What is the trickle-down effect of bilateral relations between countries on public health in India? Will livestock farming in high-income countries affect global health and environment? How will the growth of cities impact the health of populations?
These questions may be far-fetched for many who think of health only as a product of interactions between individual beliefs, behaviours and biology, and view medical care as the only pathway for improving health. However, health has many determinants that lie outside the conventional biomedical paradigm and are influenced by non-individual interventions that have a profound population-wide impact.
These interconnections have been long recognized by the public health community, but are being acknowledged only recently. They are at the forefront of ongoing discussions on the post-2015 United Nations’ sustainable development goals. While individual sectors are charting goals of their own, they are also being pressed to describe how those goals will impact other development sectors so that an integrated framework for sustainable development can emerge in 2015.
It is no secret that poverty is both a cause and consequence of ill-health, especially when the poor in India are known to have among the worst health indicators globally. Healthcare costs push 60 million Indians below the poverty line each year. It requires no imagination to recognize that water and sanitation have a great impact on health. Studies show that half of childhood under-nutrition in India can be ascribed to poor sanitation.
Nutrition and health exhibit a two-way correlation. For example, a child with diarrhoea cannot retain nutrients, and a poorly nourished child easily falls prey to infections. Similarly, many of the major heart and blood-vessel diseases, diabetes and several cancers are related to patterns of diet, and persons with these diseases end up being nutritionally compromised in many ways. The link between health and education, too, is strong. In a graded fashion, one can see that better educated persons exhibit better health outcomes. This relationship persists even after adjustment for income differences and is stronger, in many cases, than the income-health relationship. In the other direction, a sick child becomes educationally disadvantaged, if not altogether deprived. Even adult learning is adversely affected by ill-health.
Gender is another area that has a strong interface with health. Women are less likely to access health services due to a variety of sociocultural barriers. When they do, they are also less likely to receive the attention and quality of care men receive. They do not have free access to a wide range of reproductive health services. With lower income levels, they are also more likely to be impoverished by healthcare costs.
It is amazing then that women are among the foremost agents for improving health of families and communities. Women’s education and employment have been shown to improve immunization rates, reduce child mortality, and result in a smaller size and greater well-being of families. As self-help groups, front-line health workers, nurses and doctors, women are also transforming health, both as social mobilizers and care providers. These roles, in turn, are enhancing their social standing and enabling them to acquire and assert greater autonomy, providing much-needed elements of empowerment.
Going beyond the obvious, what about the questions we began with? How do energy, agriculture and urban development sectors link to health?
A positive outcome of US-Iran rapprochement is the lifting of trade sanctions against Iran. That should free India to important natural gas from Iran. If the India-Pakistan detente also reaches a state of positive engagement, the pipeline should provide an abundant supply of natural gas. That would enable household supply of cooking gas to millions of homes, overcoming the shortage of liquefied petroleum gas, which is a limited industrial byproduct. This gas will replace wood and other biofuels, which are burnt for cooking in many poor homes and cause indoor air pollution. Such pollution causes severe chronic respiratory disease among women and acute respiratory infections in young children.
Apart from freeing poor women and children from the kitchen’s curse of indoor pollution, such household energy security also liberates women from the drudgery of walking far to forest areas for gathering wood and the attendant dangers of sexual assault—other dimensions of health and well-being.
Red meat consumption exceeds desirable levels in many high-income countries, leading to several health problems. Industrial-scale livestock production causes grain diversion (animal feed), water scarcity, global warming (methane emissions from ruminants) and pandemic risks (spread of microbes across a conveyor belt from deforested wild life to closely packed captive veterinary populations to human habitat).
As urbanization shifts more people to cities and towns, health becomes a major concern if water and sanitation services are sub-optimal, road safety is not assured, air pollution levels rise, violent crime endangers personal safety, and the built environment is not supportive of walking, cycling and outdoor recreation. Planned urbanization can prevent these and protect health from many assaults.
Health is a good summative measure of sustainable development for all of these reasons. Even as other development sectors pursue their specific goals, they should consciously try to enable and not erode health through their actions.
K. Srinath Reddy is president of the Public Health Foundation of India.