Public Health Issues Related to Natural Disasters (academic)

The article “Earth Perturbations and Public Health” discusses natural disasters such as  earthquakes, tropical cyclones, floods, droughts, volcanic eruptions, landslides, and land subsidence and how they can cause both short and long term health problems.  During natural disasters, hospital and other medical facilities can be destroyed, along with food and water supplies (Earth Perturbations).  On serious public health problem that this article hardly addresses is the issue of mental health and post traumatic stress after natural disasters.  Among victims of earthquakes, floods, and hurricanes, there are dramatic increases in suicide rates in the years following these natural disasters (Krug, Kresnow, et al. 1999).

The clearest indication of the effects natural disasters have on the health of a population is the direct mortality from trauma.  In eastern Pakistan in 1970, coastal inundation caused the death of 761,000 people, and Tangshan, China, in 1976, an earthquake caused the death of 557,900 people.  More recently, the Sumatran tsunami in 2004 caused the death of at least 285,00 people.  Post disaster health issues include indirect mortality and sickness from infectious diseases, and mental health problems such as post traumatic stress and suicide (Earth Perturbations) and (Krug, Kresnow, et al. 1999).

Although natural disasters do not discriminate, it is the poorest countries that are most vulnerable to short and long term health effects.  Approximately 66% of the world’s population that live in the poorest areas account for 95% of deaths from natural disasters (Earth Perturbations).  This is likely due to the fact the poorest countries lack infrastructure that is resistant to natural disasters, and thus it is more likely that buildings and roads will destroyed during a disaster.  Also, the poorest countries already lack adequate health care services, and during a disaster, they must rely on international aid for guidance and stability.  Reasons one may commit suicide in the days, months, and years following a natural disaster include, the loss of family, friends, property, jobs, and post traumatic stress.  In impoverished areas, these issues are exasperated and pose an even greater problem (Krug, Kresnow, et al. 1999).

It is interesting however, that different natural disasters can greatly vary the effect on ones mental state.  Suicide rates increase for about 4 years after flooding, two years after hurricanes, and only one year after floods.  After flooding, suicide rates increase 13.8 percent, and 18.9 percent after hurricanes (Krug, Kresnow, et al. 1999).  A possible reason that increased suicide rates remain high for the longest period of time after flooding may be because floods occur more often than other natural disasters, even if that are not considered a federal disaster, and victims of floods report three times as much financial loss and four times as many injuries.  Also, flood victims are more likely to take out loans, giving temporary relief, but adding stress over the long run.  Water also carries many disease, which makes makes flooded regions even more vulnerable to disease outbreaks (Krug, Kresnow, et al. 1999) and (Earth Perturbations).  

The use of technology in preventing indirect deaths after a natural disaster is crucial.  Geographic Information System can be used to plot disease outbreaks and the likely rate and direction the disease will spread.  This can give epidemiologists the upper hand, and allow them to more effectively stop the spread of disease, thus saving thousands of human lives.  Also, GIS can be used to map areas and help officials determine which type of naturals disaster a certain area might be prone to (Earth Perturbations).  Strong infrastructure is also important in reducing the severity of natural disasters.  And although it is often overlooked, mental health support is necessary after severe disasters.  This could come in the form of social support, or financial aid, and because flooding causes the largest impact on mental health, the building of flood walls, and reforestation, can help reduce the intensity of flood based mental health issues, along with the obvious effects of direct mortality from trauma (Krug, Kresnow, et al. 1999).

Krug, E. G., Kresnow, M., Peddicord, J., Dahlberg, L. L., & Powell, K. E. (1999). Suicide after natural disasters. The New England Journal of Medicine, 338(6), 373-378. Retrieved from http://www.nejm.org/doi/pdf/10.1056/NEJM199802053380607

(n.d.). Earth perturbations and public health impacts. National Academy of Sciences, 99-111.

