One of the urgent problems facing mankind to-day is the increasing population and the limited food resources of the world. It is said that the population is increasing at the rate of twenty million a year, and it is predicted that by the end of the century, the population which was a little over two thousand million before World War II will be about half as much again in the course of the next fifty years. We can readily appreciate that the world does not grow enough to feed its population adequately. Even such food as is grown is badly distributed: some areas grow in plenty and some badly, there is surplus in some places and chronic deficit in others.
It is estimated that even before World War Ii a good two-thirds of the worlds families did not have enough food during the day. To-day conditions must be much worse. It is no coincidence that it is in the East that most hungry families live. Speaking of India, her population has increased from 313,766,380 to 356,829,485 between 1941 and 1951, registering a mean rate of growth of 12.5 per cent. With so many more mouths to feed every year there has hardly been any corresponding increase in food production. Consequently the country has come to depend more and more on imported food because there is never enough to go round. Apart from food in the form of cereals and other grains it is unfortunate that India is being compelled to import even an article like milk.
The shortage in food has necessitated rationing on a large scale, and the rations are not plentiful. As a result, malnutrition is common. Poor physique consequent on malnutrition is handicapped by yet inadequate sanitary and medical care, although the record of the two latter services has been considerable in reducing mortality. But the birth rate is not so easily amenable to control. India is now in what demographers call the swarming stage.
It has been estimated that the more fortunate peoples of the world who constitute about a fifth of its population receive about 2,875 or more calories per person per day. Another 30 per cent. live at intermediate levels between 2,500 and 2,875 calories per adult, while the remaining 50 pr cent, or about a thousand million people, mostly in Asia and Africa receives less than 2,500 calories. A recent investigation carried out by the Nutrition Division of the Food and Agriculture Organisation of the United Nations estimates that between 1938 and 1943 the worlds population has gone up by 8.3. per cent. but the figures for agricultural production (excepting Africa and the U.S.S.R., for which suitable data are not available) show in terms of nutrients a corresponding increase in available calories of only 0.7 per cent. and proteins of 1.4 per cent.
The aggregate daily supply of available calories has fallen from 2,390 per capita before World War Ii to 2,220 in 1948. The distribution of this output has gone more lop sided. Countries like the U.S.A. and Canada consume more calories per head now than before, while in other parts of the world, especially in the East, the increased population gets less calories a day than ten years ago. The last decade of course was abnormal. But it seems beyond resonable doubt that there has been a considerable decrease in the average amount of food available throughout the world. An all-India investigation of the average caloric intake in different economic levels would be very interesting; every thinking man now wonders how many calories a poor Indian would be getting to-day.
This brings up the questions of the potentiality of food resources in the world to-day. 150 years ago Malthus wrote that while agricultural production would at best increase in arithmetical progression, soon there would be a time when population would far outpace food production, with the result that population would be periodically decimated by natural calamities and war. He was a great pessimist and did not believe in keeping people healthy, and preferred to let people die. But death was a fairly quiet matter in the 18th century, but can be very noisy now when people are not willing to starve to death in quietness.
Malthuss theory was staved off during the next 150 years by the opening up of three new continents; the two Americas and Australia, which enormously improved food production, and advancements in science. But to-day we have explored the world rather thoroughly and practically all the space that there is to produce food. There is, of course, one channel still left open and whose potentialities we have not yet fully discovered, and that is the scientific field. During the last Science Congress in Calcutta, Professor J.B.S. Haldane said that the world might decide to augment its food resources by the production of synthetic food, the idea of which may be revolting to-day but can be acceptable tomorrow.
He cited the instance of aluminium and other alloys which have largely replaced iron and steel in everyday life. In spite, however, of Professor Haldanes optimism it remains a fact that especially in Asia much of the land is losing its fertility owing to its being-worked and other reasons, life soil erosion. The question, therefore, is now real; which is, can the world produce sufficient food to feed its population? There are those who believe that this is not possible. On the other hand, scientists are fairly optimistic.
They never cease to point out that by better methods of agriculture and irrigation, better plant selection, reclamation of waste lands, the stopping of soil erosion and the judicious use of manure and fertiliser, we can feed the worlds population very comfortably for the next 100 years.
The problem of population cannot be solved by letting large numbers of people die. This has not stopped the worlds population from growing in the past, and it is now fairly established that this is not the way to limit the worlds population in the future. The only way to control the population is to keep the existing number healthy and comfortable with a good standard of living, and only when these objects are achieved that the birth-rate falls. Unless the birth-rate falls, the death rate alone cannot make much headway in limiting the worlds ills.
