Chapter 18: Health Organisations

In June 1859, a Swiss businessman named Henry Dunant travelled into northern Italy hoping to meet the French emperor about a business matter. He arrived instead at the edge of a battlefield. At Solferino, the armies of France and Sardinia had fought the army of Austria for most of a day, and when the firing stopped, tens of thousands of dead and wounded men lay where they had fallen. There were almost no doctors, very few stretchers, and no arrangement at all for carrying the injured to safety.

Dunant gave up his errand. He walked into the nearby town of Castiglione, where the wounded were being laid out on the stone floor of a church, and began organising the townspeople to fetch water, wash wounds and feed the men. He asked them to make no distinction between a French soldier, an Austrian soldier and an Italian one. A wounded man was simply a wounded man.

Three years later Dunant published an account of what he had seen, and added two proposals. First, that every country should train volunteers in peacetime who could nurse the wounded in war. Second, that nations should agree beforehand to protect those volunteers while they worked. The first idea grew into the Red Cross. The second grew into the Geneva Conventions.

Nearly ninety years afterwards, in 1948, the governments of the world carried the same instinct further and created a single agency to look after the health of everyone on Earth.

Diagram

Fig. 18.0-1 — Care For The Wounded At Castiglione, 1859 Line drawing of the interior of a large town church converted into a temporary relief centre; wounded soldiers of different armies lying side by side on straw on the floor, townspeople carrying water pitchers and cloth bandages between them, one man directing the helpers; label the caption elements only — wounded soldiers, volunteer helpers, water and bandages. No blood, no graphic injury detail.

Curiosity Corner

Q1. Why is the emblem of the Red Cross a red cross on a plain white background, and not some other sign? Q2. Almost every hospital, chemist’s shop and ambulance you pass displays a red cross. Is that actually allowed? Q3. Which single organisation is responsible for the health of the whole world, and who set it up? Q4. Why do diseases such as typhoid and diarrhoea spread far more easily in some kinds of settlement than in others? Q5. When a person catches a disease that spreads fast, who decides that they must be kept apart from everyone else, and what is that measure called?

18.1 Common Health Problems In India

India is a very large country. Its land runs from snow-covered mountains to deserts, from thick forests to long stretches of coast. The weather, the soil and the supply of water are different in each of these places.

People live differently in each of them too. And because health depends a great deal on how people live — where their water comes from, how their waste is carried away, how crowded their homes are — the health problems of one part of India are not the same as those of another.

So before we look at the problems themselves, it helps to look at the kinds of places in which Indians actually live.

18.1.1 The Five Kinds Of Habitation

A habitation is a place where a group of people live together. The population of India is spread across broadly five kinds of habitation, shown in Fig. 18.1-1.

Big cities. These have multi-storeyed buildings and very large numbers of vehicles. Their water supply and sewage systems carry a heavy load. Many have industries, either inside the township or on its edge.
Small towns. These are built on the same pattern as cities but are not so crowded.
Villages. The population is small and life is based on agriculture. Dairies, poultry farming and cottage industries are the main sources of livelihood.
Remote areas. These are the forested and hilly tracts where tribal communities live, largely on forests and forest products. Proper drinking water and medical facilities usually do not reach them.
Slum-dwellings. Slums and jhuggi-jhompris are found at many places, especially on the outskirts of big cities. Homes stand very close together, and clean water, drains and toilets are in short supply, so unhygienic conditions prevail.

Diagram

Fig. 18.1-1 — The Five Kinds Of Habitation In India A single map of India showing the full extent of the country as officially defined by the Government of India, including Jammu and Kashmir and Ladakh, with five small line-drawing panels arranged around it and joined to it by lead lines; label the five panels big city, small town, village, remote area, slum-dwelling. Panels are simple neutral streetscapes, not caricatures of any community.

Notice what changes as you move down that list. In the first two, large numbers of people share one water supply and one drainage system. In the last three, the difficulty is the opposite — the supply and the drainage may hardly exist at all.

Either way, the result is the same: water and waste meet somewhere they should not. That single fact explains most of the health problems described below.

Two Broad Groups

The illnesses that are common across these habitations can be sorted into two broad groups, according to how the germ reaches the body. Some travel in what we swallow. Others travel on insects or through the air.

Compare Table

18.1.2 Food-Borne And Water-Borne Diseases

Water-borne diseases are diseases whose germs reach us in drinking water. Food-borne diseases reach us in the same way, but through food instead. The two are usually spoken of together, because the same germ often travels by both routes.

