By Soma Das
Pulse to Planet: The Long Lifeline of Human Health
HarperCollins
Pp 264, Rs 599
What if your elders blessed you with a shorter life, polluted black lungs, nutrition-empty food on your plate, a bouquet of lifestyle diseases and a toxic planet as a home? Gory as it may sound, this is the gift we are packing for our next generations to inherit—K Srinath Reddy seems to suggest in Pulse to Planet, a book written in the form of an apology note to the future generations, and a cautionary tale to the present ones. “Billions who are yet to be born will be innocent victims of a dark inheritance,” Reddy warns, adding that failing to act on the fundamentals of climate change and health will decisively push us into an era of ‘syndemics’—a state where several epidemics will be dangerously interacting with each other. A glimpse of that we witnessed during the recent pandemic, where the Covid-19 infection enhanced risks for those with other co-morbidities—diabetes, hypertension and obesity, among others.
Reddy explores varied themes in different sections of the book, bound by a unifying theme—that the state of human health is an indicator of the planet’s health, and vice versa. In sum, how the pulse is connected to the planet.
In the section ‘What codes our biology?’, Reddy suggests that the much hyped gene theory hasn’t lived up to expectations in explaining diseases, and we are now looking beyond tagging genes for our health problems. He takes us through the evolving understanding of ‘microbiome’, the ‘crowded cosmos of microbes—our constant companion’ and how they are linked with health disorders. We are only 43% human, the rest of our cells are from teeming trillions of microbes on our skin, gut and mouth, among other parts. The author gives an example of how during the birth process, the vaginal microbes wrap the skin and scalp of a newborn with a coating to protect her/him against infection in external world, a gift those born through caesarean sections are deprived of. Such children appear to be more prone to allergic, auto-immune and other health disorders.
Reddy cites interesting case studies from historical migration streams to cite how genes and environment interact. A study in Kenya showed that those who migrated to urban areas ended up with high blood pressure in advanced age, compared to their counterparts who stayed back in countryside. For the Japanese population who migrated to western US, the risk of brain strokes declined, but coronary heart diseases spiked. Indians and other South Asians who migrated out of country have shown higher risk of coronary heart diseases compared to their countrypeople back home. These examples shed light on how environment determines the selection of genes for survival due to evolutionary pressures of changed living conditions, or how genes are modified in their expressions by the environment.
In another section dedicated to ‘Nutrition’, the author explains that a ‘reductionist’ approach to understanding the role of nutrition, which means ‘studying and applying specific effect of each isolated nutrient’, hasn’t proved effective in predicting how the body will behave when a specific nutrient is added, reduced or eliminated. Case in point: antioxidant supplements haven’t helped as promised in most cases, trials proved. That’s because natural foods are complex wholes, each part of nutrient interacting with many more to produce the final effect—not possible to reproduce in a packaged supplement pill.
Reddy also explores the many faces of malnutrition—ranging from undernutrition to obesity to hidden hungers—micronutrient deficiencies masked under a healthy-looking body. He then laments over how our food systems and agricultural systems have forgotten their main objective—to offer a calorie-adequate, nutrition-rich diet on our tables. Mass-industrial production, transnational character and profit motives of ‘food industry’ have become primary objectives to be achieved through conquering markets of ‘customer cravings’.
In the third section, ‘Social, economic and commercial determinants’, Reddy reminds us that we can never solve poverty without solving the problem of water and sanitation and yet, a third of humanity doesn’t have access to clean water. Large income inequities within societies doesn’t only affect the poor, but the rich in unequal societies have worse health outcomes than their counterparts in more equal societies, he points out.
Reddy argues that education is a health intervention in its own right, as world-wide unhealthy behaviours such as tobacco use and alcohol abuse are negatively correlated with educational attainments.
He suggests that it is not a coincidence that the decades since mid-20th century have seen a surge in chemical loaded ultra-processed food, as well as a host of lifestyle diseases.
In the section, ‘Health system is more than a repair-shop’, the author dwells on how we should convert ‘health for all’ from an aspirational agenda to an accomplished reality and how do we address the shortage of healthcare workers in low- and middle-income countries which see droves of their trained health workers migrating to high-income countries, that have ageing population, better pay and better working conditions.
The section, ‘Environment is our life support’, speaks most directly to the ongoing climate change and health discourse. It draws the linkages between air, water, soil pollution, plastic and other chemical pollution and health outcomes, and wonders how long will we take before we impose regulatory controls on ‘endocrine disrupting chemicals’ which we know are playing havoc with our reproductive systems, and causing other grave health disorders. The answer to why pollution control is so challenging is strewn across history. The governments have found it easy to penalise an individual throwing a candy wrapper than to take on industries—tobacco, fossil-fuel, automobile, pesticides, that first deny the evidence, then delay, dilute and derail regulation. In a chapter, Reddy questions the ‘human hand’ in Covid-19, irrespective of whether it originated from the wet-market or a lab in Wuhan, and warns against ‘gain of function’ research. On biodiversity loss, he spots the irony, “Isn’t it strange that humans who like to pick from a variety of foods from menu in a restaurant, are limiting their range of food…”, ending with a plea to humanity to stop the ‘global harming’.
As Cop 28 in Dubai brings ‘climate and health’ to the centre of climate negotiations for the first time, this book attempts to give some form and shape to a yet-to-be-articulated ‘climate and health’ discipline. The narrative could have been more gripping, the storytelling more compelling, but the message here is too important, and the source too credible to fret about the style of narration. It’s not a data-packed book. Instead, Reddy, who has been instrumental in shaping the public health discourse in India in the last few decades, wraps information in knowledge and knowledge in wisdom to tell the big-picture story in oral folklore tradition, the preferred form of inter-generational storytelling in this country. The book is a wise advice from a public-health sage, we can avoid at our own peril.
Soma Das is the author of The Reluctant Billionaire and an adviser to agencies in the development space