Swasth hind, Vol. 27, No.2, February 1983.pdf
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As
FEBRUARY 1983
o Tobacco.- smoking and our health
o Care of the aged
o Yoga for keeping fit in the old age
o //Development and environment
Diarrhoeal diseases and their control
bs Energy requirements and recommended
allowances
World Assembly on Ageing
Il
I IN THIS ISSUE
Tobacco smoking and our health
33
Dr D. BrBisht
Care of the aged
February 1983
Magha-Phalguna
Y01- XXVll No. 2
1904 Saka
37
Yoga for Keeping fit in the old age
41
O. P. Tiwari
Development and environment
READERS WRITE
1 had an opportunity
‘Swasth Hind".
Dr B. C. Ghosal
to read a few old issues
of
S.
B. Cha van
Diarrhoeal diseases and their control
I found the journal highly informative and useful.
P. Purushotham
CMA Wing-6
Indian Institute of Management
Vastrapur. Ahmedabad—380 015.
45
48
On Nutrition
Energy requirements and recommended
allowances
50
B. S. Narasinga Rao
I am a Hird Year MBBS Student studying in the
KEM Hospital, Bombay. While 1 was in the library
I casually had a look at your magazine and was struck
with surprise to see that the magazine cost was only
25 paise. Imagining it to be an interesting magazine
I took a look inside and found the contents worth
reading. Topics relevant to India which one does not
read in foreign text books were very well given.
Action leads to adoption
— a case study
54
World Assembly on Ageing
56
A dramatic success for radio
59
Sanjay Bhat
27/2, Shivaji Niwas,
M.B. Raut Road,
Near Shivaji Park Fire Brigade.
Dadar, Bombay-400 028.
Asstt. Editor
D. N. Issar
Subscription Rates (Postage Free)
Annual
..
Rs. 3.00
Single copy
..
Re. 0.25
Sr. Sub-Editor
M. S. Dhillon
Layout
Articles on health topics are invited for publication in this
Journal.
G. B. L. Srivastava
Stale Health Directorates are requested to send reports of
their activities for publication.
Editorial and Business Offices
The contents of this Journal are freely reproducible. Due
credit may be given to Swasth Hind.
The opinions expressed by the contributors are not necessarily
those of the Government of India.
Central Health Education Bureau
Kotla Marg, New Delhi-110 002.
SWASTH HIND reserves the right to edit the articles sent
for publication.
TOBACCO SMOKING
AND
OUR HEALTH
Dr D. B. Bisht
he tale of tobacco is not only a tale of transitory
T
human pleasure leading to addiction, life long
misery and often premature death, but interwoven in
this talc are the tales of human intrigue, corporate
power, exploitation and international and national
hypocrisy.
It was Cristopher Columbus (1451—1506), Italian
Navigator, who first saw some Cuban natives smok
ing their pipes. However, in those civilizations the
practice was perhaps confined to socio-cultural rituals
and sometimes it was used to ward off certain illnesses.
In the 16th century, Jean Nicot, the French Ambas
sador to Lisbon, sent grounded tobacco powder to the
Queen of France for the treatment of her migraine.
And the active ingredient of tobacco, ‘Nicotine’ is
known after him.
The story of Sir Walter Raleigh, (1552—1618), Eng
lish soldier, the favourite of Queen Elizabeth, who
popularized smoking in Britain, is well known; and
perhaps he was the first victim of smoking when King
James beheaded him. King James himself is credited
for the famous description of smoking as—
“a custom loathsome to the eye
hateful to the nose
harmful to the brain
and dangerous to the lungs”.
And yet, during the epidemic of plague in London,
school boys at Eton had to smoke every morning to
ward off plague.
February 1983
Smoking has been rightly named as a
modern “Captain of Death” particularly
in the western Countries.
Use of tobacco in different forms has depended
largely on the fashions of the day. For example, dur
ing the eighteenth century, the snuff almost replaced
pipe and it was not uncommon to find delicately de
corated snuff boxes adorning the pockets and purses
of princes, priests, and pirates.
It was during the Mughal times that ‘Hooka* and
‘Chilum’ became the chief status symbol of the high
society and which to even this day decorate the houses
of Zamindars and the ex-chowdhris of rural India.
However, the harmful effects of smoking became
apparent centuries back. Ramazzani, the famous Italian
physician, who is rightly known as father of occupa
tional health, warned the nation about the health
hazards of smoking by identifying higher morbidity and
mortality amongst the factory workers who were
smokers. Unfortunately, his observations and recom
mendations were set aside by those who wielded social,
economic and political power and perhaps this frus
tration led him to say that “sweet smell of gain makes
the smell of tobacco less perceptible”. Alas! this fact
holds good even today.
It was the nineteenth century which saw the emer
gence of cigarettes as the main form of smoking. Per
haps the greatest boost to cigarette smoking was given
33
by the heroes and heroines of Hollywood. Humphry
Bogcrt could not have been the ideal hero of many
unless he showed himself on the screen the way he
smoked a cigarette dangling between his lips. That
he died of easophageal cancer, as a result of smoking,
did not make any difference to the people.
It has now been well established that smoking and
use of tobacco is responsible for a very large amount
of human misery. Today the world produces about
four trillions of cigarettes and the smokers spend 700
billions of rupees. i.e., seventy five thousand crores of
rupees, which incidently is more than the entire lay
out of our national Sixth Five Year Plan. Many of the
tobacco companies ho doubt are earning more profits.
Harmful effects
Let ,me briefly enumerate the harmful effects of
tobacco smoking.
1. It is known that a smoker has far lesser chances
of enjoying a good health and often dying prematurely
as compared to a non-smoker. It is estimated that
when a young man starts smoking at the age of 25
years—he shortens his life by approximately 8 years at
the age of sixtyfive.
2. Smoking is responsible for the crippling disease,
such as chronic bronchitis and lung cancer.
SMOKING AND HEALTH
IN INDIA
India is the third biggest producer of tobacco in
the world, with 80 per cent of the tobacco grown
being consumed locally, mostly in traditional form
(bidi, hookah, chutta, etc.). Tobacco chewing and
the taking of snuff are also practised.
According to recent estimates, 80 thousand million
cigarettes and 675 thousand million bidis are pro
duced annually. The number of cigarettes produced
per adult, which was 100 in 1950, rose to 190 in 1970
and remained at around that level in the 1970s. The
number of bidis produced per adult, around 1000 in
1950, suddenly increased to 1500 in 1976-77.
In the rural areas, various indigenous forms of
smoking are practised. Cigarette smoking tends to
predominate in the cities, particularly among white
collar workers.
Urban blue-collar workers usually
smoke bidis, although the younger ones prefer ciga
rettes. In men, the proportion of smokers shows
both occupational and regional variation. Generally
speaking, women do not smoke except in the lower
socioeconomic group. More than a third of male
smokers take to smoking before age 20.
3. Smoking is responsible for the vast increase in
the cardiac deaths due to coronary heart diseases.
Cigarette and bidi manufacturers advertise their
products vigorously.
4. Tobacco is mostly responsible for the cancer of
mouth, the commonest cancer in our country.
Governmental action for smoking
prises:
5. It has been found that cancers of all types taken
together are more common amongst smokers.
6. Smoking vastly increases the vascular complica
tions in women, particularly those who are on con
traceptive pills.
7. It has been found that smoking during pregnancy
causes lower birth weight of the newborn and increa
sed infantile mortality.
8. In certain occupations like mining, farming and
in factories where fumes are produced, smoking either
precipitates or promotes the occupational pulmonary
diseases.
Smoking has been rightly named as modern ‘Cap
tain of Death’ particularly in the western countries.
34
control com
— legislation making health warnings compulsory
on all cigarette packets
— prohibition of smoking in buses, theatres, and
cinemas
— ban on juvenile smoking in some States.
From : Smoking and Health in Asia,
WHO Chronicle, 36 (4) : 156-159
(1982).
These young boys don't seem to b,e aware of
the fact that smoking and use of tobacco is
not only responsible for a large amount of
misery but may also lead to crippling diseases
like chronic bronchitis and lung cancer.—J>
Swasth Hind
35
Harmful substances
At this stage perhaps we may ask—what is it in
tobacco that is responsible for so many diseases?
Tobacco leaf has about 1400 known chemical ingre
dients. However, the harmful substances can be broad
ly classified into three groups.
1. Toxic substances in the tobacco smoke which
have the capacity of either initiating or promoting
cancer or both. These are mostly confined to the tar
portion of the smoke.
2. Irritant gases which are mostly oxides of carbon,
nitrogen, hydrogen, and cynide. Carbon-monoxide is
the most important of these.
3. Nicotine—this has most profound effect on brain
and blood vessels and perhaps it is this substance
which leads to dependence and addiction.
The contents of the individual substances largely
depends upon the tobacco leaf and on the process of
curing the tobacco.
Having realized that high tar and high nicotine are
responsible for the higher morbidity due to tobacco
smoking, many countries, particularly in the West,
have legislations wherein only low tar or low nicotine
cigarettes are allowed to be manufactured and market
ed.
Having realized that tobacco is the ‘Captain of
Death’ and that the tobacco companies which promote
smoking are the ‘Merchants of Dealth*, the World
Health Organization had put its recommendations to
various national governments both the developed and
developing countries.
The 4th World Congress of Smoking and Health
was held in Stockholm in June 1979. It was attended
by delegates from sixtyeight countries. It was at this
conference a clearer picture of smoking pattern as it
exists in the world had emerged. It was identified that
in developed countries various measures like educa
tion, legislations and a change in social and cultural
behaviour of communities have contained the rising
trend in the number of persons who smoked and the
amount of smoking. In India about 75 per cent of the
men in the North as well as South East region were
found to smoke. In the West however, only 50 per
cent smoked. The form of smoking varied in each
area. The North preferred chilum and hookah while
South East chutta and the West bidi (World smoking
and health Vol. 5 No. 1).
36
Media can play an important role in educa
ting the community on the harmful effects
of smoking.
Unfortunately in the developing countries, smoking
habit was galloping at a very rapid rate. The young
and the student communities in the developing coun
tries of Asia and Africa together with the new-rich are
increasingly taking to smoking cigarettes. Besides,
more and more females the world over are falling
victims to this disastrous habit. There is a great
need, therefore, to contain and curtail this evil spread
ing in an epidemic form.
In India, we have made it mandatory on the part of
cigarette manufacturers to print the Statutory Warn
ing: ‘Cigarette smoking is injurious to health*. This is
also to be printed along with the advertisements and
depicted in the hoardings.
How to tackle the problem
The question arises—how should we proceed in
this direction?
