Introduction to elements of Public Health

First meeting on the topic: 9th June 2007

Public Health

• Public health is the science of protecting and improving the health of the communities through education, promotion of healthy lifestyles and research for diseases and injury prevention. Thus the focus is on entire populations rather than on individuals.

• Poor public health takes economic tolls in various ways: prevention better than cure

Public Health

• Achievements of modern public health – improved quality of life. – Attributed to vaccination programs, control of infectious

diseases, better safety policies, improved family planning, fluoridation of drinking water and programs to decrease heart diseases and stroke.

• Vast discrepancy between Developing and Developed countries – poverty being the main factor. Now the focus in developed countries is shifting towards chronic diseases such as cancer, AIDS, diabetes and heart diseases but infectious diseases continue to haunt developing countries.

• India has focused mainly on curative care and immunizations while public health services has been neglected

Public Health in Independent India

• Many problems reported in Monica Das Gupta’s paper.

• In Independent India the capacity to prevent outbreaks has reduced.– the focus was more developing heavy industry rather

than health and education.

• Public health is the responsibility of the state in India, but is not adequately funded

• Public health regulations are in place but often neglected.

Yet Future Trends are Encouraging

• Financing is available through large programs – Rural health mission, National sanitation mission and employment guaranteed scheme.

• Institutions are being built at local and national level. Panchayati Raj Act emphasizes on building local government and delegates health activities to them.

• A new thrust to build an institution like the US Center of disease control (adapted in China and EU). It recognizes that public health systems have to be coordinated and supported by a federal authority.

• India has an exceptional capacity to deliver services (ex: Elections, Censuses)

Burden of disease in India

Burden of disease in India

• Measuring the Impact of disease - DALYS – disability adjusted life years - Impact of diseases in India

• How to proceed further (as a group) - Disease specific, group specific, work specific - Anoop to lead subsequent discussion on infant diseases and intervention

• Education as means of help in public health - suggested by Manas, eg. Indradhanush magazine

Burden of disease in India by DALYS

• Non-communicable diseases:– Cardiovascular diseases (31%)– Mental illnesses (26%)– Cancer (10%)

• Communicable diseases: – Acute respiratory infections (ARI, e.g. pneumonia) (18%)– Perinatal illnesses (around childbirth) (17%)– Diarrhoea (16%)– Tuberculosis (6%) – HIV (4%)– Malaria (3%)

Post-meeting notes

• Need for affordable technological advances

• Key point is to speed up diagnosis and subsequent treatment

• List of useful sites posted on webpage

Neonatal mortality reduction

Neonatal mortality reduction

• Status of infant and perinatal issues in rural India

• Different kinds of traditional beliefs• Efforts led by Abhay Bang, Gadchiroli

dist : - Village health workers educating the households

about safe procedures - Issues regarding traditional practices

• Role of father in neonatal care, etc.

Other issues discussed

• Helping make the perinatal period safer using simple household tools/remedies– Eg: Anoop’s demo of preparing disinfectant

bleach using lime juice and baking soda

• Monitor maternal and baby health regularly – Simple tool: possible design of paper tapes

for measuring size of mother’s abdomen to estimate weight of baby.

Malnutrition in India

Malnutrition in India - statistics

• Malnutrition consists of both protein-energy malnutrition (underweight etc.) and micronutrient deficiencies.

• Cause of half of all child deaths, and more than half of deaths due to major diseases (malaria, diarrhea, pneumonia, measles) in India.

• Prevalence of underweight children is highest in the world, double of sub-Saharan Africa.

• More than a third of undernourished kids of the world live in India.

• More prevalent in rural areas, among girls, backward classes and poorer income groups.

India’s solution - ICDS (Integrated Child Development Services)

• World's largest early child development program

• Uses a multi-sectoral approach of provising healthcare as well as pre-school

education to children and mothers.

• Supplementary feeding, immunization, health checkups, health and nutrition

education to adult women, micronutrient supplements, pre-school education,

growth monitoring.

• Anganwadi centers led by anganwadi workers in every administrative block

• By 2004 6lakhs AWC workers covered 33M children and 6M women

• Very prevalent (covers 90% of administrative blocks in the country) but

effectiveness is under debate.

• We studied various success stories of anganwadi centers and measures on

how they can be improved.

Malaria

Malaria Cycle

Parasite in RBCs

Distribution of Malaria

Sachs & Malaney, Nature 2002

Malaria in India

Dr VP Sharma: http://www.pitt.edu/~super1/lecture/lec17341/001.htm

Interventions

• Preventing mosquito breeding

• Indoor spraying of insecticide

• Insecticide-treated bednets

• Larva-eating fish

• No vaccine available

Water Supply, Sanitation, and Public Health in Mumbai

Source: Field Survey on water supply, sanitation and associated health impacts in urban poor communities- a case from Mumbai City, India.

S. Kumar Karan & H. Harada, Water Science & Technology, 2002

Mumbai: Background

• Largest metropolitan area in India, 5th largest in the world

• Population: ~20 million

• About half of the population lives in slums- “urban poor”

Water Supply and Sanitation

• Govt. provides 3 billion liters/day• Only 65% of the requirement is met• Urban Poor

– Get 1/3rd the supply compared to the rest (45 liters per capita per day)

– US- ~260 liters/c.d. household consumption

• 90% of city and 40-50% of suburbs have sewerage systems– But most urban poor do not have access to it– Less than 1/3rd the requirement for public toilets is met– 90% waste water (2.2 billion l/d) is collected

• 0.1 billion is treated• 1 billion to oceans• Rest in creeks/waterways

Impact on Health

• 35-45% families in slums, >50% among pavement dwellers have at least one person ill

• Water-related diseases (diarrhea, malaria, typhoid, etc.) account for 26-32% of all diseases

• Children share 2/3rd of all disease burden

(Short duration)(Chronic)

Incidence of Water Borne Diseases

Conclusions

• Higher incidence of water and sanitation related disease in

slum and pavement dweller areas

• Environmental problems include location near polluted

sites, lack of sanitation, poor personal hygiene, poverty,

lack of environmental education

• Pavement dwellers suffer the most

• Problem lies in huge slum population, ~ 10 million

• Provide safe and adequate water and sanitation facilities

Technological ways to make water cleaner - to prevent water-borne diseases

Background

• Statistics, WHO : ~1b people do not have easy access to clean water.

• Before the goal of providing clean drinking water to everyone materializes

local or household treatment of water may protect people from disease.

Common methods of water purification

• Disinfection using chlorine

• Boiling

• Flocculation (e.g. alum)

• Filtration

• Solar/UV treatment.

Group discussed about• Techniques of different methods.

• Socio-economic obstacles on their implementation

– Cost and availability

– Ignorance and lack of belief in the benefits of water treatment

– More important concerns than purity of drinking water