Health Matters | When breath turns to smog

This week in health: a ‘one nation, one registration platform’ for doctors, Tamil Nadu’s health walk tracks and how air pollution impacts diabetes risk.

Updated - November 08, 2023 04:19 am IST

Published - November 07, 2023 10:49 am IST

Image for representational purpose only.

Image for representational purpose only. | Photo Credit: Shiv Kumar Pushpakar

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This week, as the stubble continues to be set afire in the outskirts of Delhi, in Haryana, and Punjab, there is no bigger issue we need to be dealing with is in the air. Delhi’s air pollution hit literally unrecordable levels this past week, and a sinking feeling set in with Delhi’s residents. Air quality was in the ‘severe plus’ category again; flights were being delayed and primary schools were shut till November 10. A toxic haze lingered over Delhi for the sixth consecutive day on November 5 as pollution levels once again reached the severe plus category due to unfavourable wind conditions, particularly calm winds during the night. The concentration of PM2.5, fine particulate matter capable of penetrating deep into the respiratory system and triggering health problems, exceeded the government-prescribed safe limit of 60 micrograms per cubic metre by seven to eight times at multiple locations throughout the Delhi-NCR.

The air quality index deteriorated from 415 at 4 p.m. on Saturday to 460 at 7 a.m. on Sunday. Naturally, all preparatory modes had to be switched on. Under the Centre’s air pollution control plan, all emergency measures, including a ban on polluting trucks, commercial four-wheelers, and all types of construction, are mandated to be initiated and enforced in the National Capital Region if the Air Quality Index crosses the 450-mark.

Soon, doctors began expressing concerns that air pollution is causing an increase in respiratory and eye problems among children and the elderly in Delhi. Hospitals began to see an increase in the number of patients coming in, complaining of headaches, burning eyes, or choking. Doctors also said that those who have existing pulmonary issues found that they had to up their dosage or change the drugs they were on. Those who have suffered from severe COVID-19 infection in the past are more prone to respiratory distress. With the Deepavali festival coming up over the weekend, there is a real and present fear that the smog will only worsen, making even breathing difficult.

Diabetes and pollution

Meanwhile, the results of a couple of studies linking the risk of Type 2 diabetes to air pollution raised some brows. It’s not as if the discovery of the link per se is unprecedented; it has already been studied across the world, and the link established, but these were studies that were done in Chennai and Delhi. The new studies are part of the Centre for Cardiometabolic Risk Reduction in South Asia (CARRS) Surveillance Study. Here, researchers roped in 6,722 adults in Chennai and 5,342 in Delhi and tracked their health through questionnaires and blood samples, with which they checked for fasting plasma glucose (FPG) and glycosylated haemoglobin (HbA1c), at specific intervals from 2010 to 2016.

The authors of the article, published in the British Medical Journal, Siddhartha Mandal et al, argue that this exercise has provided evidence linking short-term, medium-term and long-term exposure to PM2.5, assessed from locally developed high-resolution spatiotemporal models, glycemic markers and incidence of diabetes from a highly polluted region with a high burden of diabetes, thus adding to the existing evidence from low-pollution scenarios in the Western population.

Further studies are required to cement this links, but does not hurt to ensure that we keep our particulate matter count low.

A question of height

Meanwhile, staying on the environmental factors peg, in a significant finding, scientists have discovered that these play a greater role than genetic variants in determining the height of children in low and middle-income countries (LMICs) in contrast to those from European nations, where genetic aspects predominate in regulating childhood height. Y. Mallikarjun records how environmental factors determine the height of children in LMICs. While human height is strongly influenced by fixed genetic and variable environmental factors, the authors of the study noted that the contribution of modifiable epigenetic factors is under-explored. Epigenetic factors are external influences, including lifestyle, nutrition and environment that affect the way genes work. Epigenetic changes affect gene regulation and alter gene expression but not the DNA sequence.

Walk to health

The Tamil Nadu Government has, in an effort to improve the environment for practising good lifestyle choices decided to open Health Walk tracks in every district in the State, and made a good start in some of the cities too. Doctors said a regular walk for 8 km a day (the length of the track) keeps blood pressure, blood sugar, weight etc. under control…And an unexpected side effect is improved aesthetics on these health walk stretches, at least in Chennai, writes Prince Federick. 

A view of ‘Health Walk’ along the lines of an 8-km walking track at Besant Nagar on November 7, 2023.

A view of ‘Health Walk’ along the lines of an 8-km walking track at Besant Nagar on November 7, 2023. | Photo Credit: Velankanni Raj B.

While the impact of using cigarettes and influencing the youth has somewhat been regulated by law, rules and somewhat conscientious filmmakers, the ‘cool’ aspect of smoking now seems to have attached itself to e-cigarettes. Serena Josephine M. writes about the study conducted by The George Institute for Global Health in four nations, which concluded that a large majority of young people were being exposed to e-cigarette advertising. Incidentally, India has amongst the strictest regulatory environments in the world: nicotine and non-nicotine e-cigarettes are banned and advertising is not permitted.

Of lists — useful or not

Continuing the One Nation series that we can’t get enough of these days, the National Medical Council has announced that it is ready to launch a ‘one nation, one registration platform’ for doctors, writes Bindu Shajan Perappadan. Avowedly, this is to eliminate duplication, red tape and allow the public to access information on any physician working in India. The idea is to provide a masked ID to undergraduate students on the NMR and depending on when they complete their course the ID is unmasked and allotted. This ID can be used to update any further qualification and all State registers for licence to work in any part of the country will be linked here and will be available at the click of a button,” said Yogender Malik, member, of Ethics and Medical Registration Board, NMC. The database will also be available to the public, he added. While the idea of a central roster might be mildly useful, the purpose of it in a stubbornly federal set up where doctors root themselves within States, is questionable. 

