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Urban Health and Environment: The Indian Scene
The link between environment and health is not new. In the early 19th century, cholera was recognized as a water borne diseases. Yet, in the succeeding years, a medical view of such diseases stressed curative rather than preventive aspects and saw social and environmental conditions as merely contributory factors to the spread of disease-bearing pathogens.

In the late Sixties, the "book of infectious diseases" was declared closed. Less than 20 years later, old and new diseases emerged rendering even the best health care systems inadequate. In 1993, there were 16.5 million deaths due to infections diseases worldwide. The process of development itself appears to contribute to the spread off disease. Unplanned urbanization and the resulting deterioration in basic services has increased respiratory and gastrointestinal infections in urban areas. A shift in thinking from curative to preventive health is now unavoidable.

The Indian Scene.

IndiaThe three big metros in India (Delhi, Calcutta and Mumbai) are among the 10 most polluted cities in the world. Perhaps, the situation is no better in Mexico City, Rio de Janeiro, Bangkok and Tokyo. In developing countries, the burning of biomass, wood and coal for domestic cooking/heating purposes has been a contributing factor to air pollution. The situation has continued to be serious over the last 25 years and will definitely deteriorate over the next 20 years.

As the trend in the daily pollutant load in Mumbai is a rising one, several illnesses are likely to increase with the attendant cost of treatment. As the component of transport in terms of air pollution levels is increasing - from 399 to 1,538 metric tonnes per day (MTPD) - we need to emphasise the importance of its control Pollution from industries (which rose from 438 to 1,357 MTPD from 1978 to 1992) also needs to be brought down.

Compared to Mumbai, the air pollutant loads in Delhi and Calcutta, particularly for PM and aldehydes, are higher. These lead to a greater prevalence of dense smog in winter. The major cause is the greater density of two/three wheelers and wide spread use of coal burning. However, Mumbai city is a small island and the other metro cities have a large land mass. So the health morbidity due to pollution may be less intense.

Along with increasing levels of pollution, there is a worsening of global warming. To this, India is contributing 8 percent, China 10 percent, Western Europe 17 percent, Eastern Europe with Russia 16 percent, Africa 6 percent, Australia 3 percent, U.S. 33 percent and South America 8 percent. A 90 percent rise in human population in the poor countries, means that this explosion is also adding to rising CO2 levels. The photochemical smog, supersonic aircraft flights and uses of refrigerant gases are reducing the stratospheric ozone levels .This is along term effect, leading to an increase in the rates of cancer of skin and liver, cataracts and dermatitis.

Thus the multiplier effect of urban, industrial air pollution in poorer countries like India will have effects far beyond the national borders. The effect on health over the next 20 years will be more dramatic. Therefore, the control of air pollution should be given high priority.

Manu and Anshu, UEMRI-India

Abstracted from "Annual Survey of Environment 1997" The Hindu Newspaper.
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