(continued on page 60)
Swasth Hind
CARE OF
THE AGED
Dr B. C. Ghosal
As many of the ailments of old age develop
during earlier life, it is possible, by health
education, to eliminate such risks to health
as alcohol abuse, smoking., lack of exercise
and a badly balanced diet. Information on
health is especially necessary as people
prepare for retirement. Besides helping
the aged to overcome the enforced idle
ness that gives rise to so many health pro
blems. this kind of preparation can also
prevent domestic accidents, which are so
common among old people and which can
be serious.
ith the increase in average expectation of life and
Wimprovement in the standard of living, the number
oof old persons is increasing in India and the world.
AKgeing is not simply a physical process but a state
off mind and today we are witnessing a beginning of
choange all over the world in that state of mind.
IMore and more people are living into the old age.
Thie numbers are not reflected in life expectancy figures
because of the large mortality in middle age. but those
whoo reach 65 or 70 are much, more likely than they
werre to live on into the eighties and nineties. Those
whoo require long-term care are predominantly female;
the ifemale-male ratio being of the order of 3 :1. There
are ftwo main reasons for this. First, women live longer
than men, childbirth has now become safe. Secondly,
it is still usual for women to marry men who are
older than themselves and this was even more pro
nounced fifty years ago, when the present generation
of old! people married. As a result, widows greatly out
number widowers and are left to live without the sup
port otf a spouse.
February 1983
In the present set up of family situation, children
arc reluctant to look after their ageing parents. The
respect for parents has diminished. While it is true
that modern society and culture pay scant homage to
age, there seems to be little evidence that children are,
in fact, less willing to accept the burden of caring for
ageing parents. Other changes in our society have dimi
nished the likelihood that they will be able to do so.
Multiple problems
Not only is the size of families smaller but the
number of unmarried children, especially daughters,
is much less. Furthermore, the chance that children
will continue to live near their parents has diminished.
The problems of old age tend to be multiple rather
than single. Reduced morbidity due to osteoarthritis,
or to more easily remediable disorders such as corns
and bunions coupled with failing sight and hearing,
transform minor tasks such as housework and shop
ping into major undertakings. Falls are no longer
trivial accidents but likely to lead, especially in women,
to broken wrists and more seriously, broken hips.
Social contacts are diminished, in part by not being
able to get about, but also by the death and enfeeblement of contemporaries. Paradoxically, those who are
becoming deaf are often intolerant of noise, and fail
ing sight may make reading either difficult or impossi
ble.
Leaving aside physical diseases, such as failing
hearts, chronic chest disease, enlarged prostates and
cancer, the most serious problem of age is failing men
tal powers. Some degree of failure of memory, espec
ially for recent happenings is almost universal.
Role of health education
Because many of the ailments of old age develop
during earlier life, it is possible, by health education,
to eliminate such risks to health as alcohol abuse,
smoking, lack of exercise and a badly balanced diet.
Information on health is especially necessary as people
prepare for retirement. Besides helping the aged to
overcome the enforced idleness that gives rise to so
many health problems, this kind of preparation can
also prevent domestic accidents, which are so common
among old people and which can be serious.
In terms of useful medical intervention the routine
visiting of the elderly is difficult to justify. While it is
Regular physical check up is essential for
prevention and early diagnosis of many
diseases of old age.
rr
37
38
Swasth 0'^
true that most of these patients, are on seme sort
of continued treatment with drugs, the doctor’s meet
ing were not primarily concerned with their diseases
or their treatment.
Nonetheless, the relationship was valued by the
doctors as well as the patients and seemed to make
a real contribution to the quality of their life. Doctor
patient relationship is to be a personal transaction,
rather than impersonal exchange.
Old people, like children, arc ill-equipped to deal
with the unknown and feel threatened by strangers.
Doctors have the advantage that they are seen by
their patients as having a right to intimacy because
they are vested with authority to a degree not shared
by nurses or social workers. Doctors grow old along
side their patients and older doctors have older pati
ents; young doctors are seldom acceptable on the same
terms as their seniors to the elderly.
No matter what sacrifices families arc prepared to
make, no matter how sophisticated the community
care services are or how caring the neighbours are as
increasingly large number of the elderly require long
stay institutional care. This still remains only a small
proportion of all old people. Providing the full range
of community service-home helps, home nursing, mealson-wheels, laundry and occasional transport to hos
pitals, day centres can prove to be extremely expen
sive;
Hospital services
Many old people may require admission to hospital,
rmost of them for relatively acute conditions. The
elderly tend to stay longer in hospitals, in part be
cause of the nature of their diseases, and in part
because so many of them live alone .or with aged
spouses who cannot accept them home to convalesce.
AiS a result,' many hospital units which arc busy may
be very reluctant to admit the elderly. The old are
seoen as not requiring the high technical skills which
arcs available, as being incurable, and therefore more
a burden than a challenge, and a ‘blocking’ beds
wbiich can be used for more important and valuable
purrposes. In relative terms of number who require
lonjg-tcnn care is small but because each of them may
reqiuire care for years rather than days, the impact
on services is quite disproportionately large and is
growing.
Lsargely because of the reluctance of most doctors
to boecome involved with the long term care of the
incurrable and old, geriatrics has emerged as a specia
Febiruary 1983
lity. The problems of old age are different chiefly
because they arc so often multiple and because of the
importance of social factors in determining manage
ment. Most acute illness in old people which needs
hospital admission is dealt with not by geriatricians,
but by appropriate specialists. Once the operations
or investigations have been completed and the crisis
has passed, geriatricians tend to become involved, not
to exercise their medical skills but to facilitate arran
gements for continuing care.
The population of patients which require long-term
care is predominantly female. They require care be
cause they can no longer fend for themselves or be
cause they have become too heavy a burden on their
relations or spouses. By definition, most of their dis
abilities are incurable.
Mental health
In terms of planning how best to provide care to
patients, should be classified by need rather than by
diagnosis. Mental hospitals are important in caring
for the ambulant wanderer. They also provide a most
•suitable environment for the volatile, quick tempered,
still physically powerful and occasionally paranoid and
old men who may from time to time throw things
about or lash out with their sticks. Again, the needs
of those who are no longer able to live independent
lives are by no means always similar. So long as men
tal faculties are preserved, goal of those providing
care must be that patients retain autonomy, a sense
of individual identity and the opportunity to make the
maximum use of their remaining faculties and powers.
Unfortunately, this is difficult to achieve in an insti
tutional setting. Old people need help but too often
help consists of doing things rather than helping them
to do it themselves. It is much quicker to dress some
body or to feed them than to help them to do it
themselves. So doing encourages dependence and pre
cludes rehabilitation.
The proper care requires nursing skills, care of the
feeble elderly requires sympathy, patience, tact and
consideration. In some ways it is unfortunate that the
care of the old has become so firmly entrenched as a
medical responsibility. Doctors have relatively little to
offer which derives from their knowledge of medicine.
The use of drugs particularly sleeping pills and tran
quillisers, should be kept to a minimum. Routine visits
are important to check physical well-being and to
monitor drug treatment but they can be relatively
infrequent.
The importance of the doctor be he a practitioner
physician or geriatrician is that he supports the staff.
39
It is important to'help the elderly] to lead in dependent life in their own family
and community which alleviates the feeling of alienation and loneliness.
Because of his status, his enthusiasm and concerns are
major determinants of morale, the attitudes of junior
staff and ultimately the quality of care.
Society’s responsibility
The improved care for the old depends upon a re
cognition of their needs and a decision by society to
accord these needs a high priority. When resource is
limited, it tends to be directed to the care of the
acutely ill and to those conditions which are deemed
to be curable. The present position is likely to deter
iorate even further because the population of the old
is going to increase in size over the next twenty years.
Geriatrics does not appeal to doctors because cure of
old age, or even its ailments, is not often possible.
It is in a sense unfortunate that the care of the old is
seen as a medical problem. Medical and nursing skills
are important but their contributions to well-being are
strictly limited.
40
Ageing people and their families should be more
involved in their own care. Health educational infor
mation on the promotion of health and prevention
of disease is required, as are simple handbooks of per
sonal care. Knowledge of locally available services and
social support systems represents another important
element of prevention and will assist ageing people
and their families seeking health care. Too often the
aged fail to seek care in the belief that ailments are
part of the ageing process.
New orientations are required on the part of care
providers to help ageing people maintain indepen
dence, support self-health care, and prevent disability.
Such support to ageing people must be provided by
medical practitioners, who are knowledgeable on the
subject of ageing, interested in ageing people and
their families.
(Courtesy: All India Radio)
—YOJANA—June 1982
Swasth Hind
YOGA
for
Keeping
Fit in the
Old age
O. P. Tiwari z
Yoga helps to maintain good physical health and creates positive
healthy psychological outlook. It contributes to the better
psychosomatic condition of the individual and healthy society.
he
word yoga is
derived from the root “Yuj”
T which means to join, Jiva with paramatma. Tak
ing yoga from Saikhya point of view, this interpretatiion may not be correct. I agree with Swami Omanand
Tirtha when he says : “Yoga is a way to lead oneself
imtrovert from sthiila to suksmd*. It is a way of life
wlhich makes man a better man. It tries to take out
thee animal aspect of man from him and thus makes
hinn a man worthy in the society and for himself.
Woga leads a man to the state of samadhi. A man
in Samadhi is not a man who merely closses his eyes
fronn this world and sits in meditation. He is a man
whco is more conscious about the world, and who is
sthiitaprajna—unmoved or unaffected—and perfect
February 1983
doer of his duties. If we take Yoga to mean to join
then the very purpose of yoga is defeated. Man be
comes only concerned with his joining with God.
Leaving aside higher reaches of yoga, presently, I
am trying to devote to its social aspect; that is what
a man in this living world is concerned with. We have
to be very careful in knowing whether yoga is meant
only for sanyasls to be practized by them in the forests
or to a common man who has equal right to practice
it. If so; for what? Shri Svatmara ma in his Hatha
Pradipika says:
sftrcpftqfewd 1
I—2
(Kevalam Rajayogaya Hathavidyopadifyate). But along with Rajayoga he emphasizes
the need of the healthy body and healthy mind which
41
is a necessity for higher living. There are a few people
who claim that it is meant only for Yogis. As Ghcrajida Samhita says before you proceed for higher things
bake your body with the fire of Yoga.
wcrr^r-18 (Yoganalena sandahya ghataguddhim
samacaret. 1-8). Hence we come to the conclusion that
the teaching of Asanas, pranayama and various kriyas
is meant to keep our body healthy; and when the
body is healthy the mind is automatically healthy.
