| 26 March 2003 | Wednesday | 22 Muharram 1424 |
Welcome to a generous selection of articles from DAWN's Health section.
This page is updated every Wednesday.
Maintaining an ecological balance
Can Pakistan meet WSSD deadlines?
Environment Update
Health in the modern era is both a sensitive as well as a complex issue. Once only in the hands of physicians, healthcare now involves the crucial role of socio-economic agencies and political setups.
It should be understood that the health of a nation depends not simply on the provision of doctors, hospitals and sophisticated equipment. It depends on the existence of basic health concepts, not only in the minds of individuals but also in the mind of those who frame policies and enjoy the power of implementation.
It is most regrettable that while we are opening new hospitals and introducing state of the art technology, and human expertise. We are doing nothing about the pitiful state of public health in Pakistan. So much so, that people have in fact forgotten what public health means and what is the scope of public health measures in the overall well-being of the society.
One of the basic aspects of public health is the formation and implementation of rules and regulations governing the production, preparation and sale of eatables under hygienic environments. And that too with due medical specifications.
It is a fact that in the pre-47 era, municipal and cantonment authorities had established proper slaughter houses. There were specially designed separate markets for the sale of meat, vegetables and fruits. These markets were regularly inspected and had a certain standard of hygiene.
Half a century one, these slaughter houses and markets still exist. However, most of them are now in bad shape. This is because the basic public health facilities have not yet been introduced in the new urban settlements both in terms of quantity as well as quality.
During the first martial law, in the late-50s, strict measures related to cleanliness and provision of hygienic facilities in food shops, tea bars and restaurants were introduced.
The campaign resulted in measures such as netted windows and doors, exhaust fans, provision of water and sewerage lines, clean utensils and crockery. Though this culture prevailed for a while but it died as there was no subsequent monitoring or consistency in government policies.
Four decades later, the public health status of the nation has only deteriorated and is one of the worst in the world. In a city like Karachi, one can find meat shops selling uncovered and exposed meat, exposed to all sorts of flies and diseases.
Restaurants and tea-shops are located in filthy environments. The man-power involved work in the most unhygienic of conditions. They are not governed (at least in practice) by any regulatory law or system of monitoring. The health of the waiters may also be in a questionable state.
Water supply which is a fundamental necessity is only available to a minority of population. Drinking water is often polluted at various steps of its supply. There is no consistent monitoring of water purification plants and the whole system operates on a casual and short-term basis.
Polluted water supply is the main source of communicable infections which are mostly water borne. In addition to infective diseases, unhygienic and chemically unbalanced water supply causes endocrine disease, especially in children. A classical example is iodine deficient water supply. This results in endemic goitre (often associated with thyroid hormone disorders).
Endemic goitre is very common in Northern Areas of Pakistan and the Hazara division of NWFP. Fluoride deficient water leads to dental diseases in children. Appropriate proportion of sodium, potassium, iodine, fluoride and manganese in the water is essential for normal growth of children.
Factories, workshops and stores, exist within crowded residential areas in all major towns and cities of Pakistan. They are the source of all sorts of environmental pollution and chemical hazards. Most of these factories do not even have any license or registration.
The state has a responsibility to help the community maintain standards of health and avoid the avoidable diseases. Restaurants, hotels, schools, jails, factories, offices and other places where a large number of people live or spend substantial time along with others, provide ample opportunities for the spread of certain diseases. A classical example is tuberculosis (TB).
There exits no system in place to monitor these places or provide the basic know how of healthy living to those who are exposed to diseases. These measures do not cost much but can identify people at risk and teach them how to protect themselves. Routine medical checkups, of people directly involved with the food process, needs to be enforced to stop the spread of disease from the infected or carrier subjects to healthy individuals.
Certain professions are specially prone to the spread of communicable diseases. These include barbers, cooks, bakers, sweet merchants etc. A single baseline medical checkup of these individuals can unmask a number of diseases. Their timely treatment will not only save the lives of these poor bread earners, but will also protect those who are in contact with them.
