Health Communication

Notes
UNIT-1

Public Health

By Dr. Saima Pervez

Public Health: Definition & concepts
Health
As defined by World Health Organization (WHO), it is a "State of complete physical, mental,
and social wellbeing, and not merely the absence of disease. “

Health is the level of functional and metabolic efficiency of a living organism. In humans it is
the ability of individuals or communities to adapt and self-manage when facing physical,
mental or social changes. The word health means different things to different people,
depending on the situation. If somebody says "I was worried about my son's health when he
went for mountain climbing", it is clear that the woman is referring to her son's physical
health, possibly his heart, skin (frostbite) and risk of developing hypothermia (when the
body's temperature drops too low).

On the other hand, if you hear the phrase "With all these deadlines, presentations and
working weekends, I wonder what the effect will be on her health," most likely the word
"health" refers more to mental health than physical health (although the two are often
linked).

Three aspects to health

Most people accept that health can be divided into two broad aspects - physical and mental
health.

Physical health:

Physical health means a good body health, which is healthy because of regular physical
activity (exercise), good nutrition, and adequate rest.

As a country's or region's people experience improved nutrition, health care, standards of

living and quality of life, their height and weight generally increase. Physical health relates
to anything concerning our bodies as physical entities. Physical health has been the basis for
active living campaigns and the many nutrition drives that have swept the industrialized
world. People are exposed to so much "physical health" data these days that it is hard to
decide what is relevant and what is not.

Another term for physical health is physical wellbeing. Physical wellbeing is defined as
something a person can achieve by developing all health-related components of his/her
lifestyle. Fitness reflects a person's cardiorespiratory endurance, muscular strength,
flexibility, and body composition. Other contributors to physical wellbeing may include
proper nutrition, bodyweight management, abstaining from drug abuse, avoiding alcohol
abuse, responsible sexual behavior (sexual health), hygiene, and getting the right amount of
sleep.

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We further divide physical health into two separate sections:

Structural health - This refers to sound bones, muscles, organs etc. That the structures in
the body are performing the functions they were made for properly. Structural health is
associated with a person's height/weight ratio, their BMI (body mass index), their resting
pulse rate (heart rate), and recovery time after doing exercise.

Mental health

Mental health refers to people's cognitive (connected with thinking or conscious mental
processes) and emotional well-being.

A person who enjoys good mental health does not have a mental disorder. According to
WHO, mental health is "a state of well-being in which the individual realizes his or her own
abilities, can cope with the normal stresses of life, can work productively and fruitfully, and
is able to make a contribution to his or her community".

People have always found it easier to explain what mental illness is, rather than mental
health. Most people agree that mental health refers to the "absence of mental illness".
Mental health also includes the ability to enjoy life, the ability to bounce back from
adversity, the ability to achieve balance (moderation), the ability to be flexible and adapt,
the ability to feel safe and secure, and self-actualization (making the best of what you have).

Spiritual health:Yogaand meditation can also help you develop spiritual wellness.Having
compassion,the capacity for love and forgiveness,altruism,joy and fulfillment help you enjoy
your spiritual health.

Concepts of social wellbeing and its relationship to mental wellbeing

Social well-being is an end state in which basic human needs are met and people are able to
coexist peacefully in communities with opportunities for advancement. This end state is
characterized by equal access to and delivery of basic needs services (water, food, shelter,
and health services).

Social wellbeing, or the lack of it, is familiar to public health professionals in the context of
social and income equality, social capital, social trust, social connectedness and social
networks. These concepts are set primarily in the context of social policy and social
interactions at community or societal level. Mental wellbeing, as previously defined,
includes another aspect of social wellbeing – good relationships with others on a one-to-
one, small group or family level. All these aspects of social wellbeing are known to have a
profound effect on mental health and wellbeing individually and collectively. What is not so
widely appreciated is the reverse relationship.

Social wellbeing is:

● the basis for social equality, social capital, social trust

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 ● the antidote to racism, stigma, violence and crime.
It depends on:

● the sum of individual mental wellbeing in a group, community or society

● the quality of government – local, organisational, national and international
● the quality of services and provision of support for those in need
● the fair distribution of resources including income
● the norm with regard to interpersonal relationships in a group, community or
society, including respect for others and their needs, compassion and empathy, and
authentic interaction.
Hierarchically held power in families, communities, workplaces, schools or government is
particularly potent in this regard, and respectful, compassionate, authentic government,
families and organisations are important in the creation of collective mental wellbeing.

Public Health

According to WHO, Public Health is defined as “the art and science of preventing disease,
prolonging life and promoting health through the organized efforts of society”

According to University of Pittsburg, Public health is defined as the science of protecting the
safety and improving the health of communities through education, policy making and
research for disease and injury prevention.

“… the science and art of preventing disease and promoting health and efficiency through
organized community effort

● for the sanitation of the environment,

● the control of communicable infections,
● the education of the individual in personal hygiene,
so organizing these benefits as to enable every citizen to realize his birthright of health and
longevity.”

Public health is about helping people to stay healthy and protecting them from threats to
their health.

Sometimes public health activities involve helping individuals, at other times they involve
dealing with wider factors that have an impact on the health of many people (for example
an age-group, an ethnic group, a locality, or a country).

While medicine and nursing are vital for helping and supporting people when they fall ill,
work in public health contributes to reducing the causes of ill-health and improving people's
health and wellbeing.
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It does this through its work in three main 'domains':

Health protection- protecting people's health (for example from environmental or biological
threats, such as food poisoning or radiation)

Health improvement- improving people's health (for example by helping people quit
smoking or improving their living conditions)

Healthcare public health- ensuring that our health services are the most effective, most
efficient and equally accessible

There is no better time to join in the effort to promote and protect population health. From
growing rates of obesity to bio-terrorism and the advent of new diseases, public health
issues appear regularly in the media.

Activities to strengthen public health capacities and service aim to provide conditions under
which people can maintain to be healthy, improve their health and wellbeing, or prevent
the deterioration of their health. Public health focuses on the entire spectrum of health and
wellbeing, not only the eradication of particular diseases. Many activities are targeted at
populations such as health campaigns. Public health services also include the provision of
personal services, to individual persons such as vaccinations, behavioral counseling, or
health advice.

Overall, public health is concerned with protecting the health of entire populations. These
populations can be as small as a local neighborhood, or as big as an entire country or region
of the world. Public health professionals try to prevent problems from happening or
recurring through implementing educational programs, recommending policies,
administering services and conducting research – in contrast to clinical professionals like
doctors and nurses, who focus primarily on treating individuals after they become sick or
injured. Public health also works to limit health disparities

What is the need for a public health response?

India is experiencing a rapid health transition. It is confronted both by an unfinished agenda
of infectious diseases, nutritional deficiencies and unsafe pregnancies as well as the
challenge of escalating epidemics of non-communicable diseases. This composite threat to
the nation’s health and development needs a concerted public health response that can
ensure efficient delivery of cost-effective interventions for health promotion, disease
prevention and affordable diagnostic and therapeutic health care.

Public health fundamentals

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There are 3 “P’s” to public health:

1. Prevent disease:
Disease prevention is a branch of preventive measures that focuses on helping people avoid
contracting diseases, both in individuals and communities. In communities, disease
prevention is usually focused on providing clean living conditions and promoting education
so that people understand the mechanisms by which they get sick. Sewer systems, water
purification plants, health codes, and the establishment of sterile hospital facilities are all
examples of infrastructure which is designed to prevent diseases from spreading. For
individuals, disease prevention can include the use of vaccination and prophylactic
medications, and the identification of risk factors that could make someone more prone to
contracting an illness. General wellness may also be promoted, as healthy individuals with
strong bodies are less likely to contract disease .

2. Health Promotion:
Health promotion is the process of enabling people to increase control over, and to
improve, their health. It moves beyond a focus on individual behaviour towards a wide
range of social and environmental interventions. Health promotion is the development of
individual, group, institutional, community and systemic strategies to improve health
knowledge, attitudes, skills and behavior.

Why is Health Promotion important?

● Health promotion improves the health status of individuals, families, communities,

states, and the nation.
● Health promotion enhances the quality of life for all people.
● Health promotion reduces premature deaths.
● By focusing on prevention, health promotion reduces the costs (both financial and
human) that individuals, employers, families, insurance companies, medical facilities,
communities, the state and the nation would spend on medical treatment.
The purpose of health promotion is to positively influence the health behavior of individuals
and communities as well as the living and working conditions that influence their health.