Perfect personality
Our personality is perfect if we are sound both
mentally and physically. And yoga has contributed
richly towards them as Swami Kuvalayananda and
Dr S. L. Vinckar have rightly said in their book
Yogic Therapy: “The term ‘yoga’ is used to indicate
both the ‘End’ as well as the ‘Means’. In the sense of
‘End’ the term yoga signifies ‘Integration’; at its high
est level. All the means that subscribe to help reach
this goal, also constitute Yoga in the sense of Yukta;
it means the technique. All the practices, whether high
or low, that are calculated to help the progress of the
aspirant towards such an integration are together
known by the name ‘Yoga’ yoga thus, is an integrated
subject which takes into consideration man as a whole.
It does not divide him into water-tight compartments
as body, mind, spirit, etc.
Also, what type of personality is conceived? It is as
the Gita, puts it “Sthitaprajna” who remains undis
turbed in all situations. Such a balanced person is able
to take right decisions whenever situation demands.
The yogic thinking about the body and mind in
action is that both have a homoestatic mechanism
which contributes to a balanced integrated functioning
even in the face of outer or inner stimuli or conflicts.
Let us take the factors which contribute to the
sound mental and physical health and how far Yoga
can help it.
The Gheranda samhita claims: the purification is
acquired by the regular practice of six purificatory
processes Asana gives strength, Mudra steadiness and
Prandy anta lightness.
The same is very distinctly shown by GorakshanStha
in his Satak:
ASANENA RAJOHANTI PRANA YAMENA PATAKAM VTKARAMA
MANASAM YOGI PRATYAHARENA
SARVADA
GS 54
The above mentioned sloka clearly acknowledges the
mental and physical disorders and how they can be
removed.
42
In the Hatha Pradlpika (edited by Swami Digambarji and Pt Kokaje—published by Kaivalyadhama,
Lon5vJ5), the fifth chapter is exclusively devoted to
certain disorders and how wc can correct them. But
before we proceed further we should understand how
Yoga can contribute to the normal health. From the
health point of view, Asanas, Pranayama and Kriyas
play a very important role. Asanas arc classified into
two groups: (1) Cultural poses, purely for physical
health or condition, and (2) Meditative poses for a
comfortable sitting posture for a Sadhaka to help him
proceed easily without any discomfort for Pranayama,
Dharana, Dhyana and Samadhi (stage of sthitaprajna).
Let us see how Asanas help attain and maintain per
fect health at old age. A close look at our body shows
that to maintain perfect health, it is necessary that
every tissue in the body is maintained in excellent
condition. For the health of the tissues, it is essential
to have proper nourishment at constant intervals.
1. Nourishment of tissues
The nourishment of the tissues depends on proper
circulation of blood, which is done by our heart and
arteries, veins, etc. The main task is that of veins
which need help to bring the blood from various tissues
to the heart. Various Yogis have contributed to var
ious asanas viz. Sirasasana, Viparitakarani, Sarvafiga
sana. These contribute by bringing rich supply of blood
to the upper extremities, and to the brain.
Tissues also need oxygen in sufficient quantity to
remain healthy. This is also carried by blood. We know
that asanas keep the circulatory system in perfect,
healthy condition and thus help to supply the blood
and oxygen to the tissues.
It is also to be ensured that nerves function to their
best ability and unwanted stuff is not retained in the
body for long. This can be possible if we take care
of our digestive system, respiratory system and endo
crine. system.
Digestive system
For digestive system, to function properly, all organs
of this system like stomach, small intestines., should
get natural massage from breathing in and out. The
abdominal movements make this possible. Here, the
abdominal muscles should constantly maintain their
tone. The yogic culture not only keeps them fit but
gives them extra massage too. For example, Uddiyana,- Nauli, Agnisara and Kapalabhati are unpa rai
led exercises that no system of health provides.
Swasth Hind
“It is an admitted scientific fact that muscles can maintain its elasticity and strength
if they are subjected to stretching and contracting exercises ”
. Swami Kuvalayananda has very rightly stated that
“It is an admitted scientific fact that muscles can main
tain its elasticity and strength if they are subjected to
stretching and contracting exercises”. Asanas invol
ving upper and lower extremities for bending back
ward do it very nicely. Bhujangasana, Salabhasana,
Dhanurasana are stretching for front abdominal mus
cles. Yoga Mudra, Paschimatana, Halasana are back
stretch muscle exercises where the front abdominal
muscles are contracted. Side abdominal muscles are
taken care of by Vakrasana, Cakrasana, and Ardhamalsyendrasana. Thus we see that the tone of the
abdominal muscle can be kept up to its highest point
of normalcy with the help of above postures.
Respiratory system
Next in importance is our respiratory system.
Besides lungs, the other parts which are extremely im
portant are the respiratory muscles. If they are healthy,
the whole system can be kept healthy. Therefore, first
ly the lungs, respiratory muscles and the respiratory
passage should be clear as well as healthy. If the elas
ticity of the lungs is fully maintained we can be sure
of other factors. Asanas and Pranayama help in this
regard as stated by Swami Kuvalayananda. The
Salabhcisana and Mayurasana are also of great help.
To me Utlhita Padmasana and Vakrasana also contri
bute to the same. As we are required to inhale and
then retain the breath and perform the pose, pressure
is created inside the capillaries for every air cell to
breathe it cannot remain idle. Kapalabhati in which
rapid inhalation and exhalation is done, make the
respiratory muscles strong.
The same is the case with the respiratory passage
which gets blocked at times because of our bad ton
sils, chronic cold, synositc, etc. Asanas, Jihvubandha
Simhamiidm help cleaning the waste produce out of
these disorders.
Endocrine system
The most important factor is the healthy endocrine
secretion, obtained from thyroid, parathyroid, pitui
tary, adrenal. Sarvdnargdsana, Vipltakarani, Matsyiisana, Haliisana, Bhupangasaria, Simhamudrci arc apt
exercises for thyroid, Sirsasana is very important for
pituitary. Bliiipangdsana,
Dhanurasana, Uddiyana,
Nauli, take care of adrenal glands.
February 1983
Thus we come to the conclusion that Asanas can be
much helpful to maintain our physical health.
Nervous system
Nervous system is controlled by brain. If all the
nerves arc healthy our physical movements are smooth
and efficient. Hence, we have to see how asanas can
be of help.
All yogic poses contribute to the efficiency of the
brain by rich supply of blood to it Other yogis asanas
that help the spine, bend either forward, backward or
sideward keep it healthy. Thereby, the whole nervous
system works efficiently. So far, we have discussed the
physical aspect of asanas. Now we come to the psy
chological or menial aspect of the asanas and Prana
yama which is of great value at all age levels, specially
at old age.
Mental health
Let us now think about the mental health and how
does yoga contribute to it. The root cause of our
suffering are our expectations, liberal sex indulgence,
telling lies. These keep us always under tension and
type of VIKSHIPTA condition of mind prevails. Yoga
has devoted its first step of Yama and Niyama for
this. It has evolved a methodology which we should
try to follow in the beginning. We may not succeed
completely; but, if the aim is high we may achieve the
most. We can thus leave an example for others, where
the individual and the society can resort to it. Hence
these Yamas are being developed according to
Patanjali.
There are five yanias: Abimsa, Satya, Asteya, Brahmacharya, and Aparigraha. There arc others who have
included nine, but I shall deal with five only:—
(I) Ahimsa {Non-violence): It is not for non-kill
ing. We cannot remain even for a second without
killing; but the conscious effort is to save the most
and kill the least. Our intention should not be killing
or hurting anybody. The outlook which we have to
develop is of discrimination against evil, that is a be
lief that of even not being capable of hurting. We
do not resort to hurting as it is unhealthy and un
required. We understand the utility in the greater in
43
terest of the society and of ourself. It is easy to loose
temper but difficult to understand its evil effect and
control. But what is desirable is not to tease anyone
either by thinking, acting or talking. A Hindi poet has
very correctly put it:—
PRATHAMA AHIMSA HI SUNA LlJE I
MANAKARI KAHU DO§A NA DlJE u
KAPUA VACHANA KATHORA NA
KAHIYE i
JlVAGHATA TANASOM NAHIM
DAHIYE
TANA MANA VACHANA NA KARMA
LAGAVAI i
YAHI AH1MSA DHARMA KAHAVAI.
(2) Satya (Truthfulness): We have to control our
another sense of speech as far as possible. We should
always speak the truth (SATYAM VADA PRIYAM
VADA) and we know by speaking truth a state of
courage is produced. Man becomes fearless and can
face any situation without tensions and he can maintain
the equillibrium of mind without disturbing himself and
thus can live free from nervous tensions which may
lead him to suffer certain other disorders.
(3) Asteya (Non-stealing): It is another
contri
bution of yoga to maintain a peaceful social life.
Stealing of either kind is bad and unhealthy. A man
cannot be true to himself when he knows that he is
stealing. A guilt complex is created and unhealthy
behaviour is a product of it. Man suffers, hence one
is advised not to steal even by thought.
(4) Brahmacrya (Celebacy):
Hindi Poet puts it nicely:
Yogi Charandas, a
YATl HOYA DgpHA KANCHA
GAHIJAI
VIRYA K§HlNA NAHlM HONE DlJAIn
MAlTHUNA KAHON a§ta
parakArAi
BRAHMACHARYA RAHAIJANA SE
NYArAii
SUMIRANA TIR1YA KO NAHIM KARIYE i
SRAVANA NA SURATI RUPA NAHIM
DHARIYE H
RASA SRNGARA PATHAI NAHIM
gAtai i
NARINA SOM NAHIM HAMSAI
hamsAvai ii
DR§TI NA DEKHAI D1GH NAHIM
DAURAI i
MU KHA DEKHAI MANA HOJA
AURAI ii
BATA EK ANTA KARAI NAHIM
KABAHIM i
MILANA UPAYA JU TYAGAI
SANAHIM ii
44
SPARTA ASTAMA NIKATA NA JAVAti
KAMA JlTI YOGI SUKHA PAVAI ii
A§TA PRAKARA KE MAITHU NA
JANOM i
INHAIN TAJE BRAHMACARYA
PICHANOM ii
(5) Aparigraha (Non-hoarding or sense withdrawal):
In all the yamas we finding the more stress is being laid
on the contentment. A person is never led to feel
frustrated. He has to keep whatever minimum is neces
sary for him and not to hoard for a long period. I
see no reason why peace does not prevail in the soci
ety. Why a person would prefer to see his neighbour
suffer when he himself has ample to share with others.