In short, the pitiful state of public health in the country cannot ensure the spread of disease in the community. In the complete absence of any monitoring, check and balance and preventive measure, our people are living at the mercy of nature. It is time that various governmental agencies working at different level sense a wakeup call and realize their responsibilities towards the public health of the society.
We as a poor nation cannot bear the exuberant expenses of treatment and hospital expenses. The best and only option for us is to minimize our socio-economic miseries by adopting a healthy lifestyle and by preventing the preventable diseases. Regulatory authorities do exist at various administrative levels. Unfortunately, they do not live up to their responsibilities.
The public's perception of health revolves round therapeutic modalities only. The masses are unaware of the role played by simple ways and means in disease prevention. They are ignorant of the potential of public health measures.
It is simply a shame that a country like ours, with reasonable resources and infrastructure has one of the poorest public health standards in the world. The medical profession, media and governmental agencies have to act in an integrated way to change this appalling situation. In this regard, the following proposals have to be considered.
* The responsibilities of public health be handed over to the district Government, with appropriate funding and tax generating powers. The provincial governments, should act as monitoring and regulatory authorities.
* Public health as a subject should be taught at all levels of education. Graduates in this field should be given appropriate jobs in various government departments. Each medical college should have a chair of public health.
* Existing public health laws should be strictly enforced and new laws made to achieve the objective of public health in various areas of trade and commerce.
* Specified areas should be allocated for vegetable, meat, poultry and fish markets. These markets should have some basic criteria of ventilation, cleanliness, sewerage and waste disposable.
* All involved in food processing, cooking and distribution, like cooks, bakers, hallwais, must have periodic medical checkup and should have a certificate of freedom from major communicable diseases.
* All trades and professions which have a bearing on the public health should be registered with relevant bodies. Their registration should be subject to review and not on an indefinite basis.
* Industries that are a source of noise, pollution and chemical waste should be away from residential areas. Most inner-cities have such numerous factories in crowded residential areas, jeoparadizing the health of entire vicinity.
* If the nation spends just 10 per cent of its expenditure, on drugs and hospitals, in public health, we can get rid of communicable disease and various other ailments.
What we are doing in the health sector goes totally to waste in the absence of common sense public health measures. City district government of Karachi and Lahore, with sizable human and financial resources should adopt a comprehensive public health policy. This will act as a model for other cities, towns and tehsils to follow.
If we fail to evolve a rational public health system in the country, the huge burden of communicable disease will remain our liability in addition to the diseases of modern age such as heart diseases, strokes, diabetes and psychiatric illness.
Maintaining an ecological balance
Najam Khurshid is a wetland expert and author of many research papers, including Pakistan's first Wetland Action Plan. He is a limnologist (fresh water biologist) and has vast experience in bird conservation. He has a professional knowledge of wetlands and the condition of fresh water resources around the world, and has some radical ideas about managing such resources in Pakistan.
According to him, the available fresh water per capita is decreasing at an alarming rate. The global population has tripled in the last number of years. This has put a lot of pressure water resources, withdrawals from where have increased six times due to rapid urbanization. Growing dependence on irrigated agriculture and rising standards of living have worsened the existing situation.
To a question if enough water was available for all of world's people, he said, "On the global scale yes. As the world is currently using nearly 20 per cent of the water available in the world's rivers (not counting the floods)". However, he conceded that the situation varies from region to region. As in some arid regions, as much as 95 per cent of available water is already being used.
"There is clearly not enough water in the right places. At the same time, around 1.7 billion people live in water scarce areas and at least 1.1 billion people don't have access to safe drinking water
"Nearly three million die, many of them women and children, every year, due to disease borne by contaminated water. So improving water quality is also an equally challenging issue."
