Swasth hind, Vol. 30, No.9, September 1986.pdf

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In this Issue

swasth
hind

Page No.

Bhadra-Asvina

September 1986

Saka 1908

Vol. XXX, No. 9

OBJECTIVES

Swasth Hind (Healthy India) is a monthly journal
published by the Central Health Education Bureau,
Directorate General of Health» Services, Ministry of
Health and Family Welfare, Government of India.
New Delhi. Some of its important objectives and aims
are to:
REPORT and interpret the policies, plans, pro­
grammes and achievements of the Union Ministry
of Health and Family Welfare.
ACT as a medium of exchange of information on
health activities of the Central and State Health
Organizations.

FOCUS attention on the major public health
problems in India and to report on the latest trends
in public health.
KEEP in touch with health and welfare
and agencies in India and abroad.

workers

REPORT on important seminars, conferences, dis­
cussions, etc., on health topics.
OUR COVER

The control of many diseases in many parts of the world
has been facilitated by positive changes in health behaviour
which accompanied higher levels of education and literacy.
That, indeed, is one of the significant features of the obser­
vance of International Literacy Day 8 September. Our cover
shows children learning to read and write.

EDITOR
N. G. Srivastava

Sr. SUB-EDITORS
M. L. Mehta
M. S. Dhillon

COVER DESIGN
B. S. Nagi

Smoking, Alcohol and drugs

201

A smoke-free society by the year 2000
K. Balan

202

Smoking and its hazards — What one
should know ?
Lt. Col. A. C. Urmil

206

Col. P. K. Dutta'
Tobacco smoking — its behavioural pattern
and control
Vinod Kumar Pandey

208

Alcoholism and liver

211

Dr V. Balakrishnan
Side-effects of heavy drinking

213

Meeting the threat of drug abuse

215

Literacy and well-being

217

Fitness after retirement
Col. K. K. Vadehra (Retd.)

219

Ageing and role of hormones
Dr Vinod Kumar

221

An innovative approach in mental health
education
S. Rojaram

225

Experiences in family planning programme
in a slum community
Dr Rarnesh M. Chaturvedi

227

Editorial and Business Offices
Central Health Education Bureau
(Directorate General of Health Services)
Kotla Marg, New Delhi-110 002
Single Copy
Annual
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..
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(Postage Free)

25 Paise
Rs. 3.00

Articles on health topics are invited for publication in this
Journal.

State Health Directorates are requested to send reports of
their activities for publication.
The contents of this Journal are freely reproducible. Due
acknowledgement is requested.

The opinions expressed by the contributors are not neces­
sarily those of the Government of India.

SWASTH HIND reserves the right to edit the articles sent
for publication.

kS-NI

SMOKING, ALCOHOL AND DRUGS
r I hroughout history, human societies have recognised certain substances of natural origin which
either offer temporarily heightened perceptions or
suggest an escape route from the unpleasant features
of life, whether real or imaginary. Fermented liquor
from fruit or vegetables, or plant products such as
opium, coca leaves, cannabis, khat and tobacco have
been accepted in varying degrees as social lubricants
or as private escape mechanisms.
The drinking of wine and other fermented liquors
were chronicled in the earliest literature known to us.
But in comparatively recent times, voices have been
raised against many such substances. For instance
King James I of England, around the year 1600, in­
veighed against tobacco. It was, he wrote, “a great
contempt of God’s good gifts that the sweetness of
man’s breath........... shall be wilfully corrupted by
this stinking smoke.” For good measure, he added
that the habit was “a branch of the sin of drunken­
ness, which is the root of all sins.”

But for every such grumbler, there were scores of
poets, philosophers and physicians willing to speak
out in praise of drinking, smoking or chewing one or
another drug. What has come more slowly to the
attention of the world is the realisation that these sub­
stances produce addiction, and lend themselves to
abuse.
In the case of cigarettes, their mass production coin­
cided with the First World War, when they were

September 1986

handed out virtually free as meagre compensation to
soldiers enduring desperate conditions in the trenches.
It has taken many decades for medical science to
confirm the causal relationship between smoking and
such illnesses-as lung cancer, ischaemic heart disease
and bronchitis.
Undoubtedly it could be said of alcohol, ’ as it is
already said of tobacco, that if these substances were
invented and put on the market today, both would
promptly be condemned and outlawed by all coun­
tries’ food and drug authorities. This has already
been the fate of heroin and its derivatives, the hallu­
cinogenic drugs, and the many pharmaceutical pro­
ducts which were created to ease pain or treat disease
but unfortunately turned out to lead to dependence
and abuse.

The positive response to all these substances is to
find and promote worthwhile social alternatives to
addictive behaviour. While more pressure can be
brought to bear on governments to tighten the bor­
ders around drug-producing countries or to increase
prices of alcohol and tobacco, people must be left
with an open choice.
If individuals esteem their own health and that of
others sufficiently highly, they are less likely to in­
dulge in harmful practices. In the words of this
year’s World Health Day slogan: Healthy living—
everyone a winner.
<

201

I SMOKING

A SMOKE-FREE SOCIETY
BY THE YEAR 2000
K. Balan

Intensive anti-smoking campaigns and research together
with rigid Government control have led to the decline of
smoking habit in the developed countries, particularly in
the West. On the other hand, cigarette smoking has
established a firm footing in the third world. To change
this situation, and to achieve the goal of a smoke-free
society by 2000 A. D. is, indeed, a herculian task.
he goal, Health for all by the West. And the cigarette has
2000 A.D. is good for all and gained its losing status in the third
is essential for creating a healthy world and to know how they did
society. But, in the third world coun­ it, look at these words of a specia­
tries in general and in India in par­ list writer when he says “it is being
ticular, where the majority of inha­ actively promoted by massive ad­
bitants are inseparably habituated vertising campaigns in the third
to smoking, the idea of a Smoke- world countries, as a mark of so­
Free Society by 2000 A.D. is likely phistication just as it loses its sta­
to be pooh-poohed as an unrealistic tus in highly developed countries”.
proposition; may some people may Now, influenced by the advertise­
even dismiss it as a nonsense. But ments, cigarette smoking has esta­
if we go deep into the subject, we blished a firm footing in the third
can see that there is some common­ world and the majority inhabitants
sense in ths discussion. In the pre­ are smokers. To change this situa­
sent day smoking complex, which tion, and to achieve the goal of a
involves not only physiology but Smoke-Free Society by 2000 A.D.
also the whole range of social and is indeed a herculian task.
personal behaviour, it seems to be
But, for the Surgeon-General
an impracticable goal. However, it of US, it seems to be an easy goal.
is an indispensable one to achieve Having convinced that cigarette
the goal of Health for All by smoking is responsible for 80-90%
2000 A.D.
of the lung cancer deaths and the

T

Intensive anti-smoking campaigns
and research together with
rigid
Government controls have led to the
decline of smoking habit in the de­
veloped countries, particularly in

202

primary risk factor for heart dis­
eases and other irreparable damages
to organs and that smoking is the
largest single preventable cause of
ill-health and death in the world,

the Surgeon-General has called for
a Smoke Free Society by 2000 A.D.
By a strange coincidence, the call
came in the centennial year of the
invention of cigarette
making
machine by James Bansack. And
there is no doubt that with the pre­
sent tempo of decline in smoking
in developed countries, and with the
intensive research and anti-smoking
campaigns and controls, the deve­
loped countries are well within the
reach of the goal.

But what about the third world?
In India, for instance, the adverti­
sements have merged the cigarette
smoking habit with human beha­
viour and the massive ignorance
about the dire consequences of ciga­
rette smoking stands as a stumbling
block in this direction.
In developing countries like India,
the mild slogan “cigarette smoking
is injurious to health” which is the
only active expert) in the field to
educate people, seems to be over­
burdened with this task and is hav­
ing either a little effect or no effect
at all. With the result, from elders
the habit is fast-spreading among
teenagers. According to survey re­
port of the World Health Organisa­
tion, 9% of the teenaged boys and
6% of the teenaged girls in India
are smokers. And the increase in
smoking among little girls is linked
to the behaviour resulting from in­
creased women’s status. But as insi­
ders, we can imagine that this is
only a tip of the iceberg, for majo­
rity of teenagers smoke in private
giving no scope for a survey or for
counting their head. Thus the habit
of smoking in India is spreading
like fire and. the hungry and idle
men and women are always after
it to satisfy an unknown urge. This
belies the scope for a Free Smoke
Zone in India.

Swasth Hind

rably by taking action against the
risk factor. The primary target sug­
gested was the control of smoking,
the main risk factor both for heart
diseases and lung cancer as well as
for peptic ulcer and chronic diseases
of lungs and other diseases. The
World Conference on Smoking and
Health held in Canada in July 1983
discussed the great dangers of smok­
ing and. made various recommenda­
tions. Considering the high risk of
ill-health
acquired by
smoking
the Norwegian Medical Association
proposed that the country in effect
be declared a Cigarette Free Zone.
Being conscious of imminent dan­
ger, the American Medical Asso­
ciation has called for a complete
ban on cigarette advertisements. In
the Soviet Union, smoking is bann­
ed in all public places including the
Soviet underground rail system. All
these actions are being taken to
minimize the risk of smoking and to
reach the goal of a Smoke Free
approach and action to combat it. It Society by 2000 A.D.

The goal of a Smoke Free Society why they do it. These are the rea­
is aimed at the younger people, say sons and causes of smoking. But
upto t'he age of 18 or 25, and if we smoking habit increases as a fashion
watch the encouraging results of and status and spreads like a dis­
developed countries in this direction, ease but without a virus like that
it seems to be an approachable one. of ‘AIDS’ to spread it. Still the
But there is need for public aware­ Director-General of WHO calls it
ness, a will and determination on as the No. 1 preventable cause of
the part' of the young people, pro­ death in the world. Since there is
perly planned anti-smoking campai­ no virus involved, it is indeed easy
gns and educational strategies, le­ to control it.
gislation and Governmental controls
to make the task easy and result- Health hazards of smoking
oriented. At the same time, smok­
The great damage done by ciga­
ing among elders has to be con­ rette smoking to the physical systrolled and curtailed by self-restraint,
self-education and by anti-smoking
agents. Survey in developed coun­
tries has revealed that 80% of the
smokers are willing to cut down or
The 39th World Health Assembly,
stop the habit but they are unable
in
a resolution while affirming that
to do so. This indicates the desire
tobacco
smoking and its use in all
on the part of the smokers to cut
down and discontinue the habit pro­ forms is incompatible with the
vided there is proper control and attainment of health for all by the
year 2000, called for a global public
guidance.

Tobacco or Health

Reasons and causes

Why does one Smoke? The real
reason and cause for smoking is un­
known even to many heavy smokers.
Some say, it is an urge while others
aver it as an acquired habit. Yet
others say it is a temptation without
a base. For children or teenagers,
it is nothing but a fashion imitated
from elders at home and outside. In
the past', even elderly children smok­
ed without the knowledge of parents
dr relatives fearing them. But to­
day, many children smoke in front
of their .parents or along with them.
thanks to the growth of modernism
in Indian Life. Young people, they
say, smoke for avoiding idleness or
monotony and to stimulate think­
ing. Elders smoke to get rid of
worries and to get’ satisfaction. Some
say that smoking makes drinking
tasty while others just do not know

September 1986

urged its Member Countries and all
organizations of the U.N. system to
support WHO in all possible ways in
stemming the spread of tobaccoinduced diseases by protecting nonsmokers on their premises. The
Director-General of WHO was
requested to ensure that the Organi­
zation plays an effective global
advocacy role on tobacco andjjhealth
issues.