3. Prolong life:
Prolong life means extended life. Life expectancy is directly related to public health. Public
health historians says that the majority of the life expectancy increase during the last 200
years resulted from control of infectious diseases, more abundant and safer foods, better
sanitary conditions, and other nonmedical social improvements. The greatest increase in life
expectancy, referred to as the “First Public Health Revolution,” occurred between 1880 and
1920, before the advent of antibiotics and advanced surgical techniques

Public health is a social and political concept aimed at the improving health, prolonging life

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and improving the quality of life among whole populations through health promotion,
disease prevention and other forms of health intervention.

We actually have a disease-oriented cure system rather than a health-oriented care system
in this country today. When health improves, life improves by every measure. We have to
take the responsibility of the future in terms of making the world a 'Better place' health wise
and other wise. India being the second largest populated country in the world and with a
multitude of health problems encompassing both communicable and non-communicable
diseases and other public health-related problems. India's burden in terms of maternal, new
born, and child mortality is one the highest in the world. India has witnessed significant
changes in public health, despite significant achievements in some areas. There remain
many public health issues that are of immediate concern.

To date, it is estimated that 30% of all Indians still die without seeing a doctor. The universal
access to basic services must be ensured. Preventive and promotive health will be pursued
to bring down expenses on curative care. This emphasizes better access to health services
for the poor, underserved, and marginalized.

India Faces the Greatest Challenge of Workforce

Most of the states in India face severe health workforce shortage. Health service providers,
management, and support workers are needed to fill the gap. These states are unable to
provide basic, lifesaving services in consistent manner, for example, they generally fail to
achieve an 80% coverage rate for measles immunization and other vaccine preventable
diseases, without prompt action, the shortage will worsen.

Health workers - the people who provide healthcare to those who need it - are the heart of
health systems. There is a chronic national shortage of health workers. There is no single
solution to such a complex problems but ways forward do exist and must now be
implemented. Action must be taken now for results to show in the coming years. In India, a
rise in chronic health problems among the aging population and the aging of their own
workforce has led to an even growing demand for health workers. The hour of need is to
make the workforce a priority and put in place a national plan for managing it. Government
also needs to invest in training existing health workers to keep them up to date to the
changing priorities.

Health Awareness
Our health is affected by a wide variety of factors, from the genes that we inherit from our
parents to the climate we live in and the work we do. But there is a growing body of
scientific evidence that shows our lifestyles play a huge part in how healthy we are. From
what we eat and drink, to how much exercise we take, and whether we smoke or take

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drugs, all will affect our health, not only in terms of life expectancy, but how long we can
expect to live without experiencing chronic disease.
Taking control of your health may seem daunting, particularly for those of us who are trying
to change what may be the habit of a lifetime, like smoking. But simple changes, like eating
more fruit and vegetables, cutting down on alcohol and taking regular exercise, can and will
help you to look and feel better, now and in the future, whatever your age.

By promoting health awareness group of people knows the importance and role of health in
life. So, one can live healthy and stressless life. Health promotion and maintenance consists
of health teachings that corrects misinformation and traditional knowledge on disease and
disorders. Health maintenance may vary depending on an individual's illness. Examples of
these are blood pressure monitoring for hypertensive individuals, lifestyle modification for
the lifestyle-induced illness (heart disease, diabetes, etc.).

These two projects/programs help to prevent disease in the community as well as prevent
the development of complication of those with existing illness. It further helps to save on
money for other needs instead of allocating for hospitalization. Seventh-day Adventists, in
general, have 50 percent less risk of heart disease, certain types of cancers, strokes, and
diabetes. Recent data suggests that vegetarian men under 40 can expect to live 8.9 years
longer and women 7.5 years longer than the general population.

More specifically, Adventist vegetarian men live 3.6 years longer than Adventists who eat
meat. Researchers believe this added length of life and quality of health is due in general to
a healthier lifestyle, particularly the dietary intake of more fruits, vegetables, and whole
grains, as well as the avoidance of tobacco, alcohol, tea, coffee and meat.

Role and Importance of Yoga

The word "yoga" comes from the Sanskrit root yuj, which means "to join". Yoga is a 5000-
year-old Indian body of knowledge. Though many think of yoga only as a physical exercise
where people twist, turn, stretch, and breathe in the most complex ways, these are actually
only the most superficial aspect of this profound science of unfolding the infinite potentials
of the human mind and soul. The science of Yoga imbibes the complete essence of the Way
of Life. Yoga is a practical aid, not a religion. Yoga is an ancient art based on a harmonizing
system of development for the body, mind, and spirit. The continued practice of yoga will
lead you to a sense of peace and well-being, and also a feeling of being at one with their
environment. This is a simple definition.

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The practice of yoga makes the body strong and flexible, it also improves the functioning of
the respiratory, circulatory, digestive, and hormonal systems. Yoga brings about emotional
stability and clarity of mind.

In the practice of Yoga the ultimate aim is one of self-development and self-realization.
Think of this practice as being the means and tools to realign and rebalance your vehicle
body on a regular basis. You take control and you can then become your body mechanic
instead of having to pay someone else to do it (medical professionals). Because your body is
finely tuned you will find that your chances for injuries and illnesses will drop as you are in a
much more attuned state.

You don’t want for something major to happen to you before you decide to do something
about it. That’s reactive behavior and that’s going to set you back big time, all you have to
do is take action now Yoga is Easy to do.

Patanjali is considered as the father of Yoga and his Yoga Sutra are completely dedicated to
the knowledge of Yoga. The continued practice of yoga will lead you to a sense of peace and
well-being, and also a feeling of being at one with their environment. This is a simple
definition. By connecting to ourselves through the breath, we can bring our bodies from a
state of “dis-ease” to a place of health. The aim of Yoga is to bring balance into the body
physically, mentally and emotionally.
The ultimate goal of yoga is, to help the individual to transcend the self and attain
enlightenment. As the Bhagavad Gita says “A person is said to have achieved yoga, the
union with the self, when the perfectly disciplined mind gets freedom from all desires, and
becomes absorbed in the self alone”.

Importance of Yoga
Yoga is a way of living that aims towards ‘a healthy mind in a healthy body.’
Man is a physical, mental and spiritual being; yoga helps promote a balanced development
of all the three. Other forms of physical exercise, like aerobics, assure only physical well
being. They have little to do with the development of the spiritual or astral body.
Yogic exercises recharge the body with cosmic energy and facilitates:
● Attainment of perfect equilibrium and harmony
● Promotes self-healing
● Removes negative blocks from the mind and toxins from the body
● Increases self awareness
● Helps in attention, focus and concentration, especially important for children
● Reduces stress and tension in the physical body by activating the nervous system
The aspirant feels rejuvenated and energized. Thus, yga bestows upon every aspirant the
powers to control body and mind.

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Benefits of yoga
Benefits of yoga are based on regular practice of traditional yoga poses, breathing exercises
and meditation.
● Increases flexibility
● Increases the muscle strength and tone
● Improves respiration
● Maintaining a balanced metabolism
● Weight reduction
● Improves Cardio and circulatory health
● Improves Posture
● Increases the Energy levels
● Normalizes the Immune function

Benefits of pranayama are both tangible and intangible. God has provided prana, the
supreme source of power free of cost to all human beings. Proper utilisation of this free
source of energy can make remarkable changes to our health, vitality and self confidence.
We cannot simply equate prana with oxygen present in the air, the air we breathe is also
filled with vital energy known as prana.

All benefits of pranayama cannot be written down, there are lot of subtle changes like
mental peace and clarity of thought that occur in our mind.
Reduced Breathing Rate:
With yoga breathing you can train yourself to breathe more slowly and more deeply. You
can reduce your breathing rate from about fifteen breaths a minute to 5-6 breaths a minute,
which amounts to reducing the breathing rate by one third. Reduced breathing rate leads
to:

● Slowing down the heart rate as more oxygen can be pumped even with less number
of breaths.
● Follow the ration of 1:2 for inhalation:exhalation.
● Reduced wear and tear of internal organs.
● Lowering of blood pressure, relaxation of body tensions and quieter nerves.
Pranayama Practice Increases Life
As per yoga philosophy, longevity depends on your breathing rate. Lowering of breathing
rate is likely to increase your life. For example, a tortoise takes four to five breaths in a
minute and it lives up to 200 years or more.

Blood Circulation Improves

As a result of breathing, the freshly oxygenated blood (during inhalation) travels from lungs
to the heart. The heart pumps it via arteries and blood vessels to every part of the body,

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where in turn it seeps into every tissue and cell. This improves the blood circulation and
more oxygen/ prana or cosmic energy reaches all parts of your body.