Four of them are very common in areas where a proper water supply is lacking.

Diarrhoea — frequent, watery stools, which drain the body of water and salts.
Gastroenteritis — inflammation of the lining of the stomach and the intestine, causing vomiting along with loose stools.
Typhoid — a long fever caused by bacteria that are swallowed in contaminated food or water.
Dysentery — an infection of the large intestine in which the stools carry mucus and blood.

Do Not Mix Up

Diarrhoea and dysentery Diarrhoea is loose, watery stools with no blood in them. Dysentery is an infection of the large intestine, and the stools carry mucus and blood. Diarrhoea is a symptom; dysentery is a named disease.

How The Water Gets Contaminated

There are three routes by which drinking water in India commonly becomes unsafe.

The first is contamination of the source itself. At many places the water drawn from hand-pumps, wells and taps has germs in it, because human waste has seeped or drained into the same ground water or the same river.

The second is the emptying of untreated sewage, and of effluents from industries, into rivers and other water bodies. Everyone living alongside such a river then draws water that already carries waste from upstream.

The third has nothing to do with germs. In certain districts the ground water itself carries harmful minerals dissolved out of the rock, and no amount of boiling will remove them.

Real-World Application

Too Much Fluoride In The Ground Water A very small quantity of fluoride in drinking water protects the teeth. In parts of Rajasthan, Gujarat, Andhra Pradesh and several other states, the ground water carries far more than that. People who drink it for years develop fluorosis: the enamel of the teeth becomes chalky and stained, and in severe cases the joints stiffen and the bones become painful. Because the fluoride is dissolved, boiling and filtering through cloth do not help. The remedy has to be a different source of water, or treatment of the supply before it is delivered.

Now trace the journey of a single germ, and you will see why safe water and proper drainage are always talked about together. FC 18.1 sets it out.

Flowchart

FC 18.1 — How A Water-Borne Disease Passes From One Person To Another Germs leave the body of an infected person in the stools → the waste reaches an open drain, a field or an untreated sewer → rain or seepage carries it into a river, a well or the ground water → the same water is drawn for drinking → a healthy person swallows the germs → the germs multiply in that person’s intestine → the disease appears, and the cycle can begin again

Look at where the chain can be cut. It can be cut at the start, by disposing of sewage properly. It can be cut at the end, by boiling or otherwise treating the water before drinking it. Cutting it at either point stops the disease, which is why both steps are pressed for at once.

Curiosity Corner

Q4. Why do diseases such as typhoid and diarrhoea spread far more easily in some kinds of settlement than in others?

A. Because these germs travel from human waste into drinking water. Where homes are packed close together and drains, toilets and treated water are lacking — as in slum-dwellings — waste and water meet easily, and one infected person can pass germs to many.

18.1.3 Insect-Borne And Air-Borne Diseases

The second group of diseases does not travel in water. Its germs are carried to us, either on the body of an insect or in the air we breathe.

Insects As Carriers

Food left standing uncovered is the commonest opportunity. Houseflies settle on rubbish, on animal waste and on open drains, and then settle on food that has been left exposed. Whatever they picked up in the first place is left behind on the second.

Structure and Function

Housefly Legs and body covered with fine bristles, and sticky pads on the feet → germs from waste cling to them as the fly walks → the fly walks over uncovered food and leaves them there.

Awareness of this is uneven, and where food is sold or eaten in the open it is often left uncovered simply because there is nothing to cover it with. Keeping food covered is therefore treated as a public health measure and not only as a household habit.

Other insects breed wherever refuse and still water are allowed to collect. Mosquitoes lay their eggs in still water, and their young stages develop only there. Diseases such as malaria and dengue spread when the number of mosquitoes rises, which is why standing water is drained rather than sprayed.

Diagram

Fig. 18.1-2 — Two Ways An Insect Spreads Disease Two-panel line drawing. Panel A: a housefly on an uncovered plate of food, with a nearby open refuse heap and an arrow tracing the fly’s path from heap to food; label refuse heap, housefly, uncovered food. Panel B: an old tyre and a discarded container holding rainwater with mosquito larvae hanging below the water surface, and an adult mosquito above; label still water, mosquito larvae, adult mosquito.

Try Yourself

After the next spell of rain, walk once around your school building and count the places where water has been left standing — a tyre, a broken pot, a tray under a plant, a blocked drain. Each is a place where mosquitoes can breed. Which of them could be emptied in under a minute?

