Policy Watch Columns

Making cities disease-free

With even the national capital not spared, Indian cities are plagued by a plethora of communicable diseases of late: dengue, bird flu, typhoid, chikungunya and swine flu. This is not a new trend.

In September 1994, pneumonic plague was reported in parts of Surat, Gujarat, and hospitals were overcrowded with patients. Suspected cases totalled 1,061 between September 20 and 25, leading to mass panic. Around 25 per cent of the population is said to have fled the city, carrying the disease with them to Delhi, Mumbai, Nashik, and Kolkata. Surat’s diamond processing localities, a high-risk hotspot, were soon uninhabited. Air India flights landing in London were termed as “plague planes”. With its open sewers and slums and soaking garbage due to the monsoons, Surat was described as a “medieval horror show”.

More recently, in May 2016, there were reports of bird flu in a poultry farm in Humnabad, Bidar district of Karnataka. The State’s animal husbandry department swung into action, asking for the culling of nearly 1.5 lakh birds in the farm. While the outbreak has now subsided, such incidents remain surprisingly frequent and worrying. Disease outbreak remains common in India, with debilitating consequences.

Management of waste

Sanitation was never a major concern for pre-independent India. It has remained that way. In 1907, when plague led to the death of 1.3 million people, the colonial government remained focussed on preventing cholera epidemics, ensuring military sanitation and preventing the outbreak from infecting the bureaucracy. Instead of funding an expansion of municipality-based sanitation through sewers, the government chose to intensify manual scavenging. Any collection inefficiencies were blamed on the poverty-ridden scavengers, a bias that remains ingrained in our municipal institutions. Post-Independence, India’s cities have grown haphazardly, mostly in unsanitary conditions, with outbreaks tempered by the widespread use of antibiotics and insecticides. Mutual collaboration between the urban middle class and the hinterland has been disincentivised by institutional apathy and unequal economic progress. During epidemic outbreaks, the sick and the underprivileged are left with no recourse to satisfactory health-care systems.

Today, about 90 per cent of solid waste is directly dumped into landfills. There remains little, if any, monitoring of heavy metal concentration in municipal solid waste. Consider a seemingly well-planned city, Chandigarh. It generates an average of 370 tonnes of solid waste on a daily basis. Just 7-8 per cent of its solid waste management budget is allocated for garbage collection. Given these figures, its collection efficiency varies (70 per cent from registered households, only 20 per cent from slums and surrounding villages). For each of its 56 sectors, 10-15 sweepers are assigned, many of whom suffer from parasitic diseases like diarrhoea, jaundice and trachoma. These workers remain unaware of the health hazards of their occupation, with limited mechanical equipment to help minimise their direct contact with solid waste.

We conduct limited, if any, separation at source despite a high proportion of our household waste being biodegradable. We should seek to encourage composting, which would help reduce landfill burden while increasing collection efficiency. This can be further encouraged by setting up biomethanation plants in all Tier 2 and 3 cities to process vegetable and mixed waste. Most of our collection of solid waste takes place in an ad hoc manner. Routes are decided mostly by local sweepers and drivers and there is inadequate scheduling of collection of waste from different sectors across urban areas. Waste is mostly dumped in an unsanitary and uncontrolled manner. It is then covered with soil and buried by machinery.

Public health leaders

Cities like Chandigarh and Surat can show us the way. Chandigarh is increasingly focussing on developing an integrated municipal solid waste management process by seeking to conduct segregation and storage of waste at source while promoting recycling, composting, and generation of electricity from municipal waste.

Surat has now turned into a public health leader by overhauling its trash collection and street cleaning processes and enforcing proper hygiene in restaurants. It has overhauled its slums, offering their residents paved streets and toilets. It regularly conducts disease surveillance through 489 surveillance workers, testing more than 2.3 million malaria breeding spots in 2014 while offering active diagnosis. The municipal corporation has built up a large network of 41 urban health centres, supplemented by mobile health clinics, over 500 private hospitals, and 1,300 teaching units. Garbage collection has been given a strict timetable, with each sweeper allocated a specific area. Dustbins have been installed and litterers are heavily penalised. The results are clear: cases of vector-borne diseases are rapidly declining. Surat now retains pride over its cleanliness. Sri Lanka also offers a remarkable example: it was recently declared free of malaria.

It’s not hard to build an effective waste management system. Simple things matter. A study in Bhopal highlighted that limited collection labour, badly designed community bins in poorly thought through locations, ill-maintained collection vehicles, and a general lack of waste treatment and disposal facilities led to poor waste management. Systematic thinking is still lacking. We retain limited public participation, even more limiting institutional funding, and a feckless policy and legal framework. Political will combined with active surveillance and institutional support can turn our cities around. Changing our cities from disease-prone filthy conurbations to smarter cities is a challenge that must be met through vigilance and better execution.

Feroze Varun Gandhi is a Member of Parliament, representing the Sultanpur constituency for the BJP.

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Printable version | Feb 17, 2020 3:05:10 AM | https://www.thehindu.com/opinion/columns/Making-cities-disease-free/article15140811.ece

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