HEALTH PROBLEMS IN

MUMBAI

1
2 KUMAR GANDHI. C-11
Health in Mumbai
 Health In Mumbai

• Mumbai is the most popular city of India.

It is the commercial place and the sixth
most populated city of the world.
• There are many beggars and pickpockets
in Mumbai. All these problems increase
the need of Mumbai health and safety

3 Health in Mumbai KUMAR GANDHI. C-11

• Mumbai health and safety is badly affected by
the pollution. There are more chronic health
problems resulting due to modernization,
liberalization and globalization of the market.
The pollution causes allergies, infection and
other diseases among the Mumbai public. The
health and safety services available are very
less then their requirement. The disaster
training is also not in pace with the changing
environment.

4 Health in Mumbai KUMAR GANDHI. C-11

• The rate of chronic sickness such as
diabetes, hypertension and coronary
artery disease (CAD) increased in
Mumbai last year.

• This is according to data analyzed by

the NGO Praja Foundation between
January and December 2008.

5 Health in Mumbai KUMAR GANDHI. C-11

• Rising Rates of Diabetes and
Hypertension Among Mumbaikers
• The group looked at results taken from
25 public hospitals and four state
hospitals and dispensaries in India's
capital city
Read more at Suite101: Chronic Diseases on the Rise
in Mumbai: Health Concerns Linked to a Fast-Paced
Lifestyle in India's Capital
http://india.suite101.com/article.cfm/chronic_diseas
es_on_the_rise_in_mumbai#ixzz0kVv91T7U
6
Health in Mumbai KUMAR GANDHI. C-11
 Effect on Human Health From Waste
• Damage to central and peripheral nervous systems,
blood systems and kidney damage.
• Affects brain development of children.
• Chronic damage to the brain.
• Respiratory and skin disorders due to
bioaccumulation in fishes.
• Asthmatic bronchitis.
• DNA damage.
• Reproductive and developmental problems.
• Immune system damage.
• Lung Cancer.
• Damage to heart, liver and spleen.
7 Health in Mumbai KUMAR GANDHI. C-11
 Health Problems In MUMBAI

Public Health
• In spite of substantial reductions in mortality rate over
the years, health care in Bombay remains far below the
expected level.

Management and disposal waste

• More than 5000 metric tons of solid waste is generated
every day in Mumbai. The municipal corporation is in
charge of the disposal of this waste, and evidently cannot
cope with the task.
KUMAR GANDHI. C-11
8 Health in Mumbai
 Hospitals
• Mumbai has about 22,000 hospital beds distributed
in about 1000 health care centers. Of these about 17
are municipal hospitals which can be afforded by the
urban poor who make up 50% of the population.

Major health problems

• Among Mumbai's major health problems one must
surely count AIDS and Tuberculosis . Chronic
respiratory problems due to air pollution are endemic
among a large fraction of the population. Malaria and
polio make occasional appearances.

9 Health in Mumbai KUMAR GANDHI. C-11

Ways to improve health and safety in
Mumbai
• If all the educational institutions in Mumbai
provide proper training and education to the
students then problem can be solved to some
extend
• The students should be given training to avoid
or reduce the harmful effects of pollution.
• All the health institution should be well
equipped with the proper medical facilities to
cater to any kind of problem.

10 KUMAR GANDHI. C-11

Health in Mumbai
• If all the academic institution take part in the
health and safety program of Mumbai then
the level of problem will be reduced to
greater extend.
• The number of professionals should be
increased, all kids of equipments required
should be provided with, timely assessment of
environmental risk and impact should be
conducted.
• Education is the best solution to the Mumbai
health and safety problem.
11 KUMAR GANDHI. C-11
Health in Mumbai
Health Services in Mumbai
• Mumbai is one of India's largest cities and an
important commercial and industrial centre.
• Despite everyday pronouncements of major
breakthroughs and advances in medical and health
technology, the basic health needs of a majority of the
population in Mumbai are not yet met even in a
rudimentary manner.
• Mumbai has a vast supply of public and private health
care services.
• The Central Government has its own dispensaries,
which are available only for their employees.