Germs Carried By Air

Some germs need no insect at all. When a person with an infection of the lungs or throat coughs, sneezes or even speaks, tiny droplets of moisture are thrown into the air, and the germs travel inside them. Anyone standing close by breathes them in.

These are the air-borne diseases, and tuberculosis and influenza are familiar examples. They spread fastest in crowded, poorly ventilated rooms, where the same air is breathed again and again by many people.

18.2 Categories Of Health Organisations

Knowing what makes people ill is one thing. Doing something about it, for millions of people at once, is quite another. No family can clean a river or vaccinate a district by itself.

That work is done by organisations, and every country has several kinds of them. They can be sorted into three categories according to the level at which they work, as FC 18.2 shows.

Flowchart

FC 18.2 — The Three Levels At Which Health Organisations Work Local bodies (one city, town or large village) → national organisations (the whole country) → international organisations (many countries together)

Each level takes on the work that the level below it cannot manage. A municipality can clear the drains of its own town, but it cannot run a research centre on malaria for the whole country. India can run that centre, but it cannot by itself stop a disease that is crossing borders. That is where the third level comes in, and it is the subject of the next section.

18.2.1 Local Bodies

Every city, every town and even the larger villages have some kind of local body to look after the health and sanitation of the people living there. These include Municipal Corporations, Municipalities and Town Area Committees. Each keeps regular staff and equipment for the purpose.

Four duties fall to them.

Sanitation. This means the removal and proper disposal of garbage, sewage and other wastes, together with the elimination of the places where flies and mosquitoes breed. It is the direct answer to both groups of disease described in section 18.1.
Supply of safe drinking water. Water is treated before it is sent through the pipes, so that the germs it may carry are killed before it reaches any home.
Vaccinations. Infants in particular, and others as well, are immunised against several infectious diseases.
Keeping statistical records. The registration of births and deaths is compulsory, and every other kind of information about the health and the diseases of the people of the area is maintained regularly.

What Immunisation Actually Does

The third duty needs a word of explanation, because the word ‘vaccination’ is used far more often than it is understood.

Immunisation is the giving of a vaccine so that the body develops resistance to a disease before it ever meets that disease. The vaccine contains the germ in a killed or weakened form, or just a part of it, so it cannot cause the illness. The body nevertheless treats it as an intruder and prepares its defences against it. If the real germ arrives years later, those defences are already in place. Fig. 18.2-1 shows the idea.

Diagram

Fig. 18.2-1 — How A Vaccine Protects Three-stage line drawing joined by arrows. Stage 1: a syringe or oral drop delivering weakened germs into the body, label vaccine (killed or weakened germs). Stage 2: the body producing defence substances against them, label body prepares its defences. Stage 3: the same germ, now in its active form, arriving later and being destroyed at once, label protection on later exposure.

The infectious diseases vaccinated against under these programmes include tetanus, pertussis (whooping cough), diphtheria, tuberculosis, poliomyelitis and measles. The programmes are intensified whenever there is a risk of an epidemic breaking out — that is, a sudden outbreak in which a disease spreads through a large number of people in an area at the same time.

Do Not Mix Up

A vaccine and a medicine A vaccine is given to a healthy person, before the disease, so that the body can prepare its defences. A medicine is given to a person who is already ill, to treat the disease that has begun. Prevention before; treatment after.

Side Note

The word ‘vaccine’ comes from vacca, the Latin word for cow. The first such protection ever given used material from cowpox, a mild disease of cattle, to guard people against smallpox. The name stayed on, and today it covers every vaccine, whatever it is made from.

The fourth duty looks like clerical work, but it is the foundation of the other three. Unless births and deaths are recorded, nobody can tell whether a disease is spreading or retreating, or which locality needs help first. Records are how a health problem becomes visible.

Try Yourself

On your way home, count the places where the work of your local body can actually be seen — a covered garbage collection point, a public tap, a stormwater drain being cleared, a mosquito-control spray notice. Which of the four duties listed above does each one belong to?

18.2.2 National Bodies

Some health problems are too large for any one town. In India, several agencies, institutes and research centres are actively engaged in studying the health problems of the country as a whole.

These centres work in particular on five diseases: malaria, dengue, tuberculosis, leprosy and cholera. For each of them the same four steps are taken.