According to authoritative reports,
one million people die prematurely
in the world every year due to smok­
ing. Thousands of deaths in the
USA are associated with smoking
according to medical reports from
that country. The anti-smoking
campaign in the US is now turning
to Courts as evidenced by the grow­
ing number of law suits that seek
to fix responsibility to ill-health and
death of smokers on tobacco indus­
tern of men has already been expos­ try. Reports in the Wall Street
ed by research in developed coun­ Journal state that the doctrine of
tries. From what is already known, “Product liability” is central to the
we can very well imagine that the
increasing number of legal challen­
risk of cigarette smoking is very high ges of recent times.
The Institute of Neurology Academy
of Medical Sciences of the USSR and
The Royal College of Physicians
a number of American, British and of the UK compares the toll in hu­
Japanese clinics have demonstrated man life wrought by smoking to that
that incidence of heart diseases and of “devastating epidemics of infec­
lung cancer can be reduced conside­ tious diseases of the past”.

203

Putting at not less than 1,00,000
deaths yearly, associated with smok­
ing in the U.K., the physicians had
called upon their country's health
administration to “tackle cigarette
smoking with the urgency given to
cholera, diphtheria, polio and T.B.”.

Tobacco smoking in India has been prevalent since time immemorial.
Over the years the practice has spread all over the country — in both
rural and urban areas. Smoking of cigarettes and bi dis is fairly common,
while the hookah is also used in the rural areas. Tobacco chewing
with betel is also fairly common. Tobacco is also used in the form of
snuff; however, this is not as widespread as tobacco smoking.

Whereas in developing coun­
tries there are no such calls
or discussions in the Medical
or Science Congress about it. There
is only an ineffective mild slogan
“cigarette smoking is injurious to
health” that does the entire job in
the country. There is an urgent
need for a shift of thinking on
this issue and result-oriented ac­
tions to find out the role played
by smoking on the health of the
people which will be many fold
higher than those in the developed
countries in view of the poor living
conditions.

have higher risks of respiratory ail­
ments. Long-term epidemiological
studies in the National Cancer Cen­
tre Research Institute, Tokyo, have
found that the risk of lung cancer
from, smoking husband to non-smok­
ing wife is very high and it varies
from the number of cigarettes one
smokes daily. The risk is found
to be more in case of heavy smok­
ers. Suffers of asthma, allergy,
bronchitis, small children and pre­
gnant women are easily susceptible
to the harmful substances of smoke.
In countries like Canada, the right
of non-smokers to pure air has
priority over the right of the smokers
to indulge in private habit.

Danger to non-smokers

Research spread over several years
has proved that smoking effects the
non-smokers and passive smokers
too. An international symposium or­
ganized in 1985 in Vienna jointly
by the Austrian Society for Indus­
trial Medicine, the German Society
for Occupt’ional Medicine, the
American Health Foundation, WHO
and the International Green Cross
discussed at length their findings
in passive smokers. Tobacco, smoke
so far has been found to contain
6000 chemical substances and their
potentially damaging effect on ac­
tive smokers are well known. Many
of these substances, which go out
Jin smoke, affect the people who
are not smokers contributing to
their ill-health.

Research studies in developed
countries have brought to light that
the children of smoking parents

204

the ineffectiveness of mild slogans
in existence there, US have intro­
duced more serious solgans like:
Surgeon-Generals warning—“Smo­
ke contains carbon monoxide”,
“Smoke causes lung cancer, heart
diseases, emphysema and may com­
plicate pregnancy” and “quitting
smoking now greatly reduces serious
risks to your health”. Obviously,
this has started to reduce the habit
among the people to a great ex­
tent.

In the Soviet Union, posters issu­
ed by the National Institute of I
Health education say “STOP SMOK­
ING—TOBACCO IS POISON”.

New strategies to fight

It is urgent that the third world
countries too should embark upon
new strategies to combat the menace
of smoking and establish a Smoke
Free Society by 2000 A.D. It is
not good for the teenagers, not good
for the family, and not good for
die nation to encourage smoking
among the teenagers and young peo­
ple. It is not good for the cigarette
firms to sell cigarettes to teenagers
and make money, for by doing so,
Developed nations are far ahead they are spoiling the health of the
of us in anti-smoking campaigns. new generation. We should not
Soviet Union has now/ developed an allow the cigarette to sow the seeds
effective anti-smoking agent called of diseases before the physiological
“ANABASINUM”. It mitigates the formulations complete its growth in
inclination to smoke and minimize the younger people, and that if done,
vegetative disorders that generally will erode the health of the new
accompany the period of coming generation. So much so, the teena­
out of smoking habit. In the US, gers and the young people upto the
Cigarette commercials are already age of 25 should be the first target
banned in TV and Radio. Realising group in this direction. The rest

To help the anti-smoking cam­
paign, the Expert Committee of
WHO had earlier recommended the
following action plan: (1) non-smok­
ing as a social norm, (2) total prohi­
bition of all forms of tobacco pro­
motion, (3) the establishment of up­
per limit for tar, nicotine and carbon
monoxide, and (4) listing their levels
in all cigarette packages.

Swasth Hind

of the population should be treated
as the second target) group for the
purpose of anti-smoking campaigns.
Anti-smoking campaigns against
these two groups should be rigid,
stimulative and result-oriented. All
possible audio-visual facilities should
be used. TV, Radio, cinema, adver­
tisements, notices, folders, stickers,
lessons in educational curriculum,
counter propaganda in newspapers
and periodicals, and other educa­
tional publications together with
needed legislation and Government
control will help a lot' in this direc­
tion.

(c) Legislation making cigarette
product of adults.

a strategies, rigid
government con­
trols, celebration of anti-smoking
(d) Ban on smoking in all educa­ week every year, exhibition of short
tional institutions both during films compulsorily in all theatres
and making of new variety of films
and outside working hours.

LEGISLATION AND HEALTH WARNINGS
The Government of India has stepped in, in a positive way, to provide
legislative support to the anti-smoking campaign. “ The Cigarettes
(Regulation of Production, Supply and Distribution) Act 1975 ”, which
came into force with effect from 1 April 1976, requires all manufacturers
or persons trading in cigarettes to display prominently the statutory
warning “ Cigarette Smoking is Injurious to Health ” on all cartons
or packets of cigarettes that are put on sale. A similar warning is
also required to be displayed prominently on all advertisements.

Against the first
target group
aged upto 25, the following mea­
sures will help to expedite the con­
trol and curtailment of the habit:

(e) Exhibition of films and other pos­ based on the findings all over the
ters in and around educational world, and printing of more serious
institutions.
slogans in the cigarette packages in
(f) Health education material in the regional languages. All these acti­
vities, together with public aware­
curriculum.
(a) Strict control at home to cut
ness and co-operation will go a
down the habit among teenagers.
Also necessary are new and effec­ long way in achieving the goal of
(b) No cigarette sale to teenagers. tive posters, new health education a Smoke Free Society by 2000 AD. ®

Whole body CT Scanner at AIIMS
The All India Institute of Medical Sciences, New Delhi, has acquired a very
sophisticated computerised Whole Body Scanner. It can be used for imaging any abnor­
mality in the body resulting in an extra growth or causing a void in the body.
Such abnormality may fall in any of the four categories, namely, congenital, inflammation,
trauma or neoplastic changes. This can scan any minute part in the body, including the
head.

This is one of the latest and most sophisticated Whole Body CT Scanners now
available in the capital. Already, such scanners have been functioning at G. B. Pant
Hospital, Sir Ganga Ram Hospital and Delhi Scan Research Centre with optimum use,
the CT Scanner can handle 8-10 patients every day. The Institute has decided to
charge Rs. 750/- from the patients registered at the AIIMS Hospital, Rs. 1000/- from
the patients admitted into the Paying Ward rooms and Rs. 1500/- from patients referred
from outside. >
September 1986

205

SMOKING AND ITS HAZARDS
— WHAT ONE SHOULD KNOW?
Lt. Col A. C. Urmil
Col P. K. Dutta
Nicotine is revengeful to everybody irrespective of the form in which tobacco is smoked,

be it cigarette, bidi, hookahi chillum, cigar or pipe.

It pays no heed to the appeal that

the individual is only a mild or moderate smoker and not a heavy smoker.
ove
lady,.
Nicotine, risks cigarette consumption—one reason
your life. Today, it is known may be these smokers discard larger
that smoking is probably the largest I cigarette ends. Cigarette smokers in
single preventable cause of ill- the UK and possibly in India, are
health in the world. The epidemic three' times more likely to suffer
of smoking related diseases is of from chronic bronchitis than nonsuch magnitude as to rival only in­ smokers. It has also been observed
fectious diseases or malnutrition as that the intensity of smoking was
a public health problem in develop­ more important than its duration.
ing countries. The findings of the A study in the UK, shows that those
Royal College of Physicians men­ with chronic bronchitis run a higher
tion that one in three cigarette smo­ risk of developing lung cancer. Ciga­
kers dies prematurely as a result rette smokers are also more than
of cigarette smoking and that, on twice as likely to develop coronary
an average, each cigarette smoked heart disease and three times more
shortens the life of the smoker by likely to develop myocardial infarc­
five-and-a-half minutes. It has been tion than non-smokers. The relation
estimated that, in the world as a between cigarette smoking and cerewhole cigarette smoking is responsi­ bro-vascular disease (stroke) is
ble for more than 1 million prema­ largely confined to the younger age
ture deaths each year. Statistics groups; there is less effect after the
show that 90% of all lung cancer age of 65 years. In young people,
deaths, 25 per cent of deaths from ischaemic diseases of the legs
cardiovascular diseases and 75 per (Thrombo-angiitis obliterans) ap­
cent of all deaths from chronic bro­ pears to be confined almost exclu­
nchitis stem directly from smoking. sively to those who smoke.
Perhaps 10 per cent of all deaths
Besides, the love for lady Nico­
among smokers are attributable to
tine is also associated with some
this habit.
more miseries such as development
The studies in India shown that of cirrhosis of the liver and cancer
the lung cancer risk for cigarette of lip, oral cavity, pharynx, nose,
smokers is nearly nine times more larynx,
trachea.
oesophagus,
than for non-smokers. Japan and urinary bladder, kidney and pan­
the USA record relatively low inci­ creas. Incidence of gastroduodenal
dence of lung cancer despite high ulcers has been found twice as high

L

206

in smokers than in non-smokers.
Smoking may increase mortality by
delayed healing of ulcer. Smoking
may affect expectant mothers by way
of retarded foetal growth and in­
crease in the risk of perinatal death.

Besides nicotine, mother tobacco
has got another daughter also—iso­
prenoids and a son—the tar. How­
ever, nicotine is better known and
more notorious because of its strong
pharmacological actions. These ac­
tions include (i) vaso-constriction
(narrowing of blood vessels), tachy­
cardia (increased heart rate) and
elevation of blood pressure, (ii) ini­
tial stimulation of salivary and
bronchial secretions followed by in­
hibition, (iii) excitation of respira­
tion, vomiting, anti-diuretic actions,
(iv) inhibition of stomach contrac­
tions and gastric secretions, delay­
ing the emptying time of the sto­
mach, (v) inhibition of appetite and
reduction in body weight by some
process over and above the effect
on appetite, (vi) increased bowel
activity and diarrhoea followed by
decreased activity, (vii) release of
epinephrine from adrenal medulla
and 11-hydroxy-corticosteroids from
the adrenal cortex, and (viii) increase
in serum free fatty acids and tri­
glycerides. Tar is a well-known car­
cinogen.

