HEALTH GEOGRAPHY OF ANDHRA PRADESH Dr B Shrinagesh

HEALTH GEOGRAPHY OF ANDHRA PRADESH Dr. B. Shrinagesh Prof. Kalpana Markandey Mr. Kiran Baktula Mr. Bhagiaiah DEPARTMENT OF GEOGRAPHY OSMANIA UNIVERSITY HYDERABAD

Globalization “is the closer integration of countries and peoples of the world…. . brought about by the enormous reduction of costs of transportation and communication , and the breaking down of artificial barriers to the flow of goods, services, capital, Knowledge, and people across borders. Joseph Stiglitz

Globalization and its Impact • The world has become increasingly interconnected and interdependent • This has positive and negative consequences • Rapid industrialization and urbanization • Demand for energy and land • Profits maximized : no focus on standards and regulation • Pollution, improper waste disposal • Depletion of natural resources • Increased consumption • Globalization and infectious diseases

• With changing climate, people have become more vulnerable to health risk at global level. • With the changing climate and the environment, and the change in the seasons, which in turn, affecting agriculture globally. • India, is not far behind, the current drought and flood situation is an indication to the future. • The deficiency in food nutrition has set new challenges to the government. (Food Bill was Passed in Parliament on 26/08/2013 IST) • Common person has become a soft target to various new diseases.

Factors that Influence the Earth's Climate Source: Internet

Modulating influences Air pollution-related health effects Regional weather changes Microbial changes: Contamination pathways Contamination paths • Heat waves • Extreme weather • Temperature • • Precipitation Transmission dynamics • Sea-level rise Temperature-related illness and death Extreme weatherrelated (floods, storms, related health effects etc. ) health effects Human exposures Climate Change Healtheffects Effects Water and food-borne diseases Vector-borne and rodent- borne diseases Changes in agroecosystems, hydrology Effects of food and water shortages Socioeconomic and demographic disruption Mental, nutritional, infectious-disease and other effects

Changes in climatic phenomenon Higher maximum temperatures - more hot days Higher minimum temperatures, - fewer cold days and frost days Increase of heat index over land areas More intense precipitation events Increased summer continental drying and associated risk of drought Increase in tropical cyclone peak wind intensities Increase in tropical cyclone mean and peak precipitation intensities Confidence in observed changes (latter half of 1900 s) Probability of projected changes to 2100 Likely Very likely Likely, (N mid to high latitudes) Very likely Likely, in a few areas Likely, over most midlatitude continental interiors. Not observed in the few analysis available Likely, over some areas Insufficient data Likely, over some areas IPCC WORKING GROUP I, Third Assessment Report, 2001

IMPACTS ON HEALTH ! Physical Environment Workplace Social Environment • Pollution • Respiratory Diseases • Skin Diseases • Eye Diseases • Cluttered Built Environment • Sewerage, Garbage and Hygiene related problems • Deadlines • Stress in interpersonal relations • Psychosomatic diseases • Distances travelled • Impact on family time, relations and social distress • Anonymity and Crime • Transiency in social relations • Stress in interpersonal relations Social Pathology

In fact, different locations on earth are usually associated with different profiles: • physical, • biological, • environmental, • economical, • social, • cultural and • sometimes even spiritual profiles, that do affect and are affected by health, disease and healthcare. These profiles and associated health and disease conditions may also change with time (the longitudinal or temporal dimensions).

WHAT’S THIS BIZARRE OR

NATURE’S FURY

Today’s highly mobile, interdependent and interconnected world provides myriad opportunities for the rapid spread of infectious diseases Since the 1970 s, newly emerging diseases have been identified at the unprecedented rate of one or more per year. There are now nearly 40 diseases that were unknown a generation ago. In addition, during the last five years, WHO has verified more than 1100 epidemic events worldwide.

The categories and examples given below illustrate the variety and breadth of public health threats confronting people today. Epidemic-prone diseases Food borne diseases Accidental and deliberate outbreaks Toxic chemical accidents Radio nuclear accidents Environmental disasters

Infectious diseases such as Ø Malaria, Ø Leprosy, Ø Filariasis, Ø Tuberculosis, Ø Hepatitis and Ø Sexually transmitted infections including HIV/AIDS are major health issues

Significance of the study Health geography plays a vital role in public health surveillance, including the design and monitoring of the implementations of health interventions and disease prevention strategies. Geographical research into healthcare services can also help identifying inequities in health service delivery between classes and region, and in the efficient allocation and monitoring of scarce healthcare resources. As a modelling and decision support tool, GIS can help determining the geographical distribution and variation of diseases (e. g. prevalence, incidence) and associated factors, analyzing spatial and longitudinal trends, mapping population at risk and stratifying risk factors.

