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श्रद्धेच्या जंजाळात अडकलेली शुद्ध हवा : कबुतरांना खाद्य घालण्याच्या हट्टामागील अंधश्रद्धा 

कुठल्याही समाजाच्या अधोगतीचा एक निश्चित टप्पा असतो — जिथे श्रद्धा आणि शहाणपण यांच्यातली सीमारेषा कायमची पुसून जाते. आणि ती रेषा आपल्या शहरांच्या फूटपाथांवर, खिडक्यांच्या सिल्ल्यांवर आणि घरांच्या गॅलऱ्यांमध्ये — कबुतरांच्या विष्ठेच्या थरांमध्ये अडकलेलीदिसते.

हो, कबुतरं — ही तथाकथित “पवित्र” जीवं. पवित्रतेच्या पंखावर विराजमान झालेले रोगांचे वाहक. काहीजण त्यांना दैवी समजतात, काही धार्मिकतेचे प्रतीक. पण आजच्या काळात ती झाली आहेत शहरांच्या श्वासमुक्तीवर बसलेली जीवघेणी सावली.

कोर्टांनी कबुतरांना खाद्य घालण्यावर बंदी घातली आहे, डॉक्टरांनी इशारे दिले आहेत, आणि आरोग्य तज्ज्ञांनी स्पष्ट सांगितले आहे की यामुळे फुफ्फुसांचे आजार, एलर्जी, श्वसनदोष आणि अनेक बुरशीजन्य रोग वाढत आहेत. पण या सर्व ज्ञानावर पंखात घेत — काही स्वयंघोषित धर्मरक्षक अजूनही बिनधास्त गहू, बाजरी, तांदूळ रस्त्यावर उधळत फिरतात.

त्यांच्यासाठी ही फक्त श्रद्धा नाही, ही एक हट्टाने फुलवलेली अंधश्रद्धा आहे, जी आता सामाजिक हानीचे रूप घेत आहे.

सामाजिक  अधिकार की सामाजिक आतंक?

श्रद्धा वैयक्तिक आहे. पण जिथे तुमची श्रद्धा इतरांच्या आरोग्याचा घात करत असेल, तिथे ती श्रद्धा नसून स्वार्थी हट्ट ठरतो. आज घरोघरी श्वसनाच्या तक्रारी, सततची खोकली, डोळ्यांची खाज, आणि अ‍ॅलर्जीक अ‍ॅस्थमा वाढत आहे, त्यामागे या कबुतरांच्या विष्ठेचे सूक्ष्म कण आहेत — जे हवेत मिसळून शरीरात शिरतात आणि आजारांचा कहर घडवतात.

कबुतरं रोज एक-दोन नव्हे तर शेकडो वेळा विष्ठा करतात. ती विष्ठा इमारतींचे प्लास्टर कुरतडते, पाईपलाइन堵 करते, बाल्कनी अडवते, आणि एकंदरीत नागरिक जीवनाचा श्वास रोखून टाकते.

आणि या सर्व संकटांवर उपाय करायला गेले की, काही तथाकथित धर्मप्रेमी, धर्माची ढाल पुढे करत ओरडतात — “आमचा श्रद्धेचा अधिकार आहे!”

हो का? मग इतरांचा श्वास घेण्याचा अधिकार कुठे गेला?

‘कबुतरखान्यांचा’ कलंक

शहरांतील तथाकथित ‘कबुतरखान्यां’ मध्ये रोज हजारो कबुतरं अन्नासाठी गोळा होतात. तेथील दृश्य म्हणजे पुण्याच्या  नावावर उभारलेली जैविक महामारी. पिंजऱ्यात घातलेल्या रोगांपेक्षा या उघड्या कबुतरखान्यांतून फैलावणारे आजार जास्त धोकादायक.

सगळ्यात हास्यास्पद म्हणजे — जे लोक ही कबुतरं खाद्य घालतात, तेच त्यांना स्पर्शही करत नाहीत. घराच्या गॅलऱ्यांत जाळ्या लावतात, स्पाईक्स लावतात, पण सकाळी तांदूळ टाकतात. ही कुठली श्रद्धा? ही तर संवेदनशून्य दांभिकता आहे.

आरोग्य, विज्ञान आणि न्यायालये – या तिघांनाही झिडकारणे

जेव्हा न्यायालये निर्णय देतात, डॉक्टर सल्ला देतात, महापालिका सूचना करते — तेव्हा ही मंडळी त्या सगळ्यांना “धर्मद्रोही” ठरवतात. कारण त्यांना त्यांची श्रद्धा विज्ञान, कायदा आणि आरोग्याच्या हितापेक्षा जास्त श्रेष्ठ वाटते.

हे श्रद्धा आहे की हट्ट? भक्ती आहे की बिनडोकपणा?

कोणत्याही धार्मिक ग्रंथात “कबुतरांना विष्ठा करु दे, आणि आजूबाजूचे श्वास घेऊ शकत नसले तरी चालेल”, असे कुठेही लिहिलेले नाही.

‘पवित्रता’ की ‘पॉईझनिंग’?

कोणी पक्ष्यांना खाऊ घालणं चुकीचं नाही — पण जिथे ते सार्वजनिक आरोग्यावर घात करत असेल, तिथे ते अपराध आहे.
कोणालाही अन्नदान करायचं असल्यास शहराबाहेर, नियोजित पक्षी-आहार केंद्रांमध्ये, योग्य पद्धतीने करा.
पण घरांच्या खिडक्यांवर, रहिवासी संकुलांच्या कंपाऊंडमध्ये, किंवा रुग्णालयांच्या बाहेर कबुतरांवर अन्नवर्षाव करणं म्हणजे जनतेच्या आरोग्यावर थुंकणं होय.

शेवटी…

श्रध्देचा  उपयोग माणूस उन्नत करण्यासाठी व्हायला हवा — त्याच्या श्वासावर गुदमरवण्यासाठी नव्हे.

कबुतरांना खाद्य घालण्याचा हट्ट हा श्रद्धेचा नाही, समाजघातक अंधश्रद्धेचा मुद्दा आहे. तो थांबला पाहिजे. अन्यथा आपल्या शहरांचे भविष्य मंदिरासारखे पवित्र नव्हे, तर कबरस्तानासारखे निःशब्द असेल.

