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!

A cigarette after stress. Chewing tobacco during the day. Smoking to “calm the nerves”

But modern science is forcing us to confront the difficult truth; Tobacco does not treat mental health symptoms, in fact it quietly deepens it.

As Oncologists and physicians, we often see patients who say, “smoking makes them feel normal.” However, in reality, what they are experiencing is nothing more than the temporary relief from nicotine withdrawal not genuine emotional regulation.

Nicotine Creates A Cycle of Temporary Relief And Dependence

When we smoke or chew tobacco, nicotine stimulates dopamine release in the brain, creating a short-lived sense of relaxation or control. But overtime it leads to brain depending on nicotine to achieve the same baseline feeling again and again. The result is a vicious cycle of dependence, irritability, anxiety, and worsening emotional resilience.

Several large studies now show that long-term tobacco use is associated with higher rates of anxiety, depression, sleep issues and substance dependence. A 2023 review published in BMJ found that smoking cessation will result in improvements in both anxiety and depression and an improved mood with benefits comparable to antidepressant treatment in some individuals.

Also read: Lung Health After 40: Natural Changes, Warning Signs And Ways To Protect Your Lungs

Tobacco May Worsen Anxiety, Depression And Sleep Problems

This has serious implications for the urban Indian population in regard to the increasing prevalence of mental exhaustion, lack of social support, digital overload, work-related stress and lack of sleep. Tobacco often enters quietly during vulnerable moments of college pressure, workplace stress, loneliness, grief and gradually shifts from “social habit” to psychological crutch.

Although they think they believe in tobacco, many of them use it, thinking that they are using it to cope with their emotional symptoms, when in fact they are making the symptoms worse.

Also, recognize the biology of tobacco use. For example, the use of nicotine will result in long-term changes in how well your body handles emotional stress because of the role of long-term nicotine exposure in altering the system of cortisol regulation and the stress response pathways in neurons. So, with time, it will become harder and harder for a person to control his/her emotional response to stress because his/her body will not be able to do it. Thus, tobacco has a negative influence on the recovery process from emotional responses to stress, rather than a beneficial one.

Also read: Air Pollution May Increase The Risk Of Painful Rheumatoid Arthritis Flares, Study Finds

How Nicotine Alters The Body’s Stress Response?

Tobacco is a significant preventable risk factor for oral, head and neck, lung, oesophageal, pancreatic and bladder cancers. When many patients arrive at cancer centres, the addiction to tobacco is already set, and it is even more difficult to quit while receiving cancer treatment.

This is why it is important to help move the conversation on tobacco beyond cancer. Now, it's more than just a public health issue; it also includes issues of mental health. Individuals experiencing emotional difficulties should not think that they are being judged. They have to learn to find alternative coping strategies, get psychological support early on in their lives, sleep well, exercise, be part of the community, and access timely medical support. The goal of this care is not just to support someone in quitting tobacco, but to provide support for them to stop needing tobacco in order to feel good.

By Dr Amit Chakraborty, Consultant Oncologist, Saifee Hospital, Mumbai

India is facing a growing burden of non-communicable diseases (NCDs), with hypertension and diabetes among the major health concerns.

Experts warned that the risk of both conditions rises after 40, often without noticeable symptoms. Increasing age, weight gain, reduced physical activity, stress, dietary habits, and metabolic changes can all contribute to the risk.

Having hypertension and diabetes together is particularly concerning, as their coexistence can increase the risk of heart disease, stroke, kidney damage, retinopathy, and other complications.

Why Risk Rises After 40?

Dr. Santosh Gupta, Associate Director - CTVS, Paras Health Udaipur, told HealthandMe that several factors contribute to the rising risk after 40.

“After the age of 40, the risk of hypertension and diabetes increases due to factors such as changes in metabolism, reduced physical activity, weight gain, stress and dietary habits. What makes both conditions particularly concerning is that they can develop silently, without noticeable symptoms, while gradually affecting vital organs,” he said.

He added that uncontrolled hypertension can damage the heart, brain, kidneys, and blood vessels, while diabetes can affect the kidneys, eyes, nerves, and cardiovascular system.

"When both conditions occur together, the risk of heart disease, stroke and kidney complications becomes even higher,” Dr. Gupta added.

Because both conditions can remain silent for years, people may have high blood pressure or blood sugar without knowing it.

Also read: Breastfeeding Can Help Reduce Mothers' Risk of Type 2 Diabetes, Breast Cancer and More

Hypertension And Diabetes Often Coexist

A recent hospital-based analysis found that hypertension and diabetes frequently occur together, with their coexistence rising sharply from around age 40 among Indians.

The study, conducted by the Department of Clinical Research and Preventive Health Program at Max Healthcare, analyzed health records of more than 56,000 adults who underwent preventive health check-ups between January 2021 and December 2024.

Nearly 5% of adults had both conditions. Their coexistence increased rapidly from around 40, continued rising until approximately 58 and gradually reached nearly 17% by around age 70.

People with diabetes were nearly four times more likely to have hypertension, while those with hypertension were about 2.5 times more likely to have diabetes.