Pranayama For Healthy Heart

Our heart is the most industrious organ of our body. The heart beats 100,000 times a day. It
is pumping blood day in and day out non-stop all your life. The health of your heart
determines your life expectancy and quality of life in old age. More oxygen in the blood
means more oxygen to muscles of the heart.

Benefits Of Pranayama For Functioning Of Body Organs

● Better functioning of autonomic system improves the working of lungs, heart,

diaphragm, abdomen, intestines, kidneys and pancreas.
● Digestive system improves and diseases pertaining to digestive organs are cured.
● General irritability due to lethargy/ fatigue vanishes.
● By pranayama practice all body organs gets more oxygen, toxins are removed from
body, therefore onset of various diseases is prevented. Pranayama strengthens the
immune system.

Better Mental Health

● Pranayama practice provides freedom from negative and harmful mental conditions
like anger, depression, lasciviousness, greed for money, arrogance etc.
● With pranayama fluctuations of mind are controlled and it prepares the mind for
meditation. With practice of pranayama, you will start experiencing lightness of
body, feeling of inner peace, better sleep, better memory and better concentration
whereby improving the spiritual powers/ skills.

Better Breathing Improves Quality Of Life In Old Age

As a person with sedentary lifestyle reaches middle age, lung tissues tend to grow less and
less elastic and lung capacity decreases. Pranayama can help to reduce the effects of
following old age problems:

● Loss of vitality.
● Accumulation of uric acid in the blood stream which often leads to frequent joint
pains and discomfort.
● Backaches, headaches, rheumatism, stiffening muscles and joints.
● Proper circulation of blood is impeded by a sluggish diaphragm or hardening arteries.

It is recommended to start learning pranayama from a yoga teacher without any delay in
order to experience the immense benefits of pranayama. Benefits of yoga breathing can be

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realised only by experience. Establish a daily routine of yoga breathing exercises. If you want
to start on your own, first start with rhythmic deep breathing to get into the rhythm.

Major Public Health and lifestyle issues

People are predisposed to various diseases based on their way of living and occupational
habits. They are preventable, and can be lowered with changes in diet, lifestyle, and
environment. Lifestyle diseases characterize those diseases whose occurrence is primarily
based on daily habits of people and are a result of an inappropriate relationship of people
with their environment. The onset of these lifestyle diseases is insidious, they take years to
develop, and once encountered do not lend themselves easily to cure.

Lifestyle diseases
Lifestyle diseases are defined as those health problems that react to changes in lifestyle. All
lifestyle risk factors have one common property: they make breathing heavier and body O2
low.
Modern science through improved sanitation, vaccination, and antibiotics, and medical
attention has eliminated the threat of death from most infectious diseases. This means that
death from lifestyle diseases like heart disease and cancer are now the primary causes of
death. The onset of these lifestyle diseases is insidious, they take years to develop, and once
encountered do not lend themselves easily to cure. The main factors contributing to the
lifestyle diseases include bad food habits, physical inactivity, wrong body posture, and
disturbed biological clock. The diet [or lifestyle] of different populations might partly
determine their rates of cancer, and the basis for this hypothesis was strengthened by
results of studies showing that people who migrate from one country to another generally
acquire the cancer rates of the new host country, suggesting that environmental [or lifestyle
factors] rather than genetic factors are the key determinants of the international variation
in cancer rates.
In India the situation is quite alarming. The disease profile is changing rapidly. The World
health Organization (WHO) has identified India as one of the nations that is going to have
most of the lifestyle disorders in the near future. A report, jointly prepared by the World
Health Organization and the World Economic Forum, said that India had incurred an
accumulated loss of $236.6 billion by 2015 on account of unhealthy lifestyles and faulty diet.
The resultant chronic diseases - heart disease, stroke, cancer, diabetes and respiratory
infections - which are ailments of long duration and slow progression had severely affected
people's earnings.
According to the World Health Organization the entire world is moving towards public
health disaster as approximately 16 million people annually fall victim to lifestyle diseases
prematurely. Just in 2012, non-communicable diseases were responsible for the death of 38

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million people worldwide, with 16 million of its victims being under the age of 70. The need
for public awareness isn’t stressed enough, it is important because lifestyle diseases are also
the easiest to prevent. Simply modifying your lifestyle to eliminate band reduce risks can
make a huge difference.
The western lifestyle, characterized by convenience food, TV and PCs, is taking its toll on
children as well as adults, and is producing increased numbers of overweight, passive
youngsters with lifestyle diseases. Kids spending too much time slouched in front of the TV
or PCs, should be encouraged to find a physical sport or activity they enjoy. Fun exercises
should be encouraged into family outings. A pizza-and-video evening should be replaced for
a hike and picnic. Kids who do participate in sport, especially at a high competitive level, can
find the pressure to succeed very stressful. It's important that parents watch out for signs of
psychological strain, as well as physical fatigue from overtraining. Young athletes also have
specific nutritional needs that require extra attention. A diet of only junk food, overeating
and lack of physical activity are not only responsible for diseases related to nutrition, but
also anorexia nervosa, which involves many people starving themselves for maintaining
their figure. This type of disease is more prevalent in the fashion and showbiz industry.

Already considered the diabetes capital of the world, India now appears headed towards
gaining another dubious distinction of becoming the lifestyle-related disease capital as well.

Causes of lifestyle diseases

Diet and lifestyle are major factors thought to influence susceptibility to many diseases.
Drug abuse, tobacco smoking, and alcohol drinking, as well as a lack of or too much exercise
may also increase the risk of developing certain diseases.

Unhealthy Eating Habits

Poor eating habits and food choices greatly increase the risk of lifestyle diseases like cancer,
heart disease, diabetes and various health conditions. Poor eating habits can include the
over- consumption of certain foods, dietary deficiencies and excessive intake of saturated
fats and refined or processed foods.

Lack of Physical Activity

A sedentary lifestyle is one of the distinctive features of urbanization, development and
progress. Almost all inhabitants of cities are engaged in occupations that require little
physical activity and most don’t even permit much time to engage in any physical activity.
This is a huge contributing factor to the rise of lifestyle diseases and chronic conditions like
hypertension, high cholesterol and it can subsequently lead to problems with obesity, heart
disease, diabetes, strokes, and so on. It can also increase levels of stress and anxiety and
raise the risk of suffering from various other health conditions.

Obesity

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Obesity has become one of the greatest problems for modern society as it greatly increases
the risk of numerous health conditions from diabetes and hypertension to sleep apnea,
osteoarthritis, lower back pain and gallbladder disease. Obesity is also closely associated
with cancer, coronary artery disease and overall diminishes life expectancy. While your Body
Mass Index or BMI is normally used to calculate the extent of body fat and the extent of
obesity, the risk is also affected by your distribution of fat. Abdominal fat poses the highest
risk and is also referred to as central obesity. Central obesity greatly increases the risk of
lifestyle diseases early in life with conditions like raised insulin, high blood pressure high
triglyceride levels and high cholesterol levels even affecting young adults. As is the case
with almost all lifestyle disease risk factors, this is part of a vicious cycle, exacerbated by
poor eating habits, a sedentary lifestyle and other conditions.

Stress and Anxiety

Stress doesn’t just affect us emotionally or mentally, it also has a clear physical effect as it
aggravates and increases the risk of conditions like obesity, cardiac disease, diabetes,
asthma, Alzheimer’s disease, rapid aging and gastrointestinal problems. Stress and anxiety
can also affect one’s ability to relax and get proper sleep, contributing to a further
deterioration in health and a host of other problems. Stress doesn’t refer to stress or
anxiety that affect us from time to time due to the high pressure situations that develop at
work or at home, but it refers to frequent and constant stress.

Poor Sleep
Sleep is one of the most neglected requirements for human health and well-being. Several
studies have clearly indicated the importance of sleep in terms of both quantity and quality
for general health as it affects various metabolic, endocrine and neurological functions of
the body. Sleep deprivation, whether through a lack of sufficient sleep or interrupted and
poor quality sleep significantly increases the risk of hypertension, heart disease, elevated
cholesterol and triglyceride levels, obesity, sleep apnea and a number of other health
conditions.
Poor sleeping habits can also affect growth and development in infants and children. Sleep
disorders, when ignored or untreated can start to affect mood and behavioral patterns
thereby taking a toll on work and family relationships. This doesn’t just affect productivity
and physical health, but it also can cause depression and social disorders.

Smoking
Smoking is one of the biggest public health problems because of the high risk it poses.
Smoking is associated with various lifestyle diseases such as numerous respiratory disorders
like bronchitis and asthma, lung cancer, oral cancer and other cancers, cardiovascular
diseases, strokes and numerous other health conditions.

