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Chapter 12: The
Healthy Community: One for All, All for One
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Any man's death diminishes me, because I
am involved in Mankind; And therefore never send
to know for whom the bell tolls: it tolls for thee.
- John Donne
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No man is an island, and just keeping oneself healthy
is not enough. We all live in society, but most
of us still neglect the importance of ensuring healthy
surroundings, so that it's common to find a house
which is clean and sparkling inside, with all the
garbage tossed outside the door or window! However,
all of us pay the price for dirty and unhygienic
surroundings, as pernicious diseases such as cholera,
malaria , typhoid fever and asthma flourish under
filthy conditions. Ultimately, every locality needs
to take action to keep its environment clean, and
people need to realize that garbage and filth in
the neighborhood threatens them directly in their
own homes, through a proliferation of files, cockroaches
and mice. The need for preventive action outside
the home (using garbage bins, keeping public toilets
clean and keeping drains clear) is as important
as preventive action inside the home (washing hands
and feet thoroughly, washing vegetables properly,
storing food safely, sweeping and swabbing the floor).
It may be very difficult to organize the community,
but if you do not, you may have to pay the price
in the long run, by falling prey to a variety of
diseases.
The connection between health and cleanliness had
been recognized and respected even in ancient India.
In order to remain healthy, a community must ensure
the following:
- A regular supply of clean drinking water.
- Enough water for cleaning , bathing and washing
clothes as well as for flushing toilets.
- Safe garbage disposal.
- Safe sanitation facilities.
- Clean pure air to breathe.
Unfortunately, virtually all over India, especially
in the cities, the foregoing basic requirements
are becoming the exception rather than the norm.
While political action is needed to ensure that
the government supply these basic amenities, there
is little concerted action taken by most citizens,
with the result that the situation is likely to
deteriorate from bad to worse. Taking care of the
environment is a key part of remaining healthy,
and if the community is not healthy, it is difficult
for an individual to remain healthy.
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A promising recent development is the fact that
builders are realizing the importance of providing
a healthy environment and many of them are now developing
self-contained mini-townships, which provide all
basic amenities within their four walls. These townships
can be healthy places to live and bring up a family
in, since they provide several essential features
such as:
- lots of open space to play in;
- clubs and gymnasiums to remain fit and healthy;
- shopping arcades;
- food markets;
- chemists' shops;
- clinics and hospitals.
However, while the quality of life is excellent
for the residents of these townships, who form a
privileged minority, what about the rest of the
citizens? After all, if your domestic help and his/her
family are going to live amidst filth, it's likely
they will be afflicted by infectious diseases such
as tuberculosis and typhoid, which they could then
transmit to you and your family. In the final analysis,
this is a problem which affects all of us and we
simply cannot afford to turn a blind eye to it!
However, since it is a public health problem, we
are usually content to let the government tackle
it - which it fails to do in its usual characteristic
fashion!
By contrast, citizens in developed countries of
the world, have realized the menace of the problems
created by unhygienic conditions and have collected
together to lobby for change, in order to ensure
healthy living conditions for themselves and their
families. For example, environmental pollution affects
the health of everyone, and you cannot afford to
neglect the fact that the air you breathe is going
to contain more and more toxic matter as the days
roll by. Similarly, while it is the municipal corporation's
responsibility to provide us with clean drinking
water and to dispose off garbage hygienically, we
should also ensure that this job gets done!
The number of environmental health hazards is increasing
daily. All of us are paying the price for industrial
pollution. The 'litany of woes' is a long one! For
instance: pesticides in our food; pollutants in
the water; toxic fumes in the atmosphere; and harmful
hormones in the milk we give our children to drink.
We are bombarded by noise pollution daily which
can cause numerous health hazards, including headaches,
insomnia and hearing loss. People living in cities
spend over 80 per cent of their time indoors, and
indoor air pollutants can pose many health risks,
including an illness called the 'sick building syndrome'!
Occupational exposure to toxic chemicals is also
becoming increasingly common. However, the risk
of exposure to these chemicals is no longer restricted
to factory workers alone. The 1984 Bhopal gas tragedy
is an outstanding example of how thousands were
adversely affected because of the failure to implement
simple precautions, even though the factory from
which the deadly fumes emanated was dealing with
toxic chemicals. The Bhopal tragedy is replayed
almost daily on a much smaller scale in cities all
over India; for instance, when a tanker carrying
toxic chemicals overturns and releases its poisonous
load into the environment, or when manufacturing
units operating from residential areas spew out
toxic waste products.