Dr. Abhaya Indrayan, Biostatistics Consultant, Max Healthcare, said the findings support screening for both conditions rather than assessing them separately.

Why Screening After 40 Matters

Read More: Confused By Your Cholesterol Report? Here's What LDL And ApoB Really Mean

Experts said that preventive healthcare should go beyond checking for individual diseases. Adults over 40 should routinely assess key cardiometabolic risk factors, including blood pressure and blood sugar.

Screening can help detect hypertension, diabetes or prediabetes early, when lifestyle changes and treatment can help prevent or delay complications.

“This is why regular screening after 40 is important, even for individuals who feel completely healthy. A routine blood pressure check, fasting blood glucose or HbA1c test can help identify hypertension, diabetes or prediabetes at an early stage, when timely lifestyle changes and medical intervention can prevent or delay complications,” Dr. Gupta said.

“Screening should not be viewed only as a diagnostic exercise; it is an opportunity to understand one’s health risks and take corrective measures before the disease begins to cause irreversible organ damage,” he added.

How To Lower The Risk

Preventive care also involves addressing modifiable risk factors. Regular physical activity, maintaining a healthy weight, limiting salt, sugar and highly processed foods, getting adequate sleep and avoiding tobacco can help lower the long-term risk.

For those already diagnosed with hypertension or diabetes, regular monitoring and adherence to prescribed treatment are important to reduce the risk of complications.

With the risk of both conditions rising after 40, experts recommend making routine health checks part of regular healthcare—even when there are no obvious symptoms.

Amid the ongoing monsoon season, Delhi-NCR is seeing a rise in H1N1 influenza cases, with Delhi reporting 1,344 cases so far this season.

The figure is nearly six times higher than the 229 H1N1 cases recorded during the same period last year, The Times of India reported.

According to health officials, Delhi recorded around 4,000 influenza cases last year, most of them caused by H3N2. This year, H1N1 is the dominant strain. Both H1N1 and H3N2 are subtypes of Influenza A and spread mainly through respiratory droplets.

What Is H1N1 and Why Is Testing Important?

H1N1 is a subtype of Influenza A and can cause sudden fever, cough, sore throat, headache, body aches and fatigue. These symptoms can overlap with those of other seasonal influenza strains, COVID-19 and respiratory syncytial virus (RSV), making it difficult to identify the infection based on symptoms alone.

Dr Aijaz Ilmi, Senior Consultant – Metabolic Diseases, Pacific OneHealth Hospital, told HealthandMe that testing is particularly important when fever or respiratory symptoms persist or worsen, especially among older adults, young children, pregnant women and people with diabetes, obesity, heart or lung disease, or compromised immunity.

“With the current rise in H1N1 cases in Delhi, we are also seeing other seasonal respiratory infections, including Influenza A and B, COVID-19, RSV and other respiratory viruses. At the same time, the monsoon season brings an increased risk of mosquito-borne illnesses such as dengue.

“The key message is, don’t panic, but don’t dismiss a persistent fever as ‘just a viral’. Early recognition is particularly important in vulnerable individuals.”

H1N1 vs Other Respiratory Infections: How Are They Different?

H1N1 can be difficult to distinguish from other respiratory infections because many of them cause similar symptoms.

• H1N1 and other seasonal influenza strains: Both can cause sudden fever, cough, sore throat, headache, body aches and fatigue. Symptoms alone generally cannot determine whether the infection is H1N1 or another influenza strain.

• COVID-19: COVID-19 can cause fever, cough, sore throat, congestion and fatigue. Some people may also experience changes in or loss of taste or smell, while gastrointestinal symptoms can occur.
• RSV: RSV commonly causes a runny nose, cough and wheezing. It can be more severe in infants, older adults and people with certain underlying conditions. In young children, it can cause bronchiolitis and breathing difficulties.
• Dengue: During the monsoon, dengue can also cause fever, headache, body aches and fatigue, which may initially resemble a viral respiratory infection. However, dengue is spread by mosquitoes rather than respiratory droplets and does not typically cause cough or sore throat.

How Can H1N1 and Other Infections Be Prevented?

Dr Sharwari Sudhir Dabhade, Consultant - Internal Medicine, Diabetology & Endocrinology, Madhukar Rainbow Children's Hospital, told HealthandMe that prevention should focus on reducing exposure and maintaining good hygiene. Other measures to reduce transmission include:

• Washing hands frequently.
• Covering mouth and nose while coughing or sneezing.
• Maintaining good indoor ventilation.
• Avoiding crowded or poorly ventilated places when respiratory infections are circulating.
• If you have respiratory symptoms, limit close contact with others and wear a mask.
• Getting vaccinated against influenza, particularly if you are an older adult, young child or have an underlying health condition.
• Prevent mosquito breeding and take precautions to avoid mosquito bites to reduce risk of dengue.

When Should You Seek Medical Help?

Most viral respiratory infections recover with supportive care. However, should seek prompt immediate medical assessment in cases of

• breathlessness
• persistent high fever,
• chest pain,
• confusion,
• dehydration,
• falling oxygen saturation
• significant worsening of weakness.