The history of medicine in Sri Lanka has been shaped over the centuries by a combination of factors unique to the country. Despite the rich diversity of medical practices such as Western, Ayurveda, Unanni, Siddha, and homeopathic medicine ,Sri Lanka still experiences vital health problems in all stages of the life cycle, mainly related to lifestyle and the epidemiological transition associated with widespread societal and economic crises such as demographic trends ,health financing and resource allocation, maternal and child health, civil conflict and natural hazards.
The people of Sri Lanka beneﬁt from several social welfare programs that impact directly on the health status of the people. (Ministry of Health, Nutrition and Welfare, 2003). In Sri Lanka government-sponsored health services are free and are delivered through an extensive network of health centers, hospitals, and dispensaries located countrywide, from primary to tertiary level, reaching the majority of the community. Sri Lanka’s expenditure on health (both public and private) was around 3.2% of GDP, or US$89 per head, in 2012, according to estimates by the World Health Organization. Despite low expenditure on health care, the island’s health indicators are similar to more developed countries in the region. The key themes affecting demand for health care are expected to be aging population, lifestyle factors and increase in purchasing power .The success of Sri Lanka’s health sector is largely due to its effective public delivery system, which provides both preventive and curative care at low cost.
In Sri Lanka, infections and parasitic diseases, including diarrhoeal diseases and acute respiratory infections, continue to be among the leading causes of outpatient care in hospitals. Intestinal infections ranked as the ﬁfth leading cause of hospitalization. Non-communicable diseases, such as cardiovascular and cerebrovascular disease, pulmonary diseases, liver disease, cancer, diabetes, osteoporosis, and trauma, constitute the major causes of death and it is predictably emerging at a significant threat also in Sri lanka.
Climate Related Health Risks
Climate change affects clean air, safe drinking water, sufficient food and secure shelter. It is estimated that between 2030 and 2050, climate change is expected to cause approximately 250 000 additional deaths per year, from malnutrition, malaria, diarrhoea and heat stress. WHO assessment, taking into account only a subset of the possible health impacts, and assuming continued economic growth and health progress, concluded that climate change is expected to cause approximately 250 000 additional deaths per year between 2030 and 2050; 38 000 due to heat exposure in elderly people, 48 000 due to diarrhoea, 60 000 due to malaria, and 95 000 due to childhood undernutrition. (World Health organization).
Food and water security
The rising temperatures and variable precipitation are likely to decrease the production of staple foods in many of the poorest regions. This is contributive to the fact demands will not be met in the traditional sphere of agriculture. Farming even in the modern day depends heavily on the climatic effects that have been set for over centuries and when mitigation measure are not in place the damage done through extreme weather conditions can aggravate food security. This will increase the prevalence of malnutrition and under nutrition, which currently cause 3.1 million deaths every year. Malnutrition is not alone impacted by the insufficiency of the quantity of food available but also by the deficiency in important parts of the diet such as protein, minerals and other vital nutrients. With the effects of the climatic shifts families will be forced to down portion on quantity and also on quality as the price increases and access to nutritious food will be a significant impact of climate on health. As in most cases the the vulnerable communities are in the low-income categories lacking resources to acquire food and basic amenities resulting in malnutrition of the young and elderly making them more prone to diseases. These communities are mostly concentrated in the dry zone, coastal regions, plantations in the hill country, and shanty dwellers in urban areas.
With climatic trends drinking water is a commodity that can be most at risk, provided that most communities depend on surface drinking water. Communities dependent on surface water for drinking are susceptible for water borne diseases and concentration of contaminants from upstream, due to reduced water-flow from prolonged droughts. There is also the risk of not having sufficient water as well as not having quality water for consumption. When the prescribed water intake is not present such condition leads to several dehydration effects such fatigue, digestive problems, urinary problem, variations in cholesterol and blood pressure . When water quality is subject, there have been a widespread prevalence of chronic kidney disease in the north central provinces as the water quality has shown a marked increase in Fluoride ions.
Air quality is affected by climate conditions which affect the transport and formation of pollutants or their precursors. Climate also affects the production and emission of pollutants. These pollutants cause several respiratory problems in humans. With the onset of industrialization there have been severe problems in cities such as Beijing and New Delhi with pollution fog and the citizens are estimated to be breathing in the contaminated air of over forty cigarettes per day. Long term exposure to elevated levels of air pollutants is known to have greater health effects than acute exposure. Such air pollution related health problems are important in large cities. Pollen and other aeroallergen levels are also higher in extreme heat. These can trigger asthma, which affects around 300 million people. Ongoing temperature increases are expected to increase this burden.