Swasth Hind

and voluntary health organizations
are doing excellent work in this
field and need to be encouraged.
Besides the WHO, the other inter­
national agencies like UNESCO,
UNICEF, FAO, ILO, UNDP etc.,
are also playing their role in this
task. Tobacco Research Council
in the UK has done valuable re­
search on smoking problem. Simi­
larly. ‘The Vigilance of Action on
Smoking and Health (ASH)’, a volun­
tary organization has proved extre­
mely useful in the UK. In the USA,
‘The National Clearing House for
Smoking and Health’ has been of
inestimable value to all countries
facing this problem. In India, un­
fortunately, there is no voluntary
organization exclusively devoted to
this cause. These exists ‘The Ciga­
rette (Regulation of Production,
Supply and Distribution) Act, 1975’
and ‘The Cigarette Rules 1976’ effec­
tive from 1st April 1976 which com­
pel the manufacturers to display the
statutory warning, namely ‘Cigarette
Smoking Is Injurious To Health’ on
all cartons and packets of cigarettes
but a total ban on advertisement on
smoking has so far not been impos­
ed.
In spite of the well-known health
in the USA, advised that even hazards of smoking, the habit goes
people who have never smoked on almost unabated. Like drinking,
cigarettes, only a pipe or cigars, this habit also often starts as a means
for mental relaxation under condi­
should avoid these, too.
tions of stress, for masking shyness,
to reduce smoking, World Health to project a particular social image
Organisation announced ‘Smoking and under the false belief of its
or Health—the Choice is Yours’ as beneficial values. Social sanction
the theme of WHO Day in 1980. and social tolerance are the factors
It is high time that effective steps which play a significant role in
are taken to prevent and control perpetuating this evil. Once it takes
this modern scourge the smoking firm roots, it becomes difficult to
epidemic. These control measures abandon it as it produces many
should include besides health educa­ ‘withdrawal symptoms’ making the
tion, legislative and restrictive mea­ person depressed, morosed, sick and
sures, ban on smoking advertise­ out of form.
ments, warning on cigarette, bidi
Health as such is an individual as­
and cigar packets, product modifi­ set. The basic responsibility of
cation (production of low tar and guarding this asset against all pos­
low nicotine cigarettes), prevention sible hazards, lies with the indivi­
of tobacco cultivation on commer­ dual himself. No one therefore need
cial scale, increase in tobacco taxa­ fall in the trap of lady Nicotine, no
tion, development of public informa­ matter how much alluring it may
tion and public education program­ seem outwardly. Remember, next
mes and finally the smoking cessa­ time when you strike a match box
tion programmes at individual, group to light your cigarette, you may be
and community level. International igniting your own funeral pyre.
O

men have been found to get addict­
ed to smoking before reaching the
Lady Nicotine is revengeful to age of 20 years, even though there
everybody irrespective of the form is a considerable regional variation.
in which mother tobacco is smok­ In one study by Babu and Chuted be it cigarette, bidi, hookah, chil- tani, the prevalence of smoking
lu/n, cigar or pipe. She pays no heed among students 12 to 19 years age
to the appeal that the individual is group) was found to be 8.72 per
only a mild or moderate smoker cent. Similarly, in a study of medi­
and not' a heavy smoker. All smo­ cal students in U.P. by Sandell et
kers are thus exposed to the poten­ al, almost one-third were found to
tial health hazards inherent in smo­ be smokers. There are reasons to
king—the severity of effect being believe that during recent years
merely a question of intensity and smoking has registered an increase
duration of smoking. Lady Nicotine among the student community. Grea­
not only inflicts vengeance upon ter attention will have to be paid to
smokers but doesn’t spare the com­ curb the menace if we want to at­
pany also which they keep, although tain the goal of ‘Health for All by
such company may consist of non- 2000 A.D.’.
smokers only. These non-smokers
who inadvertently. inhale the smoke Preventive steps
generated by their smoker friends
To encourage communities and
come in the category of ‘passive nations to undertake greater effort
smokers’, ‘involuntary smokers’ or
‘secondary smokers'. Apart from
Cigars and pipes
discomfort, such exposure may cause
are dangerous, too
distress to asthmatics and
other
susceptible subjects and prejudice As few as four cigars or four pipethe cardiac function of people with fills of tobacco give the smoker as
coronary heart disease. It may
also increase the chances of non- much toxic substance as ten
smokers getting leukaemia and a cigarettes. Doctors at Minnesota
wide variety of cancers.
University’s School of Public Health,

Smoking affects non-smokers, too

Despite growing awareness about
the health, hazards of smoking
through various publicity media,
statutory warning on cigarette pac­
kets, health education campaigns
and efforts of voluntary organisa­
tions, people particularly young per­
sons, still get lured towards lady
Nicotine. Today, in most European
countries, more than 50 per cent of
males and over 30 per cent of fe­
males are smokers. In Asian coun­
tries, the rate of smoking varies from
40 per cent to 75 per cent among
males. World tobacco production
touched a record high of 5.5 million
tonnes in 1976. World wide, consu­
mers spend almost 100 billion dob
lars annually on 4 trillion cigarettes.

In India, studies carried out by
various workers reveal a wide re­
gional variation in the proportion of
smokers—from 75 per cent of the
men in the North and South-East
regions to only about 50 per cent
in the West. About one third of

September 1986

207

I SMOKING

TOBACCO SMOKING
— ITS BEHAVIOURAL
PATTERN
AND CONTROL
Vinod Kumar Pandey

Despite repeated warnings, smoking is assuming an epidemic
form particularly in adolescents and is probably the largest
single preventable cause of ill - health the world over.
Indeed, smoking is truly “ slow motion suicide
n India, no country-wide analysis

I

of smoking trend has been car­
ried out so far. However, the find­
ings of an epidemiological study
on tobacco smoking conducted by
the Indian Council of Medical
Research (ICMR) in a rural commu­
nity in Meerut district of U. P. in­
dicate that the number of smokers
increased with age as the prevalence
rate among males of 10-14 age
group was 17.5 per cent as com­
pared to 90 per cent among those
above 15 years of age.
In India,
the percentage of teenage boys and
girls who smoke is 9 and 6 respec­
tively.
The habit of smoking
among urban youth in India has
been increasing fast and poses the
biggest
threat to young people’s
health.

Those who smoke bidi have a
very high risk of pharyngeal can­
cers of the larynx and the lung and
somewhat lower risk for cancers of
the oral cavity and oesophagus.
Similarly, the habit of cigarette
smoking is a risk factor for cancer
of the pharynx and of the lung.
Numerous epidemiological investi­

208

gations have linked smoking with
insidious ailments such as coronary
heart disease, cancer, emphysema,
chronic bronchitis and
others.
Those women who smoke while
taking contraceptive pills are more
susceptible as compared to nonsmokers who are on the pill to the
risk of heart diseases, increased
foetal and infant mortality.

their products, cigarettes being the
topmost advertised product. Des­
pite repeated warnings, smoking is
assuming an epidemic form, parti­
cularly in adolescents, and is pro­
bably the largest single preventable
cause of ill-health the world over.
Indeed, smoking is a “Slow Motion
Suicide”.
Various recommenda­
tions have emphasized that it is
wiser to check smoking behaviour
at the initial stage rather than to
break its habit when strongly esta­
blished.
Therefore, illustration of
initiation of smoking is very vital.
Behavioural pattern of smoking

The very first question that raises
our eyebrows is-^-why do people
smoke even though they know its
deadly consequences.
The ans­
wers from smokers to this question
make interesting reading; although
most of these do not provide ex­
act information.
But, the analy­
sis reveals factors which directly
or indirectly motivate people to
start smoking.
In fact, die initia­
tion of smoking, a highly complex
and apparently an age-related be­
haviour, appears mostly within the
context of social interaction and
usually occurs in childhood or in
adolescence. The matter is largely
settled by the age of 20. If a per­
son is still a non-smoker at this age
he is not likely to take it up (6).
Peer pressure

Statistics indicate upward trend
in the incidence of lung cancer in
India during the past few years and
that the incidence of chronic bron­
chitis is also alarming. There is
no exaggeration if smoking is made
responsible for this.
It would
also be appropriate to mention here
that during the past few years
tobacco smoking product manufac­
tures have shown a much greater
degree of innovation in their sales
promotion than
health planners.
Rough estimates illustrate the fact
that more than 80 billion cigarettes
are produced annually in India.
Besides, a huge amount of Rs. 10
crores is being spent every year by
the cigarette manufacturers on
advertising and sales promotion of

Among the major factors of ini­
tiation to smoking are social influ­
ence or more particularly the imita­
tion of models, such as, friends
(peers), family members and media
stereotypes. In an intensive parti­
cipant observation study by New­
man (5) reports that peer pressure
and conformity to group status
norms were perceived by subjects
to be major factors in smoking.
The influence of peers seems to
have come from “best friend rela­
tionship” (7).
“Company of a
few smokers is enough to persuade
one to start smoking.
One can
easily be trapped when offered a
cigarette and light it for the sake
of company or to be mod” (10).

Swasth Hind

According to Salber, the need for
prestige and status may motivate
teenagers, who are not well adjust­
ed to familiar and adult authority,
to seek security in the company of
their peers and may use a cigarette,
which at one and the same time,
symbolizes adulthood, superiority,
and defiance.
Thus, one may
start smoking for finding integrity
with the friends’ group or to save
himself from being alienated from
it. Tn short, early adulthood is a
time of particular stress and suscep­
tibility and peer group pressure
(pressure due to friends) is probably
more influential at this time and
the teenager who has yet insufficien­
tly developed internal and social
restraints, is more likely to engage
in impulsive and irrespective be­
haviour” (1).
Family pattern of smoking

A number of research findings
reveal that the family patterns of
smoking have considerable effect]
on the initiation to smoking beha­
viour as parents can exert direct and
forceful influence on their children.
“It would be pertinent to point out
here that if one of the parents is a
smoker, a third of the adult regular
smoker started to smoke before
they were nine.
And, if children
have both parents, who are hooked
on cigarettes. There is greater pro­
bability of childern following suit”
(2). In fact, “the attitude and
practices of smoking parents could
create a. general atmosphere of per­
missiveness in the home and also
availability of cigarettes in a home
could facilitate the child’s first step
towards smoking. Children are more
susceptible
to smoking if their
mother is a smoker”.
It is wellknown that a mother has a greater
influence and proves to be a more
familiar model to emulate so far as
her children are concerned than
the father or any other male family
member.
When the father is a
smoker, the child is oriented to ac­
cept it because this practice has
been going on for generations in
India.
But, not so among the
mothers, so far.
But the Indian
kids are not confronted with their
mothers who are smokers.
And

September 1986

when the child is faced with a mo­ sonality i.e., people having extrover­
ther who smokes, he is likely to imi­ ted personality are more susceptible
tate her more frequently and at ear­ to adopt smoking. From various
lier age than when he tries to imi- I psychological and medical texts it
tale a smoking father (2). Similar- I is evident that smokers are anxious,
ly, children have a strong tendency nervous, have weak ego, show more
to imitate the smoking pattern not neurotic trend and emotionally uns­
only of parents but also of older table. They smoke or inhale more
siblings.
Older siblings who do to reduce anxiety and tension or to
not smoke, exert a slight deterrent control innerarousability and they
effect on the smoking of younger think that smoking causes strong
ego development (3).
siblings.
Influence of advertisements

The next major factor that moti­
vates people for smoking is glamo­
rous advertisements in leading news­
papers and magazines, films and
hoardings at public places attracting
people, especially youngsters, for
smoking.
Young boys or even
girls, sometimes, identify themselves
with the models shown in the gla­
morous advertisements.
They,
unfortunately, associate glamorous
life, as shown in advertisements,
with smoking and then they try to
copy them with the hope that smok­
ing will make them mature and
sophisticated.
Status symbol

Status symbol, sometimes, also
leads a person to smoking. Unfor­
tunately, some of the professionals
such as doctors, scientists, philoso­
phers, models, hotel personnel, etc.,
have been associated with smoking.
These professionals are supposed
to be smokers to be mod/smart.
Specific personality characteristics

Another vital factor in the initia­
tion of smoking is personality. A
number of research studies have
pointed out that smokers have a
specific personality characteristics
which are significantly different from
those of non-smokers (12). Ham­
mett asserts that smokers have more
difficulty
in
adjusting to the
stresses of life and are chronically
stimulated by psychosocial tension;
consequently, they turn to smoking
for a tension-relieving mechanism.
Eysenck maintains, smoking beha­
viour is due to an extroverted per­

Sometimes access to smoking sit­
uations such as frequency of alco­
hol drinking, smoking marijuana or
working in a place where most of
the workers are smokers or where
smoking is appropriate, may also
motivate any person to start ciga­
rette smoking (4).
Besides these factors, the possibi­
lity of biological and genetic predis­
position to smoking also cannot be
ruled out.
Smoking Control: need of the hour

In the western industrialized
countries more emphasis has been
given on anti-smoking programmes
that has, to some extent, checked
this smoking epidemic.
This has
compelled the tobacco smoking pro­
ducts manufacturers to be more
attentive towards their business in
developing countries. No doubt,
they have got success in opening this
new market in developing countries
by making cigarette consumption a
part of a success image. (10). Now
the problem of tobacco smoking is
becoming serious, especially in deve­
loping countries like India.

