Mirg Summer Summary

8/6/2019 Mirg Summer Summary

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Introduction to elements of Public Health

First meeting on the topic: 9 th

June 2007


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P ublic HealthP ublic health is the science of protecting and improvingthe health of the communities through education,promotion of healthy lifestyles and research for diseases

and injury prevention . Thus the focus is on entirepopulations rather than on individuals.

P oor public health takes economic tolls in various ways:

prevention better than cure


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P ublic Health

Achievements of modern public health improved qualityof life. Attributed to vaccination programs, control of infectious

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

Vast discrepancy between Developing and Developed countries poverty being the main factor. Now the focus indeveloped countries is shifting towards chronic diseases such

as cancer, AIDS, diabetes and heart diseases but infectiousdiseases continue to haunt developing countries.

India has focused mainly on curative care and immunizationswhile public health services has been neglected


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P ublic Health in Independent

India Many problems reported in Monica Das Guptas 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, butis not adequately funded

P ublic health regulations are in place but oftenneglected.


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Y et Future Trends are

Encouraging Financing is available through large programs Rural healthmission, National sanitation mission and employmentguaranteed scheme.

Institutions are being built at local and national level.P anchayati Raj Act emphasizes on building local governmentand 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 thatpublic health systems have to be coordinated and supportedby a federal authority.

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


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Burden of disease in India


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B urden of disease in India

Measuring the Impact of disease- DALY S 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


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B urden of disease in India by DAL Y S

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

Communicable diseases: Acute respiratory infections (ARI, e.g. pneumonia) (18%) P erinatal illnesses (around childbirth) (17%) Diarrhoea (16%)

Tuberculosis (6%) HIV (4%) Malaria (3%)


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P ost-meeting notes

Need for affordable technologicaladvances

Key point is to speed up diagnosis andsubsequent treatment

List of useful sites posted on webpage


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Neonatal mortality reduction


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Neonatal mortality reduction

Status of infant and perinatal issues inrural India

Different kinds of traditional beliefs Efforts led by Abhay B ang, Gadchiroli

dist :- Village health workers educating the householdsabout safe procedures- Issues regarding traditional practices

Role of father in neonatal care, etc.


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O ther issues discussed

Helping make the perinatal period safer using simple household tools/remedies

Eg: Anoops demo of preparing disinfectantbleach using lime juice and baking soda

Monitor maternal and baby healthregularly Simple tool: possible design of paper tapes

for measuring size of mothers abdomen toestimate weight of baby.


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Malnutrition in India


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M alnutrition in India- statistics

Malnutrition consists of both protein-energy malnutrition (underweightetc.) and micronutrient deficiencies.

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

P revalence of underweight children is highest in the world , doubleof 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 andpoorer income groups.


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Indias 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 nutritioneducation to adult women, micronutrient supplements, pre-school

education, growth monitoring.

Anganwadi centers led by anganwadi workers in every administrative blockB y 2004 6lakhs AWC workers covered 33M children and 6M women

Very prevalent (covers 90% of administrative blocks in the country) buteffectiveness is under debate.

We studied various success stories of anganwadi centers and measures onhow they can be improved.


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Malaria


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P arasite in R B Cs


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Malaria in India

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


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Interventions

P reventing mosquito breeding Indoor spraying of insecticide Insecticide-treated bednets Larva-eating fish No vaccine available


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Water Supply, Sanitation, andP ublic 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


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Mumbai: B ackground

Largest metropolitan area inIndia, 5 th largest in the world

P opulation: ~20 million

About half of the populationlives in slums- urban poor


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Water Supply and Sanitation Govt. provides 3 billion liters/day

O nly 65% of the requirement is met Urban P oor

Get 1/3 rd 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 seweragesystems

B

ut most urban poor do not have access to it Less than 1/3 rd 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


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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 2/3 rd of all disease burden

( Short duration)(C hronic)


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Incidence of Water B orne

Diseases


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Conclusions

Higher incidence of water and sanitation related diseasein slum and pavement dweller areas

Environmental problems include location near pollutedsites, lack of sanitation, poor personal hygiene, poverty,

lack of environmental education

P avement dwellers suffer the most

P roblem lies in huge slum population, ~ 10 million

P rovide safe and adequate water and sanitation facilities


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T echnological ways to make water cleaner

- to prevent water-borne diseases


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B ackground

S tatistics , WH O : ~1b people do not have easyaccess to clean water.

B efore the goal of providing clean drinking water toeveryone materializes

local or household treatment of water may protectpeople from disease.


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Common methods of water purification

Disinfection using chlorineB oiling

Flocculation (e.g. alum) Filtration Solar/UV treatment.


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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

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