Malaria and Dengue
Malaria is strongly influenced by climate. Transmitted by Anopheles mosquitoes, malaria kills over 400 000 people every year – mainly African children under 5 years old. The Aedes mosquito vector of dengue is also highly sensitive to climate conditions, and studies suggest that climate change is likely to continue to increase exposure to dengue. The incidence of Mutuwatte et al. (1996) modeled the impact of climate change on malaria under the scenario of a doubling of carbon dioxide (CO2), one of the major greenhouse gases. It was concluded that the endemicity of malaria in the dry zone of Sri Lanka is likely to remain unchanged or decrease slightly, provided that other conditions remain the same.
Extreme high air temperatures contribute directly to deaths from cardiovascular and respiratory disease, particularly among elderly people. In the heat wave of summer 2003 in Europe for example, more than 70 000 excess deaths were recorded. Heat stress includes a series of conditions where the body is under stress from overheating. Heat-related illnesses include heat cramps, heat exhaustion, heat rash, or heat stroke, each with its own symptoms and treatments. Symptoms can range from profuse sweating to dizziness, cessation of sweating, and collapse. At greatest risk of heat stroke are the elderly, children, and people with medical conditions, such as heart disease. However, even young and healthy individuals can succumb to heat if they participate in strenuous physical activities during hot weather. Heat induced conditions in agricultural areas have also shown a relations with mental health and suicide.
Suicides are tragic end results of complex problems ranging from socio- economical, depression, inter personal conflicts and lack of emotional support. Sri Lanka has been regarded as having a high suicide rate or many years. Varied factors can be attributed towards this phenomenon.
Although Sri Lanka has a high reported suicide rate, there is still substantial underreporting. Civil war resulting in large numbers of refugees is believed to contribute to the suicide rate (Berger, 1988), but has also made it impossible to collect suicide data from the north-eastern region of Sri Lanka, which is known to have the highest suicide rate in the country. Moreover, a large number of deaths from pesticides – the most common method of suicide in the country – are misclassified as accidental or as deaths of undetermined cause (Asian Legal Resource Center, 2003). (http://www.who.int/mental_health/resources/suicide_prevention_asia.pdf)
Suicides in farming communities has also been present. Farmers are thus exposed to a high rate of stress. Physical stressors and hazards of the farm environment are compounded by regulatory framework and economic dynamics of managing farm business. These operate in the context of declining trends of trade for agricultural produce, volatile commodity markets, limited availability of off-farm employment, growing cost of machinery and production and loss of farm or livelihood due to crop failures. (Farmers’ suicide: Across culture P. B. Behere and M. C. Bhise)
In Sri Lanka where agriculture is a livelihood of many it is worth looking at the facts of this phenomenon. The drought affected areas in Sri Lanka fall on the North Eastern side of the country. The populations in those areas engage in many occupations but mainly in crop based livelihoods.
Studies in India, Sri Lanka, USA, Canada, England and Australia have identified farming as one of the most dangerous industries associated with a high suicide rate than in general population. In India, farmers’ suicides had been reported from various states, viz. Punjab, Maharashtra, Andhra Pradesh, Kerala and various other states with varied cultural practices and farming patterns. A study in the Vidarbha region of Maharashtra had associated indebtedness (87%) and deterioration in the economic status (74%) as major risk factors for suicide. (Mishra S. Suicide of farmers in Maharashtra state: Report submitted to Govt of Maharashtra. 2006. Jan)
Crop Damage has been a severe stress factor on farming communities. Especially when the entire budgeting and loans are depended upon the success of the crops this problem becomes acute.
This eventually leads to indebtedness as farming is mostly done on borrowed funds or funds as loans have been used to sustain families in the meantime of harvest. In the following figure singled out drought stricken areas are depicted on an Indebtedness scale.
This further ilustrates the needs of these communities as finance is necessary for the upkeep as well as the management of borrowed funds.
In the map above we can see the prevalence of suicide rates across the country. There is a tendency of very high rates towards the north of the country with other areas in the north eastern and north western regions also recording high rates.
Suicide rates in farmers are the highest of any occupation. That’s an alarming statistic. Stigma and lack of education about depression are the main culprits of farmer suicides. Farmers tend to adhere to the stereotypical image of the self-reliant, tough farmer who doesn’t complain. A farmer who complains of being depressed will usually be labelled crazy, whiner or wimp by fellow farmers.( https://www.huffingtonpost.com/terezia-farkas/why-farmer-suicide-rates-_1_b_5610279.html)
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