Diseases due to change in the environment are on the rise, especially in India. Olavi Elo , World Health Organization (who) representative in India, tells Sonia Kapoor about the action being taken to combat them
On the threat to environment and health in India:
In India, the issues that need attention are: a) Water supply and sanitation. This includes drinking water quality surveillance, basic sanitation, hygiene behaviour, excreta and waste water disposal, and solid waste management. Specific to the urban context are the problems of drainage, sewerage and sewage treatment, solid waste management (including hospital waste), industrial wastes (liquid as well as solid), air pollution and noise pollution; b) Chemical safety, which refers to poison prevention management; c) Health risk assessment of development projects.
On the programmes WHO is pursuing through funding and research:
who has prepared an action plan for Government of India (goi) projects, namely, "Water Supply and Sanitation in Human Settlements" (urban and rural areas), "Environmental Health in Urban Development", and "The Promotion of Chemical Safety". During 1996-97, who supported four research projects. These include three studies conducted at the All India Institute of Medical Sciences (aiims) on lead level in blood, epidemiological study on the prevalence of pulmonary and extra-pulmonary silicosis among quarry workers around Delhi, and a study of morbidity due to air pollution in Delhi. The fourth study by Shriram Institute for Industrial Research on impacts of solid wastes at dumping sites on ground water quality in the national capital. It may be noted that who is not a funding agency. It provides catalytic technical support to the ministries of the Union government for capacity-building.
On whether WHO plays any role in formulating environmental health policies for India:
Yes, we at the who are working with the various ministries including the ministry of health and family welfare. Our representatives attended some of these national meetings which have considered policy development in environment and health sectors.
On the Indian government's response to the recommendations made by WHO on various environmental health issues:
Whenever we have worked with the ministries, the response of the Indian government to our recommendations on various environmental health issues has been positive. Response to our workshops on environmental health has been encouraging too.
On whether pesticides such as dichlorodiphenyl trichloroethane (DDT) and HCH, which are banned in most of the advanced countries, should continue to be used for public health purposes in India:
We understand that the use of hch in malaria control stopped in 1992 and that of bhc will be withdrawn. ddt production will be phased out by 2002. Already, the quantity produced is reported to be decreasing. So it appears that goi recognises the need for phasing out these substances for malaria control. However, ddt will continue to be used for kala-azar control for some more time.
On whether environmental management of vectors is an answer to the problem of vector-borne diseases in India, when there is an increasing evidence of vector and drug resistance:
Yes, it is certainly one of the answers. who has always advocated environmental management of vectors, in addition to improved sanitation, drainage, etc.
On the steps WHO is taking to tackle health hazards due to vehicular pollution:
who, for many years, has been involved in air pollution assessment on a global level and has extended assistance for training in monitoring and assessment of ambient air quality in collaboration with National Environmental Engineering Research Institute (neeri) and through its own publications. This has contributed to awareness regarding the health risk due to vehicular and industrial pollution.
On the recommendations to minimise the health problems related to environment:
In 1993, following the formulation of a who global strategy for health and environment, the Regional Strategic Plan for Health and Environment was prepared to guide and promote the preparation of national plans of action for health and environment.
We feel that the effects of development on health should be identified and mitigated before they emerge as a major problem in the country. In this regard, the health sector should sensitise other sectors such as agriculture, industry, transport, energy, housing, public works, and rural and urban developments to address health concerns in their development process.
Two recently-organised regional consultations -- one on health and environment in Maldives (October 13-15, 1997) and the other on urban environmental health in Bangkok (October 27-30, 1997) reviewed the progress in Southeast Asian regional countries including India, in preparing national plans of action for health and environment. We hope that these consultations would provide the backbone for formulating action for pursuing health and environment programmes in the country.
On WHO programmes to combat non-communicable diseases (NCDs):
At the recent regional committee meeting, countries stressed the need to address the growing problem of ncds such as cancer and cardiovascular diseases.
who programmes for ncds in India are the cancer control and palliative care, cardiovascular disease control, and the diabetes control projects.
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