12 KUMAR GANDHI. C-11

Health in Mumbai
• Further, there are the Employees' State Insurance
Scheme (ESIS) health care services that include
hospitals and dispensaries which cater to
employees in the organized sector.

13 Health in Mumbai KUMAR GANDHI. C-11

SOURCES:-
• http://www.asiarooms.com/travel-guide/india/mumbai/usef
ul-information/mumbai-health-and-safety-mumbai.html

• theory.tifr.res.in/bombay/amenities/sanitation

• http://india.suite101.com/article.cfm/chronic_diseases_on_t
he_rise_in_mumbai

• http://www.bcpt.org.in/webadmin/publications/pubimages/h
ealthservices.pdf

14 Health in Mumbai
KUMAR GANDHI. C-11
HEALTH PROBLEMS
IN
MAHARASHTRA
 Health problems in Maharashtra

• Many women in the rural areas face the problem of

infections of the reproductive tract.
• Deficiency of Vitamin A, Iron, Iodine which has led to large
number of goiter cases
• Gastrointestinal disorders, like dysentery and parasitic
infections are common, leading to marked morbidity and
malnutrition.
• Malaria and tuberculosis still remain a problem in many
tribal areas
• Genetically transmitted disorders like sickle cell anaemia
and different forms of thalassaemia are also common. All
these defects lead to the early destruction of red blood
cells and add to the overall anaemia.
• Arthritis (inflammation of the joint) is a major problem
of people of more than 55 years of age
• Osteoporosis is a silent disease in which bones become
extremely fragile. It is extremely painful and takes a
long time to heal. It is on a rise among the elderly.
• Depression is also one of the problems faced. Change
in appetite and sleep patterns, persistent fatigue,
lethargy, aches and other unexplainable physical
problems
• Blood pressure refers to the force exerted by
circulating blood on the walls of your blood vessels.
Typical values for a healthy adult human are
approximately 120/80. Large variations in blood
pressure levels can be dangerous, so it always helps to
keep your pressure under control.
• A heart attack is caused by the death of the heart
muscle due to loss of blood supply caused by blockage
in one or more of the coronary arteries. It is on a rise
especially in the urban areas in males and also females
• Among elderly men, cancers of the prostrate and colon
are the most common while for women it is breast
cancer.
• Other cancers found in geriatric patients are skin, lung,
pancreas, bladder, rectum and stomach cancer.
• Tuberculosis deaths can be prevented through modern
anti-TB treatment such as DOTS that has to be
undertaken for a prescribed duration.
Health Problems In
MAHARASHTRA
 Healthcare in Maharashtra
• Maharashtra, despite being the financial capital, is plagued by two
major issues.
 Food availability (rather access) which is the cause of unacceptable
levels of malnourishments.
 The declining sex-ratio, especially in the 0 to 6 year age group.
• District hospitals have most of the essential medical equipment,
there is a severe shortage of these facilities in FRUs and CHCs.
• Urban areas, especially in and around Mumbai and South-Western
Maharashtra are well endowed, but the rest of the state lags
behind in health infrastructure.
 Public Expenditure on Health

• Despite overall economic development, the state has failed

to give the required significance to health and healthcare.
• Health expenditure as a percentage of Net State Domestic
Product (NSDP) at current prices has declined from the levels
of 1.0 per cent in the 80s to 0.7 per cent in 2001-02
• As proportion of total govt. spending from over 6% in 1980
reduced to 4.6% in 2001-02.
 PUBLIC HEALTH

• Health care in Mumbai remains far below the expected level

 Management and disposal of waste:
• More than 5000 metric tons of solid waste is generated every
day in Mumbai.
• The municipal corporation is in charge of the disposal of this
waste, and evidently cannot cope with the task
 Hospitals:
• 22,000 hospital beds distributed in about 1000 health care
centers, of these about 17 are municipal hospitals.
 Major Issues