He contests that wetlands play an important role in the water cycle by capturing, holding rainfall, water from the melting snow; retaining sediments and purifying water in the process. Despite this fact, nearly 50 per cent of the wetlands were destroyed or disturbed during the last century. This has significantly fragmented and altered water flow in 60 per cent of the world's rivers - often compromising many of the valuable ecosystem functions upon which we depend.
Najam continues, "We have destroyed a large number of wetlands to make way for agriculture and placed increasing demands on freshwater. Agriculture now claims roughly around 70 per cent of the global freshwater withdrawals. We have further put additional pressure on the remaining wetlands through the high level of nitrogen, phosphorous, pesticides and sediment loads in surface and ground waters from agricultural activities."
Another cause of concern for Najam is the that in developing countries, nearly 90 to 95 per cent of the municipal sewage is dumped untreated into the water systems. The net result is a serious reduction in both freshwater quantity and quality. And the situation is bound to deteriorate as the global is set to increase by 1.7 billion in the coming 20 years. It is also projected that a majority of them will live in developing countries. This will put a lot of pressure on these countries as they will have to produce more grain, livestock and fish, all this from an already limited water supply.
"It is generally agreed today that the answer to providing more food from agriculture lies not in expanding agricultural areas, that require yet more water. But in becoming more efficient with what we have - producing more "crop per drop" of water.
"Technological advances such as double cropping, improved plant breeding, irrigation efficiency and rainwater harvesting techniques, among others, all offer some hope of increased production in agricultural systems."
Najam continues, "Freshwater allocations have become a challenging issue for the government in its search for that elusive balance between the agricultural, industrial and domestic demands for water. At the same time it has to realize that wetlands need water if they are to maintain their structure and function. And this includes our coastal wetlands and mangrove ecosystems. If they are to continue to deliver services and contribute to sustainable life styles, they too need to be allocated freshwater, as a top priority."
Till now, in many countries wetlands are only conserved from the point of view of being a habitat of waterbirds, migratory as well as resident. And the conservation laws are also based on these lines.
"However, we now have to think in broader terms and adopt ecosystem approach instead of single species conservation. A lot of work has to be done, laws have to be revised, new laws have to be formulated and fresh conservation strategies are to be devised and programmes are to be made according to new improved and broader visions.
"For example we should adopt the river basin management approach and also make plans for the conservation of high altitude wetlands and glaciers."
However, he acknowledges that it is not an easy task as partnerships at all levels and with all the users and stockholders of freshwater will have to be formed. Conservationists will have to be included from the planning stages in water management and controlling departments like the irrigation department, Wapda and other related agencies, in freshwater related planning and management.
"At present, a lot of water is being lost due to seepage from extensive irrigation network comprising canals, distributaries which on one hand lead to loss of already scarce water and on the other raise the water table in the vicinity. This affects the yield and the land also falls victim to water logging.
"The water distribution system needs to be improved, which will cost much lesser than constructing a new reservoir. The water will be saved and there would be no land degradation."
Najam suggests that there is a need to revive the present practices of charging subsidized rates or fixed electricity bills for agricultural land. He contends that Pakistan is situated in an arid region and that we should take all the possible measures to save our fresh water. For that we need to change our agricultural practices and adopt new water efficient methods.
"I known it's not an easy task but someone has to initiate it. Our farmers should be aware of how much water is needed for a particular crop. There are many ways which can be adopted and through them we can save our fresh water resources. It would have a multi-dimensional effect and less water will be sucked from the subsoil aquifer."
In the end, Najam concludes that tube wells be avoided in arid or water scarce areas like Balochistan, where the ancient and more efficient Karez system of irrigation should be restored and improved. Small catchment dams need to be constructed so that rainwater could be used more efficiently for recharge of the subsoil aquifer and wells.
Najam is hopeful that people will realize the importance of wetlands/freshwater and their related ecosystem. There will be consideration and planning on every aspect to have a better future.
Can Pakistan meet WSSD deadlines?
