Enviornmental Medicine and Public Health

The Kerala Model of development

The State of Kerala within India has received international attention and acclaim for its conscious policy intervention for high levels of human development which is proclaimed as “Kerala model” of development. Since 1970s, in Kerala, human development indices seemed to show a standard of living which was comparable with life in developed nations, on a fraction of the income. Kerala model demonstrated that high levels of human development have also been instrumental in registering sustained economic growth. However, there are doubts regarding the quality and type of education as well as status of health in Kerala and also the soundness of the recent growth experience.

Public health in Kerala

As regards health, according to the studies, one feature that stands out is the high level of morbidity co-existing with low levels of mortality and high life expectancy in Kerala. One salient feature of the morbidity profile of Kerala is that diseases of poverty coexist with those of affluence.

Natural ecology has been tampered with and the once-famous backwaters of the state are polluted and weed infested. Waste disposal in the municipalities and corporations still remains a formidable challenge. Conventional methods like land fill evoke furious protests from local inhabitants. Critics have re-christened 'God's Own Country' as 'God's own junkyard'.

 As a result Kerala is on the brink of a public health crisis. The state is regularly visited by emerging outbreaks of leptospirosis, dengue fever and other insect borne viral fevers; the latest entrants are chickungunya and H1N1 viruses.

Recent studies suggest that Kerala has the highest burden of coronary heart disease, stroke, hypertension, diabetes and over-nutrition. Conservative estimates put the number of people with diabetes at three million; people with hypertension at 4.5 million and those with overweight and obesity at 10 million.

Every year in Kerala, between 45,000 and 50,000 people die of heart attacks, while stroke kills over 20,000. In comparison, the annual death toll from HIV/AIDS is just over 200. But both the government and the people perceive HIV control as a greater priority than lifestyle interventions aimed at curbing the epidemic of non-communicable diseases.

Healthcare system in Kerala

It is the healthcare industry that benefits from this sordid state of affairs in Kerala. Kerala’s total health care system spread across villages and communities consists of institutions in Government sector, co-operative sector, and in private sector with systems of treatment in allopathy, ayurveda, homeopathy, sidha, and naturopathy. The Government hospitals with almost free or subsidized treatment facilities are still the sole asylum for the poor. But medical care in the state has increasingly become dehumanized and privatized. Private hospitals offering sophisticated tertiary care are mushrooming, even in villages. Commodifying healthcare - increasingly driven by profit - will demolish all that the state had achieved in the health sector during the last decades of the 20th century.

Public health and health care issues

The major problems in the health sector of Kerala may be summarized as follows:

1. Rapidly increasing prevalence of diseases associated with lifestyle and ageing.
2. Prevalence of environment related diseases owing to problems of community hygiene and pollution.
3. Difficult access to health care and impoverishment of a sizeable segment of population owing to high out of pocket health expenditure.

[Higher prevalence of the mental health problems including the higher suicide rates, health problems and death due to road traffic accidents and other traumas are other dimensions of the health problems in Kerala].

Study options for foreign students

The students can pursue their studies in any of the above three categories covering various socio-economic, environmental and medical components. The government and private hospitals will be good ‘laboratories’ for their studies. They can also explore various systems of medicine practiced in the state, both independently and in an integrated manner. The environmental issues which are identified as the main cause of burgeoning health problems open a Pandora’s Box for every enthusiastic student.

Programmes offered

1. Public health and environmental medicine tour- through health care centers and environmental problem points (10 day to 45 days)
2. hort term studies – 10-day to 3 month period studies on various issues mentioned above
3. Long term studies – 3 month to one year period (or more) research programmes on various issues mentioned

Environmental Pollution in Kerala and its impacts

Kerala is one among the most thickly populated region in the world and the population is increasing at a rate of 14% per decade. As a result of the measures to satisfy the needs of the huge population, the rivers of Kerala have been increasingly polluted from the industrial and domestic waste and from the pesticides and fertilizer in agriculture. Industries discharge hazardous pollutants like phosphates, sulphides, ammonia, fluorides, heavy metals and insecticides into the downstream reaches of the river. The major water quality problem associated with rivers of Kerala is bacteriological pollution.

In Kerala about 60% of the population relies on ground water for drinking. At the same time, studies showed that faecal contamination is present in 90% of drinking water wells. The open character of the wells and conventional maintenance habits and use of buckets and rope to draw water, kitchen wastes and pit latrines with average family load factor (5 members) at a distance of less than 5 meters from wells are some of the factors, which are found to be contributing to the bacteriological contamination.

Vehicles and industries are mainly responsible for the deterioration of air quality in the state. Both create noise and emit air pollutants. Impact of vehicular emission and noise is widespread while that due to industrial emission is limited to areas around the industries.

Kerala is a state considered to be having a developed modern society. The consumption of more resources results in the generation of more waste. All types of waste including solid, hazardous and biomedical waste generation in the state are more compared to other states in the country. There is a series of actions initiated at National and State level abate the problems arise due to the wastes, particularly the pollution problem. Solid waste generation is mainly due to industrial and domestic activities.

As a result of these rising problems Kerala is now experiencing several unprecedented incidences like recurring epidemic outbreaks, crop diseases, fish diseases, massive death of fresh water fishes and a variety of lifestyle diseases. The authorities are already recognized the signs and related measures have been getting implemented. Research studies are also in progress on the causes and solution of the problem too.

Students can visit such centres of environmental issues and also take part in research studies.

Sample Itinerary for Environmental Science Field Program