चला, पंख झाडूया — पण या अंधश्रद्धेचे, नाहीतर उद्याची हवा उरलेली नसेलच.

-महेश झगडे

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From Healing the Sick to Fostering the Healthy: Maharashtra’s 75-Year Health Odyssey and the Road Ahead

By any measure, the health journey of Maharashtra over the past seventy-five years is a story of transition—marked by aspiration, innovation, neglect, and paradoxes. Yet, to narrate this tale in isolation from national and global currents would be akin to understanding the tides without regard to the moon. For the evolution of public health in Maharashtra has been inseparably entwined with the larger saga of India’s post-independence metamorphosis and the world’s own flirtation with health, disease, and the marketplaces they now populate.

Let us begin, not at the beginning, but at a statistic that startles by the sheer distance we have travelled. Seventy-five years ago, the average life expectancy in India stood at a mere thirty-three years—half a life, if life it can be called. Today, it hovers around seventy. This doubling is not the consequence of divine benevolence or genetic miracle. It is the hard-won result of medical science, pharmaceutical breakthroughs, the spread of medical education, and the expansion of healthcare infrastructure. Significantly, these were all midwifed by the public sector in its earnest years.

However, as the decades passed, a subtle erosion began. Private enterprise slowly replaced public commitment, and in time, galloped ahead with astonishing, if disturbing, speed. What began as a complementary force became a dominant overlord. So much so, that rather than expanding state-run medical education and healthcare services, the trend reversed—privatisation became the norm, and public provisioning was left to languish, often mocked as inefficient and expendable.

In this climate, insurance giants and private hospitals constructed a colossal economic edifice under the gilded banner of “healthcare,” when in truth it has become a thriving marketplace of illness.

Let it be acknowledged that Maharashtra has indeed expanded its healthcare services over the last three-quarters of a century. But the question is not one of quantum alone, but of proportion and equity. When juxtaposed against the global benchmarks—especially those laid down by the World Health Organization—we fall short. The ratio of hospital beds per thousand persons is still a sobering statistic. More disconcertingly, the number of high-cost beds in private hospitals far outpaces the availability of free or affordable beds in government facilities.

Thus, we are forced to confront a deeper question: What precisely is our vision of health for the next twenty-five years? Is it merely a future of more ICUs, more MRI machines, more pharma chains, and more insurance cards? Or is it a reimagined ecosystem where health is not the absence of disease, but the presence of well-being?

Herein lies the critical philosophical chasm. What the world today calls a “health system” is, in actuality, a “disease treatment system.” Its lexicon is replete with surgical precision—patients, prescriptions, procedures. Were we honest in nomenclature, institutions such as the “World Health Organization” would perhaps be more aptly named the “World Disease Treatment Organization.” Ministries of health might be better recognized as Ministries of Medical Interventions.

This is no mere semantic nitpicking. It is a profound indictment. The entire edifice is built not to nurture the healthy, but to service the sick. Health has been commodified, the human body reduced to a site of transaction. Illness has become the currency.

Therefore, the imperative before us is not incremental reform but fundamental transformation. Maharashtra must take the lead in reversing the tide. We must abandon the reactive model of “curative health” as the centerpiece, and instead enthrone “promotive” and “preventive” health. The State must aspire not to treat more illnesses, but to create conditions in which fewer illnesses arise at all.

Imagine a policy framework where the success of a health department is not measured by how many hospital beds it adds, but by how few are needed. Where the metrics of governance celebrate fewer prescriptions, fewer operations, fewer ICU admissions—not because of denial, but because of robust public health that forestalls disease in the first place.

During my tenure as Municipal Commissioner of Pune in 2011, I had the privilege of drafting such a forward-looking health policy—not a treatment policy, mind you—but a health policy. It was embedded in the municipal budget and shared with the state and central governments. Yet, like so many meaningful ideas, it was neither embraced nor understood. Those in the higher echelons of power lacked either the intellectual gravitas or the moral courage to carry it forward. And so it was shelved—politely, quietly, irretrievably.

If we are serious about charting a new course for the next twenty-five years, our approach must be radical in the true sense of the word—returning to the root. We must identify the causes of premature death and eliminate them at source. Instead of “clinics” and “hospitals,” we must build “Centres for Healthy Living,” “Institutes of Wellness Advancement,” and “Health Promotion Nodes.”

We must regulate, with legal teeth and moral conviction, the market forces that have turned human vulnerability into profit margins. Adulterated food, unnecessary cosmetics, polluted air, and contaminated water—these are not mere externalities, they are assassins of health. The state must intervene, unflinchingly.

Laws must be enacted and enforced to ban tobacco, curb sugar and starch overconsumption, eliminate spurious food products, and improve environmental quality. Let us remember, that sugar—consumed by humans for just the last two millennia—has wrought more havoc on health than many known poisons. A regime of regular exercise, clean air, sunlight, movement, and strengthened immunity must form the bedrock of any public health strategy.

This is not idealism. It is realism—enlightened and long overdue.

We must also reassess road accidents and trauma within the public health domain, not merely as traffic concerns but as preventable epidemics of urban misgovernance. During my tenure as Commissioner of Food and Drug Administration in Maharashtra, I faced firsthand the brutal resistance of economic interests when I banned gutkha, pan masala, and scented supari. It became clear then: the economy is often an adversary to health. A government must decide—does it serve public health or private profit? Anything else is a betrayal of democracy.

Among all the threats to genuine public health, perhaps the most insidious is health insurance. Let it be stated unambiguously: insurance is not healthcare. It is a lucrative business masquerading as social protection. It does not heal, it harvests.

What good is an economic superpower if its citizens are chronically ill? If India wishes to be counted among the superpowers of happiness and human development, it must first become a superpower of health. That requires a brave policy choice—to publicly fund all health services as a matter of right and dignity.

Of course, even this commitment may soon be rendered transitional. The Fourth Industrial Revolution has already ushered in dramatic shifts. Genetic editing, stem-cell therapies, synthetic biology—these will soon render the very idea of “disease and its treatment” obsolete. Illness itself may vanish from the lexicon of advanced civilizations. Humanity will move beyond its present evolutionary constraints.

