EFFECT OF E-WASTE ON
ENVIRONMENT AND HEALTH
Shruti Jose
Campus Law Centre, University of Delhi
Introduction
What is E-waste?
The
discarded and end-of-life electronic consumer products ranging from computers,
equipment used in Information and Communication Technology (ICT) , home
appliances, audio and video products and all of their peripherals are popularly
known as Electronic-Waste popularly abbreviated as E-waste . There, is however,
no standard definition of e-waste in any part of the world leaving it to be
interpreted differently in different countries.Also there is a lack of
consensus as to whether the term should apply to resale, reuse, and
refurbishing industries, or only to product that cannot be used for its
intended purpose. In most cases e-waste
comprises of the relatively expensive and essentially durable products used for
data processing, telecommunications or entertainment in private households and
business.
Globally, WEEE/ E-waste are most commonly used
terms for electronic waste. There isno standard definition of WEEE/ E-waste. A
number of countries have come out withtheir own definitions, interpretations
and usage of the term “E-waste/WEEE”. The mostwidely accepted detailed definition
of WEEE/ E-waste is as per an EU directive and The Basel Convention of the UN,
and this isfollowed in member countries of European Union and other countries
of Europe and Asia including India.
At first
WEEE/ E-waste definition has been described as per EU directive and Basel
Convention.
Definition as per European Union and Basel Convention
This section describes WEEE/E-waste definition
in European Union followed by WEEE/ E-waste references in Basel Convention.
European Union
Definition as per EU directive with status of
its transposition and variation in major EU countries is described in table 2.1
followed by E-waste’s reference in Basel Convention.
WEEE Directive (EU, 2002a)
“Electrical or electronic equipment which is
waste including all components, subassemblies and consumables, which are part
of the product at the time of discarding.”
Directive 75/442/EEC, Article 1(a) defines
“waste” as “any substance or object which the holder disposes of or is required
to dispose of pursuant to the provisions of national law in force.”
(a) ‘electrical and electronic equipment’ or ‘EEE’ means equipment which
is dependent on electrical currents or electromagnetic fields in order to work
properly and equipment for the generation, transfer and measurement of such
current and fields falling under the categories set out in Annex IA to
Directive 2002/96/EC (WEEE) and designed for use with a voltage rating not
exceeding 1000 volts for alternating current and 1500 volts for direct current
Annex
IA
Categories
of electrical and electronic equipment covered by this Directive
1.
Large household appliances
2. Small household appliances
3.IT
and telecommunications equipment 4.Consumer
equipment
5. Lighting equipment 6.
Electrical and electronic tools (with the exception of large-scale stationary
industrial tools) 7.Toys, leisure and sports equipment 8.Medical
devices (with the exception of all implanted and infected products) 9. Monitoring
and control instruments 10.
Automatic dispensers
Annex
IB
List
of products, which fall under the categories of Annex IA are given below.
1.
Large household appliances
• Large cooling appliances •
Refrigerators
• Freezers
• Other large appliances used for refrigeration, conservation and
storage of food
•
Washing machines
• Clothes dryers
•
Dish washing machines
• Cooking
•
Electric hot plates
• Microwaves •
Other large appliances used for cooking and other processing of food • Electric heating appliances
• Electric radiators
•
Other fanning, exhaust ventilation and conditioning equipment
2. Small household appliances
•
Vacuum cleaners
• Carpet sweepers
•
Other appliances for cleaning
• Appliances used for sewing, knitting, weaving and other processing for
textiles •
Iron and other appliances for ironing, mangling and other care of clothing •
Toasters
•
Fryers
• Grinders, coffee machines and equipment for opening or sealing
containers or packages
• Electric knives
• Appliances for hair-cutting, hair drying, tooth brushing, shaving,
massage and other body care appliances
• Clocks, watches and equipment for the purpose of measuring indicating or
registering time Scales.
3.
IT and telecommunications equipment
•
Centralized data processing
• Mainframes •
Minicomputers
•
Printer units
• Personal computing: •
Personal computers (CPU, mouse, screen and keyboard included)
• Laptop computer (CPU, mouse, screen and keyboard included)• Notebook
computers
• Notepad computers
•
Printers
• Copying equipment
•
Electrical and electronic typewriters
• Pocket and desk
calculators
• And other products and equipment for the collection, storage,
processing, presentation orcommunication of information by electronic
means
• User terminals and systems
• Facsimile
• Telex
•
Telephones
• Pay telephones •
Cordless telephones
• Cellular telephones
• Answering systems
•
And other products or equipment of transmitting sound, images or other information
by telecommunications
4.