Patanjali, under another head, speaks of Niyama:
(i) Saucha, (ii) Santosa, (iii) Tapa, (iv) Svadhyaya and
(v) flvarapranidhana.
(1) Saucha (Cleanliness): It is an idea full of
SATTVA GUNA that is, difference between cleanli
ness and SAUGA. It is associated with feeling. Pavitratd (qf^rar)
It is both internal and external.
One is required to have not only outer cleanliness but
also clealiness in his thoughts which are ultimately
responsible for better action.
(2) Santosa (Contentment): We shall not feel frust
rated just because we do not have. We should know
what we want and we have to try for it. We have not
to sit idle; but no frustration should accumulate just
because we failed to get things. As the Gita Says:—
karmanyevAdhikAraste, mA
PHALE§U KADACANA
As also MANU puts it:—
SAMTO§A PARAMASTHAYA SUKHARTHI SANGATO BHARET
(3) Tapa (Austerity): Regarding Tapa, Gita says:
PRANAYA MAH PARAM TAPAH. One is advised
to resort to have Tapa daily. So that we get
nadi Suddhi and once we get its conception under
standing of life becomes more clear. We are able to
perceive more clearly the nature of the problem we
are facing.
We should take tapa related to our duties. We
should strive hard to achieve what is expected to help
in life process of evolution.
(4) Svadhyaya (to study): We should not lead our
life carelessly. We must read, study the texts that are
important to guide our life (whatever field of activity
(Continued on page 58)
Swasth Hind
DEVELOPMENT
AND
ENVIRONMENT
S. B. Chavan
The ecological problems with which we are concerned embrace diverse aspects ranging
from economic, social, psychological problems of human settlements to the manage
ment and use of natural resources and the conservation of natural habitats.
ince man discovered that he could use nature for
S his own purposes he has been interfering with his
environment. Man is a part of nature and only one
of many species inhabiting the earth. But he has
treated it as his colony to exploit it. The scale of his
intervention has grown to a point where it has pro
duced vast and disruptive changes which have already
modified our existence more profoundly than any
earlier human activity. Hence, the ecological problems
with which we are now concerned embrace diverse
aspects ranging from economic, social, psychological
problems' of human settlements to the management
and use of natural resources and the conservation of
natural habitats.
Environment during this century has faced severe
stresses. Population has
exploded, non-renewable
resources are being increasingly depleted and techno
logical growth has been phenomenal resulting in an
unprecedented air, water and noise pollution, land
deterioration and accumulation of pesticide- residues.
But during the last decade there has been a funda
mental change in our thinking with regard to man
environment equation. It has now been increasingly
realized that the nature of enviromnent plays a crucial
role in determining the quality of life and the well
being of the society. Technological developments and
economic progress depend on the resources obtained
from the enviionment which are finite and not
unlimited. Moreover, developmental activities pursued
without due consideration to their ecological impli
cations cause considerable environmental degradation.
This ultimately
undermines the
developmental
objectives. Environment is our essential resource for
development and its optimum utilization and wise
management is necessary for progress and national
February 1983
planning.
In our country environmental problems are of three
broad categories:
(i) Those arising from conditions of poverty and
under-development.
(ii) Those arising as negative effects of the very
process of development.
(iii) Those arising from human greed.
The first category has impact on our natural
resources; land, soil, water, forests, wildlife, etc., as a
result of poverty and the inadequate availability or
means to fulfil basic human needs of food, fuel,
shelter, employment etc. for a large section of our
population. The second category is due to the side
effects of efforts to achieve rapid economic growth
and development. These are due to poorly planned
development projects and programmes as well as
lack of attention to long term concerns. The third
category arises from a desire to make quick profit
out of natural assets without any regard for the
good of the community as a whole.
The Sixth Plan envisages, among other things, the
improvement of the quality of life of the people in
general and with special reference to the economically
and socially backward people, progressive reduction
in regional inequalities in the place of development
and in the diffusion of technological benefits, bring
ing about harmony between the short and the long
term goals of development by promoting the protec
tion and improvement of ecological and environ
mental assets, and promoting the active involvement of
all sections of the people in the process of develop
ment through appropriate education. The strategy
45
adopted for the Sixth Plan consists essentially of mov
ing simultaneously to strengthen the infrastructure
for both agriculture and industry so as to create
conditions for an accelerated growth in investments,
output and exports, and to provide, through special
programmes designed for the purpose, for increased
opportunities for employment, especially in the rural
areas and the unorganised sector and to meet the
basic minimum needs of the people. Stress has
been laid on dealing with interrelated problems through
a systems approach, greater managerial efficiency and
intensive monitoring in all sectors, active involvement
of the people in formulating specific schemes of
development at the local level, and in securing their
speedy and effective implementation.
Problems of hill areas
It has also been recognized that the pathways of
development adopted in the past have resulted in
an uneven distribution of the benefits of economic
growth as between geographical areas and also bet
ween socio-economic groups. It was in realization
of this phenomenon that certain specific target grouporiented programmes, such as sfda and mfal
were initiated during the Fourth and Fifth Five Year
Plan periods. Special programmes for droughtprone, desert and tribal areas were also initiated.
But, in spite of these programmes certain geogra
phical areas present some very special ecological and
socio-cultural features, which unless specifically taken
into account do not permit the present planning
process and the schemes developed within it, to be
of major assistance to them. The hill areas of the
country belong to this category.
The hill areas fall broadly into two categories:
(i) Those which are co-extensive with the boun
daries of the State and Union Territory. The
States and Union Territories of North Eastern
Region, Jammu and Kashmir and Himachal
Pradesh fall into this category.
(ii) Those which form a part of a State. Hill areas
of Uttar Pradesh, West Bengal, Western Ghats,
the hill areas of Tamil Nadu, etc., belong to
this category.
The development of the hilly areas in the country,
however, cannot be undertaken in isolation from the
adjoining plains, with which their economy is closely
inter-related. The hilly areas influence, to some extent.
the climate of the plains; they contain the sources,
the catchments and the water-sheds of several major
river systems which flow to the plains; they abound
in forests, plants and mineral wealth as well as hydel
energy resources. Our experience of development
planning during the last three decades has increasing
46
ly underlined the fact that unless adequate program
mes are evolved for the conservation and proper
utilization of the resources of the hill areas, not only
the problems of these areas will continue to re
main unsolved but the economy of the plains may
also be adversely affected. Symptomatic of this
aspect are the rapid siltation of dams, reservoirs,
flooding, changes in agro-climatic conditions and
pressure on the employment market because of the
large scale migration of people particularly men
from hill areas. Development of the resources of
the hill areas is, hence, necessary in order to enable
the population living in these areas, who are by
•and large very poor, to have their share of the bene
fits accruing from modern science and technology.
But such development, however, has to proceed in
a way that the eco-system constituting the hills and
the plains is not irreversibly damaged, but is preserv
ed in a suitable condition for future generations. There
is, therefore, a paramount need for conceiving an in
tegrated strategy for the development of the hill areas
based on sound principles of ecology and economics.
It was in realization of this need that special hill
areas development programmes were initiated during
the Fifth Plan.
Experiences gained in the hill area development
programmes suggest the need for greater horizontal
integration among the various elements of the deve
lopment programmes. Equally there is a need for
a balance in emphasis between beneficiary-oriented
and infrastructural development programmes, keep
ing in view the vital importance of ecological resto
ration and conservation. Better water and land
use and control of soil erosion through watershed
■management, afforestation, silvi-pasture development
and replacement of annual crops with
perennial
shrubs and trees and plantation crops in steep
slopes and development of other high-value
lowvolume crops lined with processing and marketing
are some of the methods of promoting sustainable
development.
Sixth Plan strategy
During the Sixth Plan, an integrated strategy will
be pursued. The planning process so far developed
for the hill areas would be reviewed both in its ope
rational mechanics and content. The programmes of
ecological conservation in some areas would require
a regional approach and coordinated action by seve
ral states. The Western Ghats region and the Hima
layan region, both cut across several States.. For
these regions, appropriate implementation mechanisms
would be devised for ensuring a regional over view
and action at the national level.
Swasth Hind
New approaches will have to be introduced during
the Sixth Plan for meeting the basic needs of hill
people comprising water, food, work, fodder, feed,
fuel and fertiliser. Water will have to be harnessed
in small ponds and reservoirs on a watershed basis
and stored for use during winter and spring. Since
land in the hills is best used, for perennial crops, it
will be advisable to store the needed foodgrains in
small storage structures at numerous points so that
food availability attains the requisite degree of via
bility for persuading farmers to abandon jhumming
and adopting cultivation of annual crops in steep
slopes. “Store water and food wherever possible”
has to be a major motto of the ird programme in hill
areas. Work will have to be provided under nrep
and development projects in the fields of forestry,
animal husbandry, fisheries, horticulture, agro-forestry
and cottage industries. Since women do most of
the jobs in hills, they will have to be given oppor
tunities for upgrading their skills in Krishi and PanVigyan Kendras. The district Manpower Planning
and Employment Generation Councils will have to
prepare detailed blueprints and action plans for
this purpose. Fodder and feed plants will have to
be grown extensively under the social forestry and
agro-forestry programmes. Until adequate fodder
and feed become locally available, it will be neces
sary to establish “Fodder and Feed Banks” at suitable
places involving the supply of enriched cellulosic
wastes and straw. Arrangements for fuel-supply will
have to be made under the village woodlots pro
gramme. Quick growing fuel trees will have to be
cultivated under the social forestry piogramme. The
Inter-University Eco-development Camps to be orga
nized with the help of the staff and students of uni
versities and the eco-development forces consisting of
ex-servicemen will have to play a leading role in
spear-heading the afforestation movement. This pro
gramme will have to be monitored and scientifically
supported by the Himalayan Research net-work to be
constituted with the involvement of all the 13 univer
sities in the Himalayas. A similar programme will have
to be organized for the Western Ghats region.
River pollution
Waters of our rivers are also not free from pollu
tion. There are evidences of the adverse effects of
water pollution from all over the country. These
range from the transmittal of waterborne diseases
like cholera, jaundice, typhoid and dysentery to
fish kills and loss of agricultural productivity through
the use of polluted water. From the Dal Lake in
the North, to the Pariyar and Chaliyar rivers in the
South, from the Damodar and Hooghly in the East
February 1983
to the Thana Creek in the West, the picture of water
pollution is uniformly gloomy. Even our large peren
nial rivers like the Ganga are today heavily polluted.
Investigations have revealed that the major sources
of pollution of our river waters are the discharge of
community wastes from human settlements. Most of
the community and industrial waste waters go straight
into water courses rendering them unfit for most uses,
least of all drinking water sources.
