CSE's inaugural State of India's Health report connects most environmental factors to some of the gravest public health risks faced by India today

  • CSE releases Body Burden 2015: State of India’s Health report on public health threats and their environmental linkages

  • First report in an annual series examines a range of old and new threats and why they should worry us

  • Key subjects covered by the report include air pollution, pesticides, degradation of forests, water and sanitation, climate change and lifestyle diseases

  • Air pollution is one of the top 10 killers in the world and is the fifth leading cause of death in India Revamping transportation systems and cleaner technologies are needed urgently, says CSE

  • Open defecation and malnutrition rates are linked, says the report

  • Forest degradation has helped pathogens (that were restricted to animals) jump the species barrier and infect humans

  • Report offers a compilation of case studies, stories and data which can lay the foundation for larger in-depth features


New Delhi, December 15, 2015: A number of public health catastrophes – arising largely out of environmental reasons -- are staring the people of India in the face. While the debate over polluted air and how to control it rages on in the national capital, people have also had to contend with a host of other health challenges this year, ranging from strange pathogens to heightened risk from lifestyle ailments. Centre for Science and Environment’s latest publication (released here today) -- Body Burden 2015: State of India’s Health – examines and dissects this linkage between environment and health quite comprehensively. 

Speaking to the media about it, CSE director general Sunita Narain said: “The report shows us that we must focus on prevention and not treatment. We need to improve the environment, reduce the disease burden and save money in private or public healthcare.”

The findings of the report were discussed with the media on Tuesday afternoon by Sunita Narain while the report was released later in the evening by Dr. Soumya Swaminathan, Director General of the Indian Council of Medical Research (ICMR). Other invitees included Dr. Mahesh C Misra, Director of All India Institute of Medical Sciences (AIIMS), and Dr. K VijayRaghavan, Secretary, Department of Biotechnology, Government of India.

Some of the main findings of the report include:

Air pollution
Air pollution is one of the top 10 killers in the world and is the fifth leading cause of death in India. It results in about 620,000 premature deaths which are caused by stroke, chronic obstructive pulmonary disease, ischemic heart disease, lower respiratory infections and trachea, bronchus and lung cancer, among others. The report highlights the heightened vulnerability of the poor. It calls for stringent actions on air pollution.

The report has gone into areas such as vehicular pollution, industrial pollution, polluting cook stoves that cause indoor pollution, and related issues. The report states: “Death toll due to uncontrolled air pollution-related illnesses alone has increased worldwide by a whopping 300 per cent in the last decade: from 800,000 in year 2000 to 3.2 million in 2012… In Delhi, which was named as the most polluted city of the world by WHO in 2014, air pollution is responsible for 10,000 to 30,000 annual deaths.”

“The way forward would be to reduce the source of air pollution—mainly revamping our transportation systems and forcing the industry to come up with cleaner technologies. But people are not aware of these linkages and continue to junk public transport,” said Narain.

Water and sanitation
The report informs that about 37.7 million Indians are affected by water-borne diseases annually. Around 1.5 million children die due to diarrhoea alone, and 73 million working days are lost due to water-borne illnesses each year. Estimates suggest India loses Rs 36,600 crore every year due to water-borne diseases.

Referring to the connection between water and sanitation and malnutrition, the report says that by 2015, the figure of malnutrition should have dropped to 26 per cent as per the Millennium Development Goals (MDG). But, the country fell short of the goal by seven per cent. Notwithstanding the progress, India still cannot answer why the malnutrition rate among its children is so high. The country’s economy has doubled since 1991, when the government started counting the malnourished children. The world’s largest programme to tackle child malnutrition, the Integrated Child Development Services (ICDS), has been in force in the country since 1975, much before any other country, save the US, introduced measures to tackle the problem, points out the report.

Malnutrition is prevalent in comparatively richer states as well. The survey indicates that higher income does not necessarily correlate with better health of children. India loses over US $12 billion in gross domestic product (GDP) due to vitamin and mineral deficiencies among its population. Malnutrition is not just about access to food. Children who are constantly exposed to faecal microorganisms demonstrate environmental enteric dysfunction or EED, where the gut becomes permeable and brings microbial products in contact with blood. This leads to activation of the immune system which down-regulates the growth factors in the body and leads to stunting.

States like Odisha, Chhattisgarh, Jharkhand where more people defecate in open, have more malnourished children, comparatively.

