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[hif-net] Poverty, equity and health research (5)

Thanks for the initiative. It is much needed area to deliberate upon. Many
things are going wrong, in my opinion as far as the efforts of
making the world a healthier world is concerned. Some of the thoughts are
appended below: -

1. Let us consider the environment. Is it for everyone? Humans have 'human
rights', but does animal world has rights? And what about 'environmental
rights', or rights of the environment. Only because environment cannot
speak for itself it cannot be left to be exploited as one feels or
perceives. Even in the human world do all have equal opportunity to draw
from the resources of nature? As is well known living being is a
combination of cosmic energy & body or the mass from the resources of
nature-water, air, elements, chemicals, salts etc. Upon death cosmic
energy flows to the Almighty, and the rest to the nature. But we tend to
own the resources of nature, and thus influence the future generations.
The point is that we have to stop and think of more logical concepts of
sustainability from the presently usual connotation - 'Sustainable
development'; because in the fold of Sustainable Development' one has to
accept environmental damage or degradation caused due to industrial
activity, and industrial activity has been one most important single cause
of environmental degradation. So in other words the civilization of today
has to endure effects of consumerism, changing life style, and industrial
activity (so called development) in order to be there tomorrow in a world
where environment would still provide sustenance. Does not it appear
contradictory! As we know and understand industrial activity can it be
without exploitation of nature, and therefore sustainability and
development appear contradictory. Mind you the resources of nature is
finite whereas the population (unchecked) and the desire of the man
remains infinite. The world has witnessed the adverse effects on
environment and human & animal health of industrial activity driven
'development'. Instead the concept should change to 'Sustainable
Existence' which would make better sense.

2. Health inequality. There are many strata of population suffering with
health inequality. Reasons are many, such as non-accessibility of medical
help, lack of quality health services within reach of all, geographical
limitations in form of difficult & inaccessible terrain, economic reasons,
and a host of other reasons. Economic and gender bias are two most
important reasons for health inequality, and both these are more
pronounced in the developing world. In India, public sector health care
facilities are becoming extinct gradually but surely, and giving way to
private health care facilities. No doubt private health care facilities
may promise to offer better health care but fact remains that even now
60-70 % Indian population live in rural segment, are poor, and cannot
afford private health care, or for that matter universal insurance.
Moreover private health care facilities are concentrated in the urban
areas, and are profit oriented. Primary health care with all its laudable
aims have failed to provide quality health care. Prevention (which to my
mind is the essence of medical practice) has taken a back seat.
Immunization campaigns, to my thinking cannot be considered a preventive
measure since resorting to mass immunization existence of mutated variants
have been recognized. Point is that we must strive to create situations
where parasitic, bacterial, and viral overload does not take place in the
environment. AIDS virus is a mutated variant which has surfaced and now
threatens the survival of many, and now we are spending billions
(resources of the society) to combat the scourge, and trying to develop
vaccines against it, against which in all likelihood there will be
development of resistant strains. But how much is being done to ensure
proper disposal of infected or infectious waste in the blood banks, and in
the community of injectable drug users? Most of the resources are directed
towards safe sex practices which may be more difficult to achieve. Take
malaria for example. Lot of resources are committed to treating the
manifest cases, but not much of resources are directed towards improving
the public health engineering systems. Mosquitoes and the parasite in its
determination for survival have demonstrated that it can develop
resistance to many chemicals, and indeed so has been the story of fight
against malaria but to develop situations where mosquito breeding is
minimized takes a back seat at the time of allocation of resources.
Similar is the case with viral hepatitis (HBV). Not much is being done to
improve sanitary conditions in rural & urban areas. Time and again reason
of an outbreak has been the mixing of sewage with drinking water but
greater emphasis and resources are directed towards treating the manifest
cases, and research to discover more & effective vaccines. And in all
these situations-be it epidemic, or water scarcity, or natural calamity;
it is the weaker sections of the society who bear the brunt. Some times I
feel that prevention & curative aspects of medical practice run contrary
to each other. Even the development indicators which are based on economic
parameters may have to be redefined to include social development
(educational, health parameters, declining crime rate, and measures to
bridge the wide gap in the wages etc in a society) in its ambit, and new
development determinant tools may have to be fabricated.

3. Research & Development. Environmental pollutants are of four types.
Physical, Chemical, Biological, and Radiological. All these have effects
on human health. A lot of research is being done in the areas of
environment but not much visible research is being done in the area of
impact of environmental pollutants on the human health, not at least in
the developing world. We are more concerned with R&D on manifest diseases,
and in the area of clinical medicine. I am not suggesting that it is not
important but a lot of efforts are required to find a base line data
regarding impact of environmental pollutants on the human health.
Legislative framework further complicates the issue. All rules
and legislation fall within the purview of environmental laws, and
therefore at times concern for human and animal health gets lower
priority. Multiplicity of regulating agencies (which is the case in most
of the developing countries) create confusion leading to non-compliance
and non-performance. Many very genuine efforts fail to achieve the desired
result due to lack of systematic approach keeping the local conditions,
traditions, and compulsions in mind; to a problem in the
developing countries, and in some cases even in the developed world. Take
for example waste management-MAW or BMW. Handling of both are far from
satisfactory, and is not giving results commensurate with the effort or
allocation of resources. there is a lack of concept of 'system
application', and singular regulatory, and advisory authority. When we
have to take in reckoning uneducated and poor masses we have to act like a
mother who disciplines a child, and at the same time teaches the
lessons required for survival, and tries to remove hurdles in the living
activity of a child. A lot of research is required to develop effective
systems, be it in the area of regulations or in the areas of system
application.

Main purpose of posting this is to draw discussion. I would welcome
comments/suggestions.

Dr ELK Verma
New Delhi, India

[HIF-net profile: L K Verma is a retired health professional based at
Delhi, India. He has been working in the area of hospital waste management
for the last 5-6 years. He is currently working as a consultant to
WHO-SEARO for developing a training programme in hospital waste
management. laljeeverma@vsnl.net ]

HIF-net: working together to improve access to reliable information for healthcare providers in developing and transitional countries. Send list messages to <hif-net@dgroups.org>. To join or leave the list, send an email to <hif-net@dgroups.org>. If joining, please include name, organization, country, and brief description of professional interests. Archive at: http://www.dgroups.org/groups/HIF-net/

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