• Public care sector out-patient care is inadequate or under-utilised because

of inconvenient timings or location, long queues, language barriers and
rude staff
• Inadequate equipments, poorly maintained equipments, lack of
manpower, delay of financial approvals from the bureaucracy, over
crowding and the sharp deterioration in the quality of their services have
forced many patients to turn to private hospitals.
• Even for the subsidised public health care, the poor have to pay extra as
bribes due to rampant corruption. The other expenditure is on the
medicines, which the public hospitals do not provide, the reason often
quoted as “not in stock”, although they are funded to provide medicines.
 HEALTH
PROBLEMS IN
INDIA
 HEALTH IN INDIA
India has made rapid strides in the health sector
since Independence: life expectancy has gone up
markedly, the infant mortality rate has been
halved, 42 per cent of children receive the
essential immunizations. We have a huge private
healthcare infrastructure. And yet, critical health
issues remain: infectious diseases continue to claim
a large number of lives, babies continue to die
needless deaths from diarrhea and respiratory
infections, and millions still do not have access to
the most basic healthcare.
APOORAV MEHTA ( M-31)
• India, the second most populous country in the
world, is a bewildering collection of
contradictions.
• If the people in some regions live in abysmal
conditions, and thousands die from preventable
and treatable illnesses, islands of good health
such as the southern state of Kerala have health
indicators comparable to those of developed
countries.
• Faced with massive problems of ill-health (the
burden of disease), Indians have had to address
the question of how to provide a health
infrastructure that is accessible to the people
APOORAV MEHTA ( M-31)
• Life expectancy at birth and infant mortality
are two important indicators of a society's
health and the billionth Indian baby is less
likely to die in childhood, more likely to live a
long life. She can expect to live beyond her
60th year, twice as long as her great-
grandfather did.
• If in 1947, 146 of every 1,000 babies born died
before their first birthday, the infant mortality
rate (IMR) is half that today, at 68/1,000
APOORAV MEHTA ( M-31)
THE BURDEN OF DISEASE: WHAT AILS
INDIANS?
• At present, infectious and parasitic diseases
dominate.
• As Indians live longer, chronic diseases, related
to aging, are expected to take a greater toll.
• The 2001 Census for the first time records people
with visual, hearing, locomotors and mental
disabilities.
• Indian women often tolerate ill health without
complaint
APOORAV MEHTA ( M-31)
 At present, infectious and parasitic
diseases dominate.
• They killed 2,121,000 people in 1998.
• Tuberculosis kills 500,000 Indians each year
• Almost 100,000 people died from respiratory infections in 1998
• Some 1,25,000 women died from complications of pregnancy, in
1998.
• 100,000 deaths in 1998 could be attributed to nutritional
deficiencies, more than half of which were simple protein-calorie
malnutrition.
• HIV affected 4.58 million Indians in 2005
• Malaria affects 2.6 million people each year, and killed at least
20,000 people in 1999.
• India has the largest burden of leprosy patients in the world, with a
caseload of over 4 million patients.

APOORAV MEHTA ( M-31)

As Indians live longer, chronic diseases,
related to aging, are expected to take a
greater toll.
• Cancers killed 653,000 people in 1998.

• Cardiovascular diseases, which includes those with

an infectious origin, such as rheumatic heart disease,
killed 2,820,000 people in 1998.

• Diabetes: In 1994 there were 20 million diabetics in

India.
APOORAV MEHTA ( M-31)
)
APOORAV MEHTA ( M-31)
The 2001 Census for the first time records people
with visual, hearing, locomotor and mental
disabilities.

• 60-100 million Indians are affected by disability.

• Between 4 million and 14 million Indians are blind. The most
common causes of blindness is cataract
• 3.2 million people with hearing impairment in India.
• Over 16 million people, are affected by locomotor
disabilities. The two most common causes are poliomyelitis
and cerebral palsy.
• 3 per cent of India's children have delayed development
(mental retardation)

APOORAV MEHTA ( M-31)

Indian women often tolerate ill health
without complaint

• Almost half tolerated their illnesses without

treatment
• A considerable proportion of women suffer
silently from a range of gynecological
problems
• 100,000 Indian women die of pregnancy-
related causes each year.

