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News South Asian theme issue

Every breath you take

BMJ 2004; 328 doi: (Published 01 April 2004) Cite this as: BMJ 2004;328:787

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  1. Sanjay Kumar
  1. New Delhi

    Indoor stoves and a boom in diesel cars are contributing to dangerous levels of air pollution in South Asia. Sanjay Kumar reports

    Simple neglected public health issues, not exotic ones, dominate the agenda for environmental health in the South Asian region.

    “Lack of safe sanitation, water, and hygiene are the biggest cause of infection and the key issues for environmental health in the region,” says Gourisankar Ghosh, executive director of the Water Supply and Sanitation Collaborative Council, the Geneva based UN mandated body for water and sanitation goals. The council calls this inadequacy “one of the biggest scandals of the last 50 years.”

    South Asian countries are among the countries whose hygiene levels are “disastrous,” says the council. In India alone, 519 500 children die every year from poor hygiene; the equivalent figures in neighbouring Pakistan and in Afghanistan are 135 000 and 48 000 respectively.

    The primary cause of this is unsafe disposal of human excreta: 72% of human excreta in India is disposed of in an unsafe way. The amounts of excreta disposed of in an unsafe way in other countries in the region are 72% in Nepal, 88% in Afghanistan, 52% in Bangladesh, 38% in Pakistan, and 30% in Bhutan. These figures are given by the Water Supply and Sanitation Collaborative Council in a new report called Listening (

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