A regular survey, to find out how many people are affected and where.
Identification of the transmitting agent — the insect or other carrier that brings the germ to people — and of its breeding places.
Arranging prophylactic immunisation, that is, vaccination given in advance to prevent the disease rather than to cure it.
Any other steps needed to fight that particular disease.

The order of those steps matters. Until you know which insect carries the germ and where it breeds, spraying and draining are guesswork.

The National Institute of Communicable Diseases (NICD), located at Delhi, is seriously engaged in research on infectious diseases. It was earlier known as the Malaria Institute, and it has since been renamed the National Centre for Disease Control (NCDC).

An extensive national programme called Pulse Polio has been carried out to eradicate poliomyelitis from the country.

Real-World Application

Pulse Polio Poliomyelitis is a viral disease that can leave a child permanently paralysed. The vaccine against it is given as drops in the mouth, which means no needles and no trained nurse is needed for each child. The Pulse Polio programme, begun in 1995, used that advantage: instead of vaccinating children as they happened to come to a clinic, it set aside fixed days on which every child under five in the country was given the drops, at booths, railway stations and doorsteps. Repeating this year after year left the virus with almost no unprotected child to move into. India’s last case of polio caused by the wild virus was reported in 2011, and the country was certified polio-free in 2014.

Table 18.2 sets the two Indian levels side by side.

Compare Table

18.3 International Bodies

Germs do not stop at a border. A disease that begins in one country can be carried into another by a single traveller, and no government can guard against that on its own. Some health work therefore has to be done by many countries together.

Two international bodies concerned with people’s health matter most:

the Red Cross;
the WHO (World Health Organisation).

The two are not rivals, and they do not do the same work. One reaches people who are in trouble now. The other works on the health of whole populations over years.

18.3.1 The Red Cross

The Red Cross is a national as well as an international agency. It has a society in India and in most other countries, and those societies belong to one worldwide movement.

Its main function is to carry out activities that prevent or remove human suffering, including suffering during times of war. Work of that kind began with a committee formed at Geneva in 1863, and the movement was given its formal international standing by an agreement signed between nations in 1864.

The emblem of the Red Cross Society is a red-coloured cross painted on a white background, shown in Fig. 18.3-1.

Diagram

Fig. 18.3-1 — The Emblems Of The Movement Three plain shapes side by side on white squares of equal size: a red upright cross with arms of equal length; a red crescent opening to the right; a red square standing on one corner, unfilled. Label them red cross, red crescent, red crystal.

Curiosity Corner

Q1. Why is the emblem of the Red Cross a red cross on a plain white background, and not some other sign?

A. It is the flag of Switzerland with its colours exchanged — a white cross on red became a red cross on white. It was chosen to honour Switzerland, where the movement was formed, and because a simple shape in two strong colours can be recognised instantly and from a distance.

Side Note

Many countries use a red crescent on white instead of a cross, and both signs carry exactly the same protection in law. A third emblem, the red crystal — a plain red square standing on one corner — was agreed in 2005 for societies that prefer a sign carrying no other association at all.

Help Given To Both Sides

People belonging to the Red Cross may go on to battlefields and take care of wounded soldiers, whether those soldiers are friends or enemies. This is the movement’s central rule, and it is what makes the work possible at all. If relief workers helped only one army, the other would treat them as part of the fighting and neither side’s wounded would be reached.

Major Activities Of The Red Cross

To extend relief and help to the victims of any calamity — flood, fire, famine, earthquake and the like.
To procure and supply blood for the needy victims of war or of other calamities.
To extend all possible first-aid treatment in any accident.
To educate people in accident prevention.
To arrange ambulance service in all emergencies.
To look after maternal and child welfare centres.
The Indian Red Cross Society has also been engaged in training midwives.

Read the list again and a pattern appears. Items 1, 2, 3 and 5 all deal with an emergency that has already happened. Item 4 tries to stop the emergency happening at all, and items 6 and 7 are steady, everyday work that has nothing to do with disasters. An organisation that only rushed to accidents would be idle between them; the Red Cross is not.

World Red Cross Day is observed on 8 May, the birthday of the man whose account of a battlefield began the movement.

Try Yourself

Open the first-aid box in your school laboratory and list what is inside it. Take each item in turn and decide which of the seven activities above it would serve. Is anything in the list missing from the box?

The Wrong Use Of The Emblem

The red cross emblem is very often painted on hospitals, ambulances, chemists’ shops and doctors’ coats, so that they can be identified quickly. In law this is wrong. Only units of the Red Cross Society may use it.