APOORAV MEHTA ( M-31)

 HEALTH INFRASTRUCTURE IN INDIA
1. Public health services

• India has a vast health care sector, estimated at

Rs 126.27 billion in 1998.
• This health care sector is broadly divided into the
public and private sectors.
• Public health services consist of the following
'step-up referral' network of sub-centre's,
primary health centers, community health
centers and district hospitals.
APOORAV MEHTA ( M-31)
 2. Doctors, nurses, hospitals and dispensaries

• 523,000 allopath and 115,500 practitioners of other

systems of medicine provided health services to the
Indian population.
• Institutional services were provided by 17,000
hospitals and 28,000 dispensaries (mostly privately
owned and in the urban areas), with 95,000 beds, and
supported by 566,000 nurses.
• Health providers are trained at 165 medical colleges,
which turned out 12,000 graduates and 3,140
postgraduates in 1991.
• However, more than 80 per cent of out-patient
services and a smaller proportion of hospital services
were provided in the private sector.
APOORAV MEHTA ( M-31)
APOORAV MEHTA ( M-31)
 3. Infrastructure is primarily in the private
sector

which provides at least 80 per cent of health

services in the country. The role played by
non-governmental organizations working in
health is also significant.

APOORAV MEHTA ( M-31)

 4. Indigenous medicine
1. Every rural community has its own local health tradition, using thousands
of plants for medicinal purposes. As many as 700,000 traditional dais
(midwives) conduct the majority of rural deliveries, 60,000 bone-setters
treat orthopedic problems, 80,000 herbal healers provide primary health
care for various conditions. Millions of people use home-based remedies.
2. The classical systems include Ayurveda, Siddha
Tibetan medicine, Unani-Tibb ,and Homoeopathy . Some of these
date back thousands of years, and depend on a codified system of
knowledge, some documentation, and institutions of teaching,
research and manufacture. Medical practice is largely not
institutionalized.
3. Overall, there has been no effort to strengthen these systems.
Yet only four per cent of the national health budget is devoted to
these systems. There have been very limited efforts to evaluate
these systems. Most Ayurvedic colleges do not have the required
infrastructure and faculty

APOORAV MEHTA ( M-31)

 THE CRUX OF THE PROBLEM
• Health policy
• Problems of access
• The private-public debate
• Quality of care
• The global economy and Indian people's
health

APOORAV MEHTA ( M-31)

 Health policy

• No community participation in building up the health

services
• It emphasized a primary health care approach to
prevent illness and promote good health
• Disease control programs is driven more by donor
organizations than the country's epidemiological
realities.
• Selective health interventions have become even more
focused after the World Bank's 1993 World
Development Report recommended limiting
government health money to the most 'cost-efficient'
interventions.

APOORAV MEHTA ( M-31)

 Problems of access

• Only one in two women seeks treatment for

illness, usually because the nearest health
service is too far away, or it's too expensive.

• People access to health care is limited by their

ability to pay, as well the availability of
services.

APOORAV MEHTA ( M-31)

 The private-public debate
• One out of two people seeking hospitalization go to the
private sector, which handles a larger proportion of out-
patients than of in-patients.
• In 1991, the Indian government's health care expenditure
was less than two per cent of its gross domestic product,
and just 21.7 per cent of total health expenditure
• Total expenditure on health is 5.2 per cent of the GDP, but
out of this, only 13 per cent is spent by the government.
• Private health care is not the privilege of the rich but often
the only option of the poor as well.
• In private hospitals, average costs for medicines, doctors'
and hospital fees can amount to twice a family's monthly
income.
• User charges in government hospitals
APOORAV MEHTA ( M-31)
 Quality of care

• The quality of health care available in India is

extremely variable -- from corporate hospitals
with the latest equipment, highly-qualified
doctors and patient-friendly services, to small
outfits with unqualified staff, lacking even
basic equipment or a continuous supply of
water and electricity.

APOORAV MEHTA ( M-31)

 The global economy and Indian
people's health
• In 1991, India began instituting a structural
adjustment programs (SAP), as a condition of a
loan from the International Monetary Fund to
bail it out a financial crisis.
• In the health sector, this meant cuts in public
health spending, the introduction of service
charges in public services, and handing over even
more responsibility to the private sector which
already accounted for three-fourth of health
expenditure.