Although the deadly consequences
of tobacco smoking are well known,
yet still in most of the developing
countries governments are not show­
ing their enthusiasm in anti-smoking
programmes.
Foremost reason is
that tobacco products help in im­
proving the economy of the country,
besides creating jobs.
In India,
excise revenue from tobacco is
around Rs. 7500 million per annum
and export-earning are of the level
of Rs. 2000 million per annum (8).

209

But this reason in favour of tobacco
smoking products can be reconside­
red in terms of human suffering and
the social cost of caring for sick
smokers.
Besides other practical measures
such as health warning on cigarette
packets, heavy taxation, ban on
smoking at public places, etc., nonsmokers must be encouraged in the
society.
Steps must be taken to
promote positive image of non-smo­
kers in society as is planned for
improving the health status of the
youth by the International Olympic
Committee (IOC) and WHO in a
joint campaign under the slogan
“Winners for Health”, which is aim­
ed at the 12-25 years’ age-group.
The positive image of non-smokers
in a society may force the smokers
to think “what is wrong with them”.
To achieve this goal, same advertis­
ing methods may be used as are
being used by cigarette companies to
encourage smoking and incentives
may also be provided for youngs­
ters not to initiate smoking (13).
As is evident through a number
of researches that vulnerability to
peer pressure and higher level of
conformity in adolescents may lead
them towards smoking for the sake
of group acceptance.
Hence, as
suggested in an article published in
the Health Education Journal (12)
' “Adolescents need to be equipped
with skills that will permit them to
express themselves and follow their
own conviction (remain non-smo­
ker) yet not alienate themselves from
their peer group”.
For achieving
success in this regard, pre-adolescents must be provided proper in­
formation and health education
through school curriculum, mass
media and magazines, etc.

tural activities either sponsored or
arranged by tobacco smoking pro­
duct manufacturers should be ban­
ned. Leading sportsmen, film actors/
actresses and VIPs should be appeal­
ed not to lend their name and popu­
larity in the promotion of cigarette
selling. The caption printed on eigamust be printed in big and attractive
manner in the middle of the packet
rette packets and in advertisements
in advertisements.
Besides, ciga­
rette companies should carry tougher
and more specific health warnings on
their packages and advertisements
mentioning smokers are more prone
to lung cancer, heart disease, etc.
Side by side, as a precautionary
measure to prevent pre-adolescent
group from smoking, selling of ciga­
rettes to youngsters must be prohibi­
ted under a specified age and it
should be strictly enforced. At the
same time, antismoking campaigns
should also be organized by schools,
youth clubs, youth voluntary organi­
zations, etc.
And finally, parents
are also advised that if they want
to keep their children away from
this growing epidemic they should
decrease their smoking habits and
should never smoke in the presence
of their children.
How to Quit smoking.

The decision to quit smoking is
personal one.
What is important
to quit this deleterious habit is to
have “strong will-power”'
How­
ever, smokers can be advised to
follow some suggestions given by
the National Cancer Institute, Wash­
ington. “Before you quit, try smo­
king a lot more than usual, so the
experience becomes distasteful. Then
collect every cigarette but you can
find and put them all in a large
glass container to serve as a re­
minder.
Remember, never think
To cope with glamorous advertise­ about going without a cigarette for
ment, any connection between sue- i the rest of your life, concentrate
cess, sexuality and status; and ciga­ on one day, one at a time.
rette smoking should be banned in
advertising. Because sales of tobac­
co products cannot be stopped but
If you try to quit, at least during
it is suggested that sales promotion the first few days, spend as much
of tobacco products should be prohi­ time as possible in places where
bited. Not only cigarette advertise­ smoking is prohibited such as theat­
ment but various sporting and cul- I res, etc.

210

Drink water or fruit juice, but
avoid coffee, alcohol and other
foods people usually associate with
smoking.
If you miss putting
something in your mouth, try chew­
ing-gum,” the Institute suggested.
One more hint to smokers who
want to quit smoking is “Do not
keep matchbox with you”.
It
will help reducing the rate of smok­
ing due to non-availability of mat­
chbox easily.
©

References
1.

Ahuja,5? Ram : “ Sociology of the
youth sub culture ”, Rawat Publi­
cations, Jaipur, 1982.

2.

Chatterjee Shoma, A. : ct Why does
a woman smok ?” Beauty, 15 Sep.
1985, 5—6.
3. Chatterjee, R. G. : Indian Science
Congress Association, Calcutta 1981.

4.

Curt Mettlin : Journal of Health
and Social Behaviour, 14 (June,)
1973, 144.

5.

Newman, J. M. : Journal of School
Health, 40, 1970, 28—31.

6.

Smoking or Health : A Report of
the Royal College of Physician,
London.

7.

Smoking and Health : Surgeon
General Report, U. S. A.

8.

Smoking and Health : SEARO,
Tech. Pub. No 7, WHO, New
Delhi, 1985.

Soni, S. C. : “ What tempts you
smoke ”. The Hindustan Times,
Dec. 30, 1985, 24,
10. Smoking Control : Warning from
the West: Heart News, Vol. XXIII,
No. 3, March, 1986.
9.

Tucker, Larry, A. : The Journal of
School Health, April, Vol. 55, No. 4,
1985, 127.
12. The Health Education Journal :
Vol- 39, No. 3, 1980, 80—83.
13. WHO Chronicle : 39(3), 1985, 104

11.

—106.

14.

World smoking and Health : Vol. 3,
No. 3, 1978, 41—46.

Swasth Hind

alcohol

ALCOHOLISM AND LIVER
Dr V. Balakrishnan
A lcoholism is a worldwide social and medical problem.
It has been the
subject of intensive studies. Alcoholic drinks have been used since the dawn
of civilisation. At one time or another they were considered cures for practically
all diseases. Evidence for this abounds in our ancient scriptures and classic
treatises on Indian Medicine. However, now their social value is far greater
than their therapeutic uses. Its excessive consumption results in serious medical,
psychological and sociological problems.

September 1986

211

thyl alcohol, or ethanol, is the active

ingredient
in the common alcoholic drinks like beer, wine,
toddy, whisky, gin, brandy, arrack, vodka etc. The
content of alcohol may vary from as little as 5—6
per cent in beer to 50—60 per cent in vodka.

E

Alcohol is absorbed by both the stomach and the
small intestine. Its presence can be detected in blood
within five minutes after ingestion. Maximum con­
centration is reached in 30 to 90 minutes. Intake of
milk and fatty foods impedes and water facilitates
absorption of alcohol. It is eliminated chiefly by
oxidation in the body and to small extent excreted
unchanged in the urine, sweat and breath. It is a
source of energy supplying seven colories per gram.
without any essential nutrient or vitamin content.
Persons with alcohol concentration of alcohol in the
blood above 50 mg per 100 ml, or equivalent concen­
tration in urine, saliva or breath should be consider­
ed ‘intoxicated’. This principle is used in the com­
mon breath analysis tests given to motorists by traffic
police in many countries.

‘Drunkenness* is so common that is psychologic
and physical manifestations are well known. It
causes varying degrees of exhilaration and
excite­
ment, loss of self-control, erratic behaviour, excessive
talkativeness, slurred speech, loss of coordination of
movement and gait, irritability, drowsiness, and in
advanced cases, stupor and coma. On the other
hand, “alcoholism” may be defined as both a chronic
disease and a behavioural disorder, characterised in
either context, by drinking alcohol surpassing social
drinking customs and interferring with the drinker’s
health, interpersonal relations, or means of livelihood.
Reduced to pharmacologic terms, it is addition to al­
cohol.

The extent of the problem is difficult to assess. Al­
coholics rarely admit their dependence. In statistics
published in 1971 in U.S.A, there were about seven
per cent of the adult population in that country who
had “behaviour of alcohol abuse and alcoholism”.
Figures for our country are not available. There is
reason to believe that a significant percentage of our
population are habitual drinkers and that the per­
centage is increasing. Alcohol abuse is widespread
in all levels of society. It is not confined to a privile­
ged few.
Ill-effects of alcohol

Although alcohol may alter the function of practi­
cally every organ system in the. body, the important

212

clinical effects are on the digestive organs, the ner­
vous system and the heart. Excessive alcohol intake
may set in psychological disturbances, a variety of
neurological disorders and cardiac effects and many
effects on the digestive organs like gastritis, pancrea­
titis, malabsorption and harmful effects on the liver.
Cirrhosis of Liver
Epidemiologic statistical data shows that anybody
drinking an amount of alcohol between 60 to 80 gms
per day for a given period of time is at risk to develop
cirrhosis of the liver. This risk is considerably greater
and almost a certainty if consumption exceeds 160
gms per day which is equivalent to about 2/3s of a
bottle of whisky. To define a safe amount of alcohol
intake is difficult. It varies from person to person.
About 30 per cent of proven alcoholics develop cirr­
hosis of liver. It is not possible to make any
predictions by available methods.

Alcohol acts on liver in two ways—by a metabolic
alteration or as a topical toxin. It interferes with
vital metabolic pathways. The toxic effect may be
made by ethanol itself, or its metabolic, acetalde­
hyde.

Alcohol can induce three main types of hepatic in­
jury—fatty liver, alcoholic hepatitis, and
cirrhosis.
These three diseases can occur individually or in
combination. By far the commonest and least serious
among them is fatty liver. The possibility of alcohol
inducing carcinoma or cancer of the liver has also
been recognised in recent years.
Fatty liver: Fatty liver is universally common in
chronic alcoholics. It produces a smooth enlarge­
ment of the liver with minimal functional alterations.
Microscopical accumulation of fat droplets can be
seen inside and outside the liver cell. The condition
may remain as such or may lead to serious alcoholic
hepatitis or cirrhosis. Fatty liver is essentially a
reversible process and varies with the amount and
duration of drinking.

Alcoholic hepatitis: Alcoholic hepatitis or inflam­
mation of liver is more serious and usually follows
years of hard drinking. It is often precipitated by
a bout of alcoholic excess and hearlds the onset of
cirrhosis if the patient continues to drink. This con­
dition often becomes acute with fever, collection of
fluid in the abdomen and jaundice. Patients suffer
loss of appetite, weakness and a large tender liver.
(Contd. on page 214)

Swasth Hind

ALCOHOL |

Side-effects of Heavy Drinking
Alcohol-related accidents account for a significant
proportion of deaths, especially among young people
in many countries.
Analyzing the health problems caused by alcohol, a
World Health Organization (WHO) study says acci­
dents at work, in the home and during sporting events
are more frequently related to alcohol consumption
than is widely recognized.
“Not only the alcohol dependence syndrome itself
but many disabling and sometimes fatal and psycho­
logical conditions can be attributed either wholly or
in part to excessive drinking”.
The Geneva-based world body says that excessive
drinking disrupts family life and can also result in
violence and neglect.

It expresses concern over the consumption of al­
cohol by preventing women as it “can damage the
unborn child”.
“It is clear that the vulnerable group includes many
more people than just the heavy drinkers".

The study says that in some developing countries
which do not have long traditions of consuming com­
mercially produced beverages of the variety and
strength available in most developing countries, al­
cohol-related problems may be specially serious among
technicians and professionals “who are the scarcest
resource or young people who represent the country’s
investment in future.”
It says that the total production of alcohol rose by
almost 50 per cent between 1965 and 1966 while pro­
duction per person increased by just under 15 per
cent over the same period. Two-thirds of the world’s

September 1986

alcohol production in both years was in Europe and
North America.

