A report by Swachh Bharat Mission says that 74.5 per cent of public places are equipped with toilets. Another report by the Ministry of Jal Shakti states that there are 2.23 lakh Community Sanitary Complexes built across all States and UTs under the Swachh Bharat Mission (SBM) since October 2014. Over 92 lakh toilets have been constructed since the launch of SBM Gramin (SBM (G)) in April 2020.

While toilets are there, are they accessible? This is the question one should ask. The National Family Health Survey (NFHS) focuses on 131 health indicators, but not until the NFHS 5 survey did they include the question of accessibility of toilets in the survey. This happened after the inputs from the Department of Drinking Water and Sanitation (DDWS) and the Ministry of Health & Family Welfare questioned the accessibility.

One might ask, why is the question of accessibility so important? The answer is quite simple. Access to water, sanitation and hygiene is the most basic human need and is also included under the Sustainable Development Goals by the UN.

Are These Numbers Real?

This thought crossed my mind because back in 2021, I went on a solo trip, on a bus to Udaipur from Delhi. There, the bus made two stoppages. This was done so people could get a quick dinner and freshen up, relieve themselves and be prepared for the rest of the journey. This was a nightmare. The bus only stopped for 10 minutes. While some men used the washroom, others went to the bushes.

For the women, there were three cubicles. One of them was broken, and the other one did not have a light bulb, which meant only one was usable. There was a long queue for that cubicle, and time was short. There was no point in trying to find an isolated corner, because it was past midnight, in an unknown area.

I waited anxiously. When finally, my turn came, I saw an overused, dirty washroom. The toilet seat is in a horrible condition. I wanted to touch nothing there. But I had to pee. So, I used my mask to cover my nose from the odour, folded my pants so they did not touch the floor and squatted. It was quite a task to balance.

On my way back to Delhi, I made sure to not drink any water for over a 13-hour bus journey. I dehydrated myself so I did not have to use the washroom. When I did reach, I was severely dehydrated and was sick for three days.

I shared my experience with my friends only to realise that many women have faced the same. There are no washrooms for women.

A friend of mine told me that it is because these roads and dhabas are mainly designed to serve men. They are the ones who travel at night or are on the roads most of the time. As a result, the few women who do travel or are on the road suffer.

Health Risks Women Are Prone To

Well, it is true, but partially. While holding your pee for too long can lead to health risks, peeing on a dirty toilet seat cannot lead to infections unless your urethra is in contact with the bacteria present on that toilet seat. However, nobody wants to sit on a dirty toilet seat, even if you do not get an infection. A safe and hygienic toilet is a basic need.

One of the regular saleswomen, Usha, who visits my house shared her experience with me. “Being on the road constantly means I must use the dirty public washrooms. But I do not want to use them. So, sometimes I ask my regular customers to let me use their washrooms. Some say yes, and some say no. I understand they are also concerned about their safety and privacy,” she says. As a result, Usha spends most of her day not drinking enough water and holding her pee when she is at work. Due to this, she also suffered from a Urinary Tract Infection (UTI).

Her friend, Halima too faced similar problems and due to increased levels of uric acid in her body, she suffered from Hyperuricemia.

Other health risks are kidney stones and other kidney problems, headaches, dull skin, xerostomia or dry mouth, fatigue, and urinary incontinence, which means losing control over your pelvic floor muscles leading to uncontrolled leakage of urine, seizures and weakness.

What Can You Do?

Wear comfortable clothes and capris. Capri pants are comfortable and are short in length, which means this won’t touch the toilet floor when you squat or sit.

Carry Essentials

Even though you cannot get a UTI alone from sitting on a toilet seat, it is always safe to carry a toilet seat sanitiser. If nothing, it can help you get rid of the bad odour so you can use your stand and pee device inside the toilet. You can also use disposable toilet seat covers if your knees are weak, and you cannot squat. Always flush with your seat down.

Always keep disposable gloves, a portable bidet (fill it with water before use), a pocket liquid handwash, wet wipes, tissues and sanitiser handy. Do not forget to keep extra sanitary pads. It might sound a lot, but I promise that it all fits in one pouch. Use this travel-friendly pouch every time you are on the road, or using a public washroom.

What Can We Learn From Others?

However, in case we do not get these technologically advanced toilets here, you can always pack a travel-friendly toilet kit!