Here is a list, however, that will actually be useful to the public. ICMR-NIP devises an online map to make available info on relevant laboratory services to users. The Indian Council of Medical Research (ICMR)-National Institute of Pathology (NIP), Delhi, has catalogued diagnostic public healthcare facilities throughout the country and constructed a user-friendly and comprehensive dynamic online map to make available information of relevant laboratory services to users.

Difference of fact

While an ICMR study underlined the link between post-COVID-19 cardiac events, and physical exertion, a Karnataka scientist directly countered this averment. C.N. Manjunath, director of Karnataka’s Sri Jayadeva Institute of Cardiovascular Sciences, said there was no scientific evidence to prove that COVID-affected people should not exert themselves. Asserting that exercise is very important for maintaining good health, Dr. Manjunath said a sedentary lifestyle is a risk factor for cardiovascular diseases. “Isotonic exercises such as walking, jogging, swimming, cycling and moderate workout at the gym is the general recommendation. However, it is essential to get a cardiac evaluation done before signing up for a rigorous gym programme. This is to rule out any pre-existing asymptomatic cardiac disorders,” he said.

Fertility rites

Let’s move over to social/health economics now. Prashanth Perumal explains a paper: “When social status gets in the way of reproduction in modern settings,” by Jose C. Yong, Amy J. Lim and Norman P. Li. The authors argue that evolutionary mismatch may be the reason behind falling fertility levels despite the rise in living standards over time. Evolutionary mismatch refers to the phenomenon wherein traits that worked in the favour of an organism’s survival in the past become disadvantageous to survival chances in modern times. Competing for social status, which was an evolutionary need, has now become so intense that it has impeded the supra biological need for reproduction, they argue. 

Staying on the fertility quotient and the impact of the Supreme Court judgement on a quintessential rights-based approach, Suhrith Parthasarathy writes on how the Supreme Court judgment impacts a woman’s freedom to reproductive choices. We had earlier reported the October 16 judgement, in X vs Union of India, where the Supreme Court of India declined permission to a woman who was seeking to terminate a 26-week-long pregnancy. The judgment falls short of bestowing any explicit rights to the unborn. But the upshot of its conclusion is just that: when a foetus becomes viable, and is capable of surviving outside the mother’s uterus, the woman’s right to choose stands extinguished, barring circumstances where the specific conditions outlined in the MTP Act are met. In so holding, the judgment suffers from at least two errors, he argues. Read to know what these errors are.

This week’s tailpiece is an article by behavioural scientist Jessica D. Ayers who articulates well what we’ve long suspected: friendships are so powerful that the social pain of rejection activates the same neural pathways that physical pain does. Within the last decade, researchers have begun investigating the roots of friendship preferences beyond the classic descriptions. She goes on to argue that considering the nuances of friendship preferences will be extremely important in reducing not only loneliness, but other related public health crises. For instance, suicide has a close link with loneliness, and that is directly related to friendships and/or loss of friends. Post the lonely pandemic years, this aspect sure can do with a reassessment.

From the Health page

Those few extra moments you have will be well served browsing through our also read links:

Rajan Ravichandran turns the spotlight on kidney organ donors and how keeping a low salt diet is essential for them as well.

Suhasini Haidar records that it is now India’s turn to choose between Bangladesh and Nepal candidates for WHO regional chief.

Siddharth Kumar Singh on Telangana’s midwifery miracle: From 30 to 353.

NMC to constitute committee on the issue of live surgeries.

 Afshan Yasmeen reports on a study finds Vitamin B12 absorption is not just in the small intestine but also in the human colon.

For a broad range of our regional stories, do look at the following links:

Andhra Pradesh

P. Sujatha Verma notes: Andhra Pradesh State Skill Development Corporation to facilitate training of nurses for global placements.

Centre keen on establishing Unani research centre in Andhra Pradesh’s Kadapa district.

Nellore Sravani on how Andhra Pradesh’s homeless grapples with mental health issues.

Sambasiva Rao M. reports onTDP official Lokesh questioning the treatment of patients under the shade of trees in an Andhra Pradesh government hospital.


High Court seeks Centre, Delhi government’s reply on inclusion of ayurveda, yoga in Ayushman Bharat.


Karnataka’s heart attack management programme is now ‘Puneeth Rajkumar Hrudaya Jyothi’ scheme.

No new Namma Clinics will be opened in Karnataka, says Health Minister.

Bengaluru also in the grip of other viral ailments.

Karnataka CM writes to Prime Minister requesting waiver of import taxes on medicine for a baby with a rare disease.

Karnataka steps up surveillance after detection of Zika virus in mosquito pool in Chikballapur.

U.S.-based foundation to support setting up of Centre for Computational Oncology at IISc.


A.S. Jayanth saysPrivate medical lab technicians staring at uncertain future in Kerala.

PG medicos in Kerala to strike work on November 8.

Need for ensuring nutrition security among all cross-sections in State, experts say.

Kerala should focus on preventive and primary health care, points out health experts.

Health experts urge Kerala to invest in basic and clinical research.

Tamil Nadu

Over 6,100 dengue cases, eight deaths reported in Tamil Nadu so far.

Bond period for non-service PGs who completed courses in 2023 reduced to one year, bond amount halved.

Tamil Nadu to conduct counselling for 17 vacant MBBS seats from November 7 to 15.

L. Srikrishna reportsthat health officials, government doctors swing into action as fever cases rise in Tamil Nadu’s Thoothukudi.


Rx for recruitment: Telangana medical colleges in critical need of faculty.

Telangana High Court serves notice to State govt. over The Hindu report on bodies decomposing in Gandhi hospital mortuary.

As always, do put us on your radar, as we bring more health content your way. Get more of The Hindu’s health coverage here

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