“The fact that these are the very regions of the
world where population growth rate was least rapid
is an indication of the growing importance of interna­
tional trade in alcoholic beverages”, it adds.
The study notes that liquor consumption has been
rising steadily in the Third World countries, most of
which important alcohol from industrialized coun­
tries. However, policies have yet to be implemented
to counter this threat in the Third World countries—

The growth in consumption of alcohol beverages in
some developing countries has been much more rapid
than in others, and if this trend continues for another
generation, they will attain or exceed the present
levels of per capita consumption in the developed
countries”.
The study says the rapid growth of alcoholic con­
sumption in developing countries is likely to be fol­
lowed by a higher incidence of alcohol-related pro­
blems after some time.

“These additional problems will represent a very
substantial drain on scarce economic and social re­
sources”.
It notes that in developing countries, young men
living in urban areas are often the first to adopt the
practice of heavy drinking.

“The availability of alcoholic beverages is likely to
continue to increase and spread around the world
bringing concomitant increases in alcohol-related
health problems and associated social costs”.
©
Courtesy'. Indian Red Cross Journal

213

(Contd. from page 212)

The liver invariably shows inflammatory changes.
The diagnosis of alcoholic hepatitis should be a
warning to abstain from alcohol forthwith.
Cirrhosis of liver: A most dreaded and common
complication of chronic alcoholism is cirrhosis of the
liver. Alcohol is only one major cause of cirrhosis,
the other being infection by the hepatitis virus. Only
about 23 to 30 per cent of chronic alcoholics develop
cirrhosis. Factors determining this vering vulnerabi­
lity are poorly understood. There are some sugges­
tions of hereditary vulnerability which awaits confir­
mation.

Cirrhosis is the term applied to a destruction of
liver cells which may be gradual or rapid with re­
placement of the dead or destroyed cells by inactive

tablished cirrhosis cannot be cured, there are many
methods of treatment which can give symptomatic
relief and alleviate suffering.
While it can be said that good nutrition may pro­
long survival in alcoholics, it is generally recognised
now that the harmful effects of alochol on the liver
are not due to associated malnutrition. • There is no
evidence that a good diet protects the liver against
alcohol. Same can be said of fancy drugs which claim
to protest liver from alcohol.
It is important to realise that complete abstinence
from alcohol can reverse early changes in the liver.
Careful studies have shown that even in established
cirrhosis, where a cure is beyond hope, life expectancy
can be prolonged if the person abstains from further
drinking.
Alcoholics anonymous

ALCOHOLISM IS A DISEASE
-

ARREST IT

fibrous tissue. Thus, the functioning liver cell mass
progressively shrinks and becomes inadequate to
handle the vital functions of the body. When the
destructive process and the reparative process balance
each other cirrhosis is said to be “compensated” and
may go on for years. If the destructive process over­
takes the reparative process which is the usual case—
decompensation sets in and liver failure follows. This
is indicated by loss of appetite, jaundice, weakness
and wasting, distension of abdomen with fluid, swell­
ing of legs and drowsiness. Vomiting blood, passage
of dark, tarry stools, coma etc. are later complications.
Decompensated cirrhosis is a progressive condition,
resulting in death within a few years’ time. While es­

Following the treatment of the medical complica­
tions, the underlying problem of alcohol dependence
has to be treated. This will be easier if undertaken
with the cooperation of victim. A number of methods
have proved valuable in the long term management.
The most important of these are the use of drugs
like Antabuse, averision
treatment, psychotherapy,
and participation in social organisations for combat­
ing alcoholism. Alcoholics Anonymous (AA), an
informal fellowship of former alcoholics, has prov­
ed to be the single most effective force in the rehabili­
tation of alcoholic patients in the west.

Alcoholism is not merely a medical problem. It is
a psycho-sociological problem as well, a by-product
of our culture which has eaten into its own fabric of
social and moral values. Tackling this problem effec­
tively should be a test of our ability and commitment
to save our culture from its own clutches.
©

The sjnallpox of the 1980s
In light of the fact that some 1000 persons [in the USA] die each day from cigarette smoking, the apparent
preoccupation in the United States with nitrates, saccharin, and other food additives will baffle historians
100 years from now. Cigarette smoking claims more lives in three years than all United States wars
combined. If the same number of persons died fro.n anthrax or smallpox, society would protest and demand
immediate, effective action. Yet the toll exacted by the cigarette smoking epidemic is concealed behind death
certificates which read : heart attack, stroke, cancer. Cigarette smoking is the smallpox of the 1980s in the
developed world, and society will be judged quite harshly in the future for not having dealt with this fact in
a straightforward manner.
From : FOEGE, W. Epidemiology in the experience of the United States Centjes for Disease Control—a personal view.
Epidemiological bulletin, 5 (5): 8 (1984).

214

Swasth Hind

DRUGS

MEETING THE THREAT OF
DRUG ABUSE
Marcus Grant

A preventive strategy begins from an awareness of the multiplicity of factors involved in
narcotic and psychotropic drug abuse. Importance of educational strategies should not be
forgotten. Much health education has in the past been directed exclusively at young people,
Although they remain an important group, others, such as parents and community leader s
must not be left out of the programme.

N March of this year, represen­
tatives from 30 countries met
Lancaster House, London, for
a conference of Ministers of Health
on narcotic and psychotropic drug
misuse. This conference provided
a unique opportunity for the collec­
tive views of these governments to
be brought to the attention of the
world community. Their joint state­
ment will be put before the 1987
UN Conference on Drug Abuse.

J
at

The misuse of narcotic and psy­
chotropic drugs
leads to many
other kinds of problem as well,
but the focus of the London con­
ference was specifically on health
problems and on the action that
health ministries can take to coun­
ter this threat.
Action to reduce health problems
arising from narcotic and phychotropic drug misuse still has to face
powerful political and economic
interests that are opposed to effec­
tive programmes. This is true at
both
national and international
levels. Within and between coun­

September 1986

tries, there are forces at work that
seek to undermine efforts to develop
a comprehensive response to the
health problems related to drug
misuse. The challenge to the health
sector is to dispel uncertainty about
preventive and curative action and
to mobilise the will of ordinary peo­
ple to join in the efforts to control
drug-related problems.

duce the supply of drugs through
control mechanisms have not been
sufficient to deal with the rising
demand. As the emphasis shifts to­
wards giving higher priority to stra­
tegies aimed at reducing demand,
the health sector must expect to
play a more and more central role
in developing national and interna­
tional responses.

Unfortunately,
both
nationally
and internationally, the information
available on the nature and extent
of drug abuse problems is far from
adequate. Although the general up­
ward trend is clear, estimates of
production and
consumption are
uncertain and information on the
prevalence of particular problems,
including dependence, is very hard
to obtain. There are many reasons
for this, some of which relate to
the illegal nature of the substances.

Reducing demand will call for
much more than health education,
although the importance of educa­
tional strategies should not be for­
gotten. Much health education has
in the past been directed exclusive­
ly at young people. Although they
remain an important group, others,
such as parents and community
leaders, must not be left out of the
programme.

A preventive strategy begins
from an awareness of the multi­
plicity of factors involved in nar­
cotic and psychotropic drug mis­
use. Efforts in recent years to re­

It will also be important to change
the practice of health professionals,
and this will include training medi­
cal practitioners in better prescrib­
ing practices and appropriate legal
measures. The development of actitivities at the community level, mo­

215

bilising the will of the people to
take action to counter the threat of
drug abuse, will geatly strengthen
a national programme of preven­
tion. Community development is
based on knowledge of the commu­
nity and its problems; individuals
need to be identified within the
community who will work closely
with the health sector. A programme
of education and prevention should
therefore involve the active parti­
cipation of community leaders in
its design, delivery and evaluation.
On one level, a national policy
on narcotic and psychotropic drugs
cannot be separated from the over­
all national policy on health, but
equally a national drugs policy
will involve the essential collabo­
ration of many other sectors of
government. For each country, the
process of defining a national drugs
policy will require a balance bet­
ween concerns for mental health,
for wider health issues, and for
overall national development.
A naitional policy, once formu­
lated, must be kept under re­
view. Within the
framework of
the policy, a national plan of
action can be developed that leads
to specific programme steps in pre­
vention, treatment, research and
training. But this occurs within a
changing political and
economic
climate. As circumstances change,
so must some aspects of the na­
tional programme. What remains
constant is the commitment to
long-term action and the recogni­
tion that the solution to drug mis­
use problems lies in prolonged
effort rather than in unplanned or
uncoordinated initiatives, however
sensational some of those may be.
Planning national
programmes
means planning for action by many
people working in harmony.

216

THE MORES OF MORE
In societies consumed with the many “mores” of materialism —
“more wealth, more food, more drink, more cars, more tobacco, more
sex ”— “it is not surprising if the ‘ more 9 includes more narcotic and
psychotrophic drugs,” Dr Halfdao Mahler, WHO’s Director - General
told health ministers from 30 countries at a meeting in London.
“If our social values makes drug-taking an acceptable norm
among peer groups of youngsters, then it is these values that need to
be reconsidered,’' he suggested as a step to counter the virtually
unchecked problem of drug abuse.
“ So perhaps it is not the youngsters we have to change, perhaps
it is some of our social values,9' he added.

Figures presented to participants shows there are an estimated
750,000 persons world-wide addicted to heroin, 1.7 million to opium,
4.8 million to cocaine, and 29 million to cannabis.

Opportunities for international
collaboration are most likely to
develop out of national policies on
narcotic and psychotropic drug mis­
use. Thus, technical cooperation
between developing countries can,
for example, include already exist­
ing programmes to control drug
misuse problems in each of the
countries involved. Equally, link­
ages between developing and deve­
loped
countries are likely to
grow in strength as the advan­
tages of effective cooperation be­
come apparent.
Producing coun­
tries and consuming countries may
view drug misuse problems from
somewhat different perspectives,
but they are likely to be united in
their concern to minimise their ad­
verse health consequences.
Despite social, cultural, economic
and political differences, countries
can learn from each other’s failures
as well as from each other’s suc­
cesses. All too often, experiments
are repeated that are known by
others to have been unproductive.

A fuller and more open exchange
of all types of experience at com­
munity and national level can lead
to a better international response.
Not only WHO but also other
United Nations agencies certainly
need to increase their current level
of activities. Just as a commitment
to action is essential to make na­
tional programmes effective, so too
is that commitment important for
international efforts. The interna­
tional agencies have the technical
capacity and the will to take action.
By co-sponsoring the conference in
London and by taking responsibility
for its scientific preparation, WHO
has demonstrated its willingness to
intensify its own efforts. In follow­
ing up the recommendations of the
conference, WHO and the participat­
ing countries will be working toge­
ther to meet the major threat to the
world’s health that is being created
by the misuse of narcotic and psy­
chotropic drugs.—Courtesy: World
Health, June 1986.
©

Swasth Hind

have to be taken with a certain
caution. First,
while
literacy is
measured as a dichotomous varia­
ble, it is in fact a continuous one.
It may not be possible to be a little
bit
pregnant, but it is certainly
possible to be a little bit literate.
Hence, the statistics depend upon
where you draw the dividing line.
UNESCO has its own definition:
a person is literate “who can with
understanding both read and write
a short simple
statement on his
everyday life.”
Definitions

Literacy and Well-being
The map of illiteracy coincides closely with the maps of
poverty, malnutrition, ill-health, It follows that literacy
must form part of the strategy for achieving Health for all
The basic sta­
tistics on illit­
eracy arc well
known,
and
certainly pro­
vide abundant
reason to reflect

September 1986

upon the inequalities of our world.
By the most recent estimate there
are 824 million illiterates of 15
years of age and above, over 800
million of whom live in the develop­
ing nations. While carefully com­
piled and calculated these estimates

Recognising that
this included
some who were not sufficiently lite­
rate to cope with the complexities
of an industrial society, a commit­
tee of experts developed a second
definition for functional literacy: to
be functionally literate, an indivi­
dual must be able to “engage in all
those activities in which literacy is
required for effective functioning of
his group and community...” and
also be able “...to continue to use
reading, writing and calculation for
his own and the country's deve­
lopment”. As will be
observed,
the second definition is a relative
measure. The criterion is the capa­
city to cope with the
challenges
and exigencies posed by the na­
ture of the society in which one
resides. So even the concepts of lite­
racy are slippery.