But until that Promethean leap occurs, Maharashtra must lead by example. It must transform its treatment system into a true health system. From illness management to wellness creation. From curing disease to cultivating vitality. From profit to prevention. From the sickbed to the sunbeam.

The future belongs not to those who react, but to those who reimagine.

And in this reimagining, may Maharashtra be not a reluctant follower, but a luminous pioneer.

-Mahesh Zagade

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Physical Activity: The Cornerstone of Effective Stress Management

(Endorsed by my personal experience.)

In the modern world, stress has become an almost ubiquitous part of daily life. The demands of work, family, and society, coupled with the constant barrage of information and expectations, have made stress an unavoidable reality for many. While some stress can be beneficial, motivating us to perform better, chronic stress has been linked to a host of physical and mental health issues, including anxiety, depression, heart disease, and a weakened immune system. In the search for effective ways to manage stress, physical activity emerges not merely as a recommendation but as an essential component of a healthy lifestyle. I found myself in a work environment that was an absolute stressful—a chaotic ecosystem largely of my own making. Why? Because I had this peculiar knack for “swimming against the strong current of the administrative river.” Naturally, I had to figure out a way to keep my sanity intact. So, I took up evening jogs, clocking in a cool 12 kilometers. And voilà! Not only did I shake off the stress, but I also dodged the usual suspects—high blood pressure, elevated sugar levels, cholesterol, you name it. To top it off, my memory remained as robust as ever, and my decision-making skills are now in tip-top shape.

The Link Between Stress and Physical Health

Before delving into the benefits of physical activity, it is important to understand the profound impact that stress can have on the body. When we encounter a stressful situation, our bodies respond by releasing hormones like adrenaline and cortisol, which prepare us for a “fight or flight” response. While this response is useful in short bursts, chronic stress keeps the body in a prolonged state of alertness, which can lead to serious health problems.

Research published by the American Psychological Association (APA) in 2022 highlights the alarming effects of chronic stress on the body. According to the report, prolonged exposure to stress can cause inflammation, increase blood pressure, and contribute to cardiovascular diseases. Furthermore, stress has been found to weaken the immune system, making individuals more susceptible to infections and illnesses. It is within this context that the role of physical activity becomes critically important.

Physical Activity: The Natural Stress Reliever

Physical activity is often touted for its ability to improve physical health, but its benefits extend far beyond the physical realm. Numerous studies have demonstrated that regular exercise is one of the most effective ways to manage stress and improve mental well-being.

One of the key mechanisms by which physical activity alleviates stress is through the release of endorphins. Endorphins, often referred to as “feel-good” hormones, are neurotransmitters that reduce pain and promote feelings of pleasure and euphoria. Engaging in physical activity stimulates the production of endorphins, which can help to counteract the negative effects of stress. A study published in The Journal of Neuroscience in 2021 found that individuals who engaged in regular physical activity had significantly higher levels of endorphins compared to those who led a sedentary lifestyle. This increase in endorphins was correlated with lower levels of perceived stress and greater overall well-being.

Moreover, physical activity has been shown to reduce levels of cortisol, the hormone most closely associated with stress. A 2020 study published in the journal  Psychoneuroendocrinology examined the effects of a 12-week exercise program on cortisol levels in a group of stressed adults. The results indicated that participants who engaged in regular physical activity had significantly lower cortisol levels compared to those who did not exercise. This reduction in cortisol was accompanied by improvements in mood, sleep quality, and overall stress resilience.

The Role of Physical Activity in Cognitive Function

In addition to its direct effects on stress hormones, physical activity also plays a crucial role in maintaining and enhancing cognitive function, which is often impaired by chronic stress. Stress can negatively impact memory, concentration, and decision-making abilities, all of which are essential for managing daily challenges.

Recent research has shed light on the neuroprotective effects of physical activity. A 2022 study published in the journal Nature Reviews Neuroscience found that regular exercise promotes the growth of new neurons in the hippocampus, a brain region critical for memory and learning. This neurogenesis is believed to counteract the detrimental effects of stress on the brain, helping to preserve cognitive function even in the face of chronic stress. The study also highlighted the role of exercise in increasing brain-derived neurotrophic factor (BDNF), a protein that supports the survival and growth of neurons. Higher levels of BDNF have been linked to improved cognitive function and a reduced risk of neurodegenerative diseases.

Furthermore, physical activity has been shown to enhance executive function, which includes skills such as problem-solving, planning, and emotional regulation. These skills are particularly important for managing stress effectively. A meta-analysis published in Psychological Bulletin in 2021 reviewed 29 studies on the effects of exercise on executive function. The analysis concluded that both aerobic and resistance exercises significantly improved executive function, particularly in individuals under high levels of stress. The authors of the study suggested that the improvement in executive function could help individuals better manage stress by enhancing their ability to plan, prioritize, and regulate emotions.

Physical Activity and Sleep Quality

One of the most insidious effects of stress is its impact on sleep. Stress can lead to insomnia or disrupted sleep patterns, which in turn exacerbate stress, creating a vicious cycle. Sleep is crucial for mental and physical recovery, and without adequate rest, the body and mind become more susceptible to the negative effects of stress.

Physical activity has been widely recognized as a natural remedy for improving sleep quality. According to a 2021 report by the National Sleep Foundation, regular exercise can help people fall asleep faster and enjoy deeper, more restorative sleep. The report also noted that individuals who engage in regular physical activity are less likely to experience insomnia and other sleep disorders.

A study published in Sleep Medicine Reviews in 2020 explored the relationship between exercise and sleep in individuals with chronic stress. The researchers found that participants who engaged in moderate to vigorous physical activity reported significant improvements in sleep quality and duration. These improvements were accompanied by reductions in stress levels and better overall mental health. The study’s findings suggest that incorporating regular physical activity into one’s routine can be a powerful strategy for breaking the cycle of stress and poor sleep.

Types of Physical Activity for Stress Management

While any form of physical activity can be beneficial for managing stress, certain types of exercise may be particularly effective. Aerobic exercises, such as running, swimming, and cycling, are well-known for their ability to elevate heart rate and release endorphins. These activities have been extensively studied and are consistently linked to reductions in stress and anxiety.