Nutrition in India (academic)

In the article “Nutrition transition in India,” Shetty discusses how the upper class in developing countries, specifically India, are consuming more calories, and are receiving a larger portion of those calories from animal based products.  This is leading to an epidemic of non-communicable diseases, which is commonplace in the industrialized world, but has yet to be seen in the developing world.  40 percent of deaths in the developing world are now caused by non-communicable disease, and 75 percent of deaths in the industrialized world are caused by non-communicable diseases.

Studies of the rapidly urbanizing of populations, occurring in developing countries, has shown the relationship of genetic and environmental causes of non-communicable diseases such as cancer, diabetes, and cardiovascular disease.  When migrants adopt the diet and lifestyle of the native population, they tend to acquire similar diseases as the native population, but in some instances their genetic differences can cause them to be more prone or more resistance to certain non-communicable diseases (Shetty, 2002).  Also, residents of urban areas tend to have a higher BMI because of a more sedentary lifestyle, and higher caloric consumption (World Health Organization).  As Indian society develops, and urbanizes, the standards of living increase.  Unlike already developed nations, in which there are higher rates of obesity among the poor, it is the upper class in India that are showing higher rates of weight gain and obesity.

In Urban areas of India, there is a socio-economic divide of obesity rates.  Urban residents that make up the upper class have obesity rates of 32.2 percent for males, and 50 percent for females.  Among the middle class, 16.2 percent of males, and 30.3 percent of females suffer from obesity.  For the urban poor, many of which live in slums, the obesity rate for males is only 1 percent, and 4 percent for females (Shetty).  The change in energy intake as income increases is generally not a shift towards higher caloric intake, but a shift in diet favoring increased intake of animal based fat and protein, and sugar, and a decrease in the consumption of vegetable fat and protein (World Health Organization).  In India, those in the upper income strata consumed a diet in which 32 percent of the energy was derived from fat, while those in the lower income strata consumed a diet in which only 17 percent of the energy was derived from fat (Shetty).  However, when caloric intake does increase, it is almost always because an increase in animal fat and protein consumption.  In a diet of 2000 kcal, the fat calorie ratio is 10 percent, but for a 3600 kcal diet, the fat calorie ratio is 41 percent, showing the increase of input from animal based fats going from 29 percent to 64 percent.  This increase occurred because of the per capita supply of animal goods increased since 1965 from 7 grams to 12.5 grams in 1999.  The income based disparity of caloric intake is most visible in the fact that “40 percent of all edible fat available in India is being consumed by 5 percent of the total population” (Shetty).

A healthy diet, and weight loss prevention necessitate the inclusion of vegetables, fruits, cereals, and grains in ones diet, along with physical activity (World Health Organization).  India’s large share in the international production of fruits and vegetables is not evident in its populations consumption of fruits and vegetables.  This can be attributed to the fact that much of the agricultural production in India is cash crops that are exported overseas (Shetty).

Time dedicated to physical work has decreased with population transitions to urban areas for work in offices.  Physical activity has also decreased because of the increased use of cars, mechanical replacement of once manual jobs, and increased leisure time which is generally dedicated to sedentary activity such as watching television (Shetty).  For those with sedentary lifestyles, a fat intake of no greater than 20-25 percent of total energy consumed, is necessary to minimize energy imbalance and weight gain (World Health Organization).

The inverse relationship of animal fat consumption and income, between developing and developed nations, is likely due to the fact that the most caloric dense food found in developed countries are the cheapest.  Whereas in developing countries, the caloric dense food is a luxury item the only the wealthy have access too.  As the average income of Indians continues to rise, so will the consumption of animal based products and sugar, and thus an increase in the prevalence of non-communicable disease.  Through subsidies, and mass production, it is also possible that India will make unhealthy caloric dense foods available to its poorest members, causing an increase of obesity in the poor.

Shetty, P. (2002). Nutrition transition in india. Public Health Nutrition, 5(1A), 175-182.

World Health Organization (WHO). Obesity: Preventing and Managing the Global Epidemic. Report of a WHO consultation.  WHO Technical Report Series No. 894.