Only hard
work will of course
change the literacy
situation, but
the statistics are mere numbers on
paper or in a computer. It is noted
that those who come to power in
revolutions often count illiterates
differently from their predecessors.

217

The illiterate is not only unable to read and write but he — or more usually she — is poor, hungry, vulnerable to illness

and uncertain that even his or her present miserable circumstances will not decline to the point where life itself becomes
the issue.

But whether there are 824 million
or 1000 million illiterates, there are
clearly too many of them.
What does illiteracy mean to the
illiterate? Let us note here that the
map of illiteracy closely coincides
with the maps of poverty, malnutri­
tion, ill-health, infant mortality,
etc. Hence, in the typical case, the
illiterate is not only unable to read
and write but he—or more usually
she—is poor, hungry, vulnerable to

218

illness, and uncertain that even his
or her present miserable circum­
stances will not decline to the point
where life itself becomes the issue.
In these circumstances, does his or
her literacy really matter? Would
he or she even list illiteracy among
life’s major problems? While man
does not live by bread alone, we
can assume that the hunger of the
body will normally take precedence
over the hunger of the mind, par­
ticularly if the intellectual diet

available to the new literate is as
poor as is normally the case.

It follows that the best argument
for doing something about illiteracy
is not that it is part of the im­
mense problem of inequality in our
world, but that literacy can be part
of the answer to remedying it.
O
Frem : Eleven issues in literacy for the
1990s, by Arther Gillette and John Ryan
Assignment Children (UNICEF), 63)64,
1983.

Swasth Hind

CARE OF THE AGED

FITNESS AFTER RETIREMENT
Col K. K. Vadhera (Retd.)

A long term policy should be formed by each society, comprising physical, psychological and

social dimensions for retired persons. A retired person is simply the end result of an active
working life. The goal should be to make this life-span more meaningful for every individual.

TJ etirement is an immensely important, complex,
■ urgent and inevitable problem as it means accept­
ing several personal losses, i.e., prestige, status, mone­
tary loss and loss in social acceptance. Though the
precise time of retirement is always known, but at
most of the times, it appears abrupt due to lack of
anticipatory preparation. Too many individuals are
caught by surprise as they are still in economically
good working condition.

Problems of retirement

Physical, mental and social factors determine health
after retirement.
(a) The physical health will depend upon various
stresses and strains that have happened in life during
service. It is, therefore, very essential that one should
be fit at the time of retirement. As age advances and
as old age is a lamentable inevitability, diseases of

September 1986

respiratory, cardiovascular, urinary,
locomotor sys­
tems, diabetes, cancer, etc., can affect the individual.
(b) Family relationship might be altered especially
if the retired couple have to go and live with their
grown up married children.
(c) Retirement may lead to intense marital tensions.
Most frequently, the emotional stress is greater on
the wife. For many years, she is used to have cer­
tain “comforts” in life due to various 'perks’ in ser­
vice. More important than that is that she was used
to have a few hours of peace and quietness during
the day when the husband was away to work. Now
this restless bored man who does not know what to
do with himself is around the house all the time and
consequently frictions due to constant interference in
household affairs can arise.

(d) General dissatisfaction may arise due to lack of
social participation and changing socio-economic con­
ditions and deteriorating level of health.

219

Preventive aspect of problems of retirement

Scope for prevention

Success in retirement requires a degree of emotional
maturity, a realistic comprehension of wants and
desires, foresight and acceptance of reality.

We have got sufficiently precise information on
the significance of any given factor in the develop­
ment of a particular pathological process and there­
fore the modification of lifestyle offers opportunities
in preventing such diseases.

Action is required to be taken regarding preserving,
the continuity of lifestyles, i.e., services catering to
basic and vital needs, viz., housing, health information
and work opportunities.

(a) Housing*. It is a common knowledge that old
people want to live in their own houses, in a familiar
neighbourhood and in close contact with their rela­
tives arid friends. Planning for such a residential ac­
commodation has to be done’ during service through
various governmental and private house building or­
ganisations.

(b) Social integration: Retired people may feel
loneliness and may get socially isolated and may have
very little communications and contacts. It is very
important that one should maintain social activities
and interests at the same level as before. Social par­
ticipation and activities inside the family as well as
joining clubs, associations, religious and political or­
ganisations should be actively considered.
(c) Employment: To make retirement successful,
some form of substitution for the previous work is
necessary. It may provide prestige, position, acquisi­
tion of power and would also keep the person active.
Work may also satisfy the hunger for a sense of
real worth in carrying responsibility or a service to
the community. As such the pre-retirement develop­
ment of a vocational interest is of immense value.

A long term policy requires to be chalked out in
each society for gainful employment of retired per­
sons. This is quite essential in view of the fact that
high level of unemployment in the world may cause in­
creased tensions between young and old when both of
them are in economically good working conditions.
(d) Healthy and junctional ability: Activity and
involvement alongwith ability to pick and choose and
go at one’s own deminishing pace are the corner­
stones of good retirement. With the adoption of pre­
ventive measures, the life expectancy has already
risen considerably, we can reasonably aim to further
extent the span of life to 85 or 90 years with few
people dying of disease before the age of 70.

220

(a) Smoking: The avoidance of tobacco smoking
will not only reduce the mortality from cancers by
about a third (cancer of mouth, throat, lungs, etc.)
but also reduce mortality from myocardial infarction
by about a quarter. It would also eliminate chronic
obstructive lung disease and the complication of peri­
pheral vascular diseases.

(b) Diet : Diet consisting of wholegrain cereals,
vegetables, fruits, limited fats, very few dairy pro­
ducts and eggs, little refined sugar, fish and poultry
for animal proteins and sufficiently restricted in amount
so as not to cause obesity should be taken with pre­
ference to take vegetable oils. Such a type of diet
helps in avoiding cancer, coronary heart diseases,
hypertension, diabetes, diverticulitis, duodenal ulcer,
constipation, etc.
(c) Alcohol: It is wise to reduce the consump­
tion of alcohol to as little as possible, if one takes
it at all. Many disabling and some fatal physical and
psychological conditions can be attributed to excesssive alcohol intake.

(d) Physical Activity: Physical activity helps in
controlling obesity, high blood pressure, blood lipids
and insulin activity. Brisk walking, gardening, swim­
ming, golf, fishing are all good for health.

Regular exercise should be a part of
activity.

retirement

(e) Other preventive measures to be adopted are
protection against trauma and control of infections.

Adaptation to and training for retirement are im­
portant issues to prevent health problems associated
with retirement. It requires an activity whose pur­
pose is greater than that of mere survival. It requires
co-operation of the family, community and the State.
A long term policy should be formed by each society,
comprising physical, psychological and social dimen­
sions for retired persons. A retired person is simply
the end result of an active working life. The goal
should be to make this life-span more meaningful for
every individual.
O

Swasth Hind

A\GE8NG AND ROLE OF HORMONES
Dr Vinod Kumar
Ageing still remains an intriguing issue
before the scientists. Hormones play an
important role in process of ageing. Their
imbalance leads to a number of diseases in
the adults, especially among the elderly. In
this article the author higlights the role of
hormones in the precess of ageing and oldage diseases. He says the best way to
overcome these diseases is to follow the
time-honoured values like balanced diet and
avoiding sedentary habits, smoking and
drinking.

A GREAT CONCERN for the care of
elderly people in several developed nations and a
number of programmes are available there to meet
their multi-faceted problems in health, psycho-social
and economic spheres. In medical field, the concern­
ed discipline known as Geriatric Medicine is a part of
educational syllabus in most of the medical institu­
tions where doctors are imparted the necessary train­
ing. Simultaneously, researchers have taken up the
challenge of investigating ageing and its mechanism in
their laboratories. Consequently a sizeable portion of
health budget is utilized for the welfare of the aged
people. Proportion of population over 60 years of
age is on the increase everywhere. In advanced coun­
tries, they will grow from current 17 per cent to 22 per
cent in the year 2025 AD. In our country, presently
around 40 million Indians (6 per cent of the popula­
tion) are above 60 years of age and this figure will
increase to 13 per cent by 2025. In absolute num­
bers, they are going to become 4 times in next 40
years and India will continue to have second biggest
population of old people.
here IS

T

September 1986

Process of becoming old has attracted man's atten­
tion since time immemorial. Technological advances
have helped scientists to study the mechanism of ageing
and based on their findings attempts have been made
to prolong the period of physiological competence and
delay ageing.
Several theories have been enunciated to explain
why we age. For instance, biological theory of ageing
which stresses the importance of genetic or environ­
mental factors as responsible for ageing, has held the
ground for long. In this article I would be dealing
with the science of hormones in relation to ageing and
their disorders in elderly people.
Role of Hormones.

Hormones are important substances that are form­
ed by certain parts of human body known as the en­
docrine or ductless glands. They are essential for
sustaining life because they are responsible for our
growth, development, metabolism, reproduction and
behaviour and are necessary for coordinating the acti­
vities of various organs in the body.

Brain is the vital organ that controls hormone pro­
duction by various glands. More precisely, a struc­
ture called hypotholamus, situated in the brain, is the
master of hormone orchestra. It secretes and sends
out chemical substances called 'release hormones? to
its assistant situated at a slightly lower level in the
brain, known as pituitary, gland. This gland in turn
produces a number of hormones grouped under the
trophic hormones, each of which controlling a speci­
fic hormone producing ductless gland situated at the
periphery in our body. These peripheral glands vir­
tually act as slaves to their master hypothalamus and
assistant pituitary pair and secrete hormones under
their instructions. These glands are: thyroid, adrenal,
testes and ovary; secreting their respective hormones.
In addition, growth of our bones and muscles, milk
secretion from the breast and insulin secretion from
our pancreas are also partly totally dependent on this

221

system. These hormones are capable of exerting
their specific actions for fulfilling the various func­
tions either gradually (e.g., growth promoting action)
or in response to sudden demands arising either from
inside the body or from external environment. The
system is set in such a way that even a slight excess
of hormone of a peripheral gland can put an imme­
diate stop to its whipping by its master in the back­
ward direction. Thus in health, the peripheral gland
acts as an intelligent servant and knows when to
obey and when to even guide its master. Hormone
production is, therefore, a well regulated and con­
trolled process.
Theory of ageing
The theory of ageing that incriminates hormones
propounds that the functional capacity of hypothala­
mus to direct hormone production is like an ageing
clock which is so programmed as to determine the
sequence of events right from the time of fertilisa­

tion. In other words, this hormonal capacity proceeds
in regulated steps like a pace-maker to determine our
progress from childhood through adulthood, middle
age and finally to old age. One of the hallmarks of
our entire life time's hormone regulation is repro­
ductive decline that occurs in women around thq age
of 45 resulting in stoppage of menstruation, called
menopause, and a similar decline that occurs in age­
ing men (but more gradually and less severely than
women). At least in females, deficiency of sex hor­
mones that results in this event is clearly favourable
to ageing in the form of increased risk of degenera­
tive heart disease and cancer.
Another explanation to ■* account for hormonal
changes in senescence is the breakdown of brain’s
regulatory centres that normally control hormone
production. Yet another explanation is the increas­
ing deficiency of brain’s neurotransmitters and hypo­
thalamic release of hormones, resulting in altered
catecholamine metabolism and deficiency of pituitary
hormones, both of which then causing secondary
ageing changes. Whatever the hormonal explanation
may be the fact remains that ageing is attained by­
grad u al but significant decline in the secretary reserve
of thyroid adrenal cortex, testes, ovary and growth
hormones. Sex-related trophic hormones of pituitary,
however, show a secondary rise due to depressed
hormones of testes and ovary. Opinions on status of
prolactic secretion with ageing seems contradictory
and divided.