The need for making concerted thrust involving
interdisciplinary collaboration, to solve the problems
of environment and area development have been long
felt in the past. The main reason for the gap bet
ween knowledge gathered in universities and labora
tories and their application by industry and infras
tructure is the inadequate inter-action between technolo
gists, economist and academicians. How the institu
tions of higher learning, with vast resources of edu
cated and trained manpower can lend a helping hand
to the solution of these problems has been a growing
concern within the Planning Commission. It is as a
result of this concern the Planning Commission has
been trying to collaborate with the Universities and
Research Institutions to find solutions of problems
where considerable studies and researches have to be
undertaken and necessary manpowers to be trained.
The -Sixth Plan makes a specific reference to the
role of universities in the developmental activities:
“The institution of higher learning would be en
couraged and enabled to involve themselves
within the development activities in the com
munity and provide requisite support through
extension services of students and faculties.
Such extension work would be considered part
of the normal academic work of the students
and teachers, and not as social service. Univer
sities would not only extend frontiers of know
ledge but also supply such knowledge to solve
problems of the community on whom they
depend.”
Over 40 universities and over one million students
and faculty members will participate in these coordi
nated action research projects. These universities have
already done lot of work in initiating systematic stu
dies. A number of Research Institutes administered by
the Departments of Science and Technology and En
vironment. icar, cstr, etc., are also participating
in these studies.
—-‘Excerpts' from the inaugural address fit
the meeting of Vice-Chancellors on co
ordinated’Action Rese.rch Projects—
March" 20, 1982.
(Courtesy: YOJANA, June. 1982)
47
Acute diarrhoeal diseases are one of the leading causes of morbidity and mortality in
the developing world; not only do they kill people who live in hunger and poverty, but they
retard the growth of young children and impair the quality of life of those who survive.
Diarrhoeal
Diseases
and
their Control
N some countries as much as 40 per cent of morta
lity in children up to five years of age is related to
diarrhoeal diseases.
In 1980, the population of
children aged under five in Africa, Latin America and
Asia (excluding China) was estimated at 338 million;
the number of diarrhoeal disease episodes at 744 to
1000 million; and the number of diarrhoeal deaths at
4.6 million.
I
Until recently, the cause of diarrhoeas could be
determined in less than one third of all cases. In the
past 10 years, scientific progress has made it possible
to identify the exact cause of over 80 per cent of
cases of diarrhoea visiting for treatment facilities.
How diarrhoeal diseases spread
All diarrhoeal diseases are spread, primarily, by the
faecal-oral route. This explains the vast difference in
the incidence of diarrhoeal diseases between developed
countries where appropriate sanitary facilities are
available to most people, and the developing countries
where food hygiene is often inadequate and safe
water supply and sewage disposal systems are frequen
tly lacking.
The cause of death in diarrhoea is most often
dehydration due to the loss of large amounts of water
and salts. Fatal dehydration can develop within a
few hours. Until recently, most cases of dehydration
were treated with intravenous infusion. In many
countries, over one-third of beds reserved for children
in hospitals or specialized clinics were occupied by
patients suffering from diarrhoea—treated with ex
pensive antibiotics and intravenous fluid.
48
Oral reyhydration
It has now been established that a simple oral
rehydration fluid can treat most cases of dehydration
from watery diarrhoeas, including cholera. Known as
Oral Rehydration Salt (ors) solution, it contains:
3.5 g sodium chloride (table salt)
2.5 g sodium bicarbonate (baking soda)
1.5 g potassium chloride
20.0 g glucose
in one litre of water. The glucose is an important
ingredient because it helps the salt and water to be
absorbed into the body. This method is simple, in
expensive and can be administered in the home, once
the mother has been shown the correct way io prepare
it.
Treatment should be initiated as soon as possible
after the onset of the illness, since the development
of dehydration can be very rapid. Patients should be
encouraged to drink it continuously. When the patient
cannot drink enough fluid to keep up with the amount
required for rehydration, when there is severe vomit
ing. and in cases of severe dehydration and shock,
intravenous rehydration might be necessary.
Diarrhoea and malnutrition
There is a well established link between diarrhoea
and malnutrition: malnourished children get more
severe and more frequent diarrhoea, diarrhoea makes
malnutrition worse. Food should not be withheld
during illness, since there is no physiological basis to
the common belief that the bowel should be “rested’’
during acute diarrhoea. It is essential that breast
feeding be continued if a child with diarrhoea is on
breast milk. As soon as appetite returns, soft foods
should be given.
The indiscriminate use of antibiotics and spasmoly
tics must be discouraged, not only because they are
often of no therapeutic value, but they are needlessly
expensive and can also be harmful.
Bacteria and' viruses
The agents known to be important causes of
diarrhoea are of various types: they can be bacterial or
viral organisms.
Swasth Hind
Bacterial pathogens
Vibrio cholerae 01 is the cause of cholera; two bio
types have been recognized, classical and El Tor, the
latter being responsible* for the seventh cholera pande
mic which started 20 years ago in Indonesia and has
subsequently spread to most of South East and
Southern Asia, the Middle East, West and East Africa,
Southern Europe, the Far East and the Western
Pacific, and the United States of America.
It produces an enterotoxin which causes fluid loss
resulting in severe dehydration.
Contaminated water and food play a major role in
transmission whereas transmission through direct
person-to-person contact is rare. In hyper-endemic areas,
it is predominantly a disease of children but rarely
affects breastfed infants under one year of age.
Man is the main reservoir for the vibrio, but there
is evidence that the El Tor organism can survive in
water for prolonged periods, which suggests that in
fected shellfish or coastal waters can serve as reser
voirs of V. cholerae 01 infection.
Vibrio parahaemolyticus is a food-borne pathogen
usually transmitted by inadequately cooked or impro
perly handled fish or shellfish. It has two distinct cli
nical syndromes: a watery diarrhoea or a bloody
diarrhoea with abdominal cramps and fever.
It is an important cause of diarrhoea in Asia, the
usa and Europe.
Vibrio cholerae nonM causes an illness that resem
bles cholera but is milder. Food and water play a
major role in the transmission of the organism. This
vibrio is also often isolated from the stools of persons
without diarrhoea, suggesting that it is frequently nonpathogenic.
Enterotoxigenic Escherichia coli (etec) : various
strains of this pathogen have been isolated which are
classified according to the type of enterotoxin they
produce.
Recent scientific work suggests that these organisms
are a frequent cause of diarrhoea in children of the
developing world, and by far the most common cause
of what is called “travellers* diarrhoea”.
Symptoms
can range from mild diarrhoea to a severe cholera-like
disease. The illness is most commonly caused by eat
ing and drinking contaminated substances.
February 1983
Shigella : Four sub-groups have been identified to
date. They produce bacillary dysentery and one (S.
dyscnteriac type 1—Shiga bacillus) is associated with
high mortality in children. Humans are both reservoir
and host, and the disease is most common in children
under five years of age. Person-to-person contact is
the most common mode of spread. Studies have shown
that the incidence of shigellosis decreases as the
amount of water used in the home increases:* it is a
typical example of a (clean) “water-washed” disease.
Campylobacter jejuni can cause watery diarrhoea or
dysentery and is responsible for 5—15 per cent of
acute diarrhoea cases. It can be transmitted by food
or water, or by person-to-person spread.
Salmonella: About 2000 serotypes are known which
vary from country to country; they produce cases of
febrile gastroenteritis.
The incidence of salmonello
sis is high in persons with certain underlying diseases
(e.g. schistosomiasis, chronic liver disease, etc.). Sal
monellosis is mainly transmitted by contaminated food,
especially animal products.
Salmonella typhi causes typhoid fever, in which
diarrhoea is uncommon except in infants. Up to 80
per cent of infections are mild or subclinical.
Viral pathogens
Rotavirus'. First detected in man in 1973, this virus
causes a typical syndrome of diarrhoea preceded or
followed by vomiting and fever; the illness lasts from
three to seven days and can result in severe fluid loss.
Rotavirus is responsible for up to 50 per cent of
diarrhoea cases in children between six months and
two years of age visiting treatment facilities. It is
rare in adults, probably because most people have ac
quired immunity by the third year of life. Person-toperson contact is the main route of transmission,
hence the importance of personal hygiene.
The following other agents—bacterial, viral or para
sitic—can produce diarrhoeas, but their importance as
a cause of diarrhoea in developing countries is still un
known; entero-invasive E. coli, enteropathogenic E.
coli, Clostridium perfringens, Staphylococcus aureus,
Bacillus cereus, Yersinia entcrocolitica (bacteria), Nor
walk and Norwalk-like agents (viruses). Entamoeba
histolytica, Giardia lamblia (parasites).
(Continued on page 59)
49
ON NUTRITION
Energy Requirements
and
Recommended Allowances
B. S. Narasinga RAO
he Indian Council o£ Medical Research (1CMR)
recently revised the energy allowances for Indians.
These allowances arc average needs of an individual
in a specific group. Infants during the first year of
their life need relatively more energy for their rapid
growth. Their average energy requirement during
this period is 110 Kcal/per kg. body weight. Breast
milk alone can satisfy their needs upto 4—6 months,
beyond which they have to be given supplementary
foods. Most Indian women breast-feed their infants
upto one year or beyond. Infants of poor mothers
receive adequate energy upto six months from the
breast milk and grow well. But beyond six months
their growth falters due to insufficient supplementary
foods.
T
Energy requirements for Children
Allowances of energy for children are based on
energy intakes of active healthy children. Such in*
formation on Indian children is scanty. Hence 1CMR
recommended energy allowances for Indian children
as suggested by fao/who with a few modifications.
Recent studies of National Institute of Nutrition (NIN)
have shown that actual energy intake of normal,
healthy, growing, active children (1—5 years) from
well-to-do families, was similar to the allowances
recommended by the icmr.
Surveys by nin in (he past two decades indicate
that (lie energy intakes of rural low income group
children are quite inadequate—on an average it is
30 per cent below the recommended levels. The types
of foods eaten by the two groups—well-to-do and
poor—may partly explain the difference. Cereal in
take was similar in both the groups (150 g/day). The
well-to-do children consumed higher amounts of milk
(390 ml/day) and fat (20 g/day). But the rural, poor
children consumed only 40 ml milk and 3 g. fat per
day.
50
Energy is vital for leading an active,
healthy life. Infants and children need
energy for growth and activity. Adults
need energy for work and for maintaining
an optimum body weight. During pre
gnancy and lactation, women need addi
tional energy for foetal growth and milk
secretion.