Alcoholism
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While the consumption of alcohol in moderation does not pose any significant health risk
and if consumed appropriately can even offer some health benefits, excessive consumption
of alcohol can be a major contributing factor in the development of lifestyle diseases. The
protective effect of moderate wine consumption against heart disease is often used as an
excuse to over indulge. Excessive alcohol consumption increases HDL levels, increases risk of
heart disease, colorectal and breast cancer, hypertension and diabetes. It also contributes
to the development of various other lifestyle diseases and conditions like GERD and liver
cirrhosis.
Individuals who cannot moderate alcohol intake are advised to abstain from alcohol
altogether as in such cases the risks far outweigh any possible benefits.

Top Lifestyle Diseases and their risk factors

Type 2 diabetes:
India has the largest number of people suffering from diabetes at around 40.9 million.
Diabetes is a life-long disease that affects the way your body handles glucose, a kind of
sugar, in your blood. Most people with the condition have type 2.
Causes
Your pancreas makes a hormone called insulin. It's what lets your cells turn glucose from the
food you eat into energy. People with type 2 diabetes make insulin, but their cells don't use
it as well as they should. Doctors call this insulin resistance.
At first, the pancreas makes more insulin to try to get glucose into the cells. But eventually it
can't keep up, and the sugar builds up in your blood instead.

Usually a combination of things cause type 2 diabetes, including:

Genes: Scientists have found different bits of DNA that affect how your body makes insulin.

Extra weight: Being overweight or obese can cause insulin resistance, especially if you carry
your extra pounds around the middle. Now type 2 diabetes affects kids and teens as well as
adults, mainly because of childhood obesity.

Metabolic syndrome: People with insulin resistance often have a group of conditions
including high blood glucose, extra fat around the waist, high blood pressure, and high
cholesterol and triglycerides.

Too much glucose from your liver: When your blood sugar is low, your liver makes and
sends out glucose. After you eat, your blood sugar goes up, and usually the liver will slow
down and store its glucose for later. But some people's livers don't. They keep cranking out
sugar.

Symptoms

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The symptoms of type 2 diabetes can be so mild you don't notice them. In fact, about 8
million people who have it don't know it.

● Being very thirsty

● Peeing a lot
● Blurry vision
● Being irritable
● Tingling or numbness in your hands or feet
● Feeling worn out
● Wounds that don't heal
● Yeast infections that keep coming back

Arteriosclerosis: Deposition of fatty plaques on arterial walls is called arteriosclerosis. It

causes blood circulation disorders, heart attacks and chest pain. Atherosclerosis is a
narrowing of the arteries caused by a buildup of plaque. It’s also called arteriosclerosis or
hardening of the arteries. Arteries are the blood vessels that carry oxygen and nutrients
from your heart to the rest of your body.
As you get older, fat and cholesterol can collect in your arteries and form plaque. The
buildup of plaque makes it difficult for blood to flow through your arteries. This buildup may
occur in any artery in your body and can result in a shortage of blood and oxygen in various
tissues of your body. Pieces of plaque can also break off, causing a blood clot.
Atherosclerosis can lead to heart attack, stroke, and heart failure if left untreated.

Atherosclerosis is a fairly common problem associated with aging. This condition can be
prevented, and many successful treatment options exist.

What Causes Atherosclerosis?

Plaque buildup and subsequent hardening of the arteries restricts blood flow in the arteries,
preventing your organs and tissues from getting the oxygenated blood they need to
function.

The following are common causes of hardening of the arteries:

High Cholesterol
Cholesterol is a waxy, yellow substance that’s found naturally in your body and also in
certain foods you eat. This substance can increase in your blood and clog your arteries. It
becomes a hard plaque that restricts or blocks blood circulation to your heart and other
organs.
Fat
Eating foods high in fat may also lead to plaque buildup.
Aging

16
As you age, your heart and blood vessels work harder to pump and receive blood. Your
arteries may weaken and become less elastic, making them more susceptible to plaque
buildup.

Risk factors
Hardening of the arteries occurs over time. Besides aging, factors that increase the risk of
atherosclerosis include:
● High blood pressure
● High cholesterol
● Diabetes
● Obesity
● Smoking and other tobacco use
● A family history of early heart disease
● Lack of exercise
● An unhealthy diet
Heart disease: India ranks No.1 in cardiac patients. An estimated 50 million people in India
suffer from heart disease. Heart disease describes a range of conditions that affect your
heart. Diseases under the heart disease umbrella include blood vessel diseases, such as
coronary artery disease; heart rhythm problems (arrhythmias); and heart defects you're
born with (congenital heart defects), among others.
The term "heart disease" is often used interchangeably with the term "cardiovascular
disease." Cardiovascular disease generally refers to conditions that involve narrowed or
blocked blood vessels that can lead to a heart attack, chest pain (angina) or stroke. Other
heart conditions, such as those that affect your heart's muscle, valves or rhythm, also are
considered forms of heart disease.

Many forms of heart disease can be prevented or treated with healthy lifestyle choices.
Hypertension: A blood pressure reading of above 140/90 is called high blood pressure or
hypertension. Over 100 million people in India suffer with hypertension. High blood
pressure is a common condition in which the long-term force of the blood against your
artery walls is high enough that it may eventually cause health problems, such as heart
disease.
Symptoms:
High blood pressure itself is usually asymptomatic, meaning that patients do not experience
any direct symptoms of the condition. This is why hypertension is often referred to as "the
silent killer," as it can quietly cause damage to the cardiovascular system. A few people with
high blood pressure may have headaches, shortness of breath or nosebleeds, but these
signs and symptoms aren't specific and usually don't occur until high blood pressure has
reached a severe or life-threatening stage.
Causes:
● Diabetes (both due to kidney problems and nerve damage)

17
 ● Kidney disease
● Pheochromocytoma (a cancer)
● Cushing syndrome (which can be caused by use of corticosteroid drugs)
● Congenital adrenal hyperplasia (disorder of the adrenal glands, which secrete the
hormone cortisol)
● Hyperthyroidism (overactive thyroid gland).
● Hyperparathyroidism (which affects calcium and phosphorous levels)
● Pregnancy

Hypertension can also lead to problems in the organs affected by high blood pressure. Long-
term hypertension can cause complications through arteriosclerosis, where the formation of
plaques results in narrowing of blood vessels.
Swimmer’s ear: Inflammation, infection of outer ear is called Swimmer’s ear. Swimmer's
ear is an infection in the outer ear canal, which runs from your eardrum to the outside of
your head. It's often brought on by water that remains in your ear after swimming, creating
a moist environment that aids bacterial growth. Putting fingers, cotton swabs or other
objects in your ears also can lead to swimmer's ear by damaging the thin layer of skin lining
your ear canal.
Swimmer's ear is also known as otitis externa. The most common cause of this infection is
bacteria invading the skin inside your ear canal. Usually you can treat swimmer's ear with
eardrops. Prompt treatment can help prevent complications and more-serious infections.
Causes:
The main cause of swimmer's ear is a break in the skin lining of the outer ear or ear canal
that allows bacteria or fungi to invade the outer ear. A break in the skin may be caused by
scratching the ear area, skin conditions such as seborrheic dermatitis and psoriasis,
improperly cleaning your ears with cotton-tipped swabs or other objects inserted in the ear,
using devices inserted into the ear (ear plugs, hearing aids, headphones, ear buds, and other
devices), or chemicals (hair dyes, bleaches, certain shampoos, hair sprays).It is caused due
to over exposure to loud noise and headphones.
Symptoms of swimmer's ear include
● pain
● itching
● redness
● swelling
● draining fluid or pus
● difficulty hearing
● ringing in the ear
● dizziness, or
● vertigo.
Cancer: Irregular and uncontrolled cell growth is called cancer. Cancer, also called
malignancy, is an abnormal growth of cells. There are more than 100 types of cancer,

18
including breast cancer, skin cancer, lung cancer, colon cancer, prostate cancer, and
lymphoma. Symptoms vary depending on the type. Cancer treatment may include
chemotherapy, radiation, and/or surgery. Lifestyle factors like diet is a key determinant in
colon cancer.
Causes of cancer
Cancer is ultimately the result of cells that uncontrollably grow and do not die. Normal cells
in the body follow an orderly path of growth, division, and death. Programmed cell death is
called apoptosis, and when this process breaks down, cancer begins to form. Unlike regular
cells, cancer cells do not experience programmatic death and instead continue to grow and
divide. This leads to a mass of abnormal cells that grows out of control.
Cancers are often referred to by terms that contain a prefix related to the cell type in which
the cancer originated and a suffix such as -sarcoma, -carcinoma, or just -oma. Common
prefixes include:

● Adeno- = gland
● Chondro- = cartilage
● Erythro- = red blood cell
● Hemangio- = blood vessels
● Hepato- = liver
● Lipo- = fat
● Lympho- = white blood cell
● Melano- = pigment cell
● Myelo- = bone marrow
● Myo- = muscle
● Osteo- = bone
● Uro- = bladder
● Retino- = eye
● Neuro- = brain

Stroke: A stroke occurs when the blood supply to part of your brain is interrupted or
severely reduced, depriving brain tissue of oxygen and nutrients. Within minutes, brain cells
begin to die. A stroke is a medical emergency. Prompt treatment is crucial. Early action can
minimize brain damage and potential complications.
Symptoms:
Watch for these signs and symptoms if you think you or someone else may be having a
stroke. Note when your signs and symptoms begin, because the length of time they have
been present may guide your treatment decisions:

● Trouble with speaking and understanding. You may experience confusion. You may
slur your words or have difficulty understanding speech.