222

Before we now turn our attention to a brief discus­
sion of hormone-related diseases that occur in elderly
persons, it will be pertinent on my part not to create
an impression that ageing is all due to hormonal defi­
ciencies. This is not so. There are other factors too
contributing to this phenomenon. Disabilities and
diseases acquired during life also have their role in
ageing process. Further, other systems of human
body are also undergoing senescence changes.
Hormone-related diseases

With the background knowledge of hormones al­
ready illustrated, let us now turn our attention to
some common hormonal diseases, some of which can
be seen in adults also but may present unusual fea­
tures in the elderly. Moreover, some diseases may be
unique to advancing age :

1. Male Sexual Disorders in ageing individuals are
usually slow to develop and may take on the form
of declining sexual performance and gradual decrease
in fertility potential. There are only uncommon
examples of children born to men above the age of
65 to 70 years. Reasons for declining sexual perfor­
mance in elderly males are not. however, entirely hor­
monal because basal concentration of their sex hor­
mone (or the testosterone) level may be normal. Psy­
chogenic overlay, weakness of local nerves and gene­
ral fatigue appear to be equally important and need
to be adequately looked after.

2. In the females, reproductive decline occurs
around 45 years of age and rather more rapidly to a
point of virtual cessation when compared to males.
This manifests as menopause in the middle aged
woman, sometimes accompanied by upsetting symp­
toms of hot flushes, sweating and palpitation which
can be wrongly interpreted as due to neurosis. Re­
placement of the missing female sex hormone (or the
oestrogen) appears plausible but it is usually not re­
sorted to by doctors due to serious side effects and
complications. There are some specific ways of treat­
ing this. Another effect of oestrogen deficiency in
females is the gradual bone loss called osteoporosis
in which ageing process by itself and poor nutrition
may also be contributing factors. Only in advanced
cases do the patients develop significant bone pains
and compression fractures.
3. Thyroid dysfunction is of special importance be­
cause certain characteristics of thyroid deficiency are
also the features of old age such as sluggishness, dry
skin, cold intolerance and accelerated fat deposits in
their blood vessels. Laboratory tests in ageing ordi­
narily do not show florid changes in thyroid hormone’s

Swasth Hind

concentration except some compromise in their sec­
retory reserve. If an elderly person gets into an
actual hypothyroid state, usually the dose of thyroid
hormon required by him is about 30 per cent lower.
With regard to hyperthyroidism, it is perhaps less
common in elderly but when it does occur, the effects
are a typical and demand special diagnostic expertise.
There is some evidence also in favour of hyperthy­
roidism as a factor that promotes ageing.

4. Disorders of adrenal gland are not specially
common in elderly people. However, the apparent im­
portance is the impression created that because our
elderly people are not as able as young are to adjust
to stresses and tensions they may have the deficiency
of adrenal hormones which have a special role to
play in combating stresses. Hypothalamo-pituitaryadrenal is a life support axis and can influence certain
behavioural functions and also take active part in
our interaction with external environment. Only
marginal alterations in the secretion pattern of these
hormones have been reported with ageing. However,
a hormone called noreplnephrin which comes .from
the inner part of adrenal gland is increasingly being
attributed to certain features of ageing.

5. Disorders of behaviour, sleep and depression :
New exciting areas of research have shown hormonal
basis to abnormal sleep patterns and wakefulness in
elderly persons. A high level of night time norepinephrin is often incriminated in certain sleep distur­
bances. Then these disorders have been shown in
isolated reports to have abnormality of certain other
hormones like prolactin, cortison, etc., but their exact
significance is unknown.
6. Glucose intolerance and diabetes mellitus : One
of the hallmarks of advancing age is an inability to
tolerate a load of glucose ingestion, an abnormality
also seen in the common variety of diabetes. For this

and other reasons, diabetes even if occurring at earlier
ages is sometimes considered to be a process of acce­
lerated cell ageing. In any case, this inability to uti­
lise glucose biochemically in the body is associated
with degenenerative changes in heart and arteries
which are some of the indices of ageing. Diabetes
being a common disease needs few lines of discussion.
Essentially it is considered to be due to deficiency or
inaction of a hormone called insulin secreted by a
gland called pancreas. Presuming that diabetes is at
least partly a reflection of premature ageing, we have
certain dietary and pharmacological manipulations
available that can control diabetes and possibly delay
ageing.
7. Hormone related Cancers : We will briefly men­
tion here the role of hormones in respect of cancers
of prostate, uterus, ovary and the breast.

8. Bone loss due to ageing.
9. Loss of water and salt balance in the elderly.
What’s to be done

Much has been said about the causation of ageing
and role of hormones in certain diseases of geriatric
practice. Perhaps, while making generalisations, one
could stress the importance of time-honoured values
such as intake of balanced diet, avoiding sedentary
habits, smoking and liquor. These are at least some
established factors which contribute to keeping you
fit and healthy for a longer time, which is the ultimate
aim of entire human race. Scientists will have to
work with public educationists. We can now only
extend the intricate scientific explanations for rela­
tively simple but valuable habits practised for centu­
ries. Nevertheless, scientists are at work at a much
more fundamental level to identify means to delay
ageing, e.g., repairing the ageing clock, etc. {Courtesy:
All India Institute of Medical Sciences).
O

DESIGNER DRUGS
The annual report of the International Narcotics Control Board in Vienna has warned against what
are called “ designer drugs ” — a reference to a new group of drugs now finding its way to the world’s
big cities. Because the drugs are made by altering the chemical structure of existing ones, they are now
unregulated.
In a related development, UN General Assembly set 17 — 22 June 1987 for a world conference on
drug abuse in Vienna. Proposed by the UN I Secretary-General, Javier Perez De Cuellar, it is yet another
recognition of the growing need to crack down on the drug trafficking and the illicit production of
narcotics and psychotropic substances (chemically produced stimulants such as amphetamines, barbiturates,
and hallucinogens).

September 1986

223

OUR NEW
HEALTH MINISTER
HRI P.V. Narasimha Rao, Minister of Human
Resource Development has taken over the addi­
S
tional charge of Minister of Health and Family Wel­
fare from June 24, 1986, while Mrs. Mohsina Kidwai,
has taken over as Minister of Transport.
Born in an agriculturist family in Karim Nagar
District, Andhra Pradesh, on June 28, 1921, Shri P.V.
Narasimha Rao was educated at the Osmania Uni­
versity Hyderabad, Bombay University and Nagpur
University. He obtained the degrees of B.Sc. and
LL.B.

He was elected to Parliament in March 1977 after
over three decades of political career in Andhra Pra­
desh and in the January 1980 General Election was
re-elected from Hanamkonda, Andhra Pradesh and
in December, 1984, returned from Ramtek (Maha­
rashtra). He was a member of the Andhra Pradesh
Legislative Assembly from 1957-1977 and was a
Minister in Andhra Pradesh Government from 19621971. He was Chief'Minister of the State from 19711973. He was the General Secretary of the All India
Congress Committee in 1974-1976, Minister of Exter­
nal Affairs from January, 14, 1980 to July 18, 1984,
Minister in Andhra Pradesh Government from 1962Minister of Defence from December 31, 1984.
He
assumed change as Minister of Human Resource De­
velopment on 25th September, 1985.

Shri Rao has delivered lectures at various Univer­
sities in the United States of America and the Federal
Republic of Germany on political and allied subjects.
He has maintained an abiding interest in literature
and has several publications to his credit, prominent
among these are: “Sahasra Phan”, Hindi translation
of the late Shri Vishwanatha Satyanaryana’s famous
Telugu Novel “Veyi Padagdlu” published by Jnanpith:
“Abaia Jeevitam”, Telugu translation of the late Shri
Hari Narayan Apte’s famous Marathi novel,
“Pan
Lakshat Kon Gheto” published by Central Sahitya
Academy (National Academy of Literature).
He is Vice-President of the Dakshina Bharat Hindi
Prachar Sabha, Madras and was the first Chairman of
the Telugu Academy, Andhra Pradesh.

224

His special interest are :
Indian philosophy and
culture ; fiction ; political
thought ; languages and
creative
literature
in
general.
His favourite
pastimes and recreation
are music, cinema and
theatre.

Soon after his appoint­
ment as Minister of Exter­
nal Affairs, Shri Rao
chaired the Hird Con­
ference of jUNIDO at
New Delhi in January
Shri p- v- Narasimha Rao
1980. He also chaired a meeting of the group of
77 at New York in March that year.
He was
Chairman of the .Conference of Foreign Ministers
of Non-aligned countries in February, 1981, and
led the Indian delegation to the Conference of the
Group of 77 on ECDC at Caracas in May, 1981.
Shri P.V. Narasimha Rao presided over meetings
of Foreign Ministers of Non-Aligned nations on the
eye of the''New Delhi Summit and also at the United
Nations both in 1982, when India was asked to host
the Summit, and the following year when at the initia­
tive of the Movement, informal consultations amongst
Heads of State and Government from, diverse nations
across the world were held at New York. Shri Rao
was also the leader of the Special Non-aligned Mis­
sion which visited countries in West Asia in Novem­
ber 1983 in connection with the issue of Palestine.
Shri Rao was associated actively with the Common­
wealth Heads of Government meeting in New Delhi
and with the Action Group set up by the meeting on
the question of Cyprus.

In his capacity as Minister of External Affairs, Shri
Narasimha Rao has chaired on behalf of India a num­
ber of Joint Commissions including those with the
U.S.A., U.S.S.R. Pakistan, Bangladesh, Iran, Vietnam,
Tanzania and Guyana.
OO

Swasth Hind

AN INNOVATIVE APPROACH IN
MENTAL HEALTH EDUCATION
S. Rajaram
n the past, mental health did not find its appro­

I

priate place in the national and State health plan­
ning, perhaps due to the common misconception that
the prevalence of mental illness is low in India, parti­
cularly as compared to West. In addition, it was also
thought that no effective treatment is available. Re­
search studies from different parts of the country have
shown that mental illness is as common in India as
it is elsewhere, and is equally common in rural and
urban areas. Mental illness causes immense suffer­
ing to the affected individual and the people around
him, although such a suffering may not be clearly vi­
sible to others. With the methods of treatment and

September 1986

prevention available in modern health care, chronicity
and disability can be avoided in about 80 per cent
of the cases.
Complete and lasting recovery is pos­
sible in no less than 60 per cent.
The Joint Central Councils of Health and Family
Welfare held in August 1982 considered the impor­
tance of mental health in the total development of
Society and appreciated that mental health is an in­
tegrated part of total health and therefore should be
viewed in that light. The joint conference recom­
mended that mental health must form an integral part
of the total health programme and as such should be

225

included in all national policies and programmes in
the field of Health. Education and Social Welfare.
Realising the importance of mental health in the
course curriculae for the various levels of health pro­
fessionals, suitable actions should be taken in consul*
tation with appropriate authorities to strengthen the
mental health educational components.
Mental health care to< all

To achieve the basic mental health care to all,
specific approaches and elaborate plans of actions are
being formulated for National Mental Health Pro­
gramme in India.
When the Government and the mental health ex­
perts are contemplating over such strategies, it is
relevant to focus on the lay public’s knowledge, atti­
tude and behaviour towards mental disability and the
mentally ill. Still, the treatment of mentally ill
people is being governed by primitive superstition
and religious dogma.
There is mass ignorance and
deep-rooted prejudices against them mentally ill. In
many places, the cure consists of incantation, exor­
cism, bizarre rituals, foul concoctions, amulets and
charms. Mentally ill are scorned and avoided. They
are thought as unproductive, useless and harmful. In
such a condition, systematic efforts need to be made
collectively to fight against the ill effects of the igno­
rance on the part of the public. Effective use of mass
media would go a long way in adequately counter­
acting the misconceptions. In addition to such routine
educational activities, the mental health professionals
especially psychiatric social workers need to organise
innovative programmes aiming at educating the public.
In fact, each and every professional activity should
have consciously planned educational component
with it. Then only, it is possible' to create an aware­
ness among the public about the disease and that they
will be helpful towards the mentally ill and the handi­
capped.
Integrated Camp approach

One such effort undertaken in this direction by the
author was ‘the integrated camp approach’. Small
groups of mentally ill, and mentally retarded persons
were taken for two weeks camps which were conduct­
ed in rural setting.
In addition to their medical treatment, they were
given a schedule of their day to day programme,
focussing on maintenances of personal hygiene, skills
in communication and interpersonal relationships and

226

recreational group activities. Above all, they were
given opportunities to work in the fields, help in con­
struction activities and get involved in various activi­
ties of farming and horticulture. They were gradual­
ly allowed to mingle and work with other local
labourers. A total of 36 patients were involved in
three camps. The improvement noticed in the pati­
ents, reactions of the public, interaction of the labou­
rers with the patients were systematically observed
and recorded by the Psychiatric Social Worker, ’who
organised these camps and lived with the patients
during this period.