Tn the children from the well-to-do families, 25 per
cent of energy is derived from fat. This ensured
energy adequacy by increasing energy density (Kcals/
volume) of diet. The diet of the rural poor, on the
other hand has a low energy density as it is based
exclusively on cereals with negligible fat and milk.
ENERGY ALLOWANCES FOR INDIAN
CHILDREN
Age group
(years)
Daily Energy Allowance
(Kcal)
1—3
4—6
7—9
1220
1720
2050
10—12
13—15
16—18
Boys
2420
2660
2820
Girls
2260
2360
2200
Inadequate energy intake is the primary cause for
unsatisfactory growth of rural poor children, often
resulting in various grades of malnutrition. Intakes
of other essential nutrients except proteins are also
unsatisfactory in these children. Lowered intake of
energy and other nutrients makes the child grow into
an adult with lowered body weight stature.
Swasth Hind
Growth retardation in the poor children, seen as
low body weight and height, is the result of a child
trying to adapt itself to chronic low energy intakes.
This emphasizes the need to feed, a child with ade
quate energy right from infancy. While computing
energy allowances for undernourished children it is
not desirable to make any adjustments for their actual
body weights which arc in fact less than normal. They
must be fed energy at the recommended levels for
their age so as to enable them to catch up in their
growth.
Energy requirements for adults
An entirely different approach is adopted for fixing
energy allowances of adults. The body weight, daily
activity and age influence the energy needs of adults.
These factors vary from one individual to another.
Therefore, energy allowances for adults are suggested
as for a ‘Reference Man’ (RM) and ‘Reference
Woman’ (RW) whose age, weight and activities are
well specified. The RM and RW are considered to
be in the age group of 20 to 40 years having body
weight 55 kg and 45 kg respectively.
The recommended energy intake for those engaged
in moderate activity such as agricultural or industrial
labour is 2800 Kcal (rm) and 2200 Kcal (rw), For
sedentary persons such as clerks, teachers, it is 2400
Kcal (rm) and 1900 Kcal (rw). For those doing
very heavy work like in coal mines, black smithy,
etc., the recommended energy allowances are 3900
Kcal (rm) and 3000 Kcal (rw). These figures should
not be applied for any individual without making ad
justments for his or her actual weight, activity and
age.
For example a moderate worker (man) weighing
50 kg needs only 2500 Kcal and not 2800 Kcal. If
Measurement of energy expenditure
February .1983
the same man is a sedentary person, he will need only
2.200 Kcal. After 40 years his energy needs decrease
and if his physical activity diminishes energy needs
also will reduce further. Energy needs decline pro
gressively after early adulthood because of reduced
basal metabolic rate as well as curtailed physical
activity.
EFFECT OF AGE AND BODY WEIGHT
ON ENERGY NEEDS OF MODERATELY
ACTIVE ADULT
Age
(Years)
20—39
40-49
50—59
60—69
70-79
Woman
(Kcal)
Man
(Kcal)
55 Kg.
50 Kg.
45 Kg.
40 Kg.
2800
2660
2520
2240
1960
2540
2400
2300
2030
1800
2200
2090
1980
1760
1540
1960
1860
1760
1570
1370
The National Nutrition Monitoring Bureau (nnmb)
has found that in rural adults of different Indian States
the mean body weight is 50 kg for man and 42 kg for
woman. Hence, their mean energy needs for mode
rate activity will be 2500 and 2000 Kcals respectively.
Unfortunately, the low weights of these men and
women are due to inadequate energy intake and asso
ciated poor growth during childhood, nin has shown
that capacity to do work depends on body weight.
Rural Indian adults who weigh less will have a lower
capacity to work, hence their work output will be
lower.
Energy requirements are also increased in women
during pregnancy and lactation. Additional daily in
take of 300 Kcal during pregnancy and of 500 Kcal
upto six months and 400 Kcal between 6—12 months
during lactation have been recommended. A gam nin
studies indicate that actual energy intakes of pregnant
and lactating women belonging to low income groups
arc much below the recommended allowances. These
women also have low body weights: hence their require
ments are also lower than a normal woman (rw).
nnmb surveys show that over the past five years.
mean energy intake (per consumption unit) in rural
adults ranges from 2000 to 2700 Kcals. Perhaps these
intakes are enough for the population because of
lower requirements due to their lower body weights.
Also they may be adjusting to the low energy in
takes by reducing their physical activity. This unhappy
situation affects productivity and has quite obvious
socio-economic repercussions.
51
India is the recipient of congratulations from all over
the world for the success achieved by us as hosts qf
the 9th Asian Games
Stadia were built in record time. Colour television
brought the games live into millions of homes all over
the country and abroad. Computers, electronic
exchanges, micro-wave and satellite links were
smoothly and efficiently utilised In a mammoth network
of services.
An apt example of what united endaevoor and hard
work can achieve.
Similar success can be achieved in other spheres of
national development if we work in the same spirit.
«*vd 32/5F7
LET US ALL JOIN HANDS
TO 3UILD A STRONG NATION
52
Swasth Hind
There is considerable variation in energy needs
between individuals and within individuals, nnmb
data indicates that there is a wide variation in body
weights of rural adults which may range from 35 kg
to 65 kg. Therefore, it is understandable that the
energy needs of these individuals will also range from
1750 to 3200 Kcals, even if all are engaged in mode
rate activity. This, together with the differences in
age and the intensity of physical activity contributes
largely to the observed variation in energy require
ments and intakes. There is also some difference in
energy needs because of the biological differences in
people to utilise available energy less or more effi
ciently. Its contribution if any is small indeed.
There is quite a lot of day-to-day variation within
individuals in terms of energy intake as well as ex
penditure. On some days energy intake is less than
energy spent. On other days, intake is in excess. But
over a long period of say two or three weeks, an
adult who maintains a constant body weight, will
match his average intake with his average energy ex
penditure. He is in energy equilibrium. The true
energy requirement of any individual can be deter
mined only by measurement of his energy expenditure
and intake over a number of days.
On days when an adult cats less he will draw
upon body fat stores and make up the deficit. If ex
cess is eaten it is stored as fat, if the adult continues
to eat less than his or her average requirement, first
the activities are reduced. This is followed by loss
per body weight. Adults on a continuous low energy
intake cannot lead a healthy, active life. Continuous
highcr-lhan-needed caloric intake will lead to obesity
and related problems.
In order to lead a healthy and productive life, it is
recommended that all adults should ensure an average
intake of energy as recommended for their age, weight,
activity and to meet special physiological needs, during
pregnancy and lactation in the case of women.
To
ensure satisfactory growth and development, infants
and children should receive levels of energy recom
mended for their age.
—Courtesy- Nutrition News, July 1982
WHY WOMEN SHOULD BE EDUCATED
Educating girls may be one of the best investments
a country can make in future economic growth and
welfare—even if girls never enter the labour force. Most
girls become mothers, and their
influence—much
more than the father’s—on their children is crucial:
*In health. Studies in Bangladesh, Kenya and
Colombia show that children are less likely to die if
more educated their mothes are, even allowing for
differences in family income.
*ln nutrition. Among households surveyed in Sao
Paulo, Brazil, for any given income level, families
were better fed the higher the mother’s education.
fertility. Education delays marriage for
women, partly by increasing their chances of employ
ment; and educated women arc more likely to know
about, and use, contraceptives. Yet in most parts of
the developing world, there are many more boys than
girls enrolled at school. True, female enrolment grew
faster than male between 1960 and 1977; but when
boy’s enrolments were where female enrolments are
today, they were growing even faster. The educatio
nal bias is most pronounced in South Asia, the Middle
East and North Africa, and parts of Sub-Saharan
Africa; but it exists in every region.
Why? From the parents’ point of view, education
for their daughters may seem less attractive than for
February 1983
their sons. They may fear that education will harm
their daughter’s marriage prospects, subsequent domes
tic life and even spiritual qualities. A girl’s education
brings fewer economic benefits if there is discrimina
tion against her in the labour market, if she marries
early and stops working or if she ceases after marriage
to have any economic obligations toward her parents.
But parents and their daughters do respond rapidly
to changing opportunities. When women took on key
roles in the Anand Dairy Cooperative in Gujarat,
India, education for girls became more valued. When
a nutrition project in Guatemala offered employment
to educated girls, the test scores of younger girls im
proved.
More generally, education does increase the chance
of paid employment for girls. In Brazil married
women with secondary education are three to four
times more likely to be employed than those with pri
mary education only—who in turn are twice as likely
to work as women with no education at all.
— World development report. 1980. Washington,
DC, World Bank, 1980. (From: World Health
Forum Vol. 2, No 4, 1981.)
53
A Case Study
ACTION LEADS
TO ADOPTION
This is a very good case example where the
field health workers can really assess
the impact of educational component
gone into the approved metho
dology of Integrated Rural
Development Project.
The marasmic child of the village Manamathi Kandigai.
he Field Study and Demonstration Centre (fsdc)
of the State Health Education Bureau, Directorate
of Public Health and Preventive Medicine, Tamil Nadu,
has taken up Uthiramerur Primary Health Centre for
demonstration purposes, and started the Integrated
Development Project in the Block. The
Village
Manamathi Kandigai, about 10 kms". from the Pri
mary Health Centre, was selected for the project by
the representatives of the Block.
T
The population of this village is 2000 belonging
mainly to “Balaji Naidu Community” speaking Telugu
and Tamil. Their occupation is agriculture.
The leadership pattern developed by the fsdc was
highly integral and co-ordinated. It was found that
mothers of the village Manamathi were having enough
leisure and had the desire to spend their spare time
usefully. Men and Women leaders were well-trained
and educated on the health problems of the village,
and also of the neighbouring villages.
Therefore, the fsdc encouraged the phc team to
develop a plan of action for the Integrated Rural
Development Project. The Social Worker of the fsdc
did the preliminary motivation to organize the project
and provided guidance for the same.
The child is Being physically examined.
54
While conducting the project, the Matharsangam
(ladies club) members were taken up for health training
based on fundamental of health education. Within a
year the enthusiasm of these trained mothers increased
by way of adoption of progressive projects like co-opera
tive schemes on dairy development, tailoring, deputa
tion of women for voluntary health work, etc.,
Swasth Hind
One such project, taken up by these young women,
was on nutrition improvement in the village. Timely
guidance was provided by the phc and fsdc team to
these women. The women also picked up helping good
health practices.
Marasmus child
During one of the visits to the village the FSDC staff
alongwith some of the Matharsangam members found
a marasmic child in the Day Care Centre of the Village.