19
 ● Paralysis or numbness of the face, arm or leg. You may develop sudden numbness,
weakness or paralysis in your face, arm or leg, especially on one side of your body.
Try to raise both your arms over your head at the same time. If one arm begins to
fall, you may be having a stroke. Similarly, one side of your mouth may droop when
you try to smile.
● Trouble with seeing in one or both eyes. You may suddenly have blurred or
blackened vision in one or both eyes, or you may see double.
● Headache. A sudden, severe headache, which may be accompanied by vomiting,
dizziness or altered consciousness, may indicate you're having a stroke.
● Trouble with walking. You may stumble or experience sudden dizziness, loss of
balance or loss of coordination.
When to see a doctor
Seek immediate medical attention if you notice any signs or symptoms of a stroke, even if
they seem to fluctuate or disappear.

Think "FAST" and do the following:

Face. Ask the person to smile. Does one side of the face droop?
Arms. Ask the person to raise both arms. Does one arm drift downward? Or is one arm
unable to raise up?
Speech. Ask the person to repeat a simple phrase. Is his or her speech slurred or strange?
Time. If you observe any of these signs, immediately contact your doctor without wasting
your single precious second.
In India 10-15% of strokes occur below the age of 40 years suggesting bad lifestyle.
Causes:
A stroke occurs when the blood supply to your brain is interrupted or reduced. This deprives
your brain of oxygen and nutrients, which can cause your brain cells to die. A stroke may be
caused by a blocked artery (ischemic stroke) or the leaking or bursting of a blood vessel
(hemorrhagic stroke). Some people may experience only a temporary disruption of blood
flow to their brain (transient ischemic attack, or TIA).

Chronic Obstructive Pulmonary Disease (COPD):

Chronic Obstructive Pulmonary Disease (COPD) is an umbrella term used to describe
progressive lung diseases including emphysema, chronic bronchitis, refractory (non-
reversible) asthma, and some forms of bronchiectasis. This disease is characterized by
increasing breathlessness.
Many people mistake their increased breathlessness and coughing as a normal part of aging.
In the early stages of the disease, you may not notice the symptoms. COPD can develop for
years without noticeable shortness of breath. You begin to see the symptoms in the more
developed stages of the disease. That’s why it is important that you talk to your doctor as
soon as you notice any of these symptoms. It is a progressive and permanent obstruction of
airways. Smoking and air pollution are factors contributing to this disease.

20
Symptoms:
COPD symptoms often don't appear until significant lung damage has occurred, and they
usually worsen over time, particularly if smoking exposure continues. For chronic bronchitis,
the main symptom is a daily cough and mucus (sputum) production at least three months a
year for two consecutive years.
Other signs and symptoms of COPD may include:
● Shortness of breath, especially during physical activities
● Wheezing
● Chest tightness
● Having to clear your throat first thing in the morning, due to excess mucus in your
lungs
● A chronic cough that may produce mucus (sputum) that may be clear, white, yellow
or greenish
● Blueness of the lips or fingernail beds (cyanosis)
● Frequent respiratory infections
● Lack of energy
● Unintended weight loss (in later stages)
● Swelling in ankles, feet or legs
People with COPD are also likely to experience episodes called exacerbations, during which
their symptoms become worse than usual day-to-day variation and persist for at least
several days.
Causes:
The main cause of COPD in developed countries is tobacco smoking. In the developing
world, COPD often occurs in people exposed to fumes from burning fuel for cooking and
heating in poorly ventilated homes.Only about 20 to 30 percent of chronic smokers may
develop clinically apparent COPD, although many smokers with long smoking histories may
develop reduced lung function. Some smokers develop less common lung conditions. They
may be misdiagnosed as having COPD until a more thorough evaluation is performed.

Cirrhosis: Cirrhosis is an abnormal liver condition in which there is irreversible scarring of

the liver. The main causes are sustained excessive alcohol consumption, viral hepatitis B and
C, and fatty liver disease - however, there are many possible causes. People with cirrhosis
may develop jaundice (yellowing of the skin, eyes and tongue), itching and extreme
tiredness.
For cirrhosis to develop long-term, continuous damage to the liver needs to occur. When
healthy liver tissue is destroyed and replaced by scar tissue the condition becomes serious,
as it can start blocking the flow of blood through the liver. Cirrhosis is a progressive disease,
developing slowly over many years, until eventually it can stop liver function (liver failure).

The liver carries out several essential functions, including the detoxification of harmful
substances in the body. It also purifies the blood and manufactures vital nutrients. It refers

21
to a group of liver diseases and heavy alcohol consumption is considered to be one of the
contributing factors.

Symptoms of cirrhosis
A symptom is something the patient feels and reports, while a sign is something other
people, including a doctor or a nurse may detect. For example, pain may be a symptom
while a rash may be a sign. Symptoms are not common during the early stages of cirrhosis.
However, as scar tissue accumulates the liver's ability to function properly is undermined.
The following signs and symptoms may occur:

● Blood capillaries become visible on the skin on the upper abdomen

● Fatigue
● Insomnia
● Itchy skin
● Loss of appetite
● Loss of bodyweight
● Nausea
● Pain or tenderness in the area where the liver is located
● Red or blotchy palms
● Weakness

Causes:
Hepatitis C, fatty liver, and alcohol abuse are the most common causes of cirrhosis of the
liver in the U.S., but anything that damages the liver can cause cirrhosis, including:

● Fatty liver associated with obesity and diabetes

● Chronic viral infections of the liver (hepatitis types B, C, and D; Hepatitis D is
extremely rare)
● Blockage of the bile duct, which carries bile formed in the liver to the intestines,
where it helps in the digestion of fats; in babies, this can be caused by biliary atresia
in which bile ducts are absent or damaged, causing bile to back up in the liver. In
adults, bile ducts may become inflamed, blocked, or scarred, due to another liver
disease called primary biliary cholangitis.
● Repeated bouts of heart failure with fluid backing up into the liver
● Certain inherited diseases such as:
● Cystic fibrosis
● Glycogen storage diseases, in which the body is unable to process glycogen, a form
of sugar that is converted to glucose and serves as a source of energy for the body
● Alpha 1 antitrypsin deficiency, an absence of a specific enzyme in the liver

22
 ● Diseases caused by abnormal liver function, such as hemochromatosis, a condition in
which excessive iron is absorbed and deposited into the liver and other organs, and
Wilson's disease, caused by the abnormal storage of copper in the liver

Nephritis: Inflammation of kidney is called nephritis. Around 39,840 deaths occur in India
every year due to nephritis.
Symptoms:
Your symptoms will vary depending on the type of acute nephritis you have. The most
common symptoms of all three types of acute nephritis are:
● pain in the pelvis
● pain or a burning sensation while urinating
● a frequent need to urinate
● cloudy urine
● blood or pus in the urine
● pain in the kidney area or abdomen
● swelling of the body, commonly in the face, legs, and feet
● vomiting
● fever
● high blood pressure
● glomerulonephritis
Causes:
There are several interstitial nephritis causes, which could trigger off the kidney
inflammation in people. Given below are some of the most common interstitial nephritis
causes:
Heredity factors: This condition has been known to run in the members of the family.
Bacteria: The most common causes of the inflammation in children as well as adults is the
streptococcus bacteria
Other underlying conditions: There are several other medical problems, which could cause
a person to suffer from nephritis, some of which include urethral stricture, immune complex
diseases, gout, Hermann’s syndrome, yellow fever, renal tuberculosis, typhoid fever,
hepatitis, mumps, measles, pneumonia and abscesses.
Medication: People who are taking certain medication for a long period of time may also be
more prone to nephritis, as compared to the others.