The World Summit on Sustainable Development (WSSD) was held in the South African city of Johannesburg from August 26 to September 4, 2002. Attended by 104 heads of state and government, and 5,700 delegates, the summit set some tough deadlines for Pakistan to fight poverty and protect the environment. It is to be seen whether or Pakistan can meet these deadlines.
These deadlines included the following:
* Halve by 2015 the proportion of people who earn less than $1 a day and the proportion of people who face hunger.
* By 2020, achieve a significant improvement in the lives of slum dwellers. Halve, by 2015 the proportion of people without access to safe drinking water and the proportion of people without access to basic sanitation.
* Encourage and promote the development of a 10-year framework of programmes to accelerate the shift towards sustainable consumption and production.
* Diversify energy supply and substantially increase the global share of renewable energy sources in order to increase its contribution to total energy supply.
* Develop integrated water resources management and water efficiency plans by 2005.
* Facilitate implementation of the Montreal Protocol on Substances that Deplete the Ozone Layer by ensuring adequate replenishment of its fund by 2003/2005.
* Achieve by 2010 a significant reduction in the current rate of loss of biological diversity.
* Actively promote corporate responsibility and accountability through development and effective implementation of intergovernmental agreements and measures, international initiatives and public-private partnerships, and appropriate national regulations.
* Enhance health education with the objective of achieving improved health literacy on a global basis by 2010. Reduce, by 2015, mortality rates for infants and children under five by two-thirds, and maternal mortality rates by three quarters.
* Reduce HIV prevalence among young men and women aged 15-24 by 25 per cent, by 2005 as well as combat malaria, tuberculosis and other diseases.
Though these deadlines look impressive on paper, but the question to ask here is, could a socially, morally, and economically bankrupt Pakistan meet them?
It looks impossible prima facie.
Pakistan is one of the few countries that has a National Conservation Strategy (NCS). Its NCS was widely hailed at the Earth Summit (1992) for its scope and formulation process, thus including Pakistan in the list of countries who pioneered the strategic planning for sustainable development. However, Pakistan did not author the document by itself. It simply did not have the capacity to do so. This historical policy document was jointly prepared by the Environment and Urban Affairs Division and International Union for Conservation of Nature (IUCN) Pakistan.
The NCS's mid-term review in 2001 revealed that Pakistan failed to implement the objectives of its national conservation strategy. There were several reasons behind this failure. But the major one was that in the implementation process, the civil society and the stakeholders were totally ignored. Absence of 'participatory approach' proved NCS to be a fiasco, although it was not because it had been emulated and implemented successfully in several other countries, in bits and pieces.
Pakistan's conundrums are several. Crisis of governance and infrastructure, right policies and right projects and implementation. But to meet at least the deadlines, it needs to build its capacity through forging partnerships with organizations who have rich experience in sustainable development. Without the active participation of all the stakeholders, objectives of development cannot be achieved.
It was appalling to learn at a recent convention that the government has no policy on 'energy conservation'. This was quite alarming because energy and sanitation had emerged as critically important issues at WSSD.
This accentuates the fact that WSSD targets could be achieved through forging partnerships with stakeholders from government, civil society institutions, business, industry, media, academia, etc. All this can be done in the key areas of sustainable development i.e. water, energy, health, agriculture, biodiversity (WEHAB).
The government should not forget that at WSSD, the views of civil society were given prominence in recognition of its key role in implementing the outcomes and promoting partnership initiatives. Over 8,000 civil society participants attended the Summit, reinforced by parallel events which included major groups such as NGOs, women, indigenous people, youth, farmers, trade unions, business leaders, the scientific and technological community and local authorities as well as Chief Justices from various countries.
While the government might be deliberating on achieving the WSSD targets, the civil society had set its sails in catalyzing the implementation. A recent three-day convention forged eight voluntary partnerships amongst the key players of sustainable development: government-civil society; civil society-corporate sector; government-civil society-corporate sector and intra partnerships between civil society in WEHAB areas.