Consumer equipment
•
Radio sets
•
Television sets
• Video cameras
• Video recorders
•
Hi-fi recorders
• Audio amplifiers •
Musical instruments
• Other products or
equipment for the purpose of recording or reproducing sound or image, including
signals or other technologies for the distribution of sound and image than by
telecommunications
5.
Lighting equipment
• Luminaries for fluorescent lamps
with the exception of luminaries in households
• Straight fluorescent lamps
• Compact fluorescent lamps
•
High intensity discharge lamps, including pressure sodium lamps and metal
lamps •
Low pressure sodium lamps •
other lighting or equipment for the purpose of spreading or controlling light
with the exception of filament bulbs
6. Electrical and electronic tools (with the exception of
large-scale stationary industrial
Tools)
•
Drills
• Saws •
Sewing machines
•
Equipment for turning, milling, sanding, grinding, sawing, cutting, shearing,
drilling, making, holes, punching, folding, bending or similar processing of wood,
metal and other materials
•
Tools for riveting, nailing or screwing or removing rivets, nails, screws or
similar uses • Tools for
welding, soldering or similar use
• Equipment for spraying, spreading, dispersing or other treatment of
liquid or gaseous substances by other means •
Tools for mowing or other gardening activities
7. Toys, leisure and sports equipment
•
Electric trains or car racing sets •
Hand-held video game consoles
• Video games •
Computers for biking, diving, running, rowing, etc.
• Sports equipment with electric or electronic components
• Coin slot machines
8. Medical devices (with the exception of all implanted and
infected products)
•
Radiotherapy equipment
•
Cardiology
• Dialysis• Pulmonary ventilators
•
Nuclear medicine
• Laboratory equipment for in-vitro diagnosis
•
Analysers
• Freezers
•
Fertilization tests
• Other appliances
for detecting, preventing, monitoring, treating, alleviating illness, injury or
disability
9. Monitoring and control instruments
•
Smoke detector
•
Heating regulators
• Thermostats •
Measuring, weighing or adjusting appliances for household or as laboratory
equipment • Other monitoring
and control instruments used in industrial installations (e.g. in control
panels)
10. Automatic dispensers
• Automatic dispensers for hot
drinks
• Automatic dispensers for hot or cold bottles or cans
• Automatic dispensers for solid products
•
Automatic dispensers for money
• All
appliances which deliver automatically all kind of products
EFFECTS OF E-WASTE ON HEALTH AND ENVIRONMENT
95 % of electronic waste that is generated is
recyclable. But in India we do not have enough e-waste disposal centres and
facilities which results in a large part of e-waste ending up in illegal and
unregulated recycling centre. Also unregulated recycling can cause more harm to
the environment than landfilling. In these illegal e-waste disposal centres the
waste is “recycled,” or destroyed and stripped of its valuable metals. Though
this seems like a good idea which seems economically beneficial it is actually
an extremely hazardous practise, because components are being repurposed ,these
unregulated recycling centres burn or dissolve the plastic components to
release the precious metals: a process that releases environmental contaminants
into the air, land, and water that would otherwise remain trapped and inert in
landfills.
In India, most E-waste ends in the informal or
the unorganized sector. In city by lanes and smaller towns, a large number of poor
people, including women and small children, break open these gadgets, to recover valuable parts and
materials. With no protective equipment and poor working conditions, these
workers are exposed to a cocktail of toxic chemicals and suffer physical
injuries, chronic ailments like asthma, skin and eye diseases and many other
life threatening diseases.
Environmentally unsafe recycling practices also result in discharges and
emissions that contaminate air, water and soil. They pollute our environment
and health and are an issue of concern for every citizen in this country.
The
most common type of electronic waste are cathode ray monitors which make up about 45 % of the waste stream, but there is evidence
that this is changing. We are increasingly seeing LCD products and other
advanced, technologies in the waste stream.