In this pioneering attempt, these camp activities
were found to have infinite educational, therapeutic
and rehabilitational potentials. The following are
some of the insights derived from these social exer­
cises in the community :

1. Hidden potentials of the patients can be
brought out by organized group activities.

2. Patients, whom the society considers as bur­
den, can be productive and constructive and be
an asset to the community.

3. In many of the activities, their work output is
in no way less than other labourers.
4. Their work performance
public.

could impress

5. Continuous involvement
and guided group activities
helps in reintegration.

in useful activities
by the neighbours,

the

6. There is significant improvement in their
clinical, psychological and social functioning.
7. Witnessing these changes, the villagers could
view the mental illness.in a positive way.

It is in this context, that, the mental health profes­
sionals are urged to take a critical outlook on such an
approach which implies that mere imparting scientific
information is not enough. The public will tend to
believe what they see rather than what they. hear. The
efficacy of modern treatment programmes need to be
demonstrated, to be proved. In doing so, professionals
should make it a point to make use of indigenous
means and avilable resources. Only when such at­
tempts which are effective and relevant to our settings
are repeated in different centres, that the educational
potentials of such camps will be fully realised by the
professionals and the laymen. These professional
effeorts may pave the way to achieve effective mental
health education to all in 2000 A.D.
•

Swas th Hind

EXPERIENCES
IN FAMILY PLANNING PROGRAMME
IN A SLUM COMMUNITY
Dr. Ramesh M. Chaturvedi
“ The reluctance to adopt contraceptive methods in many developing countries has religious
and socio-cultural roots. Moreover, the illiterate get confused or suspicious when they are
exposed to the cold and impersonal mass media. A novel approach by involving the decision
makers in the family can breakdown many barriers ”.

alvani, a slum of about 70,000 inhabitants in
western suburbs of Greater Bombay has a well
organised health center giving comprehensive health
care since December 1977. The population consists
of 50% Hindus, 45% Muslims, 3% Christians and 2%
others, from low socio-economic group. Initially
there was an emphasis on curative component of the
comprehensive health services. In the beginning we
did not include family planning services as a part of
our health package, as the family planning services
were usually less accepted by the Muslim community.
After two years when we had developed a rapport
with the community, we gradually introduced family
planning services in our programme.

M

The first Family Planning Camp was organized in
1981 at the Health Center which could benefit only
5 acceptors. Later on to develop rapport with the
women of the community. Ante-natal and Post-natal
Care was started in the health center. For manage­
ment of Intra-natal Care the pregnant women used to
get admitted on the basis of our Ante-natal record,
in the nearest Municipal Maternity Home, which is
located 4 km away from the health center. Previous
to this, expectant mothers were registered in the said
maternity home and because of non-availability of
proper conveyance the expectant mothers defaulted.
The Ante-Natal care (A.N.C.) registration in our
center has given us a good opportunity to come in
contact with pregnant mothers. Three hundred expec­
tant mother were interviewed regarding their nonacceptance of any of the family planning methods.

September 1'986

Reasons for non-acceptance
Their reasons and beliefs for non-acceptance
family planning methods were listed as under:

of

(1) The routine post-parturn sterilization operation
required admission at the hospital. The mothei
could not remain away from her other younger
children, nor could the father afford to lose his
daily wages, if he chose to look after the
children.

(2) There was a belief spread by word of mouth
among women that spinal anaesthesia would
cause chronic backache (In India chronic back­
ache is due to a diet deficient in calcium).
(3) Many women wanted sterilization done in secrecy
on religious or social grounds. Hence they, did
not want to have a scar or hospitalization as an
evidence.
(4) There is a belief that after tubal ligation they
cannot lift weights (women have to fetch water
for domestic use from common taps).
(5) In post-operative cases minor unrelated ailments
were not attended to, by the health care per­
sonnel.
(6) 61% of women wanted contraception but their
husbands objected.
(7) 96% women did not want to get their husbands
sterilized, since they feared that something un­
toward might happen to the bread earner of
the family (The husbands being the sole earning
members in most nuclear families in India).

227

(8) Many women were aware of contraceptive me­
thods available, but-3%* of them did not know
what to choose or whom to ask.
Husband Craft

As majority of the husbands objected to their wives
acceptance of family planning methods, it was necessary
to involve the husbands (the decision makers in fami­
ly) to participate in ANC so that they should be aware
of their responsibility as fathers. The husbands were
called for a subsequent meeting which was held on
Sundays (Sunday being a public holiday). In the be­
ginning, the husbands’ attendance was very poor.
Then it was announced that the expectant mothers
would get the privilege of admission at Municipal Ma­
ternity Home only after their case sheet was signed by
the authority conducting the meeting subsequent to
their husbands’ attending the meeting. After this an­
nouncement there was a big crowd on Sundays for the
meeting. In the Sunday Husband Craft meetings health
education was imparted, on A.N. Care with emphasis
on laparoscopic method of sterilization, lUCDs (Cop­
per-!^ and immunization of the newborn by using
models and charts.

The advantages of laparoscopic sterilization over the
older method of tubal ligation was explained to them.
During the education of parent it was emphasized that
the laparoscopic sterilization could be performed at any­
time after delivery, under local anaesthesia without hos­
pitalizing the mothers and that this was a simple
procedure taking 10 minutes without any visible ab­
dominal scar.

Even trivial ailments, unrelated to the family plan­
ning procedure, were attended to at the centre.
So

228

the acceptor got access to different components of the
health package all under one roof.
With this appproach of involving husbands in ANC,
our family planning programme got a boost. Now
we perform sterilizations at the rate of 1 per day and
insert lUCDs at the same rate. Husbands’ involve­
ment also improved the overall ANC performance.
In our programme 44% of acceptors were Muslims
and 53% were Hindus, thus showing no influence of
religion over family planning acceptance. Many fa­
mily planning acceptors (mothers) motivated other
mothers for accepting family planning methods in
keeping with the principle “A satisfied customer is
the best salesman”.
Very little is known about male attitudes and pre­
ferences regarding contraception. Most surveys and
hospital studies involve only women. The novel idea
of calling a husband to attend husband craft classes is
for involving them in bringing up the child (A far­
mer's responsibility does not end once the seeds are
sown; he has to sweat it out and look after the crops
till harvest time). The husbands are also told of
their responsibility as ‘head’ of the family, in ensur­
ing that each child is well spaced and looked after.

The policy makers should realise that in most third
world countries, propaganda and information related
to any health or family planning programme should
be beamed at the decision maker in the family. Tn
most Asian countries like India, the husband decides
and dictates what the wife should do (Unlike in the
West where the woman has a greater say in the fami­
ly). This simple realization will go a long way in
removing many of the obstacles that hinder the family
planning programme in most countries of the world. •

Swasth Hind

BOOKS

Authors of the Month
K. Balan

“ Environmental Health Aspects of Industrial
and Housing Estates” SEARO Regional Health
Papers No. 11, 56 pages, Prive : Ind. Rs. 21.—.

Puthiyadath Tezha Kuniyilhouse
Chokli 670672
Via Tellicherry
Cannano rc Distt, Kerala
Col. P. K. Dutta

Associate Professor
Department of Preventive & Social Medicine
Armed Forces Medical College
Pune 411040.

Many of the medium-and small-scale industries
established in industrial estates today are not of the
traditional agro-based types but include complex and
potent chemical industries that can affect health and
the environment, the causes ranging from vector-borne
diseases to complex ecotoxic effects. Assessment of
the impact of these industries on environmental health
is difficult because, in most cases, it is not possible to
know in advance the types, numbers and magnitude of
the industries that will be established in an estate, nor
the period within which they will all be in position.
Furthermore, the induced and unplanned growth that
invariably occurs around an estate aggrevates the en­
vironmental health problems. This publication out­
lines some environmental health impact considera­
tions which should prove useful to planners, deve­
lopers and health professionals facing such problems.

Lt. Col. A. C- Urmil

Reader
Department of Preventive &
Social Medicine
Armed Forces Medical College
Pune 411040.
Dr V. Balakrishnan

Professor and Director
Department of Gastro-enterology
Medical College
Trivandrum.
Col. K. K. Vadehra

{Retd)

Professor and Head
Deptt. of Social & Preventive Medicine
Dayanand Medical College
Ludhiana.
S. Rajaram

In planning industrial and housing estates, a rapid
assessment of the likely environmental health conse­
quences is first made, followed by a more detailed
assessment if necessary. The text explains precau­
tions necessary in siting housing estates and in plan­
ning the buildings and their infrastructure facilities.
Appropriate strategies for pollution abatement in
keeping with national environmental standards and
regulations should be given due consideration at the
conceptual and planning stage itself rather than after
the establishment of the estate.

Psychiatric Social Worker
National Institute of Mental Health
and Neuro Sciences
Bangalore 560029.
Dr Vinod Kumar

Associate Professor
Deptt. of Medicine
All India Institute of Medical Sciences
Ansari Nagar
New Delhi 110029
Dr Ramesh M. Chaturvedi

Lecturer
Deptt. of Preventive & Social Medicine
Seth G. S- Medical College

Post-implementation monitoring and surveys are
the final exercise by which the likely impact of the
operation of the estate on public health can be identi­
fied and assessed where the nature of the industries
warrants such action. These include periodic sanitary
inspections and regular monitoring of the emissions
and ambient environmental quality. Some guidelines
in this regard have been given in this book. The
organization of proper institutional arrangements and
the allocation of responsibilities are the keys to the
success of the programme but often constitute the
neglected “grey area”;
9

Parel

Bombay - 400012.
Vinod Kumar Pandey

Research and Evaluation Division
Central Health Education Bureau
Kotla Road, New Delhi - 110002.

The schools were selected as a source of informa­
tion on the assumption that children could give
reasonably accurate information on whether parents
smoked or chewed tobacco.

rural areas, and the other 44% in the cities and
suburbs.
Analysis of the survey indicates that smokers and
tobacco chewers represent a much higher proportion
of rural dwellers than of urban populations.
In rural areas as many as 61.8% of fathers and
6.6% of the mothers are smokers, while in urban
areas 29.06% of fathers and 2.6% of the mothers are
smokers.
Similarly, in the rural areas 12.02% of fathers and
16.2% of mothers are tobacco chewers, compared
with 8.80% of fathers and 7.8% of mothers in urban
areas.
The possibility of using the schools as a medium
to transmit health information on tobacco to parents,
particularly in the rural districts, is now under study.

The responses represented 40% (54,256) of the
total school population, and were addressed to the
age group 10-15.
Of these a total of 56% live in

Dr S. G. Vaidya
Honorary Secretary
Goa Cancer Society

Schools help in Goa Survey
Responses were received from 145 schools out of
a total of 450 in Goa, India, to whom questionnaires
were sent by the Goa Cancer Society regarding
tobacco use in homes.

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