The child was two-and-a half year old, but could neither
walk nor stand erect without support. She had all the
characteristics of a typical marasmus care. The Day
Care Centre has been started by the local youth seva
sangam getting a grant from the State Social Welfare
Board. There were about 25 children and two teachers
in the Centre.
Both the teachers are active members
of the Matharsangam. Except this particular child, all
the other children were apparently healthy.
On enquiry the FSDC staff came to know that the
child is from a very poor family. Her mother is an
agricultural coolie (daily wage). She goes for work
leaving the child in the Centre. She had neither the
means to improve the child nor concern for the child.
Hence, there was no use of educating the mother on
cheap protein rich food. So the Social Workers of
FSDC requested the Matharsangam members to help
the child by giving puffed ben gal gram kanji (grul)
atleast twice a day.
A member of the FSDC staff explaining the import,
once of giving puffed bengalgram Kanji atleast
twice a day to the child.
all theoretical knowledge. Only when they faced a
problem and shouldered the responsibility of improving
the condition of the affected child the theory was put in
to practice. When they practised they could see the
improvement. The improvement enhanced their confi
dence. Finally confidence led to adoption and wider
participation.
The president of the Matharsangam came forward to
give the Kamjee if somebody could meet the expense.
The social worker collected money from a well wisher
for the purpose. The next day puffed bengal gram
kanji was prepared by the president of Matharsangam
and given to the child both morning and evening. With
in a month there was remarkable change in the child.
She started walking slowly. To the surprise of the
president of the Sangam the child sometimes walked
up to her residence whenever there was delay in giving
the Kanji.
Within a short period the members identified another
marasmic child in the centre. When they saw a remar
kable improvement in the first child they slowly
weaned the child and started giving Kanji to the next
child.
Moreover, they started propagating the value of
puffed bengalgram Kanji, At present they utilize every
opportunity and situation to educate the mothers.
The Matharsangam members were well aware of the
condition called marasmus and how it could be treated
in the village itself at no extra cost. Previously it was
February 1983
The staff members utilized every opportunity and
situation to educate the mothers on nutritious diet.
Thus motivation to these mothers brought interest and
promotion in health of mothers and children. This is
a very good case example where the Field * Health
Workers can really assess the impact of educational
component gone into the approved methodology of Inte
grated Rural Development Project.
Field study Demonstration Centre of State Health Education
Bureau, Dte. of Public Health & Preventive Medicine, Tamil Nadu
55
WORLD ASSEMBLY ON AGEING
The World Assembly on Ageing, which has been four years in the making, met
in Vienna from 26 July to 6 August 1982, to discuss the ramifications of the dramatic
demographic change, and what could be done to plan for “ the age of Ageing. ”
The Assembly, had drawn thousands of participants, and delegations from over 100
countries. The Assembly discussed not only the social and financial impacts of
continuing demographic changes, but the “ humanitarian issues ”, the severe problems
that the ageing face in many parts of the world and that hamper their right to full,
independent and productive lives.
World Assembly on Ageing (waa)
Ton 26 July, 1982, in Vienna, Austria, after an
address by the Federal President of Austria, Rudolf
opened
are expected to be living in the developing regions of
the World in the year 2025.
Kirchschlaeger. In his statement, the Austrian Pre
sident said that to make the life of the elderly and age
ing better, more humane and worthwhile on an interna
tional level, the main goals of the United Nations set
out in the Charter, had to be accomplished. To ame
liorate the grievances of ageing, it was necessary to
raise consciousness and the World Assembly would
promote that consciousness throughout the world.
“The number of older persons would reach close
to 600 million by the year 2000, and this number was
sufficient to make it an issue of international con
cern.”
he
Mr Jean Ripcrt, Director-General for Development
and International Economic Cooperation, who spoke
on behalf of the Secretary-General of the United
Nations, Javier Perez de Cuellar, said: “this is indeed
a significant event, for never before have the nations
of the world gathered to focus their attention exclu
sively on issues relating to ageing and the elderly.
“We are witnessing a definite trend towards a con
siderable increase in the number and proportion of the
elderly in the total population”, “just a few years
ago, the issue of ageing was first perceived being an
important one and of immediate concern for deve
loped countries only. For developing countries, its
dimensions or urgency were not regarded to be sig
nificant.
The question of ageing can no longer be
considered a minor issue for the developing countries.
Nearly sevently-five per cent of tomorrow’s elderly
56
“Furthermore, the changes that occur in the depen
dency ratio of an increasing number of old people
dependent for their well-being, or eventual susten
ance, oq younger economically active people will
influence the socio-economic systems of all countries
irrespective of their levels of development or social
and cultural structures.
“The United Nations General Assembly stated in
1978 that the purpose of this World Assembly was to
convene a forum ‘to launch an international action
programme aimed at guaranteeing economic and
social security to older persons, as well as oppor
tunities to contribute to national development’. At
its thirty first session, two years later, the General
Assembly further indicated its desire that the World
Assembly ‘should result in societies responding more
fully to the socio-economic implications of the age
ing of population and to the specific needs of older
persons’. It is in the context of these mandates that
a draft international plan of action has been submitt
ed for your consideration which deals with both
Swasth Hind
humanitarian and develop mental issues relating to the
ageing.
valued and given its proper role irrespective of such
irrelevant categories.
“The ageing must be viewed as an integral part
of the population, and considered as an important and
necessary clement in the development process. It re
cognises, however, that at the same time, policies and
programme arc necessary to respond to the specific
needs and constraints of the elderly........... ”
Impact of industrialization
Dr Mahler's address
“All countries of the world, both developed and
developing, should identify with the goal of a level
of health for all the elderly citizens of the world
that will permit them to lead socially and economi
cally productive lives”, urged Dr Halfdan Mahler,
Director-General of the World Health Organization
(who), in his address to the World Assembly.
Dr Mahler emphasized that the cultural heritage
that favours the well-being of the elderly within the
family is a heritage that the developing countries
should do all to preserve before it is too late. “May
I suggest”, he added, “to the industrialized societies
that they relearn this lesson from those that may be
economically poor but retain their cultural richness,
as expressed for example in the biblical commandment
‘Honour thy father and thy mother’.”
He further said that the problems are world-wide.
Developing countries would have to face them no
less than developed ones.
If, in 1980, more than
half of the world’s 260 million elderly lived
in
developed countries, by the year 2000 almost threefifths of the planet’s elderly, expected to number by
then 400 million, will be in the third world.
Referring to the difficult political and economic
situation of the present world, Dr Mahler, said “in
ternational efforts for health and better ageing pro
vide little comfort given the magnitude of the world’s
divisions on other issues. But we must build upon
the slender foundations of international actions that
do exist, for it is a tragic irony that, at the very point
in time when human beings as individuals begin
to live out their lifespans, the human species comes
closer and closer to the risk of extinction”.
Mr. William M. Kerrigan, Secretary-General of
the World Assembly on Ageing, said he looked for
ward to a world in which the new and the old and
the young and the old would no longer be stereotypes
by which anything was measured.
Each would be
February 1983
Among the many issues the Assembly considered
was the impact of industrialization on the family and
its ability to care for elderly family members. This
issue involved the question of the gradual mechani
zation of agriculture, which is eliminating jobs in
rural areas, and the continuing trend towards migra
tion to the cities, which has left many elderly without
adequate support systems to replace the extended
families they once had.
The other problems are of older people who may
face mandatory retirement, or who are not psycholo
gically prepared for retirement.
In countries where
workers do have pensions, the pensions may have
been eroded by inflation.
There are also the grow
ing problems associated with the institutionalization
and “marginalization*’ of the elderly.
By the year 2025, the old will outnumber
the young in many countries. In the last few
decades, improvements in health care have
meant that life spans are increasing all over
the world. In 1950, the average life expect
ancy at birth was only 47. By the year 2025,
the average life expectancy is expected to be
70 years.
Plight of older women
The Assembly also considered the particular plight
of older women, who live the longest, who, therefore,
comprise the vast majority of the elderly, and who
are the poorest.
They are often left without adequate incomes be
cause they earn little of the world’s income (10 per
cent), own little of the world’s property (1 per cent),
and because Governments may not recognize their
life-long service to their families as constituting work.
Twenty-seven reports had been submitted for the
Assembly by various organs of the United Nations
system, and dealt both with broad developmental
issues and specific problems in areas such as health,
housing, education, employment and income security,
and social welfare services. They provided factual
information and in many cases recommendations.
57
Some of the reports suggested that there was too
much of a tendency to club together tho problems
of the ageing in different countries and regions and
even different age groups of the elderly. In a deve
loping country, with a short average life-expectancy,
47 may be old. The problems of a 60-ycars-old arc
different from that of an 80-year-old.
The very
aged, those over 80. have different sets of problems,
and this is a fast-growing age group. According to
the demographic report submitted to the World As
sembly, there will be over 25 million women and
men over the age of 80 in China, the world's most
populous country, in the year 2025.
The World Assembly on Ageing, like other United
Nations Conference, was not expected to solve all
the problems facing the ageing overnight or in the
next 10 years, or even by the year 2025. Nor could
the Assembly impose solutions on the 157 countries
that arc Members of the United Nations, each with
its varied social and cultural traditions and values.
Their contribution (o national life in their active years
must never be forgotten.
Among the recommendations, the plan of action,
which was adopted by consensus, emphasized the need
to help the elderly “lead independent lives in their
own family and community for as long as possible”.
in areas such as health care, the plan of action
slated that “all too often old age is the age of no
consent”. Decisions affecting the ageing are too fre
quently made without their participation. This par
ticularly applied to those who were very old, frail
or disabled.
The elderly should be given a choice as to the
kind of care they receive.
“The control of the
Jives of the ageing should not be left solely to health,
social service or other caring personnel, since ageing
people themselves usually know best what is needed
and how it should be carried out”, the plan stated.
Exchange of experiences
Unnoticed sufferers
The section on health emphasized the importance
of preventive care, including nutrition and exercise,
and contained a wide range of recommendations in
such areas as accidents, inappropriate use of medica
tion, and the effects of radioactive and other noxious
substances that can affect increasingly ageing popula
tions.
Mrs. Hertha Firnberg of Austria, President of the
World Assembly on Ageing, said in closing the session
that although the world was in a serious economic
recession and governments might find it difficult to
devote all of their resources required for the welfare
of the elderly, it must be appreciated that as a rule the
elderly suffered unnoticed by the rest of the society.
The plan of action noted that appropriate support
could make “a crucial difference to the willingness
and ability of families to continue to care for elderly
relatives’. Thus, governments are encouraged to pro
vide support services to assist families in the parti
cularly low-income families.
