Wednesday, December 16, 1998

Threats to world health
By Bharat Dogra

• "Any epidemic anywhere must now be seen as a threat to virtually all countries, especially those that serve as major hubs of international travel.”
• “Doctors worldwide are losing some of the most useful and affordable antibiotics against the two bacteria which are the major causes of death in children.”
• “At least 333 million new cases of sexually transmitted diseases, other than HIV infection, occurred in 1995.”
• “More than 2 billion people alive today have been infected with Hepatitis B.”
• “Dengue affects more than 100 countries in all continents except Europe, and is spreading rapidly in many areas.”
• “The latest evidence suggests that incidence of plague is on the increase. During 1995, at least 1400 cases of human plague (including at least 50 deaths) were notified to WHO.”

These quotes from The World Health Report (WHR) 1996 indicate the extent of the threat to health at a world level despite all the advances in science and technology.

According to United Nations data, infections and parasitic diseases continue to kill 17 million people annually in developing countries, including 6.5 million from acute respiratory infections, 4.5 million from diarrhoeal diseases and 3.5 million from tuberculosis.

While smallpox has been eliminated and polio shows significant decline, large number of lives continue to be claimed by malaria (one million), neonatal tetanus (600000), whooping cough (360000) and measles (800000).

In a recent cover story on infectious diseases Time Magazine said that by now nearly every disease organism known to medicine has become resistant to at least one antibiotic, and several are immune to more than one. One of the most alarming things about the cholera epidemic that has recently killed as many as 50000 people in Rwandan refugee camps is that it involves a strain of bacteria that can’t be treated with standard antibiotics. Old diseases like tuberculosis are rapidly evolving forms that are resistant to antibiotics.

The WHR has warned: “We stand on the brink of a global crisis in infectious diseases. No country is safe from them.... The optimism of a relatively few years ago that many of these diseases could easily be brought under control has led to a fatal complacency among the international community. This complacency in now costing millions of lives — lives that we have the knowledge and the means to save, yet we are allowing to trickle through our fingers.

Further this report says: “Antibiotic resistance in hospitals worldwide threatens to leave medical and public health workers virtually helpless in the prevention or treatment of many infections. Many of the most powerful antibiotics have been rendered impotent. Disastrously, this is happening at a time when too few new drugs have been developed to replace those that have lost their effectiveness. In this contest for supremacy, the microbes are sprinting ahead,” various factors have combined, this report says, to create, “Perhaps the richest opportunities ever for the spread of infections.”

In particular, this report has focused attention on the threat of new emerging diseases — “During the past 20 years, at least 30 new diseases have emerged to threaten the health of hundreds of millions of people. For many of these diseases there is no treatment, cure or vaccine and the possibility of preventing or controlling them is limited.”

So far 30 million people have been infected with HIV. Every day 16000 new infections occur, according to latest UN data, (See Time: December 8, 1997).

The WHR warns, “Without doubt, diseases as yet unknown but with the potential to be the AIDS of tomorrow, lurk in the shadows.”

Hospitals are supposed to be a place for treatment, but in the USA alone nearly 2 million cases of infectious complications acquired in hospitals occur every year, including about 70000 related deaths. (WHR)

It is true that most countries have experienced at least some rise in life expectancy in recent decades but this has been accompanied generally by an increase in chronic health problems, physical as well as mental. In Britain, for instance, General Household Surveys in 1972 and 1988 revealed a 50 per cent increase in “long standing illness” and a 75 per cent increase in acute illness during the preceding two-weeks. In the same country during 1960-90 hospital admission for children suffering from asthma went up by 10 times.

Walter Yellowless, a highly experienced doctor of this country said in a paper read to the Royal College of General Practitioners:

“I believe it is true to say that is those countries which have achieved unparalleled advance in technological skill in medicine and in what is called the standard of living, we are witnessing the decay of man — the decay of his teeth, his arteries, his bowels and his joints on a colossal and unprecedented scale.”

While the proportion of elderly people is increasing rapidly in many countries; disability, disease and above all loneliness are denying happiness in old age to many of them. The available figures show that 41 per cent of elderly women live alone in Australia and Denmark. It has been estimated that at age 60 a third of population has some kind of disability. According to HDR 1993, only 20 per cent of the elderly people in developing countries have any form of income security. Time Magazine reported recently that even in the USA, “in possibly thousands of cases, nursing home (elderly) residents are dying from a lack of food and water and the most basic level of hygiene.”

An important cause of increasing health problems even in some of the richest countries is the heavy exposure to hazardous chemicals and pollutants.

According to Samuel Epstein, an authority on this subject “The volume of hazardous wastes disposed of every year in the USA has risen from under one million tons in 1940 to well over 300 million tons in the 1980s — more than one ton per U.S. citizen per year. The industries involved — fossil fuel, metal mining and processing, nuclear and petrochemical have littered the entire land mass of the U.S.A. with some 50,000 toxic waste landfills.”