APOORAV MEHTA ( M-31)

NEW HEALTH CARE DRIVE IN INDIA
1) Implementation of "PURA PROJECT- of
VISION 2020 with adequate health care
facilities.
2) More Nursing Colleges to be opened to
balance the requirement of Paramedics.
3) Emphasis should be given towards
cleanliness, sewage system, drainage
system, and prevention of overcrowding of
the hospitals, in metros and in the cities.
4) More public health related research in
Industrial areas and in hospitals within that
locality.
5) We may have to follow these simple principles behind having petrol
stations in the highways i.e., keeping hospitals at a certain distance
according to population so that emergency services can be made
easily.  APOORAV MEHTA ( M-31)
 HEALTH
PROBLEMS
GLOBAL
MINESH KORADIA 23
 Global Health
 Global health is the health of populations in a global context
and transcends the perspectives and concerns of individual
nations.

 Health problems that transcend national borders or have a global

political and economic impact, are often emphasized.

 Global health is about worldwide improvement of health, reduction

of disparities, and protection against global threats that disregard
national borders.

Minesh Koradia C-23

 Global Health
 The major international agency for health is the
World Health Organization (WHO).

 Other important agencies with impact on global

health activities include UNICEF, World Food
Program (WFP) and the World Bank.

Minesh Koradia C-23

 Major Health Issues

 One billion people lack access to health care systems.

 Cardiovascular diseases (CVD) are the number one group
of conditions causing death globally. An estimated 17.5
million people died from CVD in 2009, representing 30%
of all global deaths. Over 80% of CVD deaths occur in
low- and middle-income countries.
 Around 11 million children under the age of 5 die from
malnutrition and mostly preventable diseases, each year.

Minesh Koradia C-23

 Major Health Issues
 In 2002, almost 11 million people died of infectious
diseases alone, far more than the number killed in the
natural or man-made catastrophes that make headlines.

 AIDS/HIV has spread rapidly. UNAIDS estimates for 2008

that there are roughly:
– 33.4 million living with HIV
– 2.7 million new infections of HIV
– 2 million deaths from AIDS

Minesh Koradia C-23

 Major Health Issues
 1.6 million people still die from pneumococcal diseases every year,
making it the number one vaccine-preventable cause of death
worldwide.
 Malaria causes more than 300 million acute illnesses and at least 1
million deaths, annually.
 More than half a million people, mostly children, died from measles
in 2003 even though effective immunization costs just 0.30 US
dollars per person, and has been available for over 40 years.
 These and other diseases kill more people each year than conflict
alone.

Minesh Koradia C-23

 New challenges in health
 Having survived the scourges of childhood, young people confront health
threats at a very vulnerable time, initiating sexual activity and entering the
age of identity-seeking and risk-taking.
 In south Africa, HIV/AIDS can reduce GDP growth by as much as a fifth. it is
by far the leading cause of death among young people ages 15-29 in sub-
Sahara Africa. In other reason non- communicable diseases are now leading
cause of death for young women. Injuries caused by accidents and violence
are the leading cause for young men.
 If death rate are the benchmark, young people are a healthy group: the
average 10- year old has a 97 percent chance to reach age of 25.

Minesh Koradia C-23

 New challenges in health
 Mortality is a misleading measure of youth health.
 Youth is when people begin smoking, consuming alcohol and
drugs, engaging in sex, and having more control over their
diet and physical activity- behaviors that persist and affect
their future health.
 In many countries people begin to have sex before age of 15.
The full effects of some of these youthful behaviors on health
will be felt only in adulthood. This lead to depleting the
economy of productive human capital and increasing public
health cost.

Minesh Koradia C-23

 New challenges in health

 As young people experiment, they take more

health risk, as they get older the tendency
falls. Policies can do much to help young
people manage these risks, especially if they
make young people more aware of the long
term consequences of their actions today.

Minesh Koradia C-23

 The Key Points
 HIV/AIDS afflicts some 40 million people worldwide and about 27
million in sub-Saharan Africa. It is the most virulent health scourge
of our generation.
 Even in the absence of AIDS, developing world health systems are
overwhelmed by disease. Other infectious diseases killed roughly 9
million people in developing nations last year — about three times
as many as died from AIDS.
 A significant percentage of developing world populations,
particularly in rural areas, has virtually no access to meaningful
health care. Poor infrastructure, especially inadequate
transportation, plays a major role in health care shortfalls.

