WAR ON DISEASE

( By Radhika Ramasubban, Bhanwar Singh & Nigel Crook )

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Preface

In the perception of the common man or woman in a city like Bombay, the tem health care is just another name for doctors, hospital and medical stores, all of which are densely present and highly visible in the city. In the absence of any significant attempts at educating people about their environments and their bodies, the response of the majority of people to disease has been one of excessive recourse to drugs.

This is true of large sections of the middle class whose options to choose their living environments are increasingly restricted by the way the land market operates in Bombay. And, it is particularly true of the poor - comprising those living on footpaths, in chawls and hutments - who form nearly 70 per cent of Bombay’s population, and whose health is directly threatened by the insanitary and polluted environment and their own low levels of nutrition.

The most effective and lasting solution lies in people becoming the guardians of their own health. This requires building of their knowledge about the diseases they are most likely to come down with, the relationship between disease and the physical environment as well as nutrition, the nature of attempts required for preventing these common diseases, and the various factors that must be kept in mind when the disease has struck and the curative process is at work.

Our research efforts over the last few years have provided us with some insights into various aspects of the evolving public health situation in Bombay. Most of our research findings are published in scientific journals and other research documents. However, the majority of those on whom our research has focussed - three-fourths of the population of the city - remain untouched by the scientific literature. And their interest in these aspects is no less.

In a city where the general level of education is high, it is striking that health literacy is woefully low. Epidemiological ( the pattern of disease within the population ) and environmental details remain unknown even to most members of the middle class. And among households living in poor environments vulnerable to disease, where a large proportion have at last one member who has completed high school, such health information might serve to help them combat their vulnerability. The potential for health education and health action in the city, therefore, is high and encompasses almost every group in the population.

For those with economic security and professional backing, this book unravels the disease and environmental profile of their city, provides basic yet refreshing information on various health related aspects, delineates the imperatives of the cheek by jowl existence of slums and middle class housing, and charts the ground for collaborative action by different sections in the population.

It is targeted even more specifically for health and environmental education efforts by industrial establishments and trade unions, school teachers, paramedical workers in the public as well as voluntary sector, other categories of voluntary agency personnel, conscious and active members from within the community and the relatively literate members of households living in poor environments vulnerable to disease. In a nutshell, the book is of relevance to all those who are interested in understanding the health related aspects of life in Bombay , and all of them, we believe, have a crucial role in the protection of public health in the city.

The book represents a significant departure from most other health education books or pamphlets. It is urban focused recognising that, notwithstanding the appalling health conditions in the vast countryside, cities with their growing populations are trapped into seriously health degrading conditions, even if these conditions are mediated by a ubiquitous curative drug culture. The book is located in a single city - Bombay. We have used situations most commonly encountered by large sections of the city’s population, to introduce a health problem. But, as the reader will readily recognise, many of these problems could as well be relevant to other urban centres in the country.

Taking off from the fact that the health of the majority of Bombay’s population is threatened by the insanitary and polluted environment and by the prevailing low levels of nutrition, we have developed a dialogue between members of the community in order to go through the relevant arguments and to indicate potential catalysts for organised action. We have used boxed sections to convey factual information that arises from the dialogues. While the first ten chapters of the book consist of ten such stories, the eleventh chapter contains a descriptive account of the pattern and magnitude of disease in Bombay across localities and over time, as well as their relationship with income, occupation, sanitation and air pollution. This account goes on to link the main points emerging from the stories in terms of the knowledge , attitudes and practices that might hamper or facilitate the task of combating disease within the overall environmental, social and political situation in the city.

Throughout, the effort has been to provide factual information, highlight the complexity of the linkages within each situation and indicate possibilities, for both preventive and curative action. Each of our stories, therefore, has taken a somewhat complex form precisely because the situation itself is so, and no simplistic solutions or messages can be expected to cope with the problem of public health. Complex situations require complex responses. The relatively developed civic sense and greater spread of formal education in the city, even among slum dwellers, fortunately equip them to grasp this complexity. For, such an understanding is the first step in the battle for a better quality of life.

The book is being published simultaneously in English and Marathi

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