The National Institute for Occupational Safety and Health in the USA has estimated that some ten million workers in this country are now exposed to 11 high-volume carcinogens. Five to tenfold increases in cancer rates have been demonstrated in some occupations.

According to estimates by WHO (1990) as many as 25 million agricultural workers in developing countries may be affected by occupational pesticide poisoning in a year.

Polychlorinated biphenyls (PCBs) which were later linked to cancers and birth defects had been earlier used not only in insecticide but even in kiss-proof lipstick.

Russell Train, former chief of the Environmental Protection Agency, USA said.

“There are today more than 30000 chemicals in actual commercial production. Every year, this list grows by some 1000 new compounds. Of the more than two million known chemicals, only a few thousand have been tested for carcinogenicity and-aside from those used in food additives, drugs and pesticides-only a few hundred have been adequately tested. We know, in fact, very little about the health effects even of the 30000 chemicals already in commercial production. We have no way of systematically screening the chemicals that go into production, we have no way of knowing precisely which chemicals go into production every year. in other words, we not only don’t know whether what’s going on out there is dangerous — we don’t even know what’s going on out there. We have, however, learned one thing: it’s what we don’t know that can really hurt us, even kill us.”

The London Food Commission said 3009 pesticides were approved for use in Britain in 1985 and that of their 426 basic ingredients, 164 have been implicated in causing cancer, reproductive effects ranging from impotence to birth defects, genetic mutations or irritant reactions.

Samuel Epstein has warned: “A lot of the cancer today reflects exposure in the 1950s and 1960s. The production, use and disposal of synthetic organic and other industrial carcinogens was then minuscule in terms of volume when compared to current levels, which will determine future cancer rates for younger populations now exposed. So there is every reason to anticipate that even today’s high cancer rates will be exceeded in coming decades.”

Several giant companies producing hazardous products such as chemicals, tobacco and above all armaments, have exerted strong-arm pressures to increase local sales and/or exports of their products. The result is that in the world as a whole, death from hazardous products is increasing at a fast pace.

Dr Richard Peto of the Cancer Studies Unit at Oxford University says: “In the 2020s there is going to be three million deaths a year in the rich countries alone from tobacco and seven million deaths a year in the poor countries.”

Dr David Werner, the internationally acclaimed health expert says, “Attempts have been made by non-government organisations, the UN and the governments of various countries to try to limit the damage caused by these powerful industries. But in the case of each and everyone of these killer industries, the US government has defended their interests at the expense of the health, quality of life, and often survival of millions.” (The same is true of the government of many other rich and powerful countries).

Another serious aspect of the profit motive being allowed to inflict serious harm is the extent to which the promotional campaigns of infant milk formulas have adversely affected breast feeding.

Studies have shown that in some poor countries the death rate from diarrhoea in babies who are bottle fed is up to 25 times higher than in babies who are breast fed. The United Nations has estimated that health problems associated with bottle feeding result in some one million infant deaths in developing countries each year.

The profit motive also plays havoc within the health industry, The new Internationalist (quoting “Which Way to Health”, June 1991) reported in January 1992:

“Surgeons in the US are usually paid on a fee-for-service or piece-rates basis. This is the land of private health care. Statistics show that people there are twice as likely to have operations as people in Britain, where there is still a National Health System and surgeons are paid simply a salary for doing their NHS work. American surgeons who are paid salaries have much lower operation rates than their fee-for-service colleagues.

“The connection between profit motive and unnecessary medical operations continues within the UK. Figures show that British women in private beds in NHS hospitals have more than twice as many caesarean births as those in the nonpaying beds. It could be that doctors have the financial incentive to operate. It could also be because some patients with private health insurance can claim for caesarean, but not for a normal delivery.”

Due to the domination of the profit motive in the medicine industry, many essential medicines are priced out of the reach of poor people while at the same time the market is flooded with several high-profit superficial medicines of dubious utility.

More generally, growing poverty, inequalities and exploitation in many parts of the world have contributed significantly to the worsening of the health situation.

Another major factor that has contributed to this is the debt-burden of the poor countries leading to transfer of resources from already poor countries to rich countries. Specially as a result of this, the overall health of people in the world deteriorated quite badly in the eighties. UNICEF has called this the decade of despair. During this decade the inequalities in poor as well as rich countries were growing, as also inequalities between poor and rich countries, increasing the burden on the poor. In the 37 poorest countries spending on health has been reduced by 50 per cent.

UNICEF has warned: “Great change is needed if a century of unprecedented progress is not to end in a decade of decline and despair for half of the nations of the world. In many countries poverty, child malnutrition, and ill health are advancing again after decades of steady retreat.”

(Bharat Dogra is a well-known crusader for “health for all”.)

Shield of immunisation

IMMUNISATION is the process of protecting the body against disease by means of vaccines or serums. Vaccines provide immunity by causing the body to manufacture substances called antibodies, which fight disease. Serums furnish immunity by adding antibodies directly to the blood.

