Politics, paani puri & pollution — almost anything can hold our health hostage. A map of India's top malaisesThe northern and southern most states of the country are facing some trouble in their head and heart. Over 55 per cent of the population suffers from some form of mental trauma in Kashmir, owing to decades of political turmoil. In Chennai, the prevalence of Coronary Artery Disease — one of the leading causes of death globally — is 11 times higher today than it was in the 1960s. And there we have it. Though middle class, urban India growing at a phenomenal rate (in three years, there'll be 53.3 million such households), invests generously in the wellness industry — pegged at Rs 49,000 cr — the rampant lack of well-being in our cities is surprising. Mirror spoke to researchers, doctors and residents across India to examine this disconnect, and ask them a simple question — what ails us and why? The answers were wide-ranging. Some connections, such as that between oral cancer and tobacco were apparent, others like the one between air pollution and infertility we wouldn't have guessed. In each case, however, experts stressed that while solutions are at hand, implementation through improved healthcare facilities and individual care is needed.
This is not an exhaustive list. Conditions like HIV/AIDS, other forms of cancer, and genetic disorders like Thalassemia, haven't been included. It's not that they aren't significant, but instead point to the fact that we have much to be concerned about. As you read this, the 12th Five Year Plan, for 2012 to 2017 is being drafted. Volume 3 of the draft tackles health, and offers an overview of the current situation — 53% deaths are caused by non-communicable diseases like malignant cancers and diabetes, 37% are caused by communicable infections. The draft recommends that greater effort be made at involving the community in planning, monitoring and delivering health services. That's what we hope to do — after all, Mirror cares for both, the head and heart.
Maharashtra at risk: 25 people per one lakh Maharashtrians have oral cancer
Cause: Tobacco
Chewed up by cancer
Nine years ago, 47-year-old Kalyan resident Vijay Kumar Prasad, a seller of kitchen utensils, gave up tobacco. "I saw my friends do it, so I tried it, too. I travelled for business, and chewed tobacco for recreation. Before I knew it, I was addicted," he says. Two years after quitting, he was diagnosed with oral cancer. During a check-up at St George Hospital, the doctor suspected Prasad had cancer. A biopsy at Tata Memorial confirmed his suspicion. "Fate pulled a fast one on me. Har ek ka luck hota hai, mera kharab nikla," says Prasad.
He underwent a surgery which left the right side of his jaw permanently disfigured. He now struggles to eat and speak. A father of two young daughters, Prasad says awareness of tobacco's consequences must be drilled into the common man. "Pictures should be put up at every bus stop and railway station. Only then can we begin to think of tackling this menace."
According to data provided by registries of the Indian Cancer Society, India accounts for 86% of the world's oral cancer cases. A study conducted by the National Institute of Public Health in 2011 reveals that 90% of these cases are due to chewing tobacco in the form of gutka, quid, pan masala, snuff, or misri (in the West, smoking is the main cause). Oral cancer is the most common cancer in India — four in 10 cases of cancer are oral. In Maharashtra, it is showing an increasing trend. "Its incidence among the youth is increasing in the state, which has one of the highest incidences of tobacco consumption. Every third Maharashtrian and every second male does it. We also have the largest cigarette and bidi smoking population in the country, which is why it is not surprising that 25 people per one lakh Maharashtrians have oral cancer. The second biggest cause is supari which, though is a confirmed cancer-causing substance, is still considered acceptable in most social scenarios," says Dr Pankaj Chaturvedi, head and neck cancer surgeon of Tata Memorial Hospital.
Shravani Koyande, executive incharge of the Cancer Registry Division, ICS offers hard data. As of 2010, the incidence of oral cancer in Mumbai is 8.3 males and 3.8 females per one lakh.
Oncologist Dr Purvish Parikh says, "Maharashtra has the lowest taxes (12% for bidis and 20% for cigarettes) for tobacco products. In Rajasthan and Gujarat, it's 65%."
Sip of sewage
We may be facing one of the worst droughts in decades, but ironically, water borne illnesses are extremely common in the state. According to Dr Ambarish Shahade, former president of Indian Medical Association, jaundice, diarrhoea, dysentery, and Hepatitis A/E are on the rise in the backdrop of the current drought. "Due to scarcity, contaminated water is consumed. In urban areas however, one of the main causes is the accidental contact of sewage pipes with the drinking water pipelines as they're usually located close together." Dr D B Kadam, head of the medicine department, Sassoon Hospital, Pune, says travellers' diarrhoea is a common ailment, which affects people when they consume water while travelling. In cities, these ailments are primarily caused by consumption of sugarcane juice, kulfi or pani puri off unhygienic roadside stands.