For example, a 2021 study published in The Journal of Sports Medicine examined the effects of aerobic exercise on stress in a group of office workers. The study found that participants who engaged in 30 minutes of aerobic exercise, three times a week, reported significant reductions in stress levels and improvements in mood after just eight weeks. The researchers concluded that aerobic exercise is an effective and accessible way to manage stress in everyday life.

Strength training, or resistance exercise, also offers significant benefits for stress management. A 2020 study published in The American Journal of Lifestyle Medicine found that participants who engaged in regular strength training experienced not only physical improvements but also psychological benefits, including reduced stress and anxiety. The study’s authors suggested that the sense of accomplishment and mastery that comes from strength training may contribute to these mental health benefits.

Mind-body exercises, such as yoga and tai chi, combine physical movement with mindfulness and deep breathing, making them particularly effective for stress management. A meta-analysis published in *The Journal of Behavioral Medicine* in 2022 reviewed 15 studies on the effects of yoga on stress. The analysis found that yoga practitioners consistently reported lower levels of stress and greater emotional well-being compared to non-practitioners. The researchers highlighted the role of yoga in reducing cortisol levels and enhancing parasympathetic nervous system activity, which promotes relaxation and recovery from stress.

Barriers to Physical Activity and Strategies to Overcome Them

Despite the clear benefits of physical activity for stress management, many people struggle to incorporate regular exercise into their lives. Common barriers include lack of time, motivation, and access to facilities. Additionally, individuals who are already experiencing high levels of stress may find it difficult to start and maintain an exercise routine.

Addressing these barriers requires a multifaceted approach. Time management is often cited as the primary obstacle to regular physical activity. However, research suggests that even short bouts of exercise can be effective for reducing stress. A study published in The Lancet Psychiatry in 2019 found that just 10 minutes of physical activity per day was associated with significant reductions in stress and anxiety. The researchers emphasized that every bit of movement counts and encouraged people to find ways to integrate physical activity into their daily routines, whether through walking, taking the stairs, or engaging in quick home workouts.

For those struggling with motivation, setting realistic goals and finding activities that are enjoyable can make a significant difference. A 2020 study published in *The Journal of Behavioral Health* found that individuals who chose physical activities they enjoyed were more likely to stick with their exercise routines and experience stress relief. The study’s authors recommended that people experiment with different types of exercise to find what works best for them, whether it’s a group class, a solo run, or a dance session in the living room.

Access to facilities can also be a barrier, particularly for those living in urban or underserved areas. However, the rise of online fitness programs and virtual classes has made physical activity more accessible than ever. According to a 2021 report by the American College of Sports Medicine, the use of online fitness resources increased by 76% during the COVID-19 pandemic. These resources provide a wide range of options for people to engage in physical activity from the comfort of their homes, making it easier to overcome logistical challenges.

The Broader Implications of Physical Activity for Society

The benefits of physical activity for stress management extend beyond the individual. When people are less stressed, they are more productive, creative, and engaged in their work and communities. A 2022 report by the World Health Organization (WHO) highlighted the economic impact of stress-related health issues, estimating that stress costs the global economy $1 trillion annually in lost productivity. The report emphasized the importance of promoting physical activity as a public health strategy to reduce the burden of stress on individuals and society as a whole.

Furthermore, the promotion of physical activity can contribute to the reduction of healthcare costs. A 2020 study published in The Lancet Global Health found that increasing physical activity levels worldwide could prevent 5

 million deaths annually and save $67.5 billion in healthcare costs. These findings underscore the importance of integrating physical activity into public health policies and programs as a means of improving overall well-being and reducing the economic burden of stress-related diseases.

 A Call to Action

The physical activity is not just a recommendation; it is a necessity for effective stress management. The evidence is clear: regular exercise reduces stress hormones, improves cognitive function, enhances sleep quality, and promotes overall mental and physical well-being. As stress continues to be a pervasive issue in modern society, it is imperative that individuals, communities, and policymakers recognize the critical role of physical activity in mitigating its effects.

The barriers to physical activity are real, but they are not insurmountable. By making small, sustainable changes to incorporate movement into daily life, individuals can take control of their stress levels and improve their quality of life. At the same time, there is a need for broader societal efforts to promote physical activity through public health initiatives, workplace wellness programs, and community resources.

Ultimately, the benefits of physical activity extend far beyond the individual. By prioritizing physical activity as a key component of stress management, we can create healthier, more resilient communities and reduce the economic burden of stress-related health issues. As we move forward in an increasingly complex and demanding world, let us embrace physical activity as a powerful tool for managing stress and enhancing the well-being of society as a whole.

(Disclaimer: The author is not a health professional.)

::::::::::::::::::::::::::::::::::::::::::::::Mahesh Zagade

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The Evolutionary Legacy and Modern Perils: The Onslaught of Sugar upon Human Health

Introduction:

The annals of human existence stretch back approximately 25 lakh years, a temporal odyssey wherein our kind navigated the currents of time, evolving in tandem with the natural milieu, adept at overcoming the challenges posed by the untamed wilderness. Central to this adaptive journey was the practice of consuming unprocessed sustenance, a behavior etched into our biological fabric through the intricate process of evolution. However, a seismic transformation unfurled over the past four millennia, as humanity shifted from a regimen of raw nourishment to an indulgence in refined victuals, notably sugar. This metamorphosis has birthed a health conundrum, with sugar emerging as a formidable adversary to human well-being. The origins of this quandary extend beyond individual choices to the very heart of our economic edifice, where an insatiable thirst for profit propels the dissemination of health hazards induced by sugar. Governments and medical practitioners, erstwhile guardians of public health, now find themselves relegated to mere spectators. Let us delve into the evolutionary trajectory of human nutrition, the repercussions of the sugar onslaught on health, and the socio-economic factors that sustain this crisis. It underscores the pressing need for corrective measures by food regulators, medical professionals, and influencers to forestall an irreversible course.

1. The Odyssey

The evolutionary chronicle of humankind spans millions of years, a saga marked by adaptation and tenacity in the face of environmental exigencies. At the heart of this adaptation lies the human diet, initially dominated by the consumption of uncooked sustenance. Nevertheless, the last approximately 4000 years have witnessed a departure from this evolutionary norm, with the advent of refined victuals, especially sugar, ushering in an epoch fraught with health risks. Let us scrutinize the evolutionary progression of human nutrition, the injurious effects of sugar consumption, and the complicity of market forces in perpetuating this crisis.