Public health Care System in India: issues

& problems in rural and urban India
Public health system in India

23
The public health system in India comprises a set of state-owned health care facilities
funded and controlled by the government of India. Some of these are controlled by agencies
of the central government while some are controlled by the governments of the states of
India. The governmental ministry which controls the central government interests in these
institutions is the Ministry of Health & Family Welfare. Governmental spending on health
care in India is exclusively this system; hence most of the treatments in these institutions
are either fully or partially subsidized.
Health care in India is delivered through a three tier structure of health services comprising
the primary, secondary and tertiary health care facilities with the objective of bringing
health care services within the reach of the people of both the rural and urban areas. The
primary tier would have three types of health care institutions, namely, a Sub-centre (SC) for
a population of 3000-5000, a Primary Health Centre (PHC) for 20000 to 30000 population
and a Community Health Centre (CHC) as referral centre for every four PHCs.

Rural Health Care System in India

The health care infrastructure in rural areas has been developed as a three tier system and
is based on the following population norms:
Sub-Centres (SCs)
The Sub-Centre is the most peripheral and first contact point between the primary health
care system and the community. Each Sub-Centre is manned by one Auxiliary Nurse Midwife
(ANM) and one Male Health Worker MPW(M). One Lady Health Worker (LHV) is entrusted
with the task of supervision of six Sub-Centers. Sub-Centers are assigned tasks relating to
interpersonal communication in order to bring about behavioral change and provide
services in relation to maternal and child health, family welfare, nutrition, immunization,
diarrhea control and control of communicable diseases programmes. The Sub-Centers are
provided with basic drugs for minor ailments needed for taking care
of essential health needs of men, women and children.
Primary Health Centres (PHCs)
PHC is the first contact point between village community and the Medical Officer. The PHCs
were envisaged to provide an integrated curative and preventive health care to the rural
population with emphasis on preventive and promotive aspects of health care. The PHCs are
established and maintained by the State Governments under the Minimum Needs
Programme (MNP)/ Basic Minimum Services Programme (BMS). At present, a PHC is
manned by a Medical Officer supported by 14 paramedical and other staff. It acts as a
referral unit for 6 Sub Centres. It has 4 - 6 beds for patients. The activities of PHC involve
curative, preventive, primitive and Family Welfare Services.

Community Health Centers (CHC)

The Community Health Centre (CHC), the third tier of the network of rural health care
institutions, was required to act primarily as a referral centre (for the neighboring PHCs,
usually 4 in number) for the patients requiring specialized health care services. The objective

24
of having a referral centre for the primary health care institutions was two-fold; to make
modern health care services accessible to the rural people and to ease the overcrowding in
the district hospitals. The CHCs were accordingly designed to be equipped with: four
specialists in the areas of medicine, surgery, pediatrics and gynecology; 30 beds for indoor
patients; operation theatre, labor room, X-ray machine, pathological laboratory, standby
generator , etc., along with the complementary medical and paramedical staff.

Secondary Health Care

The secondary health care infrastructure at the district hospitals and urban hospitals is
currently also taking care of the primary health care needs of the population in the
city/town in which they are located. This inevitably leads to overcrowding and under
utilization of the specialized services. Strengthening secondary health care services was an
identified priority in the Ninth Plan. In addition to the funds they get from the state plan,
seven states have taken World Bank loans to initiate projects to build up district hospitals.
The aim of these projects is to :
● strengthen district hospitals so that they can effectively care for referrals;
● strengthen the referral system and rationalize care at each level to:
● enable patients to get care near their residence;
● ensure optimal utilisation of facilities at PHCs/ CHCs; and
● reduce overcrowding at the district and tertiary care level.

Tertiary Health Care

The tertiary health care is to be provided by health care institutions in urban areas which
are well equipped with sophisticated diagnostic and investigative facilities.
Over the last two decades a majority of the tertiary care institutions in the governmental
sector have been facing a resource crunch and have not been able to obtain funds for
equipment maintenance, replacement of obsolete equipments, supply of consumables and
upgrading the infrastructure to meet the rapidly growing demand for increasingly complex
diagnostic and therapeutic modalities. There is a need to optimise facilities available in
tertiary care institutions, enhance the quality of services and strengthen linkages with
secondary care institutions. Overcrowding in tertiary care hospitals and underutilization of
expert care due to the lack of a two way referral system with primary and secondary care
levels requires correction. To meet some of the recurring costs and to improve the quality of
services in tertiary health care institutions

HEALTH PRACTICES AND PROBLEMS IN RURAL INDIA

Rural people in India in general and tribal populations in particular, have their own beliefs
and practices regarding health. Some tribal groups still believe that a disease is always
caused by hostile spirits or by the breach of some taboo (group of tribal people living at a
particular place). They therefore seek remedies through magic or religious practices. On the
other hand, some rural people have continued to follow rich, undocumented, traditional

25
medicine systems, in addition to the recognized cultural systems of medicine such Ayurveda,
unani, siddha and naturopathy, to maintain positive health and to prevent disease.
The basic nature of rural health problems is attributed also to lack of health literature and
health consciousness, poor maternal and child health services and occupational hazards. The
majority of rural deaths, which are preventable, are due to infections and communicable,
parasitic and respiratory diseases. Infectious diseases dominate the morbidity pattern in
rural areas (40% rural: 23.5% urban). Waterborne infections, which account for about 80% of
sickness in India, make every fourth person dying of such diseases in the world, an Indian.
Annually, 1.5 million deaths and loss of 73 million workdays are attributed to waterborne
diseases.
Three groups of infections are widespread in rural areas, as follows:
1. Diseases that are carried in the gastrointestinal tract, such as diarrhea, typhoid fever,
infectious hepatitis, worm infestations and poliomyelitis. About 100 million suffer from
diarrhea and cholera every year.
2. Diseases that are carried in the air through coughing, sneezing or even breathing, such as
measles, tuberculosis (TB), whooping cough and pneumonia. Today there are 12 million TB
cases (an average of 70%). Over 1.2 million cases are added every year and 37 000 cases of
measles are reported every year.
3. Infections, which are more difficult to deal with, include malaria, filariasis(These are
spread by blood-feeding black flies and mosquitoes) and kala-azar(a slow progressing
indigenous disease caused by a protozoan parasite). These are often the result of
development. Irrigation brings with it malaria and filariasis, pesticide use has produced a
resistant strain of malaria, the ditches, gutters and culverts dug during the construction of
roads, and expansion of cattle ranches, for example, are breeding places for snails and
mosquitoes. About 2.3 million episodes and over 1000 malarial deaths occur every year in
India. An estimated 45 million are carriers of microfilaria, 19 million of which are active cases
and 500 million people are at risk of developing filarial.

Every third person in the world suffering from leprosy(an infectious disease that causes
severe, disfiguring skin sores and nerve damage in the arms and legs) is an Indian. (Nearly
1.2 million cases of leprosy, with 500 000 cases being added to this figure every year.)
Malnutrition is one of the most dominant health related problems in rural areas. There is
widespread prevalence of protein energy malnutrition (PEM), anemia, vitamin A deficiency
and iodine deficiency. Nearly 100 million children do not get two meals a day. More than
85% of rural children are undernourished
Major health problems in rural India
● Malnutrition
Malnutrition can be described as the unhealthy condition that results from not eating
enough healthy food. A well-nourished child is one whose weight and height measurements
compare very well within the standard normal distribution of heights and weights of healthy
children of same age and sex. Malnutrition impedes the social and cognitive development of