However, more advanced technologies tend to have
new, advanced substances in them that are relatively unstudied. Platinum group
metals, for example, are found in I-phones and other modern hand-held devices,
but little or nothing is known about their potential impact on health and the
environment except that they are getting into everything. Traces of platinum
group metals, for example, have been detected in water, soil, and even snails
around recycling centres in India.
Still, it is difficult to determine how the
amount of e-waste will change in future years. There is currently a trend of
miniaturization in the electronics industry: cell phones, cameras, and laptops
are generally getting smaller. Also, computing is becoming more centralized.
Cloud computing, or linking electronics into a centralized, stream-lined
infrastructure, could lead to smaller amounts of e-waste as it requires less
large-scale servers and other computing infrastructure components. Also, some
new electronics are more recyclable and less hazardous, such as LCDs which
contain much smaller quantities of hazardous materials such as PCB’s
(Polychlorinated Biphenyls).
However, electronic lifetimes are getting
shorter as companies scramble to lower prices and increase profits. The average
laptop is engineered to be obsolete and non-functional after a time span of 2
to 3 years. Also, in today’s technology driven world appliances and vehicles
are becoming increasingly electronic. Many modern refrigerators and washing
machines contain electronic components. This will also contribute to the e-waste
stream, as appliances are not generally considered in calculations of e-waste
quantities.
On an average an individual piece of electronic
waste of 43.7% of metal, 23.3% of plastic, 15% of glass, and 17.3 % of electronics. The basic
valuable components that can be found in it are copper, gold, and platinum
group metals. The most abundant among these three is copper.
Printed circuit boards contain these precious
metals in concentrations 10 times higher than what can be achieved through
commercial mining, making it a relatively practical and economically beneficial
source for these substances. To extract them, the plastics and other
non-valuable components are either burned away or dissolved in acid. Both of
these primitive methods release toxins into the environment, many of which would
not have been released directly into the ecosystem had the electronic item
decayed slowly in a landfill (Robinson 2009).
There are a number of metals and non-metals that
can be found in the electronic waste
whichare known to be hazardous to the environment. These include Lead(Pb),
Antimony (Sb), Mercury (Hg), Cadmium (Cd), Nickel (Ni), Polybrominateddiphenyl
esters (PBDEs), and polychlorinated biphenyls (PCBs). When burned or dissolved
in acid, this kind of waste releases dioxins, furans, polycyclic aromatic
hydrocarbons (PAHs), polyhalogenated aromatic hydrocarbons (PHAHs), and
hydrogen chloride (Robinson 2009)
Recycling workers employed in illegal and
unregulated electronic waste disposal centres toil diligently to extrapolate
the various valuable elements of electronic wastes. The workers burn circuit
boards to strip off computer chips and transistors, inhaling lead, mercury and
cadmium, which causes a burning sensation in their eyes. They burn microchips
to recover copper. They dip circuit boards and electric cables into large tubs
of acid in order to extract gold. The acid is a mixture of pure nitric acid and
hydrochloric acid, and it strips the gold out of the plastic cables. When the
acid is depleted the workers often dump it in a hole, pour it into streams or
open sewers which then enters with the natural water supply thereby
contaminating it.
Plastics can be cut, washed, dried, and then
crushed into a powder and melted into long tubes that can be sold to factories
if they are properly sorted by type and colour but the workers employed in
illegal electronic waste disposal centres do not have the requisite knowledge
nor technology to do so and are not able to distinguish between ABS, PVC, PC,
PS, PPO, PP, POM, and MMA plastics, instead they use a “burn and sniff” test .
PVC coated wires are also often burned to a powdery ash to expose the copper
within. The PVC powder is then discarded. Burning plastics releases fumes of
PVCs and PAHs (polycyclic aromatic hydrocarbons). Condensation and
precipitation brings these fumes from the global air stream into local water
supplies thereby contaminating it.
Ink cartridges are taken apart manually and
workers use small brushes to sweep out the ink and toner, inhaling clouds of
chemical vapour and carbon black particles which settles in their lungs and
causes difficulty in breathing and respiration activities
A detailed description of the harmful side
effects of being exposed to theses toxic chemicals and substances described in
the above paragraphs are given as follows:
Lead
Lead is known to be extremely hazardous to
humans and animals, and has detrimental effects on reproduction. Though lead is
not known to have serious effects on the environment itself, it can accumulate
in soil and water and, in that way, be transmitted to humans and other
organisms. It can also be spread through biomagnification (Sepúlveda, 2010).