2. Evolutionary Foundations: Consumption of Raw Fare

The journey of human evolution is intricately interwoven with dietary adjustments. For around 25 lakh years, our forebears flourished in the wilderness, subsisting on unprocessed food sources. This prolonged era of consuming raw victuals played a pivotal role in shaping the human digestive system and metabolic processes. The abundance of fiber, essential nutrients, and enzymes in raw foods were crucial for the optimal functioning of the human body.

2.1. Biological Accommodations to Raw Nourishment

Evolutionary biology posits that the human digestive system adapted to the consumption of raw, fiber-rich foods such as fruits, vegetables, and lean meats. Natural selection favored individuals endowed with digestive enzymes proficient in breaking down raw foods, ensuring the absorption of vital nutrients and contributing to the robust health of our ancestors.

2.2. Nutritional Merits of Raw Food

Raw foods inherently abound in vitamins, minerals, and phytochemicals, fostering overall well-being and bolstering resistance to diseases. The absence of processing and cooking preserves the nutritional integrity of these foods, facilitating the absorption of essential nutrients by the human body. The proclivity for consuming raw food aligns with the nutritional requisites of our species, as evidenced by the robust health of hunter-gatherer societies.

3. The Sugar Revolution: A Modern Onslaught on Health

The advent of agriculture some 10,000 to 12,000 years ago marked a pivotal shift in human dietary practices. While the cultivation of grains and domestication of animals broadened the array of food options, it was the last 2500 years that witnessed the introduction of refined sugars, heralding a revolution in human nutrition. The first chemically refined sugar made its debut in India approximately 2,500 years ago. Subsequently, the technique traversed eastward towards China and westward towards Persia and the early Islamic worlds, ultimately reaching the Mediterranean in the 13th century. Cyprus and Sicily emerged as pivotal centers for sugar production. In the Middle Ages, sugar was deemed a rare and opulent spice, rather than an everyday condiment. Sugar, once a luxury reserved for the elite, has metamorphosed into a ubiquitous element in the modern diet, ushering in a cascade of health predicaments.

3.1. The Ascendance of Sugar Consumption

Historically, sugar was a scarce commodity, derived from sources like sugarcane and honey. Nonetheless, advancements in agriculture and trade democratized access to sugar, integrating it as a integral component of the average diet. The Industrial Revolution further expedited sugar production, resulting in its widespread availability and affordability.

3.2. Health Ramifications of Sugar Consumption

The shift from unprocessed to refined foods, particularly the surge in sugar consumption, has been linked to a myriad of health issues.

Sugar is often perceived as an innocuous indulgence, but recent research suggests its potential lethality surpassing that of a bullet. According to a study published in the Journal of the American Medical Association, excessive sugar intake escalates the risk of heart disease, stroke, and various other health maladies, positioning it as a leading cause of global mortality. The researchers posit that surpassing 25 grams of added sugar per day, roughly 6 teaspoons, significantly elevates the risk of health complications. This is a relatively modest amount, given that a solitary can of soda contains approximately 40 grams of sugar.

Excessive sugar intake is correlated with obesity, type 2 diabetes, cardiovascular ailments, and dental issues. The elevated fructose content in sugar contributes to metabolic dysfunction, detrimentally impacting liver health. Moreover, sugar consumption is implicated in the burgeoning prevalence of non-communicable diseases, presenting a substantial public health challenge. In 2019, diabetes directly caused 1.5 million deaths, with 48% occurring before the age of 70. An additional 460,000 kidney disease deaths were attributable to diabetes, and elevated blood glucose contributed to roughly 20% of cardiovascular deaths.

As per the WHO fact sheet, noncommunicable diseases (NCDs) stand as the primary cause of global mortality, accounting for 71% of all deaths. Within the WHO European Region, almost 90% of all deaths are attributed to NCD-related morbidity and mortality. An unhealthy diet ranks among the four principal behavioral risk factors for NCDs. Obesity, a malady in its own right, concurrently serves as a major risk factor for several NCDs, including cardiovascular diseases, type 2 diabetes, and certain cancers. Over 59% of adults and an escalating proportion of children in the Region grapple with overweight and obesity. The excessive intake of free sugars jeopardizes the nutritional quality of the diet, imparting substantial energy devoid of commensurate nutritional benefits, thereby fostering unhealthy weight gain and heightening the risk of overweight, obesity, and other NCDs. Moreover, excessive sugar intake precipitates dental caries and its attendant health ramifications.

Approximately 184,000 deaths annually can be attributed to the consumption of sugar-sweetened beverages (SSBs) globally. Epidemiological and decision models serve as indispensable tools for estimating the disease burden.

4. The Role of the Market Economy: Prioritizing Profits over Health

The exponential surge in sugar consumption is not a mere consequence of individual choices but is deeply entrenched in the fabric of our market economy. The food industry, propelled by an unquenchable thirst for profit, assumes a pivotal role in endorsing and perpetuating the sugar-laden diet. The market’s fixation on inexpensive, processed foods

laden with sugars and additives reflects a disregard for public health in the relentless pursuit of financial gain.

4.1. Profit-Centric Practices of the Food Industry

The food industry strategically employs marketing, product innovation, and flavor manipulation to craft addictive and palatable products. Highly processed foods, replete with sugars and synthetic additives, inundate the market, captivating consumers and contributing to the global health crisis. The profit-centric model prioritizes shelf stability, taste, and convenience over nutritional value, exacerbating the prevalence of health hazards induced by sugar.

4.2. Government and Medical Inertia

Governments and medical professionals, entrusted with the guardianship of public health, have largely assumed a passive stance in the face of the sugar epidemic. Regulatory frameworks frequently lag behind the swift evolution of the food industry, permitting the unhindered proliferation of sugary products. The medical community, while cognizant of the health risks associated with sugar, is often constricted by systemic factors that curtail their capacity to effect meaningful change.

5. The Sugar Menace: Surpassing Tobacco

The gravity of the sugar-induced health crisis is exemplified by its outstripping of tobacco as a primary cause of preventable diseases and fatalities. While the detrimental effects of tobacco have undergone extensive scrutiny and ameliorative efforts, the sugar epidemic continues to escalate, exacting a toll greater than any other dietary malefactor. The addictive allure of sugar, coupled with its omnipresence in processed foods, amplifies the severity of the crisis.