Water Resources (academic)

In “Problems Related to Water Resources Management in India,” the authors discuss problems, solutions, policy objectives, and locations of a number of water related issues in India.  These issues include floods, droughts, pollution, groundwater depletion, water conservation, water prices, and water as a commons (Jain et al., 2007).  Solving these water related problems is essential for India to continue its economic growth, and social advancement in the coming years.

Jain, Agarwal, and Singh’s argument concerning the depletion of groundwater is backed up Rodell, Velicogna, and Famiglietti, in their paper, “Satellite-based estimates of groundwater depletion of in India.”  Using NASA Gravity Recovery and Climate Experiment Satellites, along with hydrological modeling, it was shown that groundwater was being depleted at a rate of 4+1 cm per year (Rodell et al., 2009).

Availability and distribution of water resource varies drastically throughout different regions of India.  The region with the highest availability of water has on average 14,100 m^3 per capita, per year, while the area with the lowest water availability has on average 300 m^3 per capita, per year (Jain et al., 2007).  Although these are two extremes, the former with excess water resources, and the later with stressed water resources, India as a whole has seen massive decreases in its water resources over the passed 60 years.  Between 1947 and 2000, per capita water availability dropped from 6,008 m^3, to 2,384 m^3 (Jain et al., 2007).  

Having abundant and excess water resources is beneficial in some aspects, but because much of the rainfall is concentrated during the monsoon season, these areas are extremely prone to flooding.  Historically, flooding has caused loss of human life, death of livestock, loss of crops, and overflow of urban drainage systems.  At the other extreme, drought occurs when expected rainfall never comes.  In India, drought prone areas account for one sixth of the total land mass, and 12% of the population (Jain et al., 2007).

The widespread use of groundwater allowed for development in agriculture, and helped sustain the green revolution.  However, increasing from 3.86 million dug-wells, and 3,000 tube-wells in, to 10.2 million dug-wells, 60,000 deep tube-wells, and 5.4 million private tube wells, over the course of four decades, has lead to a drastic fall in the water table (Jain et al., 2007).  In the Region Including Punjab, Haryana & Delhi, and Rajasthan, the annual available water recharge and the annual withdraw is at a 13.2 km^3 per year deficit (Rodell et al., 2009), a product of the increase in well use.  This massive influx in well use allowed India to triple the total area of irrigated land between 1970 and 1999, to 33,100,000 hectares.  The huge reliance of the Indian people on groundwater is apparent in the the fact that 50-80% of domestic water use, and 45-50% of irrigation is dependent on groundwater (Rodell et al., 2009).

Along with higher crop productivity, the use of groundwater opened up a new source for clean drinking water.  Because life expectancy is closely tied to availability of clean drinking water, it is likely that 20 year increase in life expectancy over the last 45 years in tied to huge increase in groundwater use (Jain et al., 2007).  Pollution from anthropomorphic and natural sources are jeopardizing the quality of surface and groundwater, limiting the amount of clean water available. 

Waterlogging is a problem in coastal areas, or areas that have saltwater intrusion into groundwater.  Excess water in the soil does not allow for normal circulation of air, can cause root rot, and causes dissolved minerals from the water to be left in the soil after evaporation.  All of this leads to lower crop productivity (Jain et al., 2007). 

Climate change effects India’s water resources by shifting weather patterns, such as monsoons, and melting glaciers.  For regions that rely glacier melt for their freshwater supply, the fast retreat of glaciers is a major obstacle.  Temporally, increased melting means increased flow, and more water for drinking and agriculture, but if the melting trend continues and glaciers disappear, whole regions of people will be left without water during the dry months.  In all, 67% of glaciers in the Himalayas have receded in the past decade (Jain et al., 2007).

Flooding, droughts, groundwater depletion, pollution, waterlogging, and climate change are all serious obstacles that must be addressed and combatted if India is to continue on its path of rapid economic growth and social development. 