Antimony Antimony
has toxic properties similar to that of arsenic. It is a component of
polyethylene terephthalate (PET), a common type of plastic. Though it is safe
for relatively short periods of time, it can eventually leech into water. This
leeching occurs more quickly in more acidic environments, so if this plastic is
dissolved with acid, as is a common practice in third world recycling centres,
antimony can easily enter the environment, causing serious illness and death in
humans and other animals.
Mercury
Mercury is found in many batteries and
electronic devices, and is known to have serious health effects. As is well
known, mercury can accumulate in the bodies of fish, and thereby be spread to
all organisms that consume them, including humans. In addition, it has been
observed that, in warm climates, the oxidation of mercury in the environment
can be accelerated, leading to the creation of oxidized Hg atoms that are known
to be associated with ozone depletion.
Cadmium Cadmium
is another element that has been shown to have serious health effects. It is
contained in many electronics, and can accumulate in soil, vegetation, and
molluscs. Cadmium is present naturally in many vegetables and molluscs, but
high concentrations due to contamination are very dangerous.
Nickel
Nickel
can have extremely detrimental effects on plant growth if it exists in high
levels in soil. This toxicity increases with changes in soil Ph. However, there
was fairly wide variation in toxicity between different types of soils, so more
research is needed to assess the exact environmental effects and properties of
nickel contamination. There is evidence that high levels of nickel can change
the entire chemical composition of plant species.
Furans (polychlorinated
dibenzo-furans, (PCDFs))
Not enough is known about the precise chemicals
of furans to determine its exact environmental effects. However, studies show
that it has dangerous potential for the environment in that it can promote the
creation of aerosols and contribute to smog pollution. It could also be
dangerous because of its ability to interact chemically with chlorine, which is
often found in high concentrations on coastlines due to industrial emissions.
Furans can be carried long distances through the atmosphere, and generally
accumulate at the poles. However, little is known about their effects on the
environment or on global warming.
Polycyclic aromatic
hydrocarbons (PAHs) and Polyhalogenated aromatic hydrocarbons (PHAHs) PAHs
and PHAHs are released when e-waste is burned. These substances are lipophylic,
and therefore accumulate in the food-chain. They have been shown to have
serious health effects, including genetic damage and have been detected in
foods. More research is needed to assess the impact of these substances on the
environment.
Hydrogen Chloride
Hydrogen
chloride is known to be toxic to humans. However, it can also have serious
environmental effects. It dissociates in water and soil, and can cause the Ph
of both to become more acidic, damaging crops and entire ecosystems. It does
not, however, accumulate in plants or animals.
Environmental
effects:
PBDEs,
PCBs, and PCDD/Fs do not exist naturally in the environment. Unusually high
concentrations of all of these substances can be found in processing centres in
developing countries as well as in the farm lands, organisms, and water in the
areas surrounding them. Polybrominateddephenyl esters (PBDEs), which are used
as flame retardants, are mixed into plastic components. If the plastic is left
to degrade in a landfill, PBDEs will not be released into the environment (at
least not for hundreds or thousands of years). However, when plastics containing
PBDEs are burned these harmful substances are released into the environment.
Because they are lipophilic, (meaning they stick to lipids, or animal fats)
they can accumulate in organisms, both plants and animals, and be spread
throughout the food chain in a process called biomagnification. They have been
shown to interfere with the immune, endocrine, and reproductive systems of all
types of animals. Though these effects have never been directly observed in
humans, there is likely to be an effect. Dioxins, primarily Polychlorinated
dibenzo-p-dioxins, are released into the environment when plastic wires are
burned to recover copper. The effects they produce are similar to those of
PBDEs. They are not found in water, as they are hydrophobic, but they have been
detected in certain aquatic plants. Though no effect has been observed on the
health or growth of the plant itself, these plants are consumed by fish and
mammals, who are very sensitive to dioxins. Also, it is possible that the
effects of dioxins take a long time to be expressed, and it is simply to early
to tell what effect they might have. In addition, dioxins can travel long
distances because they are able to bind to aerosols: small particles of matter
in the air. This means that they can easily be carried outside the range of
recycling centres, and through ingestion and subsequent biomagnification,
affect ecosystems and food chains far from the actual site of contamination.