5.1. Comparative Examination: Sugar vs. Tobacco

Studies posit that excessive sugar consumption is a significant contributor to obesity, diabetes, and cardiovascular diseases, collectively surpassing the health burden imposed by tobacco use. The accessibility and societal acceptance of sugary products further contribute to the pervasive nature of this health crisis. Despite mounting evidence linking sugar to chronic diseases, public awareness remains inadequate, exacerbating the challenge.

6. The Nexus of Sugar, Pharmaceuticals, and Healthcare Profits

The sugar epidemic not only bestows lucrative profits upon the food industry but also provides opportunities for the pharmaceutical and healthcare sectors to capitalize on resultant health crises. The surge in chronic diseases linked to sugar consumption fuels the demand for pharmaceutical interventions and medical treatments. This symbiotic relationship between the sugar-laden diet, healthcare costs, and pharmaceutical profits underscores the multifaceted nature of the crisis.

6.1. The Role of the Pharmaceutical Industry

The pharmaceutical industry, positioned to address the health consequences of sugar consumption, stands to benefit from the perpetuation of the crisis. Medications designed to manage diabetes, cardiovascular diseases, and obesity become indispensable components of treatment plans, contributing to the economic growth of the pharmaceutical sector. This economic interdependence raises ethical questions regarding the motivations behind addressing the root causes of the sugar epidemic.

6.2. Healthcare Profits and Sugar-Related Maladies

As the prevalence of sugar-related diseases escalates, healthcare systems witness a surge in the demand for medical services. Doctors, in turn, experience a rise in patient visits and treatments, translating into financial gains. While healthcare professionals play a pivotal role in managing the health consequences of sugar consumption, the economic incentives associated with treating rather than preventing these conditions raise concerns about the prioritization of profit over public health.

7. The Call for Course Correction: A Collective Responsibility

The escalating sugar-induced health crisis demands a collective and expeditious response from food regulators, medical practitioners, and social influencers. Governments must enact stringent regulations to curb the marketing and production of sugary products, prioritizing public health over corporate interests. Medical professionals should engage in proactive education and advocacy, empowering the public to make informed dietary choices.

7.1. Regulatory Revisions

Regulatory bodies must evolve to keep pace with the dynamic nature of the food industry. Stringent labeling requirements, restrictions on marketing to vulnerable populations, and taxation on sugary products can serve as efficacious measures to curb excessive sugar consumption. Collaborative efforts between governments, health organizations, and the food industry are essential to institute comprehensive regulatory reforms.

7.2. Medical Advocacy and Education

Medical professionals, as trusted repositories of health information, must actively engage in public education regarding the risks of excessive sugar consumption. Integrating nutritional education into medical curricula and incorporating dietary counseling into routine patient care can empower individuals to make healthier choices. Additionally, healthcare providers should advocate for policy changes that prioritize preventive measures over reactive treatments.

7.3. The Role of Social Influencers

In the digital era, social influencers wield considerable sway over public opinions and behaviors. Collaborations between health organizations and influencers can leverage social media platforms to disseminate accurate information about the health consequences of sugar consumption. By fostering a culture of wellness and promoting responsible dietary choices, influencers can contribute to a societal shift away from the current sugar-laden norm.

A Clarion Call for Humanity

The assault of sugar on human health is a multifaceted crisis rooted in the intersection of evolutionary biology, market forces, and societal choices. The deviation from the consumption of raw food to the contemporary sugar-laden diet represents a departure from our evolutionary heritage, with profound implications for public health. Governments, medical professionals, and social influencers must unite in a concerted effort to address the root causes of the sugar epidemic, steering humanity away from the precipice of irreparable damage. The time for action is now, as the consequences of inaction threaten to exacerbate the crisis to a point of no return. The wake-up call for humanity is clear – a collective commitment to prioritizing health over profit is imperative to secure a healthier and sustainable future for generations to come.

Standard

पेशंट-केअर” धोरणाकडून “आरोग्य” धोरणाकडे.

( मा मुख्यमंत्री, महाराष्ट्र राज्य यांना दि १७.६.२०२१ रोजी लिहिले पत्र.)

दि 17/06/2021

प्रति,

मा. मुख्यमंत्री

महाराष्ट्र शासन,

मंत्रालय, मुंबई. `

विषय: “पेशंट-केअर” धोरणाकडून “आरोग्य” धोरणाकडे.

सन्माननीय महोदय,

कोरोना साथीने गेले वर्षभर जो जगभर धुमाकूळ घातलेला आहे तो सर्व जण अनुभवत आहोतच. अर्थात, गेल्या दोनशे वर्षांमध्ये जी शास्त्रीय संशोधनाची प्रगती झाली व त्यामधून इतर गोष्टींबरोबरच वैद्यकीय क्षेत्रात देखील मोलाची कामगिरी राहिल्यामुळे भारताचे सरासरी आयुष्यमान स्वातंत्र्यापूर्वी ३२-३४ वर्षे होते, ते आता एकूण ६९ वर्षे झाले आहे. औषधांचे शोध, औषध निर्मिती कारखाने, अँटिबायोटिक्स, औषधांची मुबलक उपलब्धता, सरकारी आणि खासगी इस्पितळे आणि दवाखाने, वैद्यकीय शिक्षण क्षेत्रातील प्रचंड वाढी यामुळे देशात दर हजार लोकसंख्येमागे डॉक्टरांची वाढलेली उपलब्धता, स्थानिक पातळीपर्यंत शासकीय आणि निमशासकीय आरोग्य यंत्रणेचे पसरलेले जाळे व त्यासाठी मोठ्या प्रमाणात अंदाजपत्रकातून निधीची तरतूद इत्यादींबाबतच्या “रुग्णांवर उपचार” करणे हा मूळ गाभा असलेल्या धोरणांचा अवलंब या देशाने गेली सत्तर वर्षे अव्याहतपणे केला आहे. अर्थात, असे भारतातच नव्हे तर जागतिक पातळीवर सर्वत्र अशीच आरोग्याची धोरणे असल्याचे वारे गेल्या शतकाच्या सुरुवातीपासूनच वाहू लागले. त्यामध्ये मग साहाजिकच भांडवलशाहीवर आधारित व्यापाराची संधी म्हणून पण या क्षेत्राकडे पाहण्याचा दृष्टिकोन सुरू झाला आणि त्या व्यापारीकरणाने हे आरोग्य क्षेत्र कधी काबीज केले ते कोणाच्याही लक्षात आले नाही. या व्यापारीकरणाचा पुढचा अध्याय म्हणून मग आरोग्य विमा सुरू झाला आणि आता तर हा सर्वच खेळ त्या दिशेने जगभर केंद्रित होऊ लागला व त्यास भारत कसा द राहू शकेल? पाश्चात्त्य देशांचे अनुकरण हे ठीक; पण आपण अंधानुकरणामध्येही मागे नाही, ही आपली ओळख झाली.