The World Health Organization (WHO)'s Montreal meeting focused on wearable technology like smartwatches and activity trackers as a reliable source of health tracking. The meeting discussed that wearables could in fact generate objective real-time data, which helps governments design targeted and evidence-based health interventions.

Physicians in the Montreal meetings discussed that wrist-worn devices are more reliable than traditional self-reported surveys. This is because the self-reported surveys could underestimate the levels of physical inactivity.

“Metrics such as step count, moderate-to-vigorous physical activity and sedentary time directly correlate with cardiovascular disease, diabetes and mental health outcomes. Having population-level data allows for early and preventive strategies,” said Dr Venkat Nani Kumar, consultant in internal medicine.

WHO Montreal Meeting: How Have Doctors Reacted The Shift To Wearables?

Doctors in India have welcomed this shift to wearable devices as a better way to generate data and make policies. Dr Kiran Madhala, professor at Gandhi Medical College, Secunderabad, said WHO’s shift reflects rapid advances in artificial intelligence and digital health tools, calling it a progressive step towards improved monitoring of physical activity worldwide.

City-based doctors also underlined the need for inclusive validation of devices. “Wearables must recognise varied movement patterns and step equivalents, especially in ageing populations,” a physician said, while stressing the importance of data privacy and ethical use of health information.

WHO Montreal Meeting: What Are Wearable Health Devices?

As per a 2022 study published in JMIR MHealth and UHealth, wearables refer to devices that are worn by individuals. In health care field, they assist with individual monitoring and diagnosis. Wearables are “seamlessly embedded portable computers...worn on the body," notes another 2018 study published in Telematics Informatics.

A 2018 study published in the journal Sensors noted that wearable health devices are increasingly helping people to better monitor their health status both at an activity/fitness level for self health tracking and at a medical level providing more data to clinicians with a potential for earlier diagnostic and guidance of treatment.

WHO Montreal Meeting: What Are Some Examples Of Wearables?

Blood Pressure Monitor

This is a blood pressure monitor that consists of a cuff that is placed in upper arm with a digital display that provides real time reading of systolic and diastolic blood pressure.

Glucose Monitoring Device

This device estimates your glucose levels in every few minutes. It can be worn in upper arm, with a phone sensor connected to measure readings. It also includes real time glucose alarms to make informed decisions.

Wearable ECG Monitor

ECG patches are interconnected with smartphones, where one can see their readings. They not only measure electrocardiograms, but also detect any abnormalities.

Fitness Tracker

Smartwatches or fitbits that could be worn on your wrist. They help track real time data of your health, steps, heart rate, calorie consumptions, and even sleep patterns. It can also help keep track of oxygen levels.

Integrated Activewear

These activewears come with microscopic sensors to safeguard wearer's body or assist them in reaching their fitness objective.

Atrial fibrillation (AFib) is an irregular and often very rapid heart rhythm, also called an arrhythmia and can create blood clots in the heart, which can increase your risk of having a stroke by five times.

When a person has AFib, the normal beating in the upper chambers of the heart (the two atria) is irregular and blood doesn't flow as well as it should from the atria to the lower chambers of the heart (the two ventricles).

In this case, the risk of developing blood clots in your heart increases, which can not only cause a heart attack but also damage vital organs such as your brain. An AFib may happen in brief episodes, or it may be a permanent condition.

Common symptoms include palpitations (the feeling that your heart is racing, pounding, fluttering or like you have missed heartbeats), chest pain, finding it harder to exercise, tiredness, shortness of breath, dizziness or feeling faint.

READ MORE: You Can Stop A Heart Attack With This Medicine, Cardiologist Reveals Heart Attack 101

The death rate from AFib as the primary or a contributing cause of death has been rising for more than two decades.

Over 454,000 people with AFib are hospitalized in the US each year, out of which 158,000 die of the cause. It is estimated that 12.1 million people in the US will have AFib in the US will have AFib by 2050.

Who Is At Risk Of Having AFib?

• Advancing age.
• High blood pressure.
• Obesity.
• European ancestry.
• Diabetes.
• Heart failure.
• Ischemic heart disease.
• Hyperthyroidism.
• Chronic kidney disease.
• Moderate to heavy alcohol use.
• Smoking.
• Enlargement of the chambers on the left side of the heart.

Treatment for AFib includes medications to control the heart's rhythm and rate, therapy to shock the heart back to a regular rhythm and procedures to block faulty heart signals.

