Environmental Health Bugs in the Next Millennium

While we step into the next millennium and the next century, the environmental health problems that plague the country remains largely unaltered. It was about thirty years ago that population ‘doomsayer’ Paul Ehrlich predicted ecological doom for the ‘undeveloped’ countries such as India because of population growth. His prediction of a ‘population bomb’ just did not happen although millions of dollars went down the drain for manufacturing nuclear and other bombs and millions of lives were lost by the use of such bombs. Ehrlich wrote thirty years back:

I have understood the population explosion intellectually for a long time.

I came to understand it emotionally one stinking hot night in Delhi ……..

My wife and daughter and I were returning to our hotel in an ancient taxi.

The seats were hopping with fleas. The only functional gear was third. As

we crawled through the city, we entered a crowded slum area. The

temperature was well over 100, and the air was a haze of dust and smoke.

The streets seemed alive with people. People eating, people washing,

It is certain that nothing happened at that time, but even after thirty years nothing seems to be happening either. That population growth would lead to an ecological disaster has remained as a feeling, a feeling among those who were threatened by the impending ‘disaster’. This helps us to reformulate our notions of ecology and set a new agenda as we step into the next millennium. Although, a time scale of thousand years would be far fetched, it is possible to at least identify the future ecological scenario at the beginning of the millennium.

The end of the millennium saw the evolution of a global developmental agenda through which a uniform economic package for growth is imposed on the underdeveloped countries. India formally came into this package during the nineties when the Structural Adjustment Programmes (SAP) were initiated. There is already evidence to show that these programmes serve as an appropriate epitaph to the environment. The opening of country’s economy to foreign investment has already resulted in dumping of wastes and pollutants from the North taking advantages of the liberalisation policies. India is currently experiencing this phenomena described as toxic terrorism or garbage imperialism earlier found in smaller countries like Benin, Guinea-Bissau, Nigeria and Venezuela etc. Even W.H.O admit that the effects of such wastes in the importing countries are unrecorded or underreported. For instance, in 1993 alone, India imported 79166 tonnes of plastic wastes, 502 tonnes of lead wastes, 30,498 tonnes of copper, tin, and other metal wastes in addition to 250 tonnes of ash and 346 tonnes of lead battery wastes. The country is being gradually subjected to garbage imperialism by making it into a dumping ground for the post-consumer wastes such as used plastic bottles from the United States, Britain, Canada, Australia and Germany. Much of these imports have been done with active or passive connivance of the State taking advantage of the precarious position of the poor whose priorities would be immediate livelihood in the form of employment. At the same time, there are developmental packages in the traditional sectors such as agriculture, fisheries etc. which affect the life of marginalised communities. For instance, in the fisheries sector there has been substantial increase in foreign investments. Proposals for export-oriented ventures are attracting a significant share of foreign investments in this sector. The programmes to augment export potential in inland fisheries and shrimp production with World bank assistance have already led to serious environmental problems in the eastern coast of Tamil Nadu, Andhra Pradesh, Kerala, Orissa and West Bengal. This has led to large scale conversion of paddy fields into fields for aquaculture. It has been recognised now that aquaculture would lead to salination of land, the ground water sources and to pollution of water from the chemicals used in the fish ponds. In agriculture, the emphasis on export orientation has led to farmers converting from food crops to cash crops.

However, the important aspect to be recognised is that this pattern of ‘growth’ is superimposed on a society whose basic needs for food, health, housing, water, sanitation etc. have not been met. Thus, priorities remaining unchanged, the new agenda necessitates entirely a new vision for addressing the double burden of solving the old problems while taking on the challenge of the ‘Third Wave’ of diseases from environmental factors.

The ninth plan perspective on health (1997-2002) which takes us to the next millennium starts with a broader vision on environmental health but has not explicitly considered these challenges. It focuses on detection, prevention and management of existing deficiencies or excesses of certain elements in the natural environment, macro environmental contamination of air, land, water and food, natural disasters etc. However, the communicable diseases due to environmental conditions in the urban and rural areas need to be clearly spelt out in terms of specific programmes and strategies than a garbage clearing approach which mainly evolved in the post-plague period.