Effects of other toxins may be more subtle and hormone
disrupters (such as industrial estrogenic chemicals)
have been shown to decrease sperm counts in men
all over the world ! Living safely in a polluted
world is no easy task, and is likely to become increasingly
difficult for our children, as these toxic accumulate
agents can in the environment over decades.
The prevalence of illness is increasing rapidly
in metropolises such as Mumbai and Delhi. This increase
can be attributed primarily to overpopulation, poor
sanitation and excessive pollution. Water- and food-borne
diseases are endemic, and these diarrhoeal diseases
have been the major killers, especially of children.
Also, respiratory diseases (such as asthma and bronchitis)
are beginning to pose an equally serious threat
to life because of increasing levels of air pollution.
Keeping in mind all the foregoing factors, we simply
cannot afford to continue to live in our own shells!
In the final analysis, health is a political matter,
and the types of illnesses found in society are
reflection of the nature of that society. Illnesses
do not hit all groups in society randomly and equally,
and just as wealth is unequally distributed in Indian
society, so is ill health. One of the best predictors
of a person's life expectancy is his annual income
and extensive research has proven that many illnesses
have their origins in social conditions. The difference
starts right from childhood, and poor nutrition
means that the children of the poor are shorter,
weaker, sicker and thinner than those of the rich
--- even at birth.
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Although an individual's life expectancy has increased,
the gap in life expectancy between the poor and
the rich has also continued to increase all over
the world. According to a survey of global health
by the World Health Organization, poverty was the
greatest underlying cause of disease, leaving many
with inadequate access to nutrition, drugs and basic
health care. Those living in poverty must focus
on survival priorities and often don't have the
time or the energy to prevent or treat illnesses,
until they are forced to . Leading a hand-to-mouth
existence means falling ill is a luxury they really
cannot afford! Unfortunately, many doctors and hospitals
fail to treat the poor as well as they would treat
the rich, so that many simply avoid doctors and
hospitals completely because of inferior care.
Political problems need political solutions, but
governments in India have done precious little for
providing health care for the common man. They make
grandiose plans for a primary health centre in each
village, but typically these PHCs have no medicines
or supplies, because they have been siphoned off.
They build expensive super speciality hospitals
in cities, but most of these just end up as a palace
of diseases, while the poor continue to die without
food and shelter.
In fact, the entire health care system is ill! It
concentrates on treating the sick, but does little
to prevent them from becoming so. In fact, the term
'health care' system, which takes care only of the
sick. It treats only individuals, but does not attack
the basic causes of illnesses, such as poverty and
illiteracy. Far from encouraging people to lead
healthy lives, our society encourages them to harm
themselves, and a prime example is cigarette smoking.
Unfortunately, profits come before people --- and
there are too many people making too much money
from tobacco, so that the tobacco industry continues
to spend billions a year encouraging people to smoke,
and the government allows them to do so. The question
is: what sort of society lets a small group of people
persuade the masses to engage in behavior which
might kill them --- and then provides medical care
to try to save them?
We still continue to take a piecemeal approach to
treating disease on a case-by-case basis, but this
approach is doomed to fail in the long run. Let's
take the example of bronchitis. At present, we treat
only those individuals who are suffering from the
disease. However, a social approach to treating
bronchitis would focus on removing those factors
in the environment which are known to cause or aggravate
bronchitis, such as air pollution, poor working
conditions, industrial pollution and cigarette smoking.
While the modern medical system is designed to look
after ill patients, we cannot improve the health
of our community without taking concerted political
action!
All political action, however, starts with an individual's
initiative. Doctors in India constantly complain
about the shortage of safe blood banks. Isn't this
state of affairs tragic in an overpopulated country
like India (where one would imagine that there would
be no shortage of people willing to donate blood).
When was the last time you donated blood? If we
do not develop a social conscience, we will not
be able to improve our community's health, and we
will all pay the price sooner than later.
A healthy community looks after the health of all
its members, including the underprivileged. It protects
the rights of the disabled and treats them respectfully
as individuals who are 'differently abled', and
also develops active programs for preventing and
treating drug abuse and alcohol abuse. Progressive
community also provide hotlines for suicide prevention
as well as counseling, so that people have someone
to reach out to and talk to.
So much for a vision of what a healthy society should
be. As an individual, what you can do to improve
your community's health is to participate actively
and to volunteer your services in various fields:
for example, as a guide in hospitals; to lobby against
polluting industries; or to care for older citizens.
Improving a community's health can be the entry
point for improving the quality of life for the
entire community! Remember, that by helping to improve
the health of the community, you are helping yourself
and your children!
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