PARIS, April 1: The people of India, Pakistan and other countries in South Asia are in dramatically poor health, physical and mental, British and Asian health experts warn.

Pitifully low spending on health care, surging tobacco consumption, widespread depression and anxiety, shockingly high suicide rates among disaffected youngsters, wanton neglect of girls and women and unethical sales practices by the drug industry are among the problems that they outline.

"Half the people in South Asia live below the poverty line," says the British Medical Journal (BMJ), in a special issue next Saturday devoted to the region's health.

"The region is also home to a third of the world's child deaths and almost two-thirds of the global burden of malnutrition." The BMJ angrily points the finger at the region's levels of spending on health.

While the United States spends around 4,000 dollars per person per year on health care, spending in Nepal is just three dollars a head, and in India and Pakistan it is hardly better, at four dollars per head.

In Pakistan, with 152 million people the sixth most populous country in the world, psychiatric problems appear to be widespread, according to research published in the BMJ's rival, The Lancet.

It analysed 20 studies of adult mental health in Pakistan and found that, on average, 34 percent of people interviewed had depressive disorders and anxiety, especially people with financial or relationship problems.

The figure must be treated with caution, because most of the data came from only two provinces, Punjab and Singh, the authors say. Even so, the phenomenon is clearly significant, they say, adding that a major potential cause is Pakistan's turbulent history, causing wrenching uncertainty and economic distress.

"Pakistan's population has been exposed to sociopolitical instability, economic uncertainty, violence, regional conflict and dislocation for the past three decades," the study says. "These are risk factors for psychiatric disorders."

Nor is the situation in India any source for comfort. In the countryside, the suicide rate among India's young may be far higher than is reflected in official figures.

In an analysis of deaths in Vellore, in the southern state of Tamil Nadu, researchers found that suicides account for about a quarter of all deaths in young men and up to 75 percent of all young women.

Many deaths, apparently driven by family conflicts, domestic violence and lost romantic ideals, were caused by pesticides, which are easily available. "These very high rates of suicide need urgent intervention," the study in The Lancet says.

In six of the seven countries of the region (Bangladesh, Bhutan, India, Maldives, Nepal and Pakistan, with Sri Lanka being the notable exception), girls and women suffer widespread discrimination, from basic nutrition and access to vaccination to access to reproductive health care and help against rape and domestic violence.

"Gender-based health disparities among the population aged under five years... are larger than anywhere else in the world. A girl between her first and fifth birthday in India or Pakistan has a 30-50 percent higher chance of dying than a boy."

Another problem is tobacco, which is chewed as well as smoked in many countries in the region. South Asian countries are making only cautious headway, if at all, to tackling this scourge.

"Smoking increased substantially between 1990 and 1999 in Bangladesh, India, the Maldives and Pakistan, reflecting a shift in the focus of the tobacco multinationals towards poorer countries, which have less effective regulations," an editorial in the BMJ says.

A study accompanying that piece says that the poorest Indians consume the most tobacco. In many households, tobacco gets priority over food and other essentials. -AFP