Karnataka at risk: 1 crore floating population
Cause: Poor sanitation, overcrowding resulting in infectious diseases
From garden to garbage city
?Kumaraswamy Layout fringes the posher JP Nagar in South Bengaluru. It is here that 23-year-old Yaseen Anwer lives. An engineering student, Anwer was "fit as a fiddle" till last October when he felt feverish. "It was about 101.0 F," he recounts. "It appeared on and off for a week, mostly in the evenings."
Anwer was one among thousands afflicted by the dengue epidemic that swept through the country in 2012. In a written reply in the Rajya Sabha, Minister of State for Health Abu Haseem Khan Choudhary said that 2012 saw a hike of 97 % in the number of reported cases over 2011, and 34 % more deaths. In all, there were 37,000 cases in the country.
The dengue vector, Aedus aegypti is an urban mosquito that feeds almost exclusively on humans during day time. It breeds in small quantities of water found in trays kept underneath flowerpots and clogged drains — staples in urban centres. While Anwer's platelet count dropped to 38,000 in four days, dengue can also result in the debilitating Dengue Shock or Dengue Hemorrhagic Fever that leads to multiple organ failure in critical cases. It's part of a host of infectious diseases that ail Bengaluru — chikungunya, typhoid, viral hepatitis and gastroenteritis. Dr Sudarshan Ballal, Medical Director, Manipal Hospital, counts Infectious diseases as one of the top two urban maladies that afflict the city. In 2012, according to Bruhat Bangalore Mahanagara Palike (BBMP), gastroenteritis figured after dengue with 1301 cases — 118 cases lesser than the previous year. The year 2010 saw a swell in H1N1 with 2,042 cases, which abated to 532 cases in 2012. Between January to March, 2013, 178 dengue cases were reported in Karnataka, a figure that an official says is not indicative of the actual number of cases. A Manipal Hospital spokesperson said that private hospitals are under an obligation to report only to BBMP the cases that come to them, but the figure is "just a sliver of the actual toll". Dr Purnima Parathsarathy, Senior Consultant, Infectious Diseases, Apollo Hospitals, says infectious diseases remain "up there in our list" of urban maladies. A recent standoff between Mandur village and BBMP had resulted in garbage heaps, as surrounding villages refused BBMP permission to dump the trash in their vicinity.
Death jam
Dr Vaman Acharya, Chairman, Karnataka State Pollution Control Board, (KSPCB) admits Bengaluru follows New Delhi in the largest increasing number of vehicles. "Forty five lakh vehicles ply on our roads every day," he says. "If you go to any hospital's OPD here, 25-30 per cent are respiratory cases," says Rajiv Gandhi Institute of Chest Diseases Director Dr Buggi. "The various pollutants in the air act as slow killers. Most of the afflicted patients have acute manifestation of asthma and bronchitis," he adds. Bengaluru is also beset with unburned carbon particles, road dust and pollen. "Our roads are not meant for so many vehicles," says Dr Acharya. High rise buildings on either side of main roads prevent dispersal of the pollutants. Road dust, NOX and carbon particles remain in the air for a long time, and at 11 pm, the pollution is the maximum. Bangaluru dust is thick and black with heavy metals." The garden city now has just six trees per person (Baroda has 45).
Gujarat at risk: 70 lakh pre-diabetic patients
Cause: Diet, sedentary and high-stress lifestyle
Sweet revenge
Blame the sugar in the dal. The Gujarati's love for sweets is on its way to helping make it the diabetese capital of India. The state has the highest number of people suffering from 'borderline' diabetes in the country — nearly 70 lakh, according to vice-president Diabetes India, Bansi Saboo.
A three-phase nationwide study on diabetes by the Indian Council of Medical Research (ICMR) is currently on and will cover all states and union territories. Dr V Mohan, president of the Research Society for Study of Diabetes in India, says, "It is ongoing in Gujarat, but going by Ahmedabad's past record, it could well emerge as the diabetes capital of the country."
In fact, ICMR first studied the prevalence of the disease in major Indian cities in 1972. Even four decades ago, Ahmedabad was the only city with three per cent populace suffering from diabetes compared to other major Indian cities which registered two per cent cases. At present, with 50 lakh cases, Gujarat follows Tamil Nadu in the highest number of diabetics in the country.
What's more worrying is that the incidence is high among Gujarat's youth. Based on primary research, Mohan says, "The ratio of prevalence of diabetes in people above 20 years seems close to 20 per cent."
