ENVIRONMENT AND HEALTH - ROLE OF ISHA      

      In the last 25 years, ISHA has played a significant role in discussing issues regarding Environment and Health at national and state levels. Here is a summary of initiatives by ISHA:

1. Primary Health Care for All by 2000 AD: November 12-14,1980

         To achieve the goal of Health for All by 2000 AD, the Conference observed the need to ensure protection of the environment which was being threatened by the industrialization, pollution, waste, and effluent disposal systems.

         The Conference recommended that :
              (a)  Effective legislation be enacted, and
              (b)  Suitable machinery be devised to effectively implement the legistation

2. On Growing Needs of Urban Health Management - November, 17-19. 1985. The Conference observed:

   a. Growth of urban population

                  1952       77 million
                  1981      157 million
                  2001      367 million

   b. Lack of standards for basic human needs such as housing, water supply, disposal of excreta and other wastes, etc.

  c. Pressure of urbanization was contributing to maladjustment in young people resulting in consumption of alcohol and drug addiction.

  d. There was need to prepare immediately urban health profiles of major metropolitan cities and emerging urban centers.

  e. Urban slum and Resettlement of Slum Dwellers

       Approx. 30% of the population in 12 major cities lived in slums and this population was increasing. There is a lack of clear-cut policy at national, state, and municipal level.

             During Mrs. Gandhi's time - "slum resettlement" was included in the report programme. ODA assisted Vizak and Hyderabad slum projects.

   f. Water and Sanitation

             50% of the people residing in urban areas have no sanitary latrines. Also, there was a need to improve sanitation in hotels, restaurants and markets. Strict enforcement of llegislation was considered imperative. 80% of the sickness in either water-borne and sanitation caused. In 1985 we estimated:

                           Urban water supply = Rs. 3044 crores (100 % coverage)
                           Urban sewage = Rs. 2432 crores (80% coverage)
                           Rural water supply = Rs. 7057 (100% coverage)
                           Rural sanitation = Rs. 3301 (25% coverage)

   g. Pollution

       Air and water pollution from industrial effluents and discharges hospital solid waste.

       Central and State Pollution Control Boards - Todate lack of clear cut policy and enforcement of permissions.

      Location of industries using hazardous materials and techniques

      Care of Delhi State

   h.     Roads and Traffic

         Increase - number of vehicles and traffic roads are congested and not adequately lighted - as a result increase in accidents.

         Untrained and unlicensed drivers

   i.   Processed food, fast food, hygiene of food handlers, vendors, and all types of eating places in unhygienic places

3. Health of the Metropolis - Bangalore September 8-9, 1989

      The Conference looked at Bangalore as a model city and developed methodology. It reviewed : a) population dynamics of Bangalore (b) health profile of Bangalore city (c) health infrastructure (d) engineering aspects of health care - water,sanitation, sewerage (e) housing (f) Accidents, Alcoholism and drug abuse, and (g) food adulteration and atmospheric pollution.

It was observed the following:

a. Growth of population

                  1991        43.98 Lakhs
                  2001       63.91 Lakhs
                  2011       87.03 Lakhs
                  2021        114.83 Lakhs

   However, the population has grown beyond estimates. As per the 2001 census:

          2001       - 65.23 Lakhs - urban
                         - 18.77 Lakhs Rural

b. Health

i)   High maternal and infant mortality - corporation health infrastructure covers hardly 50 percent
ii)  Cardio-vascular deaths increase - 30 % of the death
iii) Cancer - six deaths occur every day; at least two due to tobacco - related which are preventable
iv) Health infrastructure inadequate
Much of the morbidity occurs in slums. Slum growth is out of proportion.

c. Water, Sanitation, Garbage, and Sewage Disposal

      Water supply needs to be increased and systems recommended.

d. Housing

     Great shortage of Housing. Meanwhile price of land and construction have increased a great deal. House Building Cooperative Societies - laws regulating these societies have broken the spine.

e. Accidents - India with one of the lowest vehicle ownership rates contributes highest to the number of accidents.

f. Alcoholism - rapidly growing menaces of this metropolis. 50% of the psychiatric beds at NIMHANS - occupied by alcoholics.

g. Food adulterations. The infrastructure available for checking food adulteration is limited.

h. Pollution -vehicular and noise - health effects of pollution. Measure proposed to minimize the effect of pollution.

    A committee was formed to help the State Government in Implementation of the recommendations.

4. Health Care for the Villages and Urban Slums - January 22-24, 1990

a. It was observed; Housing, sanitation, water supply, drainage and solid waste disposal were the basic amenities for meaningful health programmes. WHO problems in the slums were related to water supply and sanitation.

b. Keeping in view the high degree of accident proneness in urban slums, especially in children, accidental poisoning, etc, well-equipped accident and emergency centers at suitable points need to be established.

c. Respiratory Diseases

    Respiratory diseases have a major share in morbidity but diminishing share in mortality.