हे आता चर्चेत घेण्याचे कारण म्हणजे आरोग्य क्षेत्रात इतकी देदीप्यमान प्रगती होऊन लाखो लोक करोना महामारीत का मृत्यू पावले? लोकांना हॉस्पिटलमध्ये रुग्ण म्हणून का भरती व्हावे लागले? जगाची अर्थव्यवस्था कोलमडून पडण्यापर्यंत का परिस्थिति चिघळली ? रोजगार बुडून जगण्याची भ्रांत निर्माण होण्यासारखे परिस्थिती का उद्भवली? याची उत्तरे शोधावी लागतील.

मानवाने गेल्या दोनशे वर्षांत जी प्रगती केली आहे आणि जीवन अधिकाधिक सुखकर करण्याकरिता ज्या सुविधा निर्माण केल्या आहेत, ते सर्व मानवाचा एकत्रितपणे काम करण्याची क्षमता याचा परिपाक आहे. हे एकत्रीकरण इतके झाले आहे की त्याच्या चांगल्या परिणामांबरोबरच दुष्परिणामदेखील वाढले आहेत. हे दुष्परिणाम शोधून त्या बाबतीत सर्व जगानेच पुन्हा एकदा जगण्याकरिता काही मूळ संकल्पना आहेत त्यावर लक्ष केंद्रित करणे आवश्यक आहे.

कोरोनाने जगाला खरे तर आतापर्यंत मानवाने चांगले काय केले आणि तो कुठे चुकला, याचे आत्मचिंतन आणि आत्मपरीक्षण करून त्यामध्ये सुधारणा करण्याची संधी दिलेली आहे. ही संधी जर दुर्लक्षित केली तर मानवासारखा हुशार; पण तितकाच अभागी प्राणी मानवच राहील. हा विषय far मोठा आहे, त्यावर व्यापक मंथन आणि विशेषतः कोरोनासारखी भयंकर आव्हाने आणि चौथ्या औद्योगिक क्रांतीमुळे होणारी आमूलाग्र स्थित्यंतरे यावर लक्ष केंद्रित करुन जागतिक आणि देशपातळीवरील धोरणे ठरवावी लागतील. आता आपण फक्त या कोरोनामुळे जी परिस्थिती उद्भवली ती उद्भवण्यापूर्वीच आपण ती थांबवू शकलो असतो का आणि तसे असेल तर आपले काय चुकले व या चुका भविष्यात कशा सुधाराव्या लागतील, यावर विचार करूया.

कोरोनामुळे जे मृत्यू झाले त्या आकडेवारीचे विश्लेषण केले, तर ते प्रामुख्याने 70 टक्के मृत्यू हे अशा रुग्णांचे झाले की ज्यांना अगोदरच उच्च रक्तदाब, मधुमेह , हृदयविकार, अवाजवी लठ्ठपणा, मूत्राशयाचे व इतर अवयवांचे विकार अशा व्याधींनी ग्रस्त होते. दुसऱ्या शब्दांत सांगावयाचे म्हणजे ज्या व्यक्ती कोणत्या ना कोणत्या आजारामुळे अगोदरच रुग्ण होत्या, त्यांच्यात मृत्यूचे प्रमाण फारच जास्त आणि अवाजवी होते. त्यांना या व्याधी नसत्या तर त्यापैकी कित्येक कोरोनामुळे मृत्यू होण्यापासून वाचू शकले असते. आजपर्यंत जगात सुमारे 35 लाख लोकांचा कोरोनामुळे मृत्यू झाला झाल्याची आकडेवारी आहे. वर नमूद केलेल्या व्याधींनी जर जे रुग्ण ग्रस्त होते ते तसे नसते तर कदाचित लाख लोकांचे प्राण वाचू शकले असते. अर्थात कोरोना नसतानाही या हृदयरोग, उच्च रक्तदाब, डायबिटीस, अपघात, आत्महत्या, तंबाखूसेवन इत्यादींमुळे कित्येक कोटी व्यक्ती अनैसर्गिकरीत्या मृत्यू पावतात. या सर्वांचे प्राण वाचण्याकरिता जागतिक आरोग्य संघटन तसेच सर्वच देशांच्या “रुग्णांवर उपचार करून त्यांना बरे करण्याबाबत” धोरणे आहेतच. त्यामध्ये संशोधनातून रोगाविरुद्ध प्रभावी औषधे शोधणे, त्याची भरपूर निर्मिती करणे, रुग्णांना ते उपलब्ध करणे, त्यांचे दर किफायतशीर ठेवणे, इस्पितळे-दवाखाने, हॉस्पिटल बेड्स, डॉक्टर्स, नर्सेसची संख्या वाढवणे, वैद्यकीय शिक्षणाचा व्यापक विस्तार करून त्यांची सर्वदूर उपलब्धता वाढवणे, हे सर्व नियंत्रित करण्याकरिता आरोग्यकरिता प्रशासकीय यंत्रणेचे जाळे उभारणे, विमा कंपन्यांमार्फत उपचार आणि औषधांचा खर्च भागवणे या गोष्टीचा अंतर्भाव असलेली धोरणे आखून त्यांची अंमलबजावणी करण्यावरच गेल्या शतकामध्ये भर राहिला. अर्थात, एकट्या-दुकट्या रोगासाठी लसीकरणाचा कार्यक्रम राबवून त्या रोगाचे रुग्ण तयार होणार नाहीत, असेही रोगप्रतिबंधाचे कार्यक्रम अपवादाने आहेतच; आणि त्याचे दृश्य स्वरूपात चांगले परिणाम जगाने पाहिलेही आहेत. पण एक बाब प्रकर्षाने स्पष्ट होते की, जगाचे सामूहिक आणि देशपातळीवरील आरोग्यविषयक धोरणे ही केवळ “रुग्णांवर उपचार” करून बरे करण्यावर केंद्रित राहिली आहेत. याकरिता “पेशंट-केअर” हा शब्द यासाठी रूढ झाला आहे. त्यामुळे जगाची धोरणे आरोग्याची नव्हे तर पेशंट केअरचीच आहेत, हे प्रथम सर्वांनी समजून घेणे आवश्यक आहे.