According to official data, from 2006-07 to 2010-11, nearly 10 million toilets were constructed every year across the country under the Total Sanitation Campaign. These toilets remain largely defunct and are reportedly being used as storerooms. “Researchers are finding that immediate environmental factors like access to clean drinking water and, most importantly, access to sanitation for both the mother and the child are decisive in determining children’s health,” said Narain.

Climate change
Climate change is leading to greater frequency and intensity of extreme weather events. Simultaneously, India has seen an increase in vector-borne diseases such as dengue and malaria. The report states that the potential period of spread of malaria has increased to 10-12 months (almost the whole year) which is up from 4 to 6 months. In Kolkata, dengue transmission takes place for 44 weeks in a year. With a 2.4 degree C rise in temperature, transmission may continue for 53 weeks, increasing the risk of more people getting affected. Around 600 people died due to heat waves in Andhra Pradesh and Odisha in 2015. The report states that local solutions can help. In Ahmedabad, a maternity ward was shifted from the top to the ground floor. The move helped in reduction of heat-related problems in new-born babies.

The report informs of the impact of climate change on agriculture on agriculture, and the crop loss suffered by farmers in recent years. “We are seeing an increased severity and frequency of extreme weather events. Farmers in India are facing the double blow of agrarian distress and extreme weather events as a result of climate change,” said Narain.

Forest degradation
The diseases of animals that were confined to forests are now affecting humans, says the report. These include zoonotic diseases – as many as 2.7 million people die of these diseases every year. These diseases cause illnesses among 2.5 billion humans every year. “The incidence of emerging infectious diseases among both humans and domesticated animals has increased sharply in the recent past. Over the past 70 years, more than 300 zoonoses – diseases transmitted from animals to humans – have been observed. They are increasingly being considered as threats to human society,” says the report. 

Ebola, the killer virus, is one such disease-causing virus. It was first reported in 1976 and has exploded into a public health emergency. Loss of forests is linked to these diseases finding their way into human society.

Body Burden also discusses diseases such as malaria and dengue at length. It reports that forest cover declined in most Indian states, the highest in Arunachal Pradesh, Madhya Pradesh, Maharashtra, Chhattisgarh, Jammu and Kashmir and Himachal Pradesh, among other states, between 1999 and 2013. The only states where forest cover grew in this period was in Tripura, Mizoram and Goa. Though India has a huge burden of such emerging infectious diseases, there is very little data on the number of people affected. 

Body Burden cites WHO estimates that say that 13.1 million people in India will die of cancer by 2030. This is 20 times than the current death toll in the country. “Increasing numbers of studies are establishing that the risk of getting cancer has more do with the state of one’s environment than his or her genetic makeup,” says the report, drawing a connection between cancer and pesticides and other factors. It states that five top five states for pesticide use in the country are Maharashtra, Uttar Pradesh, Punjab, Andhra Pradesh and Haryana. It also cites data which show that cancer is on the increase in urban areas. 

Noting that Punjab is the “cancer capital of India”, the report has presented evidence suggesting rampant use of pesticides in the state, and people’s exposure to these. Pesticides have found their way into tap water, ground water and food in Punjab, where incidence of cancer is almost twice the national average. Chemicals present in pesticides can suppress the immune system, triggering diseases that can be fatal. 

“Since no doctor will issue a death certificate saying that the cause is an unknown trigger, the industry is safe,” said Narain. She said the report has made detailed recommendations on how to regulate pesticide use in the country.  “Globally, the maximum residue limits (MRLs) of pesticides are reviewed periodically to incorporate changes in dietary pattern and agricultural practices. But in India, MRLs for registered pesticides are incomplete and have not been reviewed periodically,” said Narain.

The report also devotes space and attention to lifestyle-related diseases which are on the rise in India.

“There is a very tangible link between our environment and our health. In fact, environmental degradation’s first assault is on our bodies and this is one of the biggest reasons why we try to protect the environment. But the linkage is complex and is often disputed. We need to join the dots. We are often not able to take crucial decisions as we really do not know what is happening to our health and how is it linked to the environment. We don’t know and so we don’t care. There is a conspiracy of silence,” said Narain.

For further information, please contact Vrinda Nagar, CSE Media Resource Centre, at 9654106253/ vrinda.nagar@cseindia.org