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!

Living in more intensely developed neighborhoods may actually protect you against a stroke, a new University of Michigan study suggests.

Researchers tracked more than 25,000 adults across the US for over a decade and have now found that residents in areas with higher levels of development with more buildings, sidewalks and infrastructure, had a 2.5 percent lower risk of suffering a first-time stroke compared to residents in less developed areas.

Cathy Antonakos, research specialist senior in the U-M School of Kinesiology and first author explained: ""High-intensity development typically includes greater housing density and more commercial/retail outlets.

"These areas are more likely to feature compact land uses with access to health care, food stores, public transport and physical activity infrastructure like sidewalks, bike facilities and parks."

However, the study did not examine these environmental features, but there are some practical applications, Antonakos noted.

"For physicians, the study suggests that neighborhood-level factors may influence first-time stroke risk, in addition to individual-level factors," she said. "For planners, the findings suggest that enhancing environments with features that support cardiovascular health and physical activity may help lower the risk of first-time stroke."

Strokes: A Rising Crisis In India

Heart strokes are also one of the leading global health burdens, causing significant deaths and disability worldwide, including in India. Compared to Western countries, stroke also tends to occur at a younger age and is associated with