ENVIRONMENT & HEALTH

DR. SOHAIL MANZOOR
Dirctor Medical & Regulatory Affairs Hilton Pharma (pvt) ltd.
Sep 24 - 30, 2007

Pakistan has made significant development progress since its independence 60 years ago. The Health and education services have expanded and improved, Life expectancy has increased from 59 years in 1990 to 64 for males and 66 for females in 2004 and Infant and maternal mortality rates have dropped. However, despite these favorable developments, formidable challenges remain. Pakistanís social indicators still lag behind countries with comparable per capita incomes. The educated and well-off urban population lives not so differently from their counterparts in other countries of similar income range. However, the poor and rural inhabitants of Pakistan are being left behind. For example, access to sanitation in Pakistan in rural areas is 30% lower than in other countries with similar income. However, urban-rural differential persists. Also progress remains slow on maternal health with only a third of births attended by skilled personnel.

Environmental conditions help determine whether people are healthy or not, and how long they live. They can affect reproductive health and choices, and they can help determine prospects for social and economic growth, with further effects on health. Forty per cent of the disease burden is communicable diseases: diarrhea diseases, acute respiratory infections, tuberculosis, and preventable childhood diseases. A further 12% is attributed to reproductive health problems. Pakistanís high fertility rate of 5.4 births per woman means that the population is likely to double to around 260 million people over the next two decades. The use of contraceptive is about 28 % according to a WHO report.

A study estimated the annual cost of Pakistanís environmental problems at US$1.8 billion in health expenditures, reduced labor productivity, and other costs. The heavy reliance on firewood has contributed to the worldís second highest rate of deforestation. Low quality fuels and the growing use of fuel-inefficient motor vehicles have contributed to air pollution that in cities has exceeded levels deemed safe by the world health organization.

The human development index (HDI) that looks beyond GDP to a broader definition of well-being. The HDI provides a composite measure of three dimensions of human development: living a long and healthy life (measured by life expectancy), being educated (measured by adult literacy and enrolment at the primary, secondary and tertiary level) and having a decent standard of living (measured by purchasing power parity, PPP, income). The HDI for Pakistan is 0.539, which gives Pakistan a rank of 134th out of 177 countries. Unclean water and associated poor sanitation kill over 12 million people each year and air pollution kills nearly 3 million more in the world.

The Environmental change can dramatically improve urban health Crowded living conditions, particularly in urban areas, spread infection. People living in poverty are the most crowded because of the cost of housing and the larger size of their families. Infants in poorer and more crowded portions of cities are at least four times more likely to die than infants in more affluent neighbor hoods.

Environmental change can increase the location, spread and intensity of insect- and water-borne diseases. Epidemics can develop when disease-carrying insects or animals reproduce out of control, or move to new locations where people have not developed immunities. Higher temperatures may encourage insect hosts to breed and to move further up hillsides and mountains. Higher rainfall could trigger mosquito-borne disease outbreaks, increase flooding (spreading parasitic diseases), and increase the contamination of water supplies with human or animal wastes and increase exposures to run-off of pesticides and other chemicals.

Global warming will likely to an increase in infectious disease around the world., as virsus,microbes and the agents that spread them flourish. Experts suggest disease worsened by global warming already have contributed to the deaths of between 150,000 and five million people per year.

Access to safe water is a fundamental human need and, therefore, a basic human right. Experts have outlined a basic daily water requirement ó50 liters per capita per day for the purposes of drinking, sanitation, bathing, cooking and kitchen needsóand urged its recognition as the standard against which to measure the right to safe water. Per person water availability has decreased in Pakistan from 5000 cubic meters per annum in 1951 to 1100 cubic meters in 2006.The projected population growth estimates of the country suggests we will slip below the limit of 1000 cubic meters per capita per year by 2010 onwards.

The total Pharma market of Pakistan by value is 87 Billion Rs as per IMS 2007 and the Population with access to essential drugs 2000 list is only 50 % .

The real Question is are we as individuals and as a nation aware of such facts and challenges? If going by the optimistic approach (which is rare in our socio political environment) what are the interventions planned with time lines and resources to over come these challenges.