Dioxins can also accumulate in sediment or on the surface of bodies of water. Accumulation
represents a kind of sequestration, but it is possible that these captured
molecules could damage the ecosystem. Similarly, dioxins in the soil tend to
remain non-volatile, but factors such as erosion and changes in soil
characteristics could make them become active again. More research is needed to
define their potential impact on ecosystems. Very few studies assess the impact
of dioxins on plant life or soil. Polychlorinated biphenyls (PCBs) are used as
coolants and insulators for transformers and capacitors.
Platinum
Group Metals
These
metals have become common in electronics relatively recently due to their high
stability and chemical resistance. However, these elements are known to
accumulate in the environment. PGMs initially accumulate in particulate matter
on the ground, in the air, and in water, and from there get incorporated into
organisms. They seem to accumulate in the highest levels in water and in
vegetation. More research is needed to determine what effect this accumulation
can have on the environment.
Studies have shown that Mumbai and Delhi top the
list in e-waste generation. Delhi generates over 12,000 tonnes annually while
Mumbai produces around 19,000 tonnes. Kolkata and Chennai are catching up with
about 9,000 and 10,000 tonnes. Waste from other cities often lands up in Delhi,
the traditional hub of recycling with connections to towns nearby.
The
reason why this is not to be taken lightly is because it affects each and every
individual living in this country directly or indirectly.Compromised immune
systems along with heavy metal poisoning as a result of the rampant and
uncontrolled recycling process results in hazardous chemicals entering our
ecosystem thereby entering our food cycles which directly impact us. Also the
concentration of hazardous chemicals and substances is found to be way above
the normal permissible limit in soil, air and water thereby endangering us and
the environment we live in. These
problems related toenvironmental contamination result in health and economic
problems for our country. These hazardous materials, when disposed of
improperly, end up in water supplies, or burned, creating an inevitable
consumption that harms those who are unfortunate to live in proximity to these
conditions. The black-market e-waste disposal centres extract the valuable
materials from the dismantled computers and gadgets, and then proceed to burn
the unknown hazardous substances which endanger the life of many innocent inhabitants who do not
participate in these kinds of illegal practices. Black-market labour employed
to extract these substances are the ones who are left to suffer for the
inhumanity of those who drive them to utilize E-waste to the detriment of their
own health. This is only a recent problem, like stated above, because the
development of these specific types of items only dates back to about 40 years,
with each year demonstrating the exponentially conducive advancement of
technological production.
HEALTH AND OTHER SCHEMES UNDER WHICH THE
EFFECTED PERSONS ARE COVERED
Protecting the worker
Even though the recycling operation is covered
under various labour and industrial laws in India, almost none of them are implemented
in the ‘informal’ sector. Applicable laws include the Factories Act, which lays
down stringent requirements for industrial operations including some concerning
health and safety conditions as well as working hours. There are requirements
of worker compensation and medical insurance under the Employees State Insurance
(ESI) Act. The ESI Act also covers areas such as maternity benefits and hospital
care. The Provident Fund Act and The Workmen’s Compensation Act provides for a
savings to protect against old age and joblessness. There are also threshold
limit values (TLVs) set for the concentration of chemicals in the air for
worker exposure. Many of the small-scale enterprises recycling e wastes are
illegal or semi-legal, andbecause of this, checks are difficult. In order to
implement laws, information on the dangers in the workplace needs to be disseminated
and labour unions must deal with issues of worker safety adequately. Finally a
significant number of workers are children. Many policy-makers understand child
labour as a consequence of poverty, and do not take initiatives to curb it. For
a manufacturer, however, a child is nothing but a mere source of cheap labour.
Awareness about the damage caused to the
environment and health because of the hazardous substances found in e-waste
came into the picture following the Bhopal Gas Tragedy. The leakage of methyl
isocyanite from the Union Carbide plant in Bhopal left thousands dead, and many
more injured in different stages of injury, disease and disability. In 1987,
The Factories Act 1948 was amended to make special provisions in regard to hazardous
processes. Information regarding dangers, including health hazards and the
measures to overcome such hazards arising out of the handling of the materials
or substances in the manufacture , transportation, storage and other processes
is to be shared with the workers employed in the factory, the Chief inspector
of factories, the local Authorities and the general public in the vicinity. The
occupier of factory is to lay down a policy with respect to the health and
safety of the workers employed in the factory, and an on-site emergency plan in
place before launching out an activity involving hazardous processes. Measures
for handling usage, transportation and storage of hazardous substances inside
the factory premises, and the disposal of such substances outside the factory
premises, are to be laid down and publicised among the workers and the public
living in the vicinity.
