Economic Development and Disease Ecology

In his influential book, Man, Medicine, and Environment (1968), Rene Dubos makes a poignant observation about disease and development:

Disease presents itself simultaneously with so many different faces in any given area that it is usually impossible to attribute one particular expression of it to one particu lar set of environmental circumstances. Nevertheless, some generalizations appear justified. Without question, nutritional and infectious diseases account for the largest percentage of mortality and morbidity in most underprivileged countries, especially in those just becoming industrialized. ... In contrast, the toll taken by malnutrition and infection decreases rapidly wherever and whenever the living standards improve, but other diseases then become more prevalent.

South Asian societies are in the process of major change, since economic development has become the goal of all the nations (except perhaps Bhutan). In pursuit of this goal, national governments have become deeply involved in directing the nature and pace of change. Against heavy odds, the processes of social and economic change are beginning to show their impact. Even in some rural areas of India, a major reduction in seasonal morbidity of communicable diseases has been observed concomitant with agricultural prosperity (Bhardwaj and Rao 1988), suggesting that Western-style development is not a sine qua non for better health conditions. Sri Lanka, which placed great emphasis on education, has achieved a high female literacy rate (over 80 percent). This has had a major impact on the reduction of the birthrate and has helped greatly to reduce the infant mortality rate, even though Sri Lanka has not become an economically well-developed country. Nepal, India, Pakistan, and Bangladesh have not been able to accomplish the same for their female population, and consequently their infant mortality rates are still very high. Female literacy in India varies widely between social groups and regions. Where female literacy is high — for example, in the urban areas and in the southwest (Kerala) - birthrates and infant mortality have come down.

One of the results of the Green Revolution has been an increased labor demand in the highly irrigated areas of western U.P., Punjab, Haryana, and Rajasthan. Long-distance agricultural labor migrations from Bihar and eastern U.P to the above areas have now become commonplace. This means that Plasmodium from the eastern part of India has a greater chance of establishing itself in the farming communities of northwestern India. Increased availability of water in the irrigated areas provides an expanded habitat for the Anopheles mosquito vector as well.

International migration and tourism, which are intensifying in South Asia, have been implicated in the importation of newer diseases; AIDS is only one example (India Abroad, October 26,1990). When the first few cases of AIDS were reported in India, the

Indian government was alarmed enough to enforce serotesting of foreign students, especially coming from AIDS endemic areas of sub-Saharan African countries. This action immediately aroused the anger of exchange students and strong reactions from several African governments. According to a WHO warning, there may be already over 250,000 HIV-positive cases in India with an expectancy of over 60,000 AIDS patients by 1995 (India Abroad, October 26, 1990). The incidence of AIDS is, as yet, reported primarily from the major metropolitan areas such as Bombay, Madras, Calcutta, and Delhi, and is currently associated mostly with prostitution. Precisely because of this association, however, AIDS will very likely spread into the general population. Since migration to cities is large, and rural-urban interaction is intensifying, the vast rural areas will not be immune from AIDS for long. Existing models of AIDS diffusion strongly suggest this possibility (Shanon and Pyle 1989). Thus, the context of health is becoming much wider than imagined under the older health paradigm in which the physician was considered the final health authority. L. Eisenberg and N. Sartorius (1988) have rightly asserted that "health will have to be seen as a state of balance between human beings and their environment. Human ecology can help to develop this approach to health and its promotion." South Asian countries have already started to prove the efficacy of such an approach.

Surinder M. Bhardwaj

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