The Expert Committee on Public Health System of the Planning Commission had noted that major developmental activities in fields such as agriculture, industries, urban and rural development may result in environmental changes which could have adverse impacts on health. The committee recommended health impact assessment as a component of environmental impact assessment in all major developmental projects. This however needs to be concretized as to how the linkages with health could be established in a project. A detailed status report on the existing developmental projects with regard to health impacts could be prepared as a source of reference. This can be used for health clearance of future developmental projects.

The gigantic problems to be tackled during this period are with respect to meeting the unmet needs in housing, drinking water, and sanitation with respect to both urban and rural masses of this country. According to the ninth plan perspective in housing, urban development, water supply and civic amenities , the new housing stock required is about 9.0 million units in urban areas and 7.7 million in rural areas. During 1997-2002 and about 77.0 million and 63.0 million units in the longer term perspective extending up to 2021. Considering the fact that the approach of housing policy at present is to give proroity to private sector participation with the government playing only the role of a facilitator, it is possible to imagine that a roof over one’s head would become a mirage for large sections of the population.

Regarding water supply, the surveys undertaken by state governments in 1991-94 for the Rajiv Gandhi National Drinking Water Mission showed that there were 1.41 lakh non-covered villages/ and 4.30 lakh partially covered villages/habitations, apart from 1.43 lakh villages/habitations suffering from acute water quality problems. In terms of population, it is claimed that 85 per cent of the rural population is expected to have been provided with drinking water. However, the coverage is only in terms of habitations and in many cases one or two hand pumps have been installed to show full coverage. It therefore does not addresses the issues of sustainability, accessibility and availability of safe drinking water.

The performance in rural sanitation, on the other hand is more dismal. Recent data show that population coverage by sanitary latrines has increased only by about 5 per cent in the eighth plan. Although the 9^th plan perspective talks about a people-centred sanitation programme, this is often confused with a programme based on the purchasing power of the individual households.

On the whole, the ninth plan perspective on these sectors indicate a partial or total withdrawal of the State from these areas which largely determine the epidemiological profile of this country. The epidemiological profile of the country still remains in a pre-transition period. Although some states such as Kerala are witnessing an epidemiological and demographic transition, large number of states have not reached anywhere near a transition period. Communicable diseases such as malaria, cholera, tuberculosis, viral hepatitis etc. which have a significant ecological dimension are rampant in these states. The post liberalisation era has also witnessed a worsening of this disease scenario (see Table 1). Apart from these disease scenario, a number of epidemics have also broken out in different parts of the country. The frequency of such epidemics has increased and become a part of the disease profile of this country. Malaria has become a major public health problem in the North eastern states and in Rajastan. Japanese encephalitis, another disease which has appeared in states such as Kerala, Tamil Nadu and West Bengal has already claimed a number of lives. The most important epidemic in the post reform period is however the plague epidemic of Surat which can not be viewed independently of the recurrent epidemics in different parts of the country. It reflected the gross neglect of public health and civic amenities in the country. The investments for health have declined from 3.3 per cent of the total plan investment in the first plan to about 1.8 percent in the eighth plan. On the other hand the investment for family planning has been steadily increasing from 0.1 per cent in the second plan to 1.5 per cent in the eighth plan These trends means that public health programmes including control of communicable diseases can not de-emphasised and the investments which are declining over the plan periods have to be maintained at a high level. It also means recognition of environmental factors in disease control and therefore simultaneous and integrated actions in health related sectors like housing, water supply and sanitation.

The environmental health scenario is quite nebulous and complex at present. While we have to deal with the worsening communicable disease scenario which have a large ecological component, the third wave of environmental diseases which result from the environmental backlash of liberalisation of the economy could also take a heavy toll. It is necessary to recognise that the sources of pollution are localised and unconventional and therefore localised actions and movements which are rising in different parts of the country could be a green hope. However, the State can not abdicate its responsibility and it has to recognise the linkages, conceptualise concerted actions and initiate programmes for grappling with the complexity.

Table Disease Profile in India 1988-1993