Chapter 12: The Healthy Community: One for All, All for One

Any mans 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

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.

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:

1. lots of open space to play in;
2. clubs and gymnasiums to remain fit and healthy;
3. shopping arcades;
4. food markets;
5. chemists shops;
6. 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, its 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!

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.

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 persons 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.

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.

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. Lets 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!

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 communitys 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 communitys 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!