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 particu­lar set of environmental Circxunstances.

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.

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 (JndiaAbroad, 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