The target group has shifted from 45 years to young men and women in their 20s and 30s, confirms Dr Ramesh Goyal, diabetologist at Apollo Hospitals in Gandhinagar.
Cement and steel trader Amit Telreja is one of them. The 28-year resident of Motera stands 5'7" tall, and weighs 81 kg. "My grandmother is diabetic. When accompanying her on a check-up, I got my blood sugar checked too, and was surprised to see the results," says Telreja, who blames his sedentary lifestyle for the condition. "Considering there was a family history, I should have been more careful," he says. According to Dr Mohan, the Gujarati diet is high in calories, and includes ghee and sugar, rendering them more prone to the condition. Nikunj Chauhan, an MBA aspirant from Ghatlodia, was detected with diabetes at 19. "My weight suddenly plummeted from 55 kg to 35 kg. I was in the ICU for 20 days," he says. Surprisingly, Chauhan's family has no history of diabetes." Unfortunately, almost 73 per cent of diabetics are unable to make immediate changes in their lifestyle once detected with diabetes says Dr Goyal.
Tamil Nadu at risk: 30% of the 5mn population
Cause: Sedentary lifestyle, obesity, smoking, high levels of alcohol consumption
Chennai's blood is boiling
Twenty eight year-old software engineer Vinod (name changed) knew about hypertension — his businessman father had suffered from it for 20 years. A few months after his wedding, Vinod was in for a surprise. At a health camp organised in his office, he was told his blood pressure was 180/110 mmHg. According to the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure, BP of 140/90 mmHg indicates hypertension. Vinod cut out salt from his diet to lose his belly fat. He managed to bring down his BP to 160/95 mmHg before his doctor put him on antihypertensive medication. According to the Merck Manual of Medical Information, high BP may not manifest for several years until a vital organ is damaged, which is why is why it has earned the moniker 'silent killer'. The manual states, "Uncontrolled high blood pressure increases the risk of stroke, heart failure, heart attack and kidney damage". According to an ongoing Chennai Urban Population Study (CUPS), the prevalence of coronary artery disease (CAD) is 11 per cent in the city, 10 times higher than what it was in the 1960s. Hypertension is growing at an alarming rate in Chennai, says Dr V Mohan. Latest observations indicate that the general prevalence rate has gone up to 30 per cent. Not only is the age of detection decreasing, but the prevalence rate is increasing with age. In a population of 50 year olds, the prevalence of hypertension is half the population. For the younger lot, a sedentary lifestyle, which is related to obesity, stress, smoking and drinking, makes matters worse.
Kashmir at risk: 55% of population has suffered from psychiatric conditions
Cause: Two decades of political turmoil, human rights violations
A state in depression
The state of Jammu and Kashmir has borne witness to one of the worst conflicts and human rights violations in the past two decades. Yet, the discussion on the mental health of its residents is a relatively recent one. It is estimated that nearly one lakh people, mostly youth, have lost their lives in the conflict (however, according to government figures, the number is nearly half). Over 50,000 women have been widowed, and over 4,000 have disappeared (or abducted and perhaps killed by insurgents or security forces).
Recent data from the Government Psychiatric Diseases Hospital in Srinagar reveals that 15% of women suffer from stress and prolonged trauma, and 16% have Post Traumatic Stress Disorder (PTSD). In 2006, famous Kashmiri psychiatrist Dr Mushtaq Margoob conducted a study that found a jump in mental health cases since the 1990s, when insurgency began. The number of patients visiting the Psychiatric Diseases Hospital — the only government mental health hospital in Kashmir — reached one lakh in 2006, from 1,700 in 1989. One such case is that of 45-year-old Zarina, who has been Margoob's client for 16 years. "She was brought to the hospital in a critical condition. She had consumed 13 sleeping pills to end her life,'' he recalls. The trigger was the death of a relative, killed before her in a cross-fire between militants and security forces. According to Margoob, 88% Kashmiris who suffered psychological trauma used faith as the foremost tool to recuperate. This is just as well — the Mental Health Act of 1987 had made it obligatory for the state to create a mechanism for licensing and monitoring mental health care facilities. According to a study by international NGO Action Aid India in 2011, whatever care existed in the form of the mental hospital in Srinagar is inaccessible due to hazards involved in travel and stay.
Andhra Pradesh at risk: Women of reproductive age, exposed to plastics
Cause: Air, water, food pollution
Breathing infertility
Sex wasn't a pleasure for Hyderabad resident Manasa (name changed), who married at 22. Excrutiating pain during intercourse led her to a gynaecologist, who diagnosed her with endometriosis — a painful gynaecological condition in which the tissue that normally lines the inside of the uterus (endometrium) grows outside on the ovaries, bowel or the lining of the pelvis. This displaced tissue continues to act as it normally would — it thickens, breaks down and bleeds with each menstrual cycle. Because this displaced tissue has no way to exit the body, it is trapped, leading to cysts and scar tissue. The gynaecologist warned Manasa that endometriosis may lead to infertility if she didn't undergo a surgery immediately.