There are two types of immunisation. Active immunisation involves the use of vaccines, and passive immunisation uses serums.

Active immunisation is another term for vaccination. A vaccine contains substances that stimulate the body's immune system to produce antibodies against a particular infectious disease. These antibodies protect the person if he or she becomes infected by the actual disease-causing organism.

Vaccines contain substances that are powerful enough to trigger antibody production but not so potent as to actually cause disease. Many vaccines consist of disease-causing bacteria or viruses that have been killed. Others consist of the live germs, but in a weakened form that does not cause the disease. Vaccines known as toxoids are made from poisons produced by disease-causing organisms. These poisons are chemically treated so that they provide immunity without causing disease. Still others are made from parts or products of disease-causing organisms. Another group of vaccines consists of live organisms that resemble a disease-causing one. These organisms provide immunity but do not cause diseases.

Effective vaccines have been developed against many diseases, including bubonic plague, cholera, diphtheria, German measles (rubella), influenza, measles, meningitis, mumps, pneumococcal pneumonia, poliomyelitis, rabies, tetanus, whooping cough, and yellow fever. Most vaccines must be injected into the body, but Sabin polio vaccine can be taken by mouth.

A single dose of some vaccines provides life-long protection against infection. Other vaccines require several doses to produce immunity and then must be reinforced at regular intervals with booster doses. Protection against German measles, measles, and mumps may be provided in one vaccine. Most vaccines begin to provide a person with immunity about two weeks after being administered.

Vaccines are safe and dependable, but they are not perfect. For example, up to 10 per cent of all the people who are vaccinated may not develop any immunity. In addition, vaccines occasionally produce harmful reactions. Sabin polio vaccine, for instance, may cause paralysis. This reaction occurs on an average of about 1 in every 2.7 million people who are immunised.

Passive immunisation involves the injection of serum into the body. A serum contains antibodies that have been formed in another person or an animal. It provides almost immediate protection from injection. However, this passive immunity lasts for only a few months because the antibodies gradually disappear. Doctors give serums to people who already have been exposed to such diseases as hepatitis, measles, rabies, and tetanus. Vaccines may work too slowly to help these patients. In addition, doctors use serums to protect people against diseases for which vaccines have not been developed.

Edward Jenner, a British doctor, introduced vaccination in 1796 as a preventive measure against smallpox. By the late 1970's, smallpox vaccination had wiped out the dreaded disease.

(Courtesy: Scott Fetzer Company, Sydney.)

Sacrifice or survival?

THE present population control policy favours technological interventions instead of examining the problem in its holistic perspective. In a desperate quest to meet the lofty targets set by the planners and decision-makers, bureaucrats rely on technology. The casualty of this approach is individual dignity and freedom, and the worst victims of this assault on human dignity are women. The government-sponsored sterilisation camps, which provide the medical bureaucracy an opportunity to fulfil these targets, present an atmosphere of deprivation and insensitivity, as the following extract from the attract from the article “whose sacrifice, whose survival?” by S.G. Kabra and Harsh Sethi indicates.

Official records discussed in the Rajasthan Assembly reveal that 44 women died in the course of family planning operations. This figures is likely to be a serious underestimate, not only because it is official, but because it does not account for casualties due to later complications. Though the minister concerned took great pains to argue that the death rate in Rajasthan was only1.1 per 10,000 cases as against a national average of 1.7, we would do well to remember that the acceptable death rate as per the World Health Organisation (WHO) is one per one lakh operations, making the Rajasthan figure 11 times higher than internationally acceptable figures.

Equally horrifying are the stories of Geeta Rawal, Suman Sethia and Manbhari, as reported in The Telegraph (May 24, 1998). Geeta was paralysed as a result of an incompetent tubectomy operation, and for the last one year has been in a Jaipur hospital. So too Suman, who has been battling for normalcy for the last two and a half years. These cases incidentally do not feature in the “honour roll” of 44. The same report reveals that in a camp at Madar, Ajmer district, Dr Padma Vachhani performed 140 operations in a single day! Need we say more?

In a sterilisation operation, the woman submits to a surgical procedure from which she does not stand to benefit healthwise. The operation is, however, justified on the grounds that the risks of pregnancy are greater than those of sterilisation. It is a moot point whether probability charts offer much succour to the individual who is at the receiving end.

Rarely is it realised that the person submitting herself to such an operation (which is not for a disease), motivated probably by her family, friends or more likely the inducements offered under the official programme is doing so to benefit society. She is thus worthy of the greatest care and respect from the medical establishment, and not, as is common in the case of a mishap, to probabilistic platitudes of ‘inevitable and unavoidable risks’.

Mass sterilisation camps end up resembling a slaughter house. Given the vast number of women who present themselves for sterilisation, the doctors are put under pressure to clear the numbers as fast as they arrive; everything scientific and safe is sacrificed in the interest of speed with an inevitable decline in standards as evidenced by the horrifying statistics that emanate from these camps.

— Source: “State of India’s Health”

(To be concluded)