26
a child. These irreversible damages result in lower productivity. As with serious malnutrition,
growth delays hinder a child’s intellectual development. Sick children with chronic
malnutrition, especially when accompanied by anemia, often suffer from a lower learning
capacity during the crucial first years of attending school. Also, it reduces the immune
defense mechanism, which heightens the risk of infections.
● High infant mortality rate
Despite health improvements over the last thirty years, lives continue to be lost to early
childhood diseases, inadequate newborn care and childbirth-related causes. More than two
million children die every year from preventable infections.
Approximately 1.72 million children die each year before turning one. The under five
mortality and infant mortality rates have been declining, from 202 and 190 deaths per
thousand live births respectively in 1970 to 64 and 50 deaths per thousand live births in
2009. However, this decline is slowing. Reduced funding for immunization leaves only 43.5%
of the young fully immunized. Infrastructure like hospitals, roads, water and sanitation are
lacking in rural areas. Shortages of healthcare providers, poor intra-partum and newborn
care, diarrheal diseases and acute respiratory infections also contribute to the high infant
mortality rate.
Poor sanitation
As more than 122 million households have no toilets, and 33% lack access to latrines, over
50% of the population defecate in the open (2008 estimate). Although 211 million people
gained access to improved sanitation from 1990–2008, only 31% use the facilities provided.
Only 11% of Indian rural families dispose of stools safely whereas 80% of the population
leave their stools in the open or throw them in the garbage. Open air defecation leads to the
spread of disease and malnutrition through parasitic and bacterial infections.
Safe drinking water
Several million more suffer from multiple episodes of diarrhea and still others fall ill on
account of Hepatitis A, enteric fever, intestinal worms and eye and skin infections caused by
poor hygiene and unsafe drinking water.
Access to protected sources of drinking water has improved from 68% of the population in
1990 to 88% in 2008. However, only 26% of the slum population has access to safe drinking
water, and 25% of the total population has drinking water on their premises. This problem is
exacerbated by falling levels of groundwater caused mainly by increasing extraction for
irrigation. Insufficient maintenance of the environment around water sources, groundwater
pollution, excessive arsenic and fluoride in drinking water pose a major threat to India's
health.
● Female health issues
Maternal deaths are similarly high. The reasons for this high mortality are that few women
have access to skilled birth attendants and fewer still to quality emergency obstetric care. In
addition, only 15 per cent of mothers receive complete antenatal care and only 58 per cent
receive iron or folate tablets or syrup. Women's health in India involves numerous issues.
Some of them include the following:

27
 ● Malnutrition: The main cause of female malnutrition in India is the tradition
requiring women to eat last, even during pregnancy and when they are lactating.
● Breast Cancer: One of the most severe and increasing problems among women in
India, resulting in higher mortality rates.
● Maternal Mortality: Indian maternal mortality rates in rural areas are one of the
highest in the world.

Urban health in India

The share of the urban population in modern India is relatively low, comparable to the least
developed countries. In the future, the share of the urban population will grow in India much
faster than in the past: the average growth of the urban population will be 6% per decade.
This means that India will become predominantly urban sometime between 2040 and 2045.
India will be more than double its urban population from 367 million in 2010 to 915 million
in 2050. Thus India has to expect an additional 548 million urban dwellers in the next forty
years.

Major health problems in rural India

Poor environmental hygiene
The unregulated growth of the Indian cities is mainly driven by the private sector. Obviously
his leads to numerous negative consequences. Urban environments are heavily affected by
air pollution, water pollution and the collapse of the waste management system – to name
only the most obvious threats. The provision of basic amenities is a severe problem in many
cities.
The living conditions of the slum populations in particular, which constitute a significant
proportion of the population as a whole, are often unhygienic and highly unhealthy: in
Mumbai for example more than 60% of the population are slum dwellers. One of the key
provisions influencing health is water. The often neglected wastewater is an especially
important factor and a carrier of infectious and non-infectious diseases.

Rapid urbanisation and disparities in urban India:

India's urban population has increased from 285 million in 2001 to 377 million (31%) in 2011.
It is expected to increase to 535 million (38%) by 2026. The United Nations estimates that
875 million people will live in Indian cities and towns by 2050. If urban India were a separate
country, it would be the world's fourth largest country after China, India and the United
States of America. According to data from Census 2011, close to 50% of urban dwellers in
India live in towns and cities with a population of less than 0.5 million, while the four largest
urban agglomerations Greater Mumbai, Kolkata, Delhi and Chennai are home to 15% of
India's urban population.

28
Child Health, Survival Disparities in Urban India
Analysis of National Family Health Survey Data for 2005-06 (the most recent available
dataset for analysis) shows that within India's urban population – the under-five mortality
rate for the poorest quartile eight states, the highest under-five mortality rate in the poorest
quartile occurred in Uttar Pradesh (110 per 1,000 live births), India's most populous state,
which had 44.4million urban dwellers in the 2011 census followed by Rajasthan (102),
Madhya Pradesh (98), Jharkhand (90) and Bihar (85), Delhi (74), and Maharashtra (50). The
sample for West Bengal was too small for analysis of under-five mortality rate. In Uttar
Pradesh was four times that of the rest of the urban populations in Maharashtra and
Madhya Pradesh. In Madhya Pradesh, the under-five mortality rate among its poorest
quartile was more than three times that of the rest of its urban population.

Maternal Health care Disparities in Urban India

Among India's urban population, one should note the much lower proportion of mothers
receiving maternity care among the poorest quartile; only 54 per cent of pregnant women
had at least three ante-natal care visits compared to 83 per cent for the rest of the urban
population. Less than a quarter of mothers within the poorest quartile received adequate
maternity care in Bihar (12 percent), and Uttar Pradesh (20 percent),and less than half in
Madhya Pradesh (38 percent), Delhi (41 percent), Rajasthan (42 percent), and Jharkhand (48
percent). Availing three or more ante-natal check-ups during pregnancy among the poorest
quartile was better in West Bengal (71 percent), Maharashtra (73 percent).

High levels of under nutrition among the urban poor

For India's urban population in 2005–06, 54 percent of children were stunted, and 47
percent underweight in the poorest urban quartile, compared to 33 percent and 26 percent,
respectively, for the rest of the urban population. Children under five years being stunted
was particularly high among the poorest quartile of the urban populations in Uttar Pradesh
(64 percent), Maharashtra (63 percent), Bihar (58 percent), Delhi(58 percent), Madhya
Pradesh (55 percent), Rajasthan (53 percent), and slightly better in Jharkhand (49 percent).
Evenin the better-performing states close to half of the children under-five were stunted
among the poorest quartile, being 48 percent in West Bengal respectively.

High levels of stunted growth and being under-weight for age among the urban poor in India
points to repeated infections, depleting the child's nutritional reserves, owing to sub-optimal
physical environment. It is also indicative of high levels of food insecurity among this
segment of the population. A study carried out in the slums of Delhi showed that 51% of
slum families were food insecure.

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Twelfth Five Year Plan
The Twelfth Five Year plan covering 2012-2017 was formulated based on the
recommendation of a High Level Experts Group (HLEG) and other stakeholder consultations.
The long term objective of this strategy is to establish a system of Universal Health Coverage
(UHC) in the country. Key points include:

1. Substantial expansion and strengthening of public sector health care system, freeing
the vulnerable population from dependence on high cost and often unreachable
private sector health care system.
2. Health sector expenditure by central government and state government, both plan
and non-plan, will have to be substantially increased by the twelfth five-year plan. It
was increased from 0.94 per cent of GDP in tenth plan to 1.04 per cent in eleventh
plan. The provision of clean drinking water and sanitation as one of the principal
factors in control of diseases is well established from the history of industrialized
countries and it should have high priority in health related resource allocation. The
expenditure on health should increase to 2.5 per cent of GDP by the end of Twelfth
Five Year Plan.
3. Financial and managerial system will be redesigned to ensure efficient utilization of
available resources and achieve better health outcome. Coordinated delivery of
services within and across sectors, delegation matched with accountability, fostering
a spirit of innovation are some of the measures proposed.
4. Increasing the cooperation between private and public sector health care providers
to achieve health goals. This will include contracting in of services for gap filling, and
various forms of effectively regulated and managed Public-Private Partnership, while
also ensuring that there is no compromise in terms of standards of delivery and that
the incentive structure does not undermine health care objectives.
5. The present Rashtriya Swasthya Bima Yojana (RSBY) which provides cash less in-
patient treatment through an insurance based system should be reformed to enable
access to a continuum of comprehensive primary, secondary and tertiary care. In
twelfth plan period entire Below Poverty Line (BPL) population will be covered
through RSBY scheme. In planning health care structure for the future, it is desirable
to move from a 'fee-for-service' mechanism, to address the issue of fragmentation of
services that works to the detriment of preventive and primary care and also to
reduce the scope of fraud and induced demand.
6. In order to increase the availability of skilled human resources, a large expansion of
medical schools, nursing colleges, and so on, is therefore is necessary and public
sector medical schools must play a major role in the process. Special effort will be
made to expand medical education in states which are under-served. In addition, a
massive effort will be made to recruit and train paramedical and community level
health workers.