The rule can look fussy until you see the reason behind it. The emblem is not a general sign for medicine. It is a signal that says: this vehicle, this tent, this person is neutral and must not be attacked. If everyone paints it on everything, the sign stops meaning anything in particular, and the protection it offers to a relief worker in a war zone is lost.

Curiosity Corner

Q2. Almost every hospital, chemist’s shop and ambulance you pass displays a red cross. Is that actually allowed?

A. No. Only Red Cross Society units may use the emblem. It is a protective signal of neutrality, not a general symbol for medical help, and using it freely would weaken the protection it gives to relief workers.

18.3.2 WHO (World Health Organisation)

The World Health Organisation, established in 1948, is a specialised agency of the United Nations Organisation (UNO). Where the Red Cross is a movement of volunteer societies, the WHO is an organisation of governments: its members are countries, not individuals.

Curiosity Corner

Q3. Which single organisation is responsible for the health of the whole world, and who set it up?

A. The World Health Organisation. It was set up in 1948 by the member countries of the United Nations Organisation, as one of the UNO’s specialised agencies, and it works for the health of the people of all its member states.

18.3.2.1 Reasons For The Formation Of WHO

The member countries of the UNO focused on the need for creating an international body to look after the health problems of the people of the world.

The need was felt particularly in the field of research on the causes and the cures of diseases. Research is slow and expensive, and a dozen countries each working alone on the same disease repeat the same effort a dozen times. Combined efforts in this direction were expected to give better and faster results.

Poor and developing countries stood to benefit quickly. A finding made anywhere would reach them without their having to fund the research themselves.

The headquarters of the WHO are located at Geneva, in Switzerland. The organisation also has six regional offices in the world, including one at Delhi, and each regional office works for its own member countries. Their locations are shown in Fig. 18.3-2.

Diagram

Fig. 18.3-2 — The Six Regional Offices Of The WHO Outline world map with boundaries as officially recognised by the Government of India, and India shown to its full officially defined extent including Jammu and Kashmir and Ladakh. Mark and label six cities with dots on straight, non-crossing lead lines: Brazzaville (Africa), Washington DC (Americas), Cairo (Eastern Mediterranean), Copenhagen (Europe), New Delhi (South-East Asia), Manila (Western Pacific). Mark Geneva separately with a different symbol and label it headquarters.

Member states of the WHO are bound by international health regulations to send in all relevant information about the internationally notifiable diseases — the diseases that a country is required by agreement to report, rather than deal with quietly on its own. Malaria has long been one of them.

Reporting sounds like a small duty, but it is the whole basis of international health work. FC 18.3 shows why.

Flowchart

FC 18.3 — What Happens When A Notifiable Disease Appears A doctor recognises a case of a notifiable disease → the case is reported to the national health authority → the national authority informs the WHO → the WHO alerts the other member countries → those countries screen travellers, arrange vaccination and impose quarantine where needed → the spread is checked before it reaches them

Smallpox was once the second of the two diseases most often named as notifiable. It no longer appears on any such list, and the reason is a remarkable one.

Real Incident / Discovery

The Disease That Was Wiped Out Smallpox killed and blinded people for thousands of years. In 1967 the WHO began a worldwide campaign against it, built on a simple idea: instead of trying to vaccinate everyone on Earth, teams would chase each outbreak, find every person the patient had met, and vaccinate that ring of contacts. The virus was slowly hemmed in. The last case caught in the natural way was recorded in Somalia in 1977, and in 1980 the World Health Assembly declared smallpox eradicated. It remains the only human disease ever removed from the world completely, and no child anywhere is now vaccinated against it.

18.3.2.2 Main Activities Of WHO

To collect and supply information about the occurrence of diseases of an epidemic nature, such as cholera, plague, typhoid and yellow fever.
To promote and support projects for research on diseases such as cancer.
To supply information on the latest developments about the use of vaccines, and about the health hazards of nuclear radiation.
To suggest quarantine measures to prevent the spread of a disease to others.
To lay pharmaceutical standards for important drugs, so as to ensure their purity and the size of the dose.
To organise campaigns for the control of epidemic and endemic diseases.

Two of these need unpacking.

The fourth is quarantine. When a person has caught a disease that spreads easily, that person is kept apart from healthy people until the danger of passing it on is over. The germ may be able to travel from person to person, but it cannot cross an empty room. Keeping the patient separate simply denies the germ its route.

