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Last Updated: Wednesday, 7 January, 2004, 13:48 GMT
India 'needs public health drive'
By Vineeta Dwivedi
BBC reporter, in Chandigarh

India needs to place greater emphasis on basic public health education and better water and sanitation provision.

The call has been made by Dr Jacob John who recently headed the Department of Virology at the Christian Medical College in Vellore, Tamil Nadu.

He told the Indian Science Congress that the median age of mortality in the country - the age by which 50% of deaths have occurred - was 22 years.

Many communicable diseases such as cholera were easy to prevent, he said.

Dr John raised the intriguing possibility that too much emphasis was being placed on new medical advances at the expense of basic public health measures.

Birth impact

The theory is that the current preoccupation with technical solutions such as vaccines, and with building a network of primary health care centres, distracts the authorities and individuals from thinking about issues like clean drinking water and sanitation.

Dr John said poor public health was still a big problem in India, leading to communicable diseases and many deaths at a young age.

In a developed society people will die of old age; the lowest mortality rates should be among the young.

But in societies where there are many deaths due to preventable causes, such as infectious diseases, the ratio changes; children are more likely to die than mature adults.

In his paper at the congress, Dr John said that in Western countries, diseases such as cholera were not beaten by medicine alone but by basic health measures as well. That was a lesson, he said, which Indians should take heed of.

High mortality in early life had a knock-on effect on future generations, Dr John added.

Integrated services

"A society which is depleted by the death of the young overcompensates by having a high birth rate. And therefore the fertility rate does not come down."

"A rise in population then is always more than required".

Indian doctors believe that the primary health centres in India still offer minimal services and poor patients find it impossible to obtain expensive private medical treatment.

Dr John said all of the communicable diseases were exogenous infectious diseases transmitted through water, food, the environment, mosquitoes, and so on, and were theoretically eminently preventable.

"And for this, there are multiplicities of intervention to be put in place. There should be a synthesis in health, education, environmental and occupational systems," he said.

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