A person with atrial fibrillation also may have a related heart rhythm disorder called atrial flutter. The treatments for AFib and atrial flutter are similar.

How To Improve Your Heart Health

Experts recommend following the below to reduce yor risk of stroke or developing AFib and maintaining heart health:

• Don't smoke or use tobacco.
• Aim for at least 150 minutes of moderate physical activity or 75 minutes of vigorous physical activity (or an equal combination of both) each week. Eat a heart-healthy diet.
• Stay at a healthy weight.
• Get quality sleep.
• Manage stress levels
• Get regular health screening tests.
• Eat a fiber, nuts and fish-rich diet
• Limit salt intake
• Reduce saturated fat intake

Changes in your voice, whether in tone, volume, speed or overall quality, can act as early warning signs for a wide range of medical conditions, experts say.

Your voice is produced by the coordinated effort of your respiratory system, vocal cords (also called vocal folds), and the resonating chambers of your throat, mouth, and nose. Even subtle shifts in hormone levels, hydration status or tissue health can noticeably affect how you sound.

Recent research shows that subtle changes in speech, for example, slurring or vocal cord tremors, may be signs of disease or illness like Parkinson’s disease, depression, cardiac and mental health problems, as speech requires coordination with the brain, muscles and respiratory system.

Which Conditions Can You Identify By A Change In Voice?

• Diabetes: High-pitched, raspy voices or vocal strain can be linked to diabetes, with AI studies showing up to 75% accuracy in prediction.
• Cardiovascular Disease: Voice analysis can detect high, fluttering voices associated with coronary artery disease, caused by stress or fluid changes in the vocal cords.
• Hypothyroidism: A deeper, softer, or huskier voice can indicate thyroid dysfunction.
• Respiratory Illnesses: Conditions like COVID-19 or COPD are often associated with a breathy voice, coughing, and short, interrupted sentences.
• Throat Cancer: Persistent hoarseness and raspy voice, especially lasting more than 2-3 weeks, can indicate laryngeal cancer.
• Parkinson’s Disease: Identified by a monotone voice, reduced volume, increased breathiness, and vocal cord tremors.
• Alzheimer’s Disease/Dementia: Characterized by slower speech rates, hesitation, frequent pauses, and simplified vocabulary/sentence structure.
• Stroke or Brain Injury: Indicated by slurred speech or difficulty finding words (global aphasia).
• Cerebellar Disorders (caused by damage to the nerves in the brain's cerebellum): Manifest as loud, staccato speech (bursts of broken sounds).
• Depression: Linked to a flatter, softer, and more monotone voice with a reduced pitch range.
• Anxiety/Stress: Often presents as a higher-pitched, faster, and more tremulous voice.
• Schizophrenia: Indicated by monotone, disorganized speech.

What Else Can Affect Your Voice?

Apart from serious medical conditions, voice changes may also be linked to aging and lifestyle factors. Fluctuations in testosterone, estrogen, progesterone, and thyroid hormone levels may also influence the structure and function of the vocal cords.

Dehydration is one of the most common causes of voice problems, as cords need adequate moisture to vibrate efficiently. Aim for at least 64 ounces of water daily, and more if you use your voice professionally or live in a dry climate.

Smoking irritates and inflames the vocal cords, causing chronic hoarseness and increasing the risk of vocal cord cancer. Even secondhand smoke and vaping can affect voice quality.

Diet also plays a role in vocal health. Caffeine and alcohol are diuretics that can dehydrate your vocal cords. Spicy foods and acidic beverages may trigger reflux, irritating the throat.

Dairy products can increase mucus production in some people, affecting voice clarity. Voice overuse or misuse, common in teachers, singers, and public speakers, can lead to vocal fatigue and damage. The following table compares how different lifestyle factors impact your voice.

How Can You Take Care Of Your Voice?

Whether the cause is hormonal changes, medical conditions, aging, or lifestyle factors, most voice problems can be improved with proper diagnosis and treatment. Here are some things you can do to take care:

• Stay hydrated by drinking water throughout the day and using a humidifier in dry environments
• Warm up your voice before extended speaking or singing with gentle humming or lip trills
• Avoid shouting or whispering, both of which strain the vocal cords
• Take voice breaks during prolonged speaking to prevent fatigue
• Manage stress through relaxation techniques, as tension affects voice quality
• Treat allergies and sinus problems promptly to reduce postnasal drip
• Maintain good posture to support optimal breathing and voice production