Definition

Quarantine The keeping apart of a person who has, or may have, an infectious disease, for as long as there is a risk of passing it on to others.

Curiosity Corner

Q5. When a person catches a disease that spreads fast, who decides that they must be kept apart from everyone else, and what is that measure called?

A. The measure is called quarantine. The WHO suggests quarantine measures for the disease, and each member country’s own health authorities then apply them.

The sixth activity names two words that are easily confused. An epidemic spreads suddenly through a large number of people at once. An endemic disease is one that is always present in a particular area, at a fairly steady level, year after year.

Do Not Mix Up

Epidemic and endemic An epidemic is sudden and widespread — many cases at once, then the outbreak passes. An endemic disease is always there in that area, in smaller numbers, all the time. Sudden and wide, against constant and local.

The fifth activity is the least dramatic and one of the most useful. A tablet is of no use if it contains less of the drug than the label claims, or if it contains something else as well. By laying down standards that manufacturers in every member country follow, the WHO makes a medicine bought in one country mean the same thing as the same medicine bought in another.

Table 18.3 sets the two international bodies side by side.

Compare Table

18.4 Summary

Health problems differ from place to place, because health depends on how people live — on their water supply, their drainage and how crowded their homes are.
The population of India lives in broadly five kinds of habitation: big cities, small towns, villages, remote areas and slum-dwellings.
In cities and towns, large numbers share one water supply and one drainage system. In villages, remote areas and slums, such systems may hardly exist. In both situations water and waste come into contact.
The common health problems of India fall into two broad groups, according to how the germ reaches the body.
Food-borne and water-borne diseases are swallowed with food or drinking water. Diarrhoea, gastroenteritis, typhoid and dysentery are common examples.
Drinking water becomes unsafe in three ways: contamination of the source itself, the emptying of untreated sewage and industrial effluents into water bodies, and harmful minerals dissolved in ground water.
A water-borne disease travels from the waste of an infected person into a water source and then into a healthy person. The chain can be cut at either end — by disposing of sewage properly, or by treating water before drinking it.
Insect-borne diseases are carried by insects. Houseflies pick up germs from waste and leave them on uncovered food; mosquitoes breed in still water and their numbers rise where refuse and water are allowed to collect.
Air-borne diseases travel in droplets thrown into the air when an infected person coughs, sneezes or speaks. Tuberculosis and influenza are examples, and crowded, poorly ventilated rooms favour their spread.
Health organisations are classified into three categories according to the level at which they work: local bodies, national organisations and international organisations.
Local bodies such as Municipal Corporations, Municipalities and Town Area Committees look after the health and sanitation of one city, town or large village.
Their four duties are sanitation, the supply of safe drinking water, vaccinations, and the keeping of statistical records including the compulsory registration of births and deaths.
Immunisation is the giving of a vaccine so that the body builds resistance to a disease before meeting it. Vaccines are given against tetanus, pertussis, diphtheria, tuberculosis, poliomyelitis and measles, and the programmes are intensified when an epidemic threatens.
An epidemic is a sudden outbreak in which a disease spreads through a large number of people in an area at the same time.
National bodies in India — agencies, institutes and research centres — study the health problems of the whole country, working in particular on malaria, dengue, tuberculosis, leprosy and cholera.
For each such disease they carry out a regular survey, identify the transmitting agent and its breeding places, arrange prophylactic immunisation, and take any further steps needed.
The National Institute of Communicable Diseases at Delhi, earlier the Malaria Institute and now the National Centre for Disease Control, carries out research on infectious diseases. The Pulse Polio programme was launched to eradicate poliomyelitis.
Two international bodies are chiefly concerned with people’s health: the Red Cross and the WHO.
The Red Cross is a national as well as an international agency, formed at Geneva in 1863 and given formal international standing in 1864. Its main function is to prevent or remove human suffering, including in times of war.
Its emblem is a red cross on a white background. Its workers help the wounded of both sides in a war, and only Red Cross Society units may lawfully use the emblem.
Its major activities are relief in calamities, supply of blood, first aid, education in accident prevention, ambulance service and maternal and child welfare; the Indian society also trains midwives. World Red Cross Day is 8 May.
The World Health Organisation, established in 1948, is a specialised agency of the UNO. Its headquarters are at Geneva, and it has six regional offices, one of them at Delhi.
It was formed because research on the causes and cures of diseases gives better and faster results when countries combine their efforts, and because poor and developing countries benefit quickly from such findings.
Member states are bound to report the internationally notifiable diseases, so that other countries can act before the disease reaches them.
The main activities of the WHO are collecting and supplying information on epidemic diseases, supporting research, supplying information on vaccines and on the hazards of nuclear radiation, suggesting quarantine measures, laying pharmaceutical standards, and organising campaigns against epidemic and endemic diseases.
Quarantine is the keeping apart of a person who has, or may have, an infectious disease for as long as there is a risk of passing it on. An endemic disease, unlike an epidemic, is always present in a particular area at a steady level.

