Pakistan needs a holistic approach to tackle erratic public health issues
We sometimes take it for granted that nature provides a clean environment that does not affect human health, but this is far from the truth. “All substances are poisons; there is none which is not a poison. Only the dose differentiates a poison and a remedy” said Paracelsus, the founder of Toxicology. Disease is an imbalance between human and natural environment. In countries such as Pakistan a very substantial portion of the population lives in close contact with the natural environment. They are exposed to mineral dust, trace elements, naturally occurring organics and radiation in the air that they breathe, the food that they eat and the water that they drink. It is well known that exposure to harmful minerals (quartz, asbestos, and pyrite) and to high levels or long-term low-level exposure of toxic elements can cause wide-spread, serious health problems. Outbreaks of such diseases cost precious lives, permanent frailties and drain huge public funds in addition to adversely impacting productivity of citizens. The deficiency of certain elements, essential for human health, in the soils and water of a particular area is reflected in the crops cultivated in these soils.
Wellbeing of billions of people worldwide is at risk due to natural environment. Iodine deficiency is the world’s most common cause of mental retardation and brain damage with about 1.6 billion people at risk. It is estimated that around 50 million people in Pakistan suffer from iodine deficiency and 70 percent of the total population is at risk. Iodine deficiency results in severe consequences such as deafness and loss of cognitive abilities. It can affect individual intelligence and can lower the IQ of a population by as much as 15 points. Iodine deficiency in women can lead to infertility, spontaneous abortions and having physically and mentally challenged children. It is estimated that around 2.2 million children are born each year with mental disorders in Pakistan due to iodine deficiency in pregnant women. This dilemma pertains to iodine deficiency in soils and water.
Studies show that in Punjab and Sindh provinces about 20 percent and 36 percent population is exposed to arsenic contamination respectively. More than 65 percent of the people living in Lahore metropolitan are consuming arsenic contaminated water
The catastrophic health problems caused by arsenic in the well waters of Bangladesh and West Bengal, India, have been front-page stories in mass-media and in scientific journals. The estimates as to how many people are at risk show as high as 100 million in South Asia alone. This situation has been called the “greatest mass poisoning in history”. Pakistan is one of the countries along with Bangladesh, India and Nepal where arsenic contamination in groundwater has been reported. Arsenic is carcinogen and a major cause of bladder, lung and skin cancer and in some cases kidney and liver cancer as well. Drinking arsenic contaminated water is just like drifting towards a slow death.
Studies show that in Punjab and Sindh provinces about 20 percent and 36 percent population is exposed to arsenic contamination respectively. More than 65 percent of the people living in Lahore metropolitan are consuming arsenic contaminated water. Public Health Engineering Department and UNICEF have jointly undertaken arsenic assessment of drinking water and identified high arsenic concentrations (10 – 200 µg/L) in many areas of Pakistan. The WHO standard of arsenic in the drinking water is less than10 µg/L. The experts confirm that the arsenic contamination in the water is due to its glut in the soil. Such reports are rarely disclosed to the public, however, remained headlines of local and international media throughout last decade. As reported by the British Geological Survey “of the provinces of Pakistan, those with aquifers most vulnerable to arsenic contamination are the recent alluvial and deltaic sediments of the Indus Plain. These sediments have many similarities with the arsenic affected aquifers of Bangladesh and West Bengal, India.”
The excessive intake of fluoride leads to “dental fluorosis” and in more severe cases “skeletal fluorosis”. Both cases have been observed in Pakistan. High fluoride concentrations have been found in drinking water of several districts. For example, in Faisalabad fluoride level in well waters has been assessed up to 3.44 ppm against WHO standard of 1.5 ppm. According to the estimates of Pakistan Council of Research and Water Resources (PCRWR) only 25 percent of population in Pakistan has access to safe drinkable water. It is estimated that water-related diseases cause an annual national income loss of Rs25-58 billion. At any given time 20-40 percent of the hospital beds in the country are occupied by patients suffering from water-related diseases and responsible for one-third of all fatalities. Elimination or restrain in the root causes of major diseases help governments to improve communal health and significantly chop down health expenditures.
District health departments must be at frontline to implement health programs and enhance capacity building. Print and electronic media could play a cutting edge role in spreading awareness among public and diverting attention of the government officials to the outrageous situations
“From my experience in Pakistan I saw a country that could greatly benefit from medical geology research as so many people live in close contact with the natural environment. A very large percentage of the population derive their food locally, their water from wells, they breath the ambient dust, and experience the legacy of earthquakes. In short, they are vulnerable to medical geology problems,” says Dr Robert Bob Finkelman, co-founder of Medical Geology and professor at University of Texas at Dallas. However, he adds, “a modest investment in characterisation of the soils and water and an education program aimed at the villagers could be very effective in reducing these problems. Such a program could ultimately lesson the country medical expenses and resulting in a healthier population.”
Pakistan needs a holistic approach to tackle erratic public health issues. Essential tactics include keeping disease registry data, mapping geochemical information and correlating with registry data to potentially identify what the likelihood is of a particular population developing particular kinds of diseases and what corrective actions can be taken to virtually eliminate the disease. In addition, analysis of ground water to help villages avoid fluoride and arsenic-laden waters, providing test kits for toxic elements in vulnerable areas, maps to direct people away from areas that contain dangerous materials and ensuring availability of dietary minerals such as iodised salt. Perhaps, the most cost-effective method to lessen health expenditures is education — of the villagers, health care workers, local decision makers (village leaders and politicians). This could go a long way in helping to prevent environmental health issues.
District health departments must be at frontline to implement health programs and enhance capacity building. Print and electronic media could play a cutting edge role in spreading awareness among public and diverting attention of the government officials to the outrageous situations. It is imperative that government must stimulate changes in attitude of politicians, decision makers and the public. Medical Geology should be incorporated in medical and earth sciences curricula. Government must fund investigatory researches related to public health issues to use their outcome for developing and optimising public health policy and land-use planning.