A study conducted in the twin cities of Hyderabad and Secunderabad by a team of doctors headed by Dr Roya Rozati, chief fertility specialist at the Maternal Health and Research Trust found that air, water and food pollution are the leading causes of infertility among men and women in the city. The study conducted in three city hospitals between 2005 and 2009 examined 640 persons and found that 15 per cent women suffered from infertility. Globally, at least 30 per cent women with infertility are diagnosed with endometriosis. In Hyderabad, over 70 per cent of women with infertility have it, say gynaecologists. In 2007 the Infertility Institute & Research Centre in Hyderabad screened 640 infertile couples in Hyderabad with no history of alcohol, smoking or any other addiction. The researchers were baffled by the exceptionally high incidence of endometriosis in the city — 13.1 per cent women had it. Presence of polycholrinated biphenyls (PCBs) and pthalate esters (found in plastics) in air, water and food was found to be the main culprit for increasing infertility among women.
Fuming!
Among the bouquet of urban health hazards, Hyderabadis are exposed to high levels of carcinogenic agent, benzene, in the air (8.4 million mega grams per cubic metre of air, where the permissible level is 5 mmg), besides dust and other pollutants. The Government Chest Hospital has recorded an increase of pulmonary diseases by 25 per cent annually. Sinus, asthma, allergies and acute respiratory diseases like bronchitis have become alarmingly common according to hospital superintendent Dr P Navanith Sagar Reddy. "Resistance has halved, particularly among the youth aged below 30 years. They drink alcohol, smoke and eat refined food. They travel long distances to reach their colleges or offices, exposing themselves to toxic air."
North, East at risk: 5 lakh sq km; population over 500 million
Cause: Ground water contamination, Ganga-Meghan-Brahmaputra plain, including Uttar Pradesh, Chhatisgarh, Jharkhand, Bihar, Paschimbanga, Assam, Manipur
Wear the toxic belt
In 2005, 22-year old Afruza Bibi of Khejurdanga in North 24 Parganas district married Manirul, a resident of Kaliyani in Deganga Block of the same district. A day later, she discovered lesions that covered her husband's body. Manirul explained to her that the disease was 'genetic'. What he didn't know — since he was diagnosed incorrectly — was that he was suffering from arsenic poisoning, having drunk contaminated water from the tube well for years. Manirul died four years later, leaving behind Afruza and a three-year-old son. The family's drinking water is contaminated with 300 micrograms per litre of arsenic. WHO and the Indian government stipulate a permissible limit of 10 micrograms. Investigations conducted by the School of Environmental Studies (SOES) of Jadavpur University, Kolkata, reveal that arsenic contamination is rife in the Gangetic-Meghan-Bhramaputra belt. Dr Dipankar Chakraborti, director (Research) SOES has collected data on this for over 25 years, ever since the first case of arsenic poisoning in Paschimbanga was diagnosed in 1982, by Dr K C Saha of the Institute of Tropical Medicine in Kolkata. The SOES screened 1.10 lakh people in the state over the past 15 years and found lesions, of the sort Manirul had, in 10%. "The remaining — around 90% of the population — had arsenic in hair, nail, and urine in quantities that are much higher than the permissible limit. So, several people are sub-clinically affected," he says. In another study, Bhaskar Das of SOES studied samples from 5,042 hand tube-wells from all the 141 wards in Kolkata, and found areas where arsenic concentration was more than 50 micrograms/litre. "Arsenic contamination at ground water-level is a rural and urban phenomenon, found in 13 districts. Kolkata and several urban centres are sitting on an arsenic bombshell," says Dr Chakraborti. Arsenic enters the human body through ingestion, inhalation, or skin absorption. It gets distributed to the lungs, liver, spleen, kidney and skin, causing cardiovascular, hematological (anemia), hepatic, renal, dermal and neurological problems, besides asthmatic bronchitis and cancer. Arsenic has been washing away from the Himalayas as sediment with Ganga water, sinking in and mixing with groundwater. After 1970, indiscriminate drawing of groundwater resulted in water table sinking and increasing arsenic content.
(With inputs from Mrunmayi Ainapure, Jayanthi Madhukar, Kuldeep Tiwari, Anil Raina, Pavan Kumar, Jayatri Nag)