A
Rather, the Assembly was meant to be a forum for
the exchange of experiences, and an opportunity to
think ahead and plan for the inevitable result of
development and social progress.
(Continued from page 44)
we have selected we must keep ourselves at least with
the latest knowledge having sound background of our
culture and religion but not in narrow sense) which
shall enrich our knowledge for proper understanding.
(5) Isvarapranidhana (Devotion to God)’.—From a
wider out look devotion can be called the faith in
which wc believe. We should devote ourselves to be
understanding of what it is. What wc arc; what wc
think; why we think; what is the nature of the reality
and that there are several ways to realize this reality.
We have to resort to Tsvarapranidhana. For a Hindu,
it is VISNU RUDRADI PUJANAM.
(About are the aids Tor mental health of an indivi
dual). Patanjali‘has* advocated the necessity of it to
58
develop an integrated personality which can stand up
to any situation.
Il can thus be concluded that Asana, Pranayama
help us lo maintain good physical health and Yama
and Niyama on the other hand create positive healthy
psychological outlook. When a man can remain with
out menial frustration, free from tensions and can re
turn to simple living and high thinking, I am sure, that
it’s the way of our life. And I have no doubt once
again it is to be the way of our life. It shall contribute
to the better psychosomatic condition of the indivi
dual and healthy society. Where old age will not be
felt as old age—it will be respectable old and healthy
age.
/’
A
Swasth Hind
COMMUNICATION
A DRAMATIC SUCCESS FOR RADIO
Sian ford University study released by the Popula
tion Institute, New York, shows that a radio pro
gramme in Costa Rica has been largely responsible for
a sharp reduction in the birth rate in that country. A 20minute programme called Dialogo, produced by Costa
Rica’s Family Orientation Centre, is broadcast twice
daily throughout Costa Rica, once during the early
morning prework period and again in the evening. It
is the only regularly scheduled programme designed to
teach human sexuality education.
A
The Stanford study also showed that Dialogo has not
only reached its priority audience—low-income indivi
duals—but it has also affected their knowledge, attitu
des, and practices in matters of human sexuality. The
findings in the study go against expectations based on
other media research, which indicate that in family
matters only the upper—and middle—income groups
arc reached. With Dialogo poorer people are reached
in greater numbers and are more strongly affected.
While the use of radio to communicate ideas is not
new in Central America, the objective and content of
Dialogo make it different from any of its predecessors.
It is designed to teach its listeners about themselves,
their sexuality, and their relations with others. Its
priority audience is low-income Costa Ricans in the
city and the countryside. While other agencies were
opening family planning clinics, the Family Orienta
tion Centre chose to launch Dialogo 13 years ago on
the promise that before Costa Ricans made family
planning decisions they should have all the necessary
information.
Dialogo is a simple programme. Professionals and
religious leaders talk about such topics as the need
for family planning, sexuality, women’s rights, and
the religious aspects of the subject. Listeners are
asked to send in questions about any phase of sexua
lity that may concern them. In its 13 years on the
air, Dialogo has received more than 20,000 letters.
During the years the programme has been broadcast,
Costa Rica has experienced one of the sharpest reduc
tions in birth rate of any country—from 3.8 per cent
to 2.7 per cent according to the Population Reference
Bureau.
The report, An evaluation of Dialogo:
human
sexuality education through radio in Costa Rica by
Felipe Risopatron and Peter T. Spain, is available
from the Population Institute, 777 United Nations
Plaza, New York NY 100 17, USA.
While television is a luxury item for most people
in the developing countries and utterly impractical in
many villages, and while the press is an excellent
medium of education for those who can read, it is
radio that has proven to be the “go-everywhere, reacheverybody” information resource. Because most radio
is local and can communicate in familiar language and
dialect, it is now seen as a truly important system of
communication and one that has been less used than
it should.
—International Dateline. July 1981.
(From: World Health Forum Vol. 2, No. 4, 1981)
(Continued from page 49)
WHO programme
To help prevent and manage diarrhoeal diseases, the
World Health Organization (who) established in
1978 a global Diarrhoeal Diseases Control (cdd) Pro
gramme. This Programme has as its immediate ob
jective a reduction of the mortality caused by acute
diarrhoeal diseases. Its longer-term objectives are to
reduce the morbidity caused by these diseases and
their associated ill-effects, particularly malnutrition, in
infants and young children and to promote the selfreliance of countries in the delivery of health and
social services for their control.
February 1983
To attain its objectives, the cdd Programme has
been built up on two main components: a health ser
vices component, through which who cooperates with
Member States in the development of national pro
grammes of diarrhoeal diseases control as a part of
primary health care, and a research component, through
which support is being given to applied research to
determine the best ways of applying available know
ledge in national programmes, and to biomedical re
search to find new tools for control, especially new
and more effective vaccines and drugs.
—Courtesy :
WHO
59
YOUNG PEOPLE AND SMOKING
Some of the reasons are:—
1. A feeling that smoking is fashionable and will
enable admission to higher strata of society.
2. Easy availability at home of smoking mater
ials like cigarettes, lighters, ash trays, etc.
3. Exposure to smoking at home.
4. Smoking is a show-piece method of indicating
virility.
A worldwide campaign is on to educate people about
the serious health hazards (including heart attacks)
caused by cigarette smoking. While more and more
adults are quitting smoking, unfortunately, more stu
dents and children especially girls in advanced West
ern countries arc taking to the bad habit. This is a
matter of serious concern. By a study of the problem
the reasons for young people taking to smoking have
been ascertained.
5. Influence of advertising.
Young people usually begin to face pressure to
smoke between the ages of 10-15. This is the age when
children move away from their parents and families
and get closer to their friends. This is also the time
when they begin to rebel against adult authority and
are willing to take more risks. Knowing this may help
parents to understand some of the reasons why chil
dren start to smoke.
A first step, therefore, to prevent young people from
taking to smoking is that smoking should not be
allowed at home either by the inmates or visitors. If
this step is taken children will come to know that
smoking will not be accepted by their parents or eld
ers who may be living with them.
Courtesy: Heart News, July, 1982
(Continuedfrom page 36}
Medicalization of the problem and taking effective
measures by the health teams has not shown and is not
likely to show the desirable results.
The problem, therefore, has to be tackled at the
socio-economic and political levels. Unfortunately
many developing countries have neither appropriate
legislations nor the means to enforce even if such legis
lations are enacted. It is not surprising, therefore, that
international companies are publicising private pres
sure advertisements to promote smoking in the deve
loping countries and are making huge profits. On the
other hand many developing countries depend upon
tobacco leaf as one of the main sources of foreign
currency earning.
India produced approximately 455.6 million kg. of
tobacco from 428.2 thousand hectares in 1980-81 and
plans are afoot to increase the production further.
If we realized that 80 per cent of the tobacco is con
sumed within the country then the onus of respon
sibility falls upon us and political leaders to take
appropriate measures to see that this does not harm
the health of the millions of our countrymen.
We shall have to adopt a national policy based on
sound socio-economic foundations and take measures
at different levels of governmental agencies with the
departments of agriculture, social welfare, labour,
health and finance and associate other national, social,
cultural, religious voluntary organizations so that
the evil of smoking and use of tobacco can be controll
ed and perhaps eliminated totally to ensure better
health for our coming generations.
A
OUR NEXT ISSUE IS A SPECIAL NUMBER
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BOOKS
Contraceptive effect of breast feeding (editorial).
Ho ore, PW and McNeilly, A.S. Journal of Tropica!
Pediatrics 1982 Feb. 28(1) : ii—v.
It is well established that breast feeding mothers
experience longer interbirlh intervals and longer post
partum amenorrhea than mothers who do not nurse
their babies. Adequate interbirth intervals are im
portant for maternal and child health as well as
having profound demographic consequences. In deve
loping countries, where the use of artificial contra
ceptives is low, the contraceptive effect of breast feed
ing is of major importance for the individual and the
community breast feeding and artificial contraception
should not be regarded as alternatives which are mutu
ally exclusive but as complementary methods of ferti
lity control to be used together. It is important that
infant feeding policies are formulated only after full
consideration has been given to the contraceptive effect
of breast feeding.
From : Highlights from Current Health
Literature. Sept, 1982 No. 13.
A review of (he literature on access and utilization
of medical care with special emphasis on rural pri
mary care. Fielder, JL. Social Science & Medicine
1981 Sep.; 15C (3) : 129-42.
Over the past 35 years medical care resources in
the United States have become increasingly concen
trated in medical centers and university hospitals of
large urban areas. This trend has left, inhabitants of
rural areas increasingly relatively deprived of access
of health care resources.
More importantly, this
relative deprivation of access to medical resources has
been a key factor explaining ruralite’s deprivation in
the utilization of those resources.
Although policy makers have been aware of the
evolving structural pattern of the industry for some
time, to date they appear unwilling and/or unable to
fundamentally alter its continued growth aiid deve
lopment. This review describes various forces in
fluencing this developmental pattern at both the in
dividual and the system (macro) level. It further dis-
Authors of the month
Dr D.B. Bisht
Additional Director General
of Health Services,
Nirman Bhavan
New Delhi-110011.
Dr B.C. Ghosal
Director
Central Health Education Bureau
Directorate General of Health Services
Kolla Road,
New Del hi-110002.
Shri O.P. Tiwari
Kaivalayadhama
Lonavla,
Pune-410403.
Sliri S.B. Chavan
Union Minister for Planning &
Deputy Chairman of Planning Commission
New Delhi-110001.
B. S. Narasinga Rao
C/o National Institute of Nutrition
Jam;a-Osmaniji P.O.
Tarnaka
Hyderacad-500007.
cusses how government health policy, the characteris
tics of the health delivery system and the characteris
tics of the US people transactionally relate to affect
access to and utilization of health care resources.
Public participation in health care. McKeith, JS.
Hospital and Health Services Review,
1982 Feb.;
78(2) : 49-51.
Involvement of the community in health care is not
a rejection of the service provided by professionals, but
rather an assertion that people have the right to take
part in matters concerning health. Not only is health
too important to be left to professionals, it cannot be
achieved without the active participation of the indi
vidual and the community. Functioning of separate
movements like Community Health Councils (CHCs),
patient participation in primary health care, role of
community development in health, self-help or mutu
al health groups are reviewed. It is likely that forms
of public participation will grow and develop stimu
lating established health services to adopt and become
more open and responsive.
From : Highlights of Current Health Literature, Vol. I
No. 15, Oct. 1982
Regd. No. P-(C) 359
Regd. No. R. N. 4504/57
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