Andhra Pradesh is one of the fastest growing states in the country. IT development has made A. P. as the most preferred global destination. Many MNCs have established themselves. In spite of development in IT field, there is considerable backwardness in Health sector. During the last ten years, the state has witnessed many new health related problems mainly in the rural areas. When it comes to the urban areas, the city of Hyderabad, which is considered as the health capital of India, has its own drawbacks.

Objectives • To study the prevalent diseases across the state of Andhra Pradesh. • To study the infrastructural facilities available and suggest the alternatives.

Methodology Data Collection Spatial Data Satellite Image ( Medium & High Resolution) AP Map & Survey of India Toposheets Primary (Attribute Data) Sample Survey of villages Secondary (Attribute Data) DMHO data APVVP data Data from DME And other private hospitals Digitization of Layer Boundaries Carving of AOI Linking of Spatial & Attribute Data

DATA SOURCES Primary Data through a sample survey of households by means of a multidimensional questionnaire Directorate of Medical and Health Office Andhra Pradesh Vaidya Vidhana Parishad National Sample Survey Directorate of Medical Education Private Hospitals and Research centres Census of India Satellite Imagery of the disasters form NRSC Toposheet and ground checks

PHYSICAL ENVIRONMENT AND HEALTH

LANDUSE/LANDCOVER OF ANDHRA PRADESH

WATER BODIES OF AP

PREVALENT DISEASES IN ANDHRA PRADESH

DISEASES PREVALENT IN ANDHRA PRADESH 2001 -2011 3500 NO. 0 F CASES 3000 CHICKEN POX 2500 CHOLERA 2000 DIPTHERIA DYSENTRY 1500 FOOD POISON GE 1000 HEPATITIS MALARIA 500 0 2001 2002 2003 2004 2005 2006 2007 YEAR 2008 2009 2010 2011

Contd. DISEASES PREVALENT IN ANDHRA PRADESH 2001 -2011 14000 12000 MEASELS No. OF CASES 10000 MENINGITIS DENGU FEVER 8000 BRINCO PNEMONIA SMALL POX 6000 TETANUS TB 4000 TYPHOID WHOOPHING COUGH 2000 OTHERS 0 2001 2002 2003 2004 2005 2006 YEAR 2007 2008 2009 2010 2011

DEATHS AS PER DISEASES PREVALENT No. OF DEATHS 30 25 CHICKEN POX CHOLERA 20 DIPTHERIA DYSENTRY 15 FOOD POISON GE HEPATITIS 10 MALARIA 5 0 2001 2002 2003 2004 2005 2006 YEAR 2007 2008 2009 2010 2011

Contd. DEATHS AS PER DISEASES PREVALENT No. OF DEATHS 80 70 MEASELS 60 MENINGITIS DENGU FEVER 50 BRINCO PNEMONIA 40 SMALL POX TETANUS 30 TB 20 TYPHOID 10 WHOOPHING COUGH OTHERS 0 2001 2002 2003 2004 2005 2006 YEAR 2007 2008 2009 2010 2011

Gastroenteritis cases in Andhra Pradesh 1991 -2001 45000 40000 35000 30000 25000 Cases Deaths 20000 15000 10000 5000 0 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

AN ILA AN BA TA D PU C R H IT O EA O ST KA R D G AP O A D AV G AR H UN I YD T U KA ER R A R IM BA N D A KH GA AM R M KR AM IS H M N AH KU A AB RN O U BN OL AG A M R E N AL DA K G O N N E DA N LLO IZ AM RE PR AB A A R AN KA D SA G A R M S E VI RIK DD SH A Y AK KU L VI AP AM A ZI AN TN AG AM A W WA RA ES R AN M T G G O AL D AV AR I AD CASES MALARIA CASES IN ANDHRA PRADESH 2006 -2010 45000 40000 35000 30000 25000 20000 M 2006 C M 2007 C 15000 M 2008 C M 2009 C 10000 M 2010 C 5000 0 DISTRICTS