There is a responsibility on the occupier of the
factory to maintain health records, or medical records of the workers in the
factory who are exposed to any chemical, toxic or other harmful substances
which are manufactured, stored, handled or transported, and such records are to
be accessible to the workers. There is a provision for a Safety Committee in
which both the managers and workers have equal representation so as to provide
an effective platform for their complaints to be addressed about the imminent
dangers to their life and health.
It is only due to The Bhopal Gas Tragedy that
gave the workers a clear idea of the risks and imminent dangers involved in
their line of duty and to be informed of the steps to be undertaken in the case
of a tragedy. The Bhopal Gas Tragedy almost brought this issue into the main
picture that people unconnected with the factory but who live in its vicinity
may also become victims of the disaster. Persons in the neighbouring vicinity
were for the first time included in the law. These persons are now among the
categories of persons who are to be forewarned of what they should do when such
a hazard arises.
The Public Liability (Insurance) Act(PLIA) 1991,
also a fallout of the Bhopal Gas Tragedy was enacted to provide ‘immediate
relief to the persons affected by the accident while handling any hazardous
substances. The PLIA excludes workmen from it’s purview on the basis of the
reasoning that while workmen and employees handling hazardous substances are
protected under separate laws, members of the public are assure of any relief
except through long legal process.
The PLIA makes it mandatory for persons handling,
or controlling hazardous substances to take one or more insurance policies by
which he is insured against the liability to provide relief to the affected
persons on the principle of ‘no fault’. That is, the affected person does not
have to establish that the accident occurred owing due to the fault or
negligence of the person owning or controlling the hazardous substances, this
is a departure from the traditional principle of fault liability which fixes
liability only where fault is proved. The statement of object and reason,
refers to the reluctance of industry to pay victims of accidents.Iteven goes on
to say that some units may not have adequate financial resources to even pay
for the minimum relief.
The unwillingness of the insurance industry to
take on unlimited liability under these policies led to the PLIA being amended
in 1992. Through this amendment liability of the insurance companies was
limited to the extent that was specified in each insurance policy. An insurance
policy taken out by the owner was not to be for an amount less than the amount
of the paid-up capital of the undertaking handling any hazardous owned or
controlled by that owners and mot more than fifty crore rupees. The rules under
the newly amended PLIA provide that the maximum aggregate liability of that
insurer shall not exceed five crore rupees in claims arising out of an
accident. In case there are claims arising out of more than one accident during
the currency of the policy, or one year, whichever is less, the liability of the
insurer is not to exceed , in the aggregate, fifteen crore rupees in the
aggregate.
The 1992 Amendment introduced the Environment
Relief Fund(ERF) into which owners were to deposit an amount equal to the
premium paid to the insurer. With that the PLIA, designed a three-layered
interim compensation scheme.
The National Environment Tribunal Act was
enacted in 1995 to deal with claims arising out of industrial disaster. The
tribunal deals with claims arising out of accidents including matter of interim
compensation.
In the case of environmental pollution the court
has adopted the polluter pays principle and insisted on the polluters paying
the compensation using their own resources in remedying the degradation for
which their industrial units are responsible. While the ‘polluter pays’
principle is premised on the offender having to go ‘deep pocket’, that is the
loss is not shared by a community of potential offenders. The court has also
cautioned that industries dealing with hazardous chemicals are the main culprits
in the matter of polluting the environment so there is every need for
scrutinising their establishment and functioning more rigorously.
REFERENCES
1.
Compensation
and Insurance by Dr. Usha Ramanathan published in S. Parasuramanad P.V.
Unnikrishaned’s India Disasters Report:
Towards a Policy Initiative ( International Environmental Law Research
Centre)
2.
Electronic
Waste And India : Dr. S. Chatterjee ( Department of Information Technology) ; sandit@mit.gov.in
4.
Environmentally
Sound Options for E-Waste management by Ramachandra T.V. and Saira Varghese K.
published by Envis Journal Of Human Settlements, 2004
5.
E-Waste
Management : As a challenge to Public Health in India
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