To hell with the hippocratic oath

THE burst of infectious diseases like malaria, kala-azar, cholera and tuberculosis in India is indicative of a deeper malaise. Despite a stated emphasis on participatory health management, in actual practice the dependence on expensive curative and therapeutic drugs is matched only by inadequate emphasis on preventive measures.

With the growing development of resistance of disease causing microbes to drugs developed to combat them, the need to reorient public health policy has become imperative. Developing more powerful drugs requires continuous and expensive research. With the conquest of infectious diseases in the developed world, its research priorities have changed, creating a huge shortage of drugs effective against new drug-resistant microbe strains flourishing in developing countries. According to WHO, 90 per cent of the global disease burden occurs in the tropics, but only 5 per cent of global health research and development investment is directed to reducing their impact.

The resurgence of drug resistant TB associated with HIV infection in the West is causing growing concern there, and research into new drugs has intensified. AIDS is the golden goose of pharmaceutical companies the world over -- which is why it is imperative develop drugs effective against diseases of subcontinental concern. Unfortunately, given the prohibitive costs of drug development, it is unlikely that Third World countries will be able to conjure up appropriate drugs soon, even if they were to reorient their research programmes.

Moreover, the real technological gap is not only in the absence of appropriate drugs, but in the absence of an appropriate technology to deliver cheap, cost-effective preventive health systems to the majority of the people -- an absence which arises from a lack of understanding of the linkages between disease, environment and poverty.

The links between the resurgence of diseases and environmental degradation and mismanagement are well established. There is considerable evidence of the spread of malaria and kala-azar with the development of largescale irrigation and flood control projects which are accompanied by waterlogging. This, in turn, not only reduces soil fertility, but also leads to mass migrations to urban areas where the pressure on scarce urban resources goes through the roof, resulting in the growth of unsanitary, disease-breeding slums. There is an urgent need for development planners to integrate environmental and social concerns into the planning process for, if nothing else, sane sanitation.