खरे म्हणजे या धोरणांवर आधारितच व्यवस्था आणि सरकारी किंवा खाजगी क्षेत्रात इन्फ्रास्ट्रक्‍चर निर्माण झाले आहे. त्याला किंवा वैद्यकीय शिक्षणाला ‘आरोग्य क्षेत्र’ असे संबोधणे हाच मुळात दुटप्पीपणा आहे आणि तसा दुटप्पीपणा मानवाने निर्बुद्धपणे गेले शंभर वर्षे अंगीकारला आहे. ज्या पद्धतीने गेल्या दशकात काम झाले, त्या पार्श्वभूमीवर जागतिक आरोग्य संघटनेचे नाव जागतिक आरोग्य संघटने ऐवजी जागतिक “पेशंट केअर” संघटना तसेच देशाच्या आरोग्य मंत्रालयांना किंवा विभागांना रुग्ण मंत्रालय किंवा रुग्ण विभाग हीच नावे चपखलपणे बसू शकतात!

आता कोरोनाने अंतर्मुख होऊन मानवास आरोग्याबाबत नवीन धोरणे आखण्याची आणि जुन्या चुका सुधारण्याची संधी दिलेली आहे. गेल्या शतकातील अनुभव विचारात घेता आता खडबडून जागे होऊन जगाने एका शब्दात सांगायचे तर लोक आरोग्यदायी कसे राहतील आणि त्यांचे रुग्ण होण्याचे प्रमाण कसे कमीत कमी ठेवता येईल, हा गाभा असलेली नीती अंगीकारणे व आरोग्य वर्धन धोरणे तयार करून ती राबविणे हे एकमेव उद्दिष्ट ठेवणे आवश्यक राहील. त्याकरिता मग जागतिक पातळीवरील धोरणे, जागतिक आरोग्य संघटनेच्या कार्यात बदल, सर्व देशांची धोरणे, शिक्षणपद्धती, प्रशासकीय यंत्रणा, त्या दिशेने संशोधन, तसे इन्फ्रास्ट्रक्चर इत्यादींचा समावेश करून एका नवीन अध्यायाची सुरुवात करावी लागेल. सरकारे सध्या जो “आरोग्याच्या” नावाखाली पेशंट केअरवरच बहुतांश खर्च करतात त्यामध्ये बदल करून आरोग्य सुधारण्याकडे हा निधी वळवणे किंवा नव्याने उपलब्ध करून द्यावा लागेल. ज्या देशामध्ये रुग्णसंख्या जास्त त्या देशाचे सकल उत्पादनावर देखील काही प्रमाणात विपरीत परिणाम होतो, असेही संशोधन आहे. त्यामुळे हा रुग्णसंख्या घटविण्याच्या धोरणांचे नवीन वारे जगभर सुरू केले तर त्याचे सर्वच बाबतीत चांगले परिणाम दिसू लागतील. अर्थात, कुटुंबाचा आणि सरकारांचा जो खर्च औषधे”, डॉक्टरच्या फी, वैद्यकीय चाचण्या, हॉस्पिटलायझेशन, हॉस्पिटल व दवाखाने उभारणे यांवर होतो, त्यामध्ये प्रचंड बचत होऊ शकते. उदाहरणार्थ- जगात आज 70 लाख कोटी रुपयांचा खर्च नागरिकांच्या खिशातून औषधावर प्रत्यक्ष किंवा अप्रत्यक्षरित्या कररूपाने जातो. त्यामध्ये माझ्या अंदाजाप्रमाणे या खर्चात साठ-सत्तर टक्के बचत होऊ शकते.

ही “रुग्ण संख्या कमी करण्याची” धोरणे आखताना जे निर्णय घ्यायचे आहेत त्यामध्ये निधीपेक्षा नेतृत्वाची धमक आवश्‍यक राहील. उदाहरणार्थ- रस्ते अपघातामुळे तयार होणाऱ्या रुग्णसंख्येत घट करावयाची असेल, तर रस्त्यामधील सुधारणा, चालकांवर शिस्त ते येथपासून ते तंबाखू पिकावर बंदी, कंपन्यांवर कडक निर्बंध, अन्नभेसळीचे निर्मूलन, खाण्याच्या संस्कृतीमध्ये पैसे कमावण्यासाठी आलेल्या व्यापारी प्रवृत्तींना आळा अशा अनेक गोष्टींवर लक्ष केंद्रित करावे लागेल. क्षुल्लक गोष्टींमुळे रुग्ण तयार होतात त्याचे उदाहरण म्हणजे तोंडाला लावण्याच्या पावडरपासून ते गुटख्यामुळे होणारे कॅन्सर टाळता येतात. हेही आपण अनुभवले आहे.

माणसाने कोरोनाच्या धक्क्यातून सावरताना अंतर्मुख होऊन अशा चुकलेल्या वाटा बदलून नव्या धोरणाच्या माध्यमातून जगाला वाचवणे आवश्यक राहील. त्यामुळे सध्याच्या पेशंट केअर धोरणऐवजी “रुग्णसंख्या कमी करणे” हेच आरोग्य धोरण महाराष्ट्र राज्याने देखील पुढाकार घेऊन तयार करावे आणि भविष्यातील पिढ्यांच्या आरोग्य सुरक्षिततेसाठी ते वापरावे हि विनंती. असे धोरण तयार करण्याकरीता काही मदतीची आवश्यकता भासल्यास मी सदैव तयार असेल.( या विषयावर माझा दि १७/०६/२०२१ रोजी दै लोकसत्ता मध्ये लेख प्रकाशित झाला आहे.)

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