Measuring the interactions of the determinants of health.

Considering environmental sanitation and health care services as most important determinants of health, this study was undertaken to know their impacts in an urban slum area of Calcutta. The families were studied in-depth and detail in relation to their health status in the form of morbidities and utilisation of preventive and promotive services. The health service impact was mainly assessed through comparative study between these who availed the services and to these who did not. Similarly, environmental sanitation services impact on health was measured through comparing the slum group with those who lived in Pucca houses. The criteria of priority decision on determinants was attempted through analysis of cost of these services and comparing their beneficial effects on health.

PIP: The study was undertaken in urban slums of Calcutta and at the Urban Health Center, Chetla (UHC), a field practice area of the All India Institute of Hygiene and Public Health, Calcutta. The first community received only health care services but no environmental sanitation services, the second one received only environmental services but no health care services, the third community had both health care and environmental services, and the fourth had none. Each of the 4 groups consisted of 80 families. Those who took advantage of the UHC health care services were compared to those who did not. Similarly, the impact of environmental sanitation services on health was measured through comparing the group who lived in pucca houses (multistoried flats). 2 groups each in pucca houses and slums primarily used UHC comprehensive health care services, while the groups who did not take advantage of UHC services used hospitals (88% in pucca houses and 96% in slums) and private practitioners (24% in pucca houses and 11% in slums). The incidence of sickness per 100 persons in 2 residential areas was significantly higher among slum dwellers in all ages and sex groups (79% for males [p 0.05], 83.5% for females, and 81.1% for children) as compared to those residing in pucca houses (59.8%, 54%, and 57.2%, respectively). For all ages taken together, females suffered comparatively more than males among slum dwellers, whereas this was the reverse among pucca house residents. The incidence rates were significantly lower among beneficiaries of UHC than among those who did not use the services except for the age group 5 years. The sickness rate was around 63% for all ages vs. around 74% of those not using UHC. Analysis of variance substantiated that both type of residence and utilization of UHC had a significant impact (p 0.01) on the morbidity rates and the average duration of sickness per person, but the effects of utilization of services was not more than 3 times that of residence.

The role of health journal in the delivery of health care.

PIP: The functions of public health journals, the titles of articles on relevant topics published by the Indian Journal of Public Health, and a brief summary of the history of this journal are included. Health journals reflect the fact that 80% of Indian medicine is primary, preventive and community service. Their role has expanded recently into environmental, mental and occupational health. Health journals are expected to publish the frontiers of knowledge, present new findings and treatments, aid in training of manpower, publish results of surveys, analyze problems due to epidemics and specific diseases, further health education in local languages, educate health workers and the public on community health participation, publish reports, meetings, seminars, workshops, lectures and policy resolutions. The actual articles published by the Indian Journal of Public Health are listed by type of article, such as editorials, health policy, preventive medicine, communicable diseases, health education, environmental health, statistical data and lead articles. Then articles are enumerated by title, in 9 categories totaling 454 titles. The Indian Journal of Public Health was begun in 1956, the date of the founding of the association.^ieng

Present health status and some suggestions for the future action.

PIP: As health is concerned with all aspects of human life, in a developing country like India plans for improvement of health services to ensure maintenance of health of the population should be an integral part of the total and overall development program. Modern public health measures are facing a difficult situation because of population growth. In regard to population structure, 2 age groups have been a concern of the health services, namely those 0-15 years and those 65 and older. The child's group constituted 42-44% of the total population, now reduced to 38.2% in 1982 and is a heavy dependent group particularly if another contingent of 20.4% in the 15-24 age group and requiring education is added. With an increasing life expectancy, there is now more than a 6% accumulation of aged persons in need of support. The Indian Council of Medical Research has established a National Institute of Nutrition and a Food and Drug Technology Center at Hyderabad, both of which have been doing useful work on nutrition and food technology. Both the history of public health during the last 100 years and all recent studies and observations amply demonstrate the dominant role played by the environment in the development of physical health and well-being of individuals and the community. The majority of iillnesses in a rural setting arise from 3 situations--pollution of water, soil, and air. A serious consequence of uncontrolled use of insecticides has been the health problems arising out of their toxic effects on persons handling them and on the people consuming contaminated foodstuff. Another effect on the health services is the increasing conversion of the vector insects to resistant form. In the field of communicable diseases the problems are vast and varied in India. For tackling all diseases a need exists for training courses to produce field epidemiologists. Among the noncommunicable diseases there is a definite rising trend in cancer, coronary heart disease, hypertension, diabetes, mental disorders, peptic ulcer, allergic disorders, rheumatic conditions, lung cancer, and leukemia. Another cause of morbidity and mortality which are assuming serious proportions is accident and deaths due to violence. India has undertaken to expand maternal and child health services and to establish new services where none exist. Every state has established a Family Planning Training Institute and created clinics throughout. Knowledge about the mental health conditions in India is generally poor as few surveys have been carried out to collect the information. Following the 2nd 5-year plan, industries are being rapidly developed in the country both in public and private sectors. Most of the problems can be solved to a great extent by mobilizing all medical and health personnel and services into 1 integrated service, but it is not considered feasible at this time. A concerted effort to rethink and reorganize present health services is required.^ieng