Jain, S. , Agarwal, P. & Singh, V. (2007). Problems related to water resources management in india. Water Science and Technology Library, 57, 871-936.

Rodell, M. , Velicogna, I. & Famiglietti, J. (2009). Satellite-based estimates of groundwater depletion in india. Nature, 460, 999-1002. Retrieved from http://www.nature.com/nature/journal/v460/n7258/pdf/nature08238.pdf

Gender, Environment and Poverty Interlinks (academic)

In the paper “Gender, Environment, and Poverty Interlinks: Regional Variations and  Temporal Shifts in Rural India, 1971-91,” Agarwal argues that the effects of  environmental degradation are more heavily felt by female members of poor rural communities.  However, Agarwal does make it clear that one variable does not necessarily cause the other.  Such as in United Arab Emirates, where gender discrimination widespread, but poverty is a non issue.

In India, environmental degradation takes the takes the form of deforestation, soil erosion, and water depletion.  Deforestation, because of expanding cities, agriculture land expansion, timber demand, and firewood collection have left only about 20% of India forested.  Loss of ground cover has caused much of the nutrient rich top soil to wash away, and the overuse of chemical fertilizers as caused a reduction in soil fertility.  Heavy reliance on wells for drinking water and agriculture has drastically lowered the water table, causing many wells to go dry.

In poor rural villages, forests are considered commons, but privatization and deforestation of these lands has caused these already poor villages to lose one of their few resources, accelerating the cycle of poverty.  The poor in rural villages depend on the commons for 90% of their firewood,  without the commons, the poor have lost a valuable resource used for cooking fuel, and warmth.  Because deep tube wells are expensive to install and maintain, they are mainly utilized by wealthy farmers, and because of their widespread use, water tables have fallen, drying up shallower wells that poor villages depend on.  Polluted groundwater tends to be found in the shallower areas of the water table, wealthy individuals can afford to sink deeper wells to access cleaner water, whereas the poor are forced to continue use of polluted shallow wells.  

Gender discrimination is widespread throughout India, but is especially prevalent in poor rural areas.  In rural areas, men almost always control the finances, and thus control access to food, education, and health care.  However, when women do share access to finances, they allocate the resources to meet the needs of the family, whereas men tend to allocate the resources to please themselves.  Both because of law and tradition, women have historically been denied the right to inherit arable land, a practice that has forced some women to forage on common lands for survival.  Considering women’s restricted access to private property, fewer employment opportunities, and lower wages, access to common resources are essential for the well being of both the women and the children.  The privatization of once common land, has taken away vital resources for women and children.

Much of the foraging in poor rural communities is done by the women, so the combination of land privatization and environmental degradation has decreased the productivity of women while foraging.  Another problem associated with less availability of fuel wood is the consumption of lower quality and less nutritious foods, that take less fuel to prepare.  Less nutritious food has negative health effects, and can lower the productivity of workers.  Now, women and girls taking over even more of a role in manual labor, because the male children are sent off during the day to attend school, likening the possibility that the gender gap will widen, at least in rural areas.

In northern India, gender discrimination plays an even greater role in everyday society, than the rest of India.  In general, the northern states have lower literacy rates for women, and higher fertility rates.  In the state of Rajasthan, literacy rates are only 9.24, and fertility rate is 4.8.  Rajasthan also has much lower percentage forest cover than almost every other state in India.  The lack of education, the toll high rates of child birth play on ones health, and lack of forested area for food collection, can play a major role in keeping women marginalized in society.

Although Agarwal’s analysis provided good insight into the condition of women, poverty, and the environment during the period studied (1971-1991), over the last two decades there have been significant improvements in the treatment of women.  Although not always followed, there are laws in place to stop gender discrimination and allow for the advancement of women.  Poverty is being fought through social programs such as micro loans, and there have been efforts to reverse environmental degradation through reforestation.  If small improvements can be made in these three categories, it is possible that feedback loop discussed by Agarwal could be reversed.