Flowchart

FC 18.4 — The Chapter In One Chain How people live → the health problems they face → food-borne and water-borne diseases, and insect-borne and air-borne diseases → local bodies act within a town → national bodies act within a country → international bodies, the Red Cross and the WHO, act across countries → the problems are met at the level at which they arise

18.5 Key Terms

Air-borne diseases — diseases whose germs travel through the air in droplets thrown out when an infected person coughs, sneezes or speaks.
Diarrhoea — frequent, watery stools that drain the body of water and salts.
Dysentery — an infection of the large intestine in which the stools carry mucus and blood.
Endemic disease — a disease that is always present in a particular area, at a fairly steady level, year after year.
Epidemic — a sudden outbreak in which a disease spreads through a large number of people in an area at the same time.
Food-borne diseases — diseases whose germs are swallowed along with food.
Gastroenteritis — inflammation of the lining of the stomach and the intestine, causing vomiting along with loose stools.
Habitation — a place where a group of people live together.
Immunisation — the giving of a vaccine so that the body develops resistance to a disease before it ever meets that disease.
Notifiable disease — a disease that a country is bound by international agreement to report, so that other countries can be warned.
Quarantine — the keeping apart of a person who has, or may have, an infectious disease, for as long as there is a risk of passing it on to others.
Sanitation — the removal and proper disposal of garbage, sewage and other wastes, together with the elimination of the breeding places of flies and mosquitoes.
Typhoid — a long fever caused by bacteria swallowed in contaminated food or water.
Vaccine — a preparation containing a germ in a killed or weakened form, or a part of it, which cannot cause the disease but leads the body to prepare its defences against it.
Water-borne diseases — diseases whose germs reach the body in drinking water.

18.6 Points To Ponder

Boiling makes germ-laden water safe, but does nothing to water that carries harmful dissolved minerals. What does that single difference tell you about the two kinds of unsafe water, and why no one remedy can be offered for both?
A vaccine protects the person who receives it. Yet a child who has not been vaccinated is still safer in a locality where almost everyone else has been. Why should that be so, if the child’s own body has prepared no defences?
Campaigns have been run for decades against both smallpox and malaria, but only one of them has ended in the disease disappearing. What features of a disease — how it spreads, what carries it, where it can survive — might decide whether it can be wiped out at all?
Removing still water is treated as a more effective step against mosquitoes than spraying the adults. Think about where a mosquito spends the early part of its life, and explain why the earlier stage is the better target.
Local bodies are required to register every birth and every death. What could a health worker learn from those records that no amount of walking through the locality and talking to people would reveal?
The Red Cross helps the wounded of both sides in a war. Set the moral argument aside for a moment: why is this rule also a practical condition without which the organisation could not do its work at all?

18.7 Objective Questions

The headquarters of the World Health Organisation are located at : (1 mark)
1. Delhi
2. Manila
3. Geneva
4. Cairo
Which of the following is not a duty of a local body ? (1 mark)
1. Removal and disposal of garbage and sewage
2. Supply of safe drinking water
3. Registration of births and deaths
4. Laying pharmaceutical standards for drugs
World Red Cross Day is observed on : (1 mark)
1. 8 May
2. 7 April
3. 24 June
4. 1 December
A disease that is always present in a particular area, at a steady level, year after year, is said to be : (1 mark)
1. epidemic
2. endemic
3. notifiable
4. air-borne
Houseflies spread disease mainly because they : (1 mark)
1. bite human beings and suck blood
2. breed only in still, clean water
3. carry germs from waste to uncovered food on their bristles and pads
4. release germs in the droplets they breathe out
Choose the correct option. (1 mark) Assertion (A) : Only units of the Red Cross Society may lawfully use the red cross emblem. Reason (R) : The emblem is a signal of neutrality, and it loses that meaning if everyone displays it.
1. Both A and R are true, and R is the correct explanation of A.
2. Both A and R are true, but R is not the correct explanation of A.
3. A is true but R is false.
4. A is false but R is true.
Choose the correct option. (1 mark) Assertion (A) : Boiling makes every kind of unsafe drinking water fit to drink. Reason (R) : Boiling kills the germs present in water.
1. Both A and R are true, and R is the correct explanation of A.
2. Both A and R are true, but R is not the correct explanation of A.
3. A is false but R is true.
4. Both A and R are false.
Match each item in column I with the correct item in column II. (4 marks)