N O A N H O L BN AG AR M ED N AK AL G O N D N EL A LO N R IZ AM E A PR BA D A R AN KAS AM G A R ED SR D IK VI SH AK Y AK UL AP AM VI AT ZI AN NA AG M AR W AR AM W ES AN T G G AL O D AV AR I U AB AR AD M AM IS R KU KR AM KH N AG AB R I A AR TU U N ER IM R KA AH M G AV D AP R O O R AD PU D KA O G YD H ST EA IT H C TA AN AN IL AB AD DEATHS MALARIA DEATHS IN ANDHRA PRADESH 2006 -2010 20 18 16 14 12 10 2006 8 2007 6 2008 4 2009 2 2010 0 DISTRICT

MALARIA CASES & DEATHS IN ANDHRA PRADESH 2002 -2012 CASES AND DEATHS 40000 39099 38053 35995 35427 35337 34081 33393 35000 27803 30000 26424 25152 24508 25000 MALARIA CASES 20000 MALARIA DEATHS 15000 10000 5000 0 3 2 10 0 2 0 3 20 5 2 0 2002 2003 2004 2005 2006 YEAR 2007 2008 2009 2010 2011 2012

50 45 40 35 30 25 CDRPER 1000 POPULATION INFANT Mortality rate per 1000 Live births 20 15 10 5 0 MALE FEMALE RURAL TOTAL MALE FEMALE TOTAL URBAN MALE FEMALE TOTAL

PROJECTION OF VITAL STATISTICS 80 70 60 50 2001 -05 40 2006 -10 2011 -15 2016 -20 30 2021 -25 20 10 0 POPULATION CRUDE BIRTH CRUDE DEATH GROWTH RATE INFANT MORTALITY RATE UNDER-5 MORTALITY RATE TOTAL FERTILITY RATE EXPECTATION OF LIFE AT BIRTH FOR MALES FEMALES

INFRASTRUCTURE FACILITIES

Amartya Sen for better health care (24 -10 -2009) (The Hindu) Nobel laureate Amartya Sen said that India needs to invest more on providing basic health care services, especially in rural areas and backward states. The elementary health care services are worst in some of the backward states like Chhattisgarh, Bihar, Jharkand. He also lauded India’s growth trajectory but he emphasized that health care planning is not able to tackle various problems in its implementation.

STRENGTH OF HOSPITALS IN AP, DISTRICT WISE 2011 DISTRICT Sub Centres PHCs CHCs SDH Dist Hosp ADILABAD 470 70 13 2 0 ANANTHAPUR 609 82 11 3 0 CHITTOOR 653 94 9 5 1 CUDDAPAH 462 72 12 1 1 EAST GODAVARI 809 96 20 3 1 GUNTUR 689 74 16 2 1 HYDERABAD 53 10 0 4 1 KARIMNAGAR 580 70 16 3 1 KHAMMAM 591 69 13 2 1 KRISHNA 609 72 9 2 1 KURNOOL 576 88 18 1 1 MAHABOOBNAGAR 680 85 14 4 1 MEDAK 489 67 8 3 1 NALGONDA 626 72 4 4 1 NELLORE 481 61 15 2 1 NIZAMABAD 412 50 14 3 1 PRAKASHAM 555 85 14 3 0 RANGA REDDY 399 48 9 1 1 SRIKAKULAM 488 86 14 2 0 VISHAKAPATNAM 573 76 13 2 0 VIZIANAGARAM 470 58 10 1 1 WARANGAL 605 69 14 2 0 WEST GODAVARI 643 70 15 3 1

PUBLIC HEALTH CENTRES ANDHRA PRADESH

Climate change and Health – Impact on Health through Climate change, Mitigation and Adaptation.

CASE STUDY – I NETWORK ANALYSIS

Conclusions v. More health workers are located in urban areas than in rural areas. The availability of health workers and therefore health services is much better for the urban population as compared to the rural. differences are quite high both in Andhra Pradesh and at the v. Rural-urban national level. v. There is also a large difference in the per capita availability of health workers between rural and urban areas, indicating the disadvantage of rural people in terms of access to health services in general and public health services in particular. v. Owing to inadequate public health facilities, while awareness and demand for health services are increasing, private health care has developed on a wide scale. v The rising cost of health care at the household level is a cause of concern and needs public action. The average share of household budget spent (7 per cent) on health care is relatively higher than the share of public budget spent (5 per cent) on health care in the state.