Minesh Koradia C-23

 The Key Points
 The research-based pharmaceutical industry has launched a
significant effort to support developing world health systems,
including donations of critical medicines and long-term agreements
to provide antiretroviral drugs (ARV) for AIDS at prices at or below
cost. Some AIDS medications have been provided free.
 Over the last four years, the industry has provided $1.9 billion in
assistance. In partnership with the United Nations, the industry has
established the Accelerating Access Initiative (AAI) to expand access
to ARV and other AIDS medications. By the end of 2001, 72 nations
were exploring the AAI program and 14 (including 10 in Africa) had
signed AAI accords.

Minesh Koradia C-23

 The Key Points
 The door is wide open to generic AIDS treatments in Africa
because relatively few ARV are under patent in African
countries. But even generics may be beyond the financial means
of many developing countries. A study in the Journal of the
American Medical Association said "the dearth of international
aid finance, rather than patents, is most to blame for the lack of
antiretroviral treatment in Africa.”
 Conquering AIDS will require significant new resources. As the
United Nations recognized in 2001 by creating the Global
Fund for AIDS, Tuberculosis and Malaria, defeating AIDS
requires a worldwide effort of all sectors of society.

Minesh Koradia C-23

Health Problems in all
over World
Hunger Is the Major World
Health Problem 
World Health Organization (WHO) findings in a new study.
Some 170 million children in poor countries are
underweight, mainly from lack of food.  
From more than 25 major preventable risks selected for in-
depth study, the report finds that the top 10 globally are,
in order of occurrence:-
1) Childhood and maternal underweight
2) Unsafe sex
3) High blood pressure;
4) Tobacco
5) Alcohol
6) Unsafe water, sanitation and hygiene
7) High cholesterol
8) Indoor smoke from solid fuels
9) Iron deficiency
10) Overweight/obesity.
High Blood Pressure
• High blood pressure is a medical condition in
which:-
– blood pushes in the artery wall too hard that it
creates pressure.
– This happens because the arteries walls become
too narrow due to the deposition of fats in it.
– It is also known as hypertension as it creates
tension in the arteries.
ASTHAMA

• Asthma is a very common disease, affecting

about one in every forty people, and
approximately two thirds develop symptoms
in early childhood. It is characterized by
• Narrowing of the airways of the lung (bronchi)
due to tension or spasm of the muscles in the
bronchial walls.
• The respiratory tract invariably becomes
congested with thick sputum.
 Diabetes
• Diabetes is a metabolic disorder
where in human body does not
produce or properly uses insulin, a
hormone that is required to convert
sugar, starches, and other food into
energy.
• Diabetes mellitus is a common disease in the
United States. It is estimated that over 16 million
Americans are already caught with diabetes, and
5.4 million diabetics are not aware of the
existing disease.
 AIDS?

• AIDS is caused by HIV.

• HIV is a virus that gradually attacks
immune system cells.
• As HIV progressively damages these cells, the
body becomes more vulnerable to infections,
which it will have difficulty in fighting off.
• It is at the point of very advanced HIV infection
that a person is said to have AIDS.
• It can be years before HIV has damaged the
immune system enough for AIDS to develop.
Diarrhoeal diseases
• A range of diarrhoeal diseases caused by a large
number of non-typhoidal Salmonella serovars
(NTS).
• These NTS, which usually have a broad vertebrate
host range, show dramatically more severe and
invasive presentation in immunocompromized
individuals especially HIV carriers, including
severe and progressive diseases such as chronic
granulomatosis disease, blockade of IL-12/ IL-23
/IL-17 and TNF, suppurative foci and bacteremia
which may be recurrent.
 Depressive
• Major depressive disorder (also known as
clinical depression, major depression,
unipolar depression, or unipolar disorder)
is a mental disorder characterized by:-
– All-encompassing low mood accompanied by
low self-esteem
– loss of interest or pleasure in normally
enjoyable activities
TUBERCULOSIS

• Tuberculosis (TB) is an infectious disease caused

by bacteria whose scientific name is
Mycobacterium tuberculosis.
• It was first isolated in 1882 by a German
physician named Robert Koch who received the
Nobel prize for this discovery.
• TB most commonly affects the lungs but also can
involve almost any organ of the body.
• tuberculosis usually can be treated successfully
with antibiotics.