11 APRIL 2016
The wages of negligence
Even in a country that has unreasonably high tolerance for poor safety planning and lack of governmental accountability, the tragedy in the Puttingal Devi temple in Kerala’s Kollam district is a complete shocker. The death of more than a hundred people and injuries caused to scores by explosions in a storehouse, was a result of gross negligence, a combination of appalling carelessness and a reckless disregard for the safety of others. That the deadly blaze was triggered by a display of fireworks that were set off despite permission having been refused by the District Collector raises serious questions about the actions of the organisers. What is equally surprising is the failure of the police to implement the decision of the district administration and stop the show. The police and the organisers were in breach of the law on another count as well — that of bursting firecrackers after 10 p.m. As with all such distressing incidents, there is bound to be a search for post-hoc explanations, but the only way to ensure that lessons are learnt from the heart-rending tragedy is to conduct a quick and impartial police investigation and bring the guilty to book. Political parties must refrain from trying to extract electoral capital from the tragedy in poll-bound Kerala — it is important that the truth is not crowded out by the noise. A case has already been registered against the temple committee and the contractors hired for the fireworks; at the same time, the Kerala government has ordered a judicial inquiry, as it did in the last major temple tragedy five years ago, when over a hundred Sabarimala pilgrims were killed in a stampede.
Ironical as it may seem, Kerala on paper is better placed to ensure the safety of mass gatherings, especially religious ones, than other States. The State’s Department of Revenue and Disaster Management has a research-based institute dedicated to the study of accidents and has brought out a standard operating procedure for festival organisers. If government departments had taken the code seriously — it was prepared after a study of five major mass religious gatherings in the State including Sabarimala — there would have been no opportunity for anyone to violate orders, notably on the staging of fireworks and stocking of incendiary materials. Zero tolerance for violations, and a strong commitment to safety even in the remotest of locations, should be non-negotiable if human lives are not to be put in harm’s way. The speedy attention bestowed by the Central government to the relief operations and the support provided by the armed forces and expert medical teams have raised the profile of the Kollam incident and created a new benchmark for collaboration between the Centre and States during such emergencies. All contingency planning ultimately rests on protocols that should be tested through regular field drills. With nearly 50 major annual mass gatherings for religious occasions, including the mammoth Thrissur Pooram which is round the corner, Kerala cannot afford to fail again.
On detecting and delaying diabetes
Between 1980 and 2014, the age-adjusted prevalence of diabetes in India more than doubled among men (from 3.7 to 9.1 per cent) and women (4.6 to 8.3 per cent). In absolute terms, the number of diabetics in India galloped from 11.9 million to 64.5 million in the same period, according to a paper published on April 2, 2016 in The Lancet. India stands next only to China in the prevalence of diabetes, and contributes nearly one-sixth to the global disease burden of 422 million. It will be difficult to meet the UN global target of halting adult prevalence of diabetes at 2010 levels by 2025 if the current rates of increase continue in China, India and other low- and middle-income countries. In fact, if the post-2000 trend continues, the global prevalence of diabetes in 2025 will surpass 700 million. It is true that increase in longevity and population growth have been responsible for the spike in diabetes in India, but going forward it is rising levels of obesity that could well be the more significant contributing factor. Obesity is the most important risk factor for diabetes. According to the paper published in The Lancet, the number of obese men in India increased from 0.4 million in 1975 to 9.8 million in 2014; and from 0.8 million to 20 million women during the same period. Indeed, in 2014 there were 3.7 million severely obese women in the country. Besides obesity, there are other factors that put Indians at greater risk of developing diabetes. Increased consumption of sugar-rich and refined food products, central adiposity (commonly seen in Indian adults), sedentary lifestyles, and genetic susceptibility make more Indians vulnerable to the disease than Caucasians.
According to the Global Burden of Disease Study 2013 report, the number of years both men and women live with disease and disability has shot up since 1990. In India, diabetes is one of the major causes of disability in adults. With a direct annual cost of $73 billion, the economic burden of diabetes in India is considerable. And a substantial part of treatment costs is met by out-of-pocket expenditure. Concerted efforts must be directed at preventing and delaying the onset of the disease. A relatively easy and short-term intervention that can go a long way in keeping the disease burden under check is to diagnose and treat gestational diabetes — mostly through dietary changes and physical activity. The management of gestational diabetes — started in Chennai, it is now a national programme — which can prevent the disease in mother and child, has unfortunately not got the same attention as prevention of vertical transmission of HIV. Another missed opportunity is early detection of pre-diabetes when the blood sugar level is higher than normal but not elevated enough to be classified as diabetes. The progression to full-blown diabetes can be effectively delayed and even prevented through dietary changes and increased physical activity. This is why public awareness is crucial.