars, the
lops of bamboo fence-poles and
hundreds of similar sites, and
have continued to spread widely
with increasing urbanization, in
the litter of unplanned urban
settlements.
As with most viral diseases,
there is no specific treatment, and
no vaccine is yet available
(although WHO has sponsored
dengue vaccine research for many
years, and at least one promising
candidate vaccine has recently
entered human trials). Patients
with classical dengue must be
given bed-rest and analgesics, and
cool sponging if the fever becomes
extreme. Children with severe
DHF/DSS develop high fever,
vomiting and bleeding from
capillaries, and must receive
transfusions to compensate for
fluid loss. Without proper medi
cal attention, death rates can
average some 15%; with attention
this can be reduced to 1—
3%. Nearly three million child
ren have been hospitalized by
dengue in South-East Asia in the
past three decades.
The World Health Assembly
resolution called for increased
resources to be devoted to Aedes
control—involving training, plan
ning and educational measures—
at every level from the affected
communities to WHO itself.
WHO should establish strategies
which will be sustainable at the
country level; and increase the
Organization’s, capacity for re
search in dengue surveillance,
“■epidemiology and vaccine deve
lopment. WHO needs USS 2.8
million for dengue control in
1994-1995 much of it to be drawn
from extrabudgetary (voluntary)
donations. The resolution adop
ted by the World Health Assembly
today calls on the DirectorGeneral in addition “to increase
efforts to find extrabudgetary
resources for support to national
and international dengue preven
tion and control activities”.
—WHO
Swasth Hind
160
COMMUNITY HEALTH CELt
326, V Main, I Block
Korambngsla
Benga;ore-5 60034
India
PAIN RELIEF DEVICE
electronic drug-free pain
device named Xenos, which
won a 1991 British Design Award
for its manufacturer, is based on
the proven method TENS (Trans
cutaneous Electrical Nerve Stimu
lation), and is used for conditions
such as sports and spinal injuries,
arthritis and post-operative pain.
n
A
Electrodes are placed on either
side of the pain area (as shown in
photograph), and a low frequency
current is applied between them.
The patient experiences the
stimulation as a mild tingling
sensation.
Xenos operates by activating
two natural pain relieving mecha
nisms within the body. The ‘Gate
Control’ mechanism, whereby
pain impulses from a painful area
are intercepted and weakened
within the spine on the way to the
brain, which reduces the perceived
intensity of the pain, and by
increasing levels of the body’s own
natural pain-killing substances,
endorphins and enkephalins.
The product has innovative
touch-control technology which
overcomes the problems of con
ventional operation. To operate
it, the patient simply holds the
intensity ‘increase’ button until
stimulation is felt. The control is
then released and ‘single touch’
operated until the right level of
pain relief is reached. Using a
microchip, the electronics have
been miniaturised, producing a
small compact product which can
be worn discreetly and comfor
tably on a belt or in a pocket
Other features include an
automatic memory to retain set-+
tings for future use, a sensor which
shuts down operation on detection
of a loose lead or electrode, and a
new randomly modulated output
waveform which helps overcome
long term ‘patient accommoda
tion’ that can occur when the body
is subjected to a repetitive
stimulus for long periods, thereby
reducing the pain-relieving effect
of TENS.
—Spectrum, March-April 1993.
Authors of the Month
Dr (Col) A.C. Urmil
Dr Deoki Nandan
Harbir Kaur
Professor (PSM)
Krishna Institute of Medical Sciences
P.O. Karad-415 110
Maharashtra
Associate Professor
Department of S.P.M.
S.N. Medical College
Agra
Uttar Pradesh
English (Hons) HI Yr
Shyama Prasad Mukherji College
Punjabi Bagh
New Delhi
Dr Pul. Somaiya
Addl. Professor (PSM)
Krishna Institute of Medical Sciences
Karad-415 110
Maharashtra
Dr (Capt.) A.K. Urmil
RMO 15 Grenadiers
C/o 56 APO
C/o Press Information Bureau
New Delhi-1.
Dinesh Chand
Asstl. Adviser (PHE)
Ministry of Rural Development
9th Floor, B-l Block
Paryavaran Bhavan
CGO Complex, Lodi Road
New Delhi-110 003
Dr S.C. Gupta
Asstl. Professor
Department of S.P.M.
S.N. Medical College
Agra
Uttar Pradesh
Lester R. Brown
Dr Manjit Singh
Chief Medical Officer (Trg)
Central Health Education Bureau
Kotla Road
New Delhi-110 002
Dr AT. Kanan
Reader
and
Dr K. Pandit
Reader
Dept, of PSM
University College of Medical Sciences
Delhi
Dr S. Venkatesh
Deputy Assistant Director General
(Medical)
Directorate General of Health Services
Nirman Bhavan
New’ Delhi-110 011
ISSUED BY THE CENTRAL EDUCATION BUREAU (DIRECTORATE GENERAL OF HEALTH SERVICES), KOTLA MARG,
NEW DELHI-110 002 AND PRINTED BY THE MANAGER, GOVERNMENT OF INDIA PRESS, COIMBATORE-641 019.
—-SWASTH HIND
No. D—(C) 359
Regd. No. R.N. 4504/57
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