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 7. The multiplicity of Central sector or Centrally Sponsored Schemes has constrained
the flexibility of states to make need based plans or deploy their resources in the
most efficient manner. The way forward is to focus on strengthening the pillars of the
health system, so that it can prevent, detect and manage each of the unique
challenges that different parts of the country face.
8. A series of prescription drugs reforms, promotion of essential, generic medicine and
making these universally available free of cost to all patients in public facilities as a
part of the Essential Health Package will be a priority.
9. Effective regulation in medical practice, public health, food and drugs is essential to
safeguard people against risks and unethical practices. This is especially so given the
information gaps in the health sector which make it difficult for individual to make
reasoned choices.
10. The health system in the Twelfth Plan will continue to have a mix of public and
private service providers. The public sector health services need to be strengthened
to deliver both public health related and clinical services. The public and private
sectors also need to coordinate for the delivery of a continuum of care. A strong
regulatory system would supervise the quality of services delivered. Standard
treatment guidelines should form the basis of clinical care across public and private
sectors, with the adequate monitoring by the regulatory bodies to improve the
quality and control the cost of care,

National Rural Health Mission (NRHM)

The National Rural Health Mission (NRHM) was launched in April 2005 by the Government of
India. The goal of the NRHM was to provide effective healthcare to rural people with a focus
on 18 states which have poor public health indicators and/or weak infrastructure. It has
18,000 ambulances and a workforce of 900,000 community health volunteers and 178,000
paid staff. Only 2% of doctors are in rural areas - where 68% of the populations live.

National Urban Health Mission (NUHM)

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The National Urban Health Mission as a sub-mission of National Health Mission was
approved by the Cabinet on 1 May 2013. It aims to meet health care needs of the urban
population with the focus on urban poor, by making available to them essential primary
health care services and reducing their out of pocket expenses for treatment.

MEDICAL TOURISM IN INDIA

Medical tourism is a growing sector in India. In October 2015, India's medical tourism sector was
estimated to be worth US$3 billion. It is projected to grow to $7–8 billion by 2020. According to
the Confederation of Indian Industries (CII), the primary reason that attracts medical value travel
to India is cost-effectiveness, and treatment from accredited facilities at par with developed
countries at much lower cost. The Medical Tourism Market Report: 2015 found that India was
"one of the lowest cost and highest quality of all medical tourism destinations, it offers wide
variety of procedures at about one-tenth the cost of similar procedures in the United States." [1]

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Foreign patients travelling to India to seek medical treatment in 2012, 2013 and 2014 numbered
171,021, 236,898, and 184,298 respectively.[2] Traditionally, the United States and the United
Kingdom have been the largest source countries for medical tourism to India. However,
according to a CII-Grant Thornton report released in October 2015, Bangladeshis and Afghans
accounted for 34% of foreign patients, the maximum share, primarily due to their close proximity
with India and poor healthcare infrastructure.
Russia and the Commonwealth of Independent States (CIS) accounted for 30% share of foreign
medical tourist arrivals. Other major sources of patients include Africa and the Middle East,
particularly the Persian Gulf countries.[3] In 2015, India became the top destination for Russians
seeking medical treatment.[4] Chennai, Kolkata, Mumbai, Hyderabad, Bangalore and the National
Capital Region received the highest number of foreign patients primarily from South Eastern
countries, with Chennai having come to be known as "India's health capital".

Attractions
Advantages of medical treatment in India include reduced costs, the availability of latest medical
technologies,[6] and a growing compliance on international quality standards, Doctors trained in
western countries including US and UK, as well as English speaking personnel, due to which
foreigners are less likely to face language barrier in India. According to the Confederation of
Indian Industries (CII), the primary reason that attracts medical value travel to India is cost-
effectiveness, and treatment from accredited facilities at par with developed countries at much
lower cost. The Medical Tourism Market Report: 2015 found that India was "one of the lowest
cost and highest quality of all medical tourism destinations, it offers wide variety of procedures at
about one-tenth the cost of similar procedures in the United States." [1]

Cost
Most estimates found that treatment costs in India start at around
one-tenth of the price of comparable treatment in the United States or the United
Kingdom.[7][8] The most popular treatments sought in India by medical tourists are alternative
medicine, bone-marrow transplant, cardiac bypass, eye surgery and hip replacement. India is
known in particular for heart surgery, hip resurfacing and other areas of advanced medicine.

Quality of care
India has 28 JCI accredited hospitals. However, for a patient traveling to India, it is important to
find the optimal Doctor-Hospital combination. After the patient has been treated, the patient has
the option of either recuperating in the hospital or at a paid accommodation nearby. Many
hospitals also give the option of continuing the treatment through telemedicine.
The city of Chennai has been termed "India's health capital".Multi- and super-specialty hospitals
across the city bring in an estimated 150 international patients every day. [10] Chennai attracts
about 45 percent of health tourists from abroad arriving in the country and 30 to 40 percent of
domestic health tourists.[5] Factors behind the tourists inflow in the city include low costs, little to
no waiting period,[13] and facilities offered at the specialty hospitals in the city.[10] The city has an
estimated 12,500 hospital beds, of which only half is used by the city's population with the rest
being shared by patients from other states of the country and foreigners.[14] Dental clinics have
attracted dental care tourism to Chennai.

Ease of travel
The government has removed visa restrictions on tourist visas that required a two-month gap
between consecutive visits for people from Gulf countries which is likely to boost medical
tourism.[16] A visa-on-arrival scheme for tourists from select countries has been instituted which

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 allows foreign nationals to stay in India for 30 days for medical reasons. [17]In 2016, citizens of
Bangladesh, Afghanistan, Maldives, Republic of Korea and Nigeria availed the most medical
visas.[18]

Language
Despite India's diversity of languages, English is an official language and is widely spoken by
most people and almost universally by medical professionals. In Noida, which is fast emerging as
a hotspot for medical tourism, a number of hospitals have hired language translators to make
patients from Balkan and African countries feel more comfortable while at the same time helping

in the facilitation of their treatment.

Major Medical Tourism Facilitators.

In order to promote the positioning of India as a Medical destination and increase the presence of
the medical fraternity in the international travel exhibitions, a dedicated space of 4 sq m. was
provided to the medical fraternity within the India Pavilion at ITB Berlin. All stakeholders engaged
in Wellness and /or Medical Tourism activities would endeavour to form either Wellness Tourism
Association of India or Medical Tourism Association of India or Wellness and Medical Tourism
Association of India, which will have open all India membership, is committed for holding
elections at regular intervals & hold annual Audit of Accounts and is registered as a non
profitable society.
Road shows focusing on Medical Tourism is a continuous process and is organized in
consultation with the Stakeholders from time to time. The last road show was organised in West
Asia (Dubai, Riyadh, Kuwait and Doha) in October 2009 which was led by the Minister of State
for Tourism. The Ministry of Tourism would consider providing financial support in the ratio of
50:50 for making publicity and promotional material subject to the condition that the Ministry of
Tourism would provide a maximum of Rs.10.00 lakh under the category for each stakeholder in a
financial year.

Why India is the best choice for medical tourism

● Some of the reasons commonly stated by tourists from other countries are
● Reduced cost of treatment
● International Quality standards
● Better availability of specialist doctors for transplant surgeries
● Modern Infrastructure
● State-of-the-art treatment facilities and diagnostic instruments
● Expertise of doctors in their super speciality fields
● Trained and compatible staff for international patient care
● Visa on arrival scheme for tourists from selected countries
● Favourable Health covers for international patients
● Remote patient follow up & assistance

A visit that is more than just treatment

Patients coming to India often seek more than treatment and learn wellness techniques like
Yoga, Ayurveda and Naturopathy. Many facilities in India have become a destination for learning
and healing together. One can opt for a complete body detox using Yoga techniques and learn
them too.

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While these treatments are not available in foreign countries, it becomes an opportunity for
international patients to extend their stay to learn and get certified in Yoga and Ayurvedic
techniques for personal well being or starting a teaching school in their own country.
Centres like Patanjali in Haridwar and Varanasi, Astang Yoga Ashrams in Mysore and
Shirodhara oil massage schools in Kerala are in close vicinity of urban cities with international
airports.
Many tourists extend their stay and enjoy the Indian scenery by travelling to these places to
celebrate their health and add a touch of tourism to their trip.

Conclusion
There are many more micro factors that attract medical tourists such as the relative ease in
getting a donor for heart, kidney or liver transplant and commercial surrogacy being legal in India.
Commercial surrogacy is very well established marked with surrogate mothers receiving medical
cover, care and nutrition as covered by the foreign patients.
It’s tough to say if Medical tourism will touch the $8 million projection by 2020, but the increase in
numbers will guarantee India a stronghold in International healthcare market thanks to the Best
hospitals in India.

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