General Health Conditions in South Asia

South Asia is home to most diseases of humankind; surprisingly, yellow fever and some others are absent. The major causes of death include infectious and parasitic diseases such as tuberculosis, diarrhea, malaria, typhoid, gastrointestinal disorders, and a variety of childhood diseases such as tetanus, pneumonia, whooping cough, diphtheria, measles, and other preventable diseases (Nyrop 1984). A health survey in Pakistan during the mid-1970s revealed that nearly 30 percent of the people had malaria, and almost 100 percent had worm or parasitic afflictions (Nyrop 1984). Although published data on many health indicators are lacking or woefully deficient, some indication of health conditions may be obtained from life expectancy, crude death rates, and infant mortality rates. Death rates in South Asia, as in most developing regions of the world, have declined markedly since the 1970s, although they are still above the world average. Within South Asia, Sri Lanka has the lowest death rate (about 6 per 1,000), which is lower than most of the European countries and the United States (9 per 1,000). Death rates are higher for India (10 per 1,000) and even higher for Pakistan (14), Bangladesh (15), Nepal and Bhutan (17 each). Infant mortality rates, however, reveal a grimmer picture of the prevalent health conditions. Despite official claims to the contrary, infant mortality rates are very high, except in Sri Lanka, thanks largely to a very high female literacy rate compared with other South Asian countries. Considering Sri Lanka as the exception, South Asia as a whole shows clear signs of environmentally related causes of death, especially of infants.

Sanitation conditions in South Asia are appalling, made worse by the monsoon rains. Most rural inhabitants and those living on the outskirts of the cities use fields and any open space as a latrine. Although the new "Sulabh" (semiflushing) latrine is gaining ground in Indian cities, human waste disposal remains a serious problem, leading to a variety of gastrointestinal diseases. Contamination of municipal drinking water during the rainy season, including cities such as Delhi, results in periodic outbreaks of hepatitis epidemics.

The process of urbanization in South Asia is bringing vast numbers of rural unemployed workers to the cities. Those unable to find relatives, or who are too poor to rent, must live wherever they can. Thus, many semipermanent urban accretions have developed. Health conditions in these periurban slums are very poor. In fact, these settlements form a virtual ring of high morbidity around growing cities. Engulfed by rapidly growing suburban housing, these shanties are frequently found in close proximity to outward developing metropolitan areas. City governments are constantly trying to "clear" these semipermanent worker settlements (in India called jhuggies and jhonparies, or simply J<Ts), often with great difficulty. In the meantime, they remain as centers of high morbidity and infant mortality.

Expanding cities are also engulfing preexisting villages, thus juxtaposing two very different ways of life. Demand for milk and meat in the burgeoning urban populations has spurred these farming communities to intensify their farming by growing vegetables, and by keeping dairy cows, buffaloes, and chickens. The lower castes raise goats and pigs in these periurban locations. One effect of this urban agriculture is that the density of flies and mosquitoes in these areas is very high, thus helping to maintain endemicity of gastroenteric diseases.

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