It was a unique representation comprising of 80 participants from various tiers of government, including district and tehsil nazims. Sixty-nine were from small, medium, and large national businesses and multinational companies. A hundred and thirty-five were from civil society organizations including CBOs, and NGOs while 58 were from academia, research institutions and media. Fourteen were from various UN agencies. Moreover, there was a strong representation by bilateral and multilateral agencies throughout the session.
The convention generated several ideas for systematic follow-up actions. These are, establishing standing committees on WEHAB; a periodic score-card on Pakistan's effort to meet WEHAB targets, special training and capacity building activities; development of case studies and best practices as well as conducting email conferences.
WSSD in its plan of implementation gave a large boost to partnerships between governments, business and civil society. Over 220 partnerships with $235 million in resources were identified in advance of the Summit and around 60 partnerships were announced during the Summit by a variety of countries.
Civil society has the opportunity to make the biggest difference. It has built up an enormously powerful asset of human capital and the network capital.
In today's world if you could learn to mobilize networks, you can have a much bigger impact if each member of your network is working individually. Opportunity and the challenge is to mobilize every actor so that everyone could make a bigger difference than before.
Organizations can play a vital role in making aware the parliamentarians about Pakistan's obligations to development. Taking a leaf out of WSSD's book, the government should reciprocate and provide stakeholders opportunity to share experiences at all levels, local, regional and national, so that the process of translating promises into deeds and words can take-off.
Environment Update
* The level of carbon dioxide in the atmosphere is now 30 per cent above the pre-industrial level.
* While the South Pole is covered by a huge continent, the North Pole is covered by the Arctic Ocean. There, the sea ice is fast melting. Over the last 35 years, the ice has thinned 42 per cent - from an average of 3.1 meters to 1.8 meters. It has also shrunk by six per cent since 1978.
Together, thinning and shrinking have reduced the mass of the sea ice by half. A team of Norwegian scientists projects that the Arctic Sea could be entirely ice-free during the summer by mid-century, if not before.
* British scientists have cracked the puzzle of why lobsters turn pink in the pot. Their shell loses its natural blue-black colour due to changes in a key protein - and now researchers understand precisely how. The colour-change molecule is a powerful antioxidant and of great interest to the medical world.
The discovery could lead to new treatments for a number of human diseases including cancer. It also raises the possibility of novel "lobster-colour" food dyes that could provide a more natural alternative to existing colourants.
* A UN report on the state of the world's fresh water warns that decreasing water supplies could lead to epidemics and international conflict.
* The number of plant species threatened with extinction may be more than three times higher than previously thought, researchers report. Current estimates put 13 per cent of the global flora at risk of extinction. But this number does not include a reliable count of plants from tropical regions, where the majority of the world's plants grow. Based on the results of the new study, scientists conclude that as many as 47 per cent of the world's plants are endangered.
* Five of California's largest grocery retailers have begun displaying signs cautioning consumers about the dangers of mercury in fish. The signs mark the first time that any retailers in the state, and possibly in the US have issued such a strong warning about the health risks associated with a food product.
* A multi-shilling fund has been launched in Kenya to put an electric fence around one of the east African nation's largest forest reserves to protect it from illegal loggers, poachers and general human encroachment.
* Pesticide use in Pakistan increased 1,169 per cent between 1981 and 1999, according to an exhaustive study, Policy and Strategy for Rational Use of Pesticides in Pakistan. The study was conducted by the FAO,UNDP and Government of Pakistan.
* The Sindh governor has underlined the need to develop salt tolerant crops for the utilisation of salinity affected agricultural lands of the country.
* The Environmental Law Centre, built on the Punjab University campus, is the first of its kind in Pakistan. The Centre was formerly named Dr Parvez Hassan Environmental Law Centre after its founder, a lawyer, who donated over Rs25 million for the project.
"The Centre will be a step towards providing education on environmental problems facing the Third World countries, such as ours," said Dr Hassan.