Recently a Punjab Pollution Control (PPCB) sponsored epidemiological study done by Post Graduate Institute of Medical Research (PGIMR) Chandigrarh has indicated the rise in cancer cases in cotton belt of Punjab. The study indicates that Cotton belt of Punjab is engulfed by lethal pesticides and causing major health problems. Though this study was done in one Talwandi Sabo block of Bathinda district but the similar symptoms are emerging from entire cotton belt. The situation is so grim that village after village is reporting cancer, reproductive disorder, birth of mentally retarded children and other pesticide related diseases.

The PGI study clearly indicts pesticides for high prevalence of cancer in the area. Study found both tap and ground water laced with carcinogenic chemicals. Tap water contains high content of arsenic, chromium, iron, and Hg. Where as ground water also was replete with arsenic, chromium, nickel and iron. Even these deadly pesticides had seeped into locally - grown vegetables as well. The cauliflower was toxicated with Heptachlor Endoepoxide, Chlorpyrifos, Alpha Endosulfan and Alfa HCH.

It is also an most worrisome factor that traces of Persistent Organic Pollutants- POPs are found at large in Punjab. This is Slow poisoning of Punjab. POP’s are banned in majority of countries. POP’s are known Endocrine disrupters and the main reason behind neurotoxicity, immunotoxicity, reproductive disorders, testicular cancer, and congenital malformations. Even the motherhood is challenged by POP’s through foetotoxicity.

The pollution from POPs knows no boundaries. They travel long distances and get deposited and accumulated in terrestrial and aquatic ecosystems. They are highly toxic even in very low concentrations, and resist degradation. The POPs can accumulate in fatty tissue (Bioaccumulation), becoming more concentrated higher in the food chain and with time by biomagnification process.

Kheti Virasat Mission volunteers also came across the frightening truth in Rampura block of Bathinda district in year 2002. Several villages facing acute health problems in this block. The high cases of cancer, reproductive health disorder, congenital abnormities and physical – mental illness is a common factor here. More over the contaminated ground water is also aggravating the devastating situation.

Now the cancer cases are reported from other parts of cotton belt too. Villages in Lambi, Giddarbaha, Malout and Abohar also witnessing spreading clutches of deadly cancer.

Another aspect of environmental health crisis is that skeletal fluorosis is fast taking the greater cotton belt in its grip. Which is more serious issue to be tackled urgently.

It is evident that Punjab is trapped into a disastrous vicious cycle of slow poisoning. The Study conducted by Kheti Virasat and Green Peace in the year 2003, indicated that pesticide exposure to the children in cotton belt is adversely effecting their growth. The children of the study area (Talwandi Sabo Block) has several problems related to their physical and mental growth. A comparative study was taken up in the high pesticide consuming area of Talwandi Sabo block with an average consumption rate of 17.5 liters per acre per annum against the lowest pesticide consuming area of Anandpur Sahib block with average comsumpting rate of less then 0.5 liter per acre per annum. This study has shown that pesticides impair the development abilities of children. Documentation of other instances was done to link various disease like cancer, infertility, mental retardation or neural tube defects- NTD and loss of physical stamina to pesticides.

It was note worthy that Kheti Virasat has first indicated the higher rate of cancer, infertility and several other health problems in some villages of Bathinda. This was reported in media. Punjab Government took cognizance of this and ordered an inquiry. Then Punjab Pollution Control Board commissioned a study to the PGIMR Chandigarh, which had submitted its final report in February 2005. This report is a clear warning to people of Punjab that they setting on time bomb of environmental health hazards.

Executive summary of PPCB - PGIMER report:

In the developed world, life expectancy has increased substantially during the last century. Deaths due to infectious diseases also declined in these countries whereas deaths due to cancer and other cardiovascular diseases increased. With the rising socio-economic status, similar health transition is occurring in some of the developing countries. In India, though infectious diseases continue to be a public health problem but an increase in the occurrence of non-communicable diseases has also been noted particularly in urban areas and in economically advanced states.

Citizen groups has observed a rising trend of cancer deaths in jajjal and Giana villages of Bathinda District. Punjab Health Department conducted a preliminary inquiry and found that the prevalence of cancer cases in these villages is similar to the other parts of India. The reasons for higher number of cases were attributed to better awareness about the diseases and availing of medical facities for its diagnosis.. As local population has suspected water to be cause of this problem, Punjab Pollution Control Board tested the water samples and found traces of DDT and BHC in the canal-based water supply. However, these insecticides were not detected in the underground water. Based on these preliminary observations, it was decided that Community Medicine Department of PGIMER Chandigarh should conduct an epidemiological study to investigate weather cancer cases are higher in Talwandi Sabo block of District Bathinda compared to other areas and if that is the case then what are the possible causes of this problem?

A house –to-house survey was conducted in Talwandi Sabo Block in Bathinda District and Chamkaur Sahib Block of Roop Nagar District to identify the number of existing cancer cases, and the number of cancer deaths that have occured in last 10 years. Cancer cases and deaths were found to be significantly higher in Talwandi Sabo compared to Chamkaur Sahib Block. The prevalence of confirmed cancer cases was 103 per lakh at Talwandi Sabo (107/85315) and 71 per lakh at Chamkaur Sahib (71/97928). Cancer of female reproductive system, i.e., breast, uterus/cervix and ovary were more common in Chamkaur Sahib Block. Cancer deaths per lakh per year were 52 in Talwandi Sabo compared to 30 per lakh at Chamkaur Sahib.

A comparison of the characteristics of randomly selected individuals, from the villages where a cancer cases existed of death due to cancer had occurred in last 2 years, revealed that involvement in cultivation, pesticides use, alcohol and smoking were more common in Talwandi Sabo Block as compared to Chamkaur Sahib Limited studies show that in drinking water the levels of heavy metals such as As, CD, Cr, Se, Hg were generally higher, and pesticides such as heptachlor, ethion, and chlorpyrifos were also higher in samples of drinking water, vegetables, and blood in Talwandi Sabo as compared to Chamkaur Sahib.

The cancer cases and deaths are higher Talwandi Sabo probably due to more use of pesticides, tobacco and alcohol. It is found that multiple factors were responsible for cancer cases in the Talwandi Sabo area. Therefore, a multi pronged strategy to provide safe water supply, discouraging the indiscriminate use of pesticides. Tobacco and alcohol is recommended. A cancer registry should be established in the region for monitoring the trend of cancer cases in future.

Recommendations:

As cancer cases and deaths are significantly higher in Talwandi Sabo due to multiple factors such as indiscriminate use of pesticides, tobacco and alcohol, the technical committee of the project recommended that

1. Agriculture Department should educated people involved in agriculture about pesticides storage, use, and proper disposal of the empty pesticides containers. Steps should be taken so that pesticides are used judiciously and safely.
2. Public Health Department should monitor the level of pesticides and heavy metals in drinking water periodically and monitoring reports should be Communicated to Director, Health services for necessary action.
3. Local Health Authority designated by Health Department under the prevention of food Adulteration act should monitor the level of pesticides and heavy metals in food.
4. Medical colleges/institutions should set up a cancer registry in the state for monitoring the trend of cancer cases and should also enhance provision of screening, diagnosis and treatment facilities for cancer cases.
5. Health Department should start a Non-Communicable Diseases Control Programme focused on behavior change communication so as to change the harmful life styles, i.e. tobacco, alcohol, and other substance abuse.
6. A comprehensive study of the status of environmental health in other cotton growing areas of Punjab should be conducted for which a scheme may be prepared in consultation with Punjab Pollution Control Board and forwarded to Ministry to Environment and Forest for the sanction of founds.