     Chronic airways disease - bronchitis, emphysema and asthma - are important group of respiratory diseases. Tobacco smoking (even passive smoking) is the main risk factor, although outdoor and indoor air pollution and occupational exposure to dusts have an important role in etiology.

     Role of indoors air pollution, warm, damp conditions promote the growth of biological agents (house dust mites and fungal spores ) that produce allergens that may provoke allergic respiratory diseases, especially in children.

      Ambient air pollution is related to respiratory health problems - reduced lung function level, lower respiratory tract illness and the worsening of chronic obstructive lung disease.

d. Communicable Diseases

      The main infections diseases causing death is respiratory tuberculosis microbiological contamination of drinking water causes out breaks of water-borne diseases. Microbiological contamination of food has increased over the last decade.

       For bathing water, links have been established between sewage contamination and gastrointestinal and upper respiratory symptoms. Swimming in heavily polluted water carries the risk of contracting infections such as typhoid fever, hepatitis A and other related communicable diseases. Assuming 100 million people bathe in polluted waters, 2.5 million cases of gastrointestinal infections annually can be expected.

e. Injury and Poisoning

      Injury and poisoning are the leading causes of death in males and females. Road traffic accidents account for a major proportion of death.

      Injuries from accidents at work are another important public health problem. In construction, 25% of workers have accidents at work. The cost to the people affected and their families is un-quantifiable.

      Bhopal Gas Tragedy, Dhanbad Mining

f. Effects on the Nervous System and Mental Disorders

      The prevalence of mental disorders ranges from 6% to 22% of the adult population in various countries.

       Common Mental disorders - depression, anxiety, aggressive behaviour, alcohol, abuse and suicides.

       Several chemicals are a hazard to the nervous system. Exposure to lead is impaired mental development in children.

       Old lead containing paint, dust, and contaminated soil, including the deposition of emissions from vehicles using leaded petrol, lead in the air near industrial emission sources such as metal smelters and processing plants.

      Neurological effects - linked with exposure to methyl mercury people who consume large amounts of fish. The risk to the fetus or new born is associated with consumption of large amounts of contaminated fish by pregnant women and nursing mothers.

g. Birth Defects and Reproductive Effects

      Exposure to environmental contaminants before or after conception may affect reproduction by causing cell death or damage can lead to infertility in the adult, spontaneous abortion, low birth weight, birth defects or later structural or functional defects in the offspring.

  Exposure to methyl mercury, pesticides is associated to reproductive effects.

      The effects may be seen 20-40 years later. Defects in babies born today will not become manifest 20-40 years later.

h. Effects on well being.

    Environmental factors affect well being living conditions determine the feeling of well being.

       Depleted housing, sanitation, lack of water for bathing, unemployment, social discrimination and poverty, create an environment not appropriate for well being. Waste and garbage pile ups odors from waste disposal diminish the aesthetic value of the environment.

      Road traffic, noise, lack of greenery, load music - affect, aging, grey hair, develop anxiety, irritation and nervous system disorders.

5. National Meeting on, Environment and Health in India, February 25-27, 2002,
at Bangalore

        This Meeting was organized with the following objectives:

(a) To create an awareness among the administrators, policy makers, the professionals, and the public regarding environmental issues affecting health and quality of life.

(b) To assess the present status of the critical environmental issues, infrastructure resources, plans and programmes of concerned departments and agencies.

(c) To develop action plans for development of infra-structure resources and systems towards environmental management for health and quality of life.

The Meeting focused on the following issues:

a.    Effect of Environment on well being and quality of life
b.    Urbanization and health, accidents, alcohol, drug abuse, law and order.
c.     Microbiological and Contamination of drinking water.
d.     Pollution, urban growth, and health problems of slums, water, traffic, lead pollution.
e.     Population, development, and environmental impact of development policies on health.
f.     Role of voluntary organizations in environmental education and protection
g.    Waste production and management
h.    Environmental health and
i.     Environment, Health and Law
j.    Sanitation and solid waste
k.   Industrial injuries and poisoning
l.    Environment and Health. Life expectancies - cardiovascular diseases, cancer, respiratory       diseases, birth defects, and reproductive effects.

6. Publications

       ISHA has brought out the following piblications regarding public hea;th, environment and health.

A. Journals

    Health Institution Building in India
    Community Participation in Health Care
    Planning and Management of Public Health Programmes
       - Communicable Diseases
       - Non-Communicable Diseases

B. Conference Report

    (a) Health for All by 2000 AD (1980)
    (b) On Growing Needs for Urban Health Management (1985)
    (c) Health of the High Risk Groups - 1987
    (d) Health Care of the Villages and Urban Slums 1990

C. Books

   (a) Community Participation in Health and Family Welfare: Innovative Experiences
   (b) Health of the Metropolis - Bangalore
   (c) Health and Development of the Tribal People in India
   (d) The Third Force: Role of Voluntary Organizations in Health and Family Welfare in                  India
    (e)Disasters Preparedness and Emergencies Management in India
    (f) Hospital Clinical Waste, Hazards Management, and Infection Control
    (g) Environment and Health in India (In press - 2005)