Column I	Column II
a. Municipal Corporation	i. Specialised agency of the UNO
b. NICD, Delhi	ii. Isolation of a person who may spread infection
c. WHO	iii. Local body
d. Quarantine	iv. Research on infectious diseases

Complete the following. (5 marks)
1. The giving of a vaccine so that the body builds resistance in advance is called ______.
2. ______ is an infection of the large intestine in which the stools carry mucus and blood.
3. The WHO has ______ regional offices in the world.
4. Mosquitoes lay their eggs in ______ water.
5. The removal and proper disposal of garbage, sewage and other wastes is called ______.
State whether each statement is true or false. (5 marks)
1. Tuberculosis spreads chiefly through contaminated drinking water.
2. The Red Cross treats the wounded of both sides in a war.
3. An epidemic disease is one that is always present in an area in small numbers.
4. The Pulse Polio programme was launched to eradicate poliomyelitis.
5. A vaccine is given to a person who has already fallen ill, in order to cure the disease.
Name the following. (5 marks)
1. The five kinds of habitation in which the population of India lives.
2. Two diseases spread by insects.
3. The Indian city in which a regional office of the WHO is located.
4. Three kinds of local body that look after the health and sanitation of a town.
5. The measure by which a person who may spread an infection is kept apart from healthy people.
Pick the odd one out in each group and give a reason for your choice. (3 marks)
1. Diarrhoea, gastroenteritis, dengue, dysentery
2. Municipal Corporation, Town Area Committee, Municipality, WHO
3. Tetanus, diphtheria, measles, fluorosis

18.8 Check Your Concepts

Define quarantine. (2 marks)
Name the four common water-borne diseases dealt with in this chapter. (2 marks)
State the year in which the WHO was established, and name the organisation of which it is a specialised agency. (2 marks)
Give a reason for each of the following. (3 marks)
1. Food sold or eaten in the open is kept covered.
2. Standing water around houses and schools is drained away.
3. Air-borne diseases spread fastest in crowded rooms with poor ventilation.
Differentiate between an epidemic disease and an endemic disease, stating the basis of difference. (3 marks)
Explain what immunisation is, and state why it is given to healthy infants rather than to people who are already ill. (3 marks)
State the four duties that a local body carries out for the health of its area, and explain briefly what each involves. (4 marks)
Describe, step by step, how the germs of a water-borne disease pass from an infected person to a healthy one. (4 marks)
Differentiate between the Red Cross and the WHO on any four points, stating the basis of difference in each case. (4 marks)
List any five major activities of Red Cross Societies. (5 marks)
Explain why the supply of safe drinking water and the proper disposal of sewage are always pressed for together, and not one without the other. (5 marks)
What would happen if the member states of the WHO stopped sending in information about notifiable diseases ? Explain your answer with reference to the way such a disease travels between countries. (5 marks)

18.9 Figure-Based Questions

Study Fig. 18.1-2. (4 marks)
1. Name the insect shown in panel A and state how it contaminates the food.
2. Name the stage of the mosquito shown hanging below the water surface in panel B.
3. State one step by which the situation shown in panel B can be prevented.
4. Name one disease spread by the insect shown in panel B.
Study Fig. 18.2-1. (3 marks)
1. Name the process that the three stages together represent.
2. State what the material introduced at stage 1 contains, and why it does not cause the disease.
3. Explain what happens at stage 3 when the active germ arrives.
Study Fig. 18.3-1. (3 marks)
1. Name the three emblems shown.
2. Name the organisation to which they belong.
3. State who may lawfully display these emblems.
Study Fig. 18.3-2. (3 marks)
1. Name the organisation whose offices are marked on the map.
2. Name the city marked with the separate symbol, and state what is located there.
3. Name the Indian city marked on the map, and state the region its office serves.
Redraw the emblem of the Red Cross Society, using the correct colours, and label the two parts of the design. (3 marks)