It is poverty and lack of standards that keep the birth rate high; this is one of Natures ways of replenishing waste: if there is less waste, nature replenishes less quickly. A higher death rate is almost immediately accompanied by a higher birth rate. A falling death rate means a higher standard of living and eventually it brings about a lower birth-rate. There seems to be very little short cut out of a rapidly increasing population, except by increasing the prosperity of the population in question.
But in the present circumstances it looks as if there will be a long time before Natures laws operate in this country. It will take a long time at the present rate to up-grade the standard of living of the common man. If India can grow more food the immediate effect will be a raid increase in population, as has been the case in England, America and every other country in the 18th century, accompanied by a falling death rate on account of better nutrition and medical care. It is only after this stage of rapid increase is worked off that we can expect a falling birth rate. India can ill afford to go through the whole cycle.
Experts, therefore, consider that at the same time that food is increased together with the standard of living, it is essential to try to control the birth rate to some degree and to dissemimate now knowledge about family planning, or as it is popularly known, birth control. Although it hardly appeals to the masses of our country, it is worth recalling that as long as 1933 the All-India Womens Conference passed a resolution urging birth control to be included in the municipal health services.
In 1938 the Indian National Congress appointed a committee which approved of family planning. Mrs. Margaret Sanger a pioneer in the cause of birth control in the U.S.A., once said that during her visit to India she was very much impressed by the attitude of India women whom she found in favour of birth control. She interviewed Mahatma Gandhi who, however, did not believe in artificial birth control, but thought that husband and wife should separate after they had had a number of children. It is often said that our primitive people will have nothing to do with family limitation in any form.
But any one who keeps contact with that people tells a different story; the womenfolk especially frequently ask for information on the spacing of children. The whole problem, however is not so simple as distribution of birth control clinics all over the country. It involves problems which go to the roots of society deserving to be studied in all its aspects.
PUBLIC HEALTH PROBLEMS.
I have said before that better health and food reduces mortality which ultimately is instrumental to a reduction of the birth rate. In India especially public health problems are as important as food or birth control in bringing about an eventual fall in the birth rate. Apart from the general public health problems that face every country we have special problems in respect of tropical disease. It is the diseases, peculiar to the tropics, that cause the greatest havoc in India, and of which the most important is malaria.
At present we are in a vicious circle. Diseases diminishes our work output, which in turn diminishes the production of food. Deficient nutrition is one of the main causes of insufficiency, ill health and general backwardness in tropical countries. The control of malaria will be definitely a great step forward in increasing the food production of our country. Other things which will help us, are, safe water supply, a programme for maternal and child health and campaign against tuberculosis and venereal diseases.
One main task of the public health service is to adapt mans environment to his needs, so that disease may be avoided; this adaptation includes public health measures viz., control of water, food, housing etc. Success in eradication has been achieved by alternation of environment, by eliminating the causative agent or the transmitting agent of the disease. For instance, cholera has been eliminated from Britain where there were epidemics in the nineteenth century, and louse-borne typhus ceased to be a serious problem in a several countries during the last war when means were found of controlling lice. Success has also been achieved by inoculations, by vaccines, as in smallpox, typhoid fever and other diseases.
Apart from other public health measures it is also important to maintain the health of the people by ensuring proper nourishment and facilities for rest, exercise, and fresh air. In these matters the public health services are intimately related to the agricultural, veterinary, and educational services. Another function of the medical departments is to provide the means for cure of disease – hospitals, dispensaries, clinics, travelling team – and to train the staff to administer them. In this work the Government can be effectively aided by the voluntary organisations.
These facts indicate the directions in which the activities of public health departments are turned. The diseases due to contagion, in so far as they can be controlled, are controlled by regulations affecting isolation and treatment of patients. But in relation to venereal diseases, isolation is not practicable. The air-borne diseases are controlled by regulations affecting isolation of the patients, and by general rules of living conditions.
But no amount of legislation can prevent the scattering in public, of bacteria or viruses from the throats of infected persons; yet many diseases are in this way, either before the patient becomes ill enough to be seen by a doctor, or because a person may carry the infecting agent without suffering from the disease, or after recovery from it. The water-borne and food-borne diseases are controlled by supervision of water supplies and foodstuff, and by the careful disposal of faeces and refuse. They are also controlled by vaccination where this is appropriate (as in typhoid and cholera).
The insect-borne diseases like malaria are controlled largely by measures directed against the insects concerned, and by drug treatment of the people diseased or exposed to infection. All these however clearly indicate how important it is for medical men of the tropics to know “Tropical Medicine” well. This refers to special study of diseases, viz., malaria, Kala-azar, dysenteries, cholera, plague, filariasis, hookworm disease, leprosy, certain skin diseases etc., which are particularly prevalent in the tropics and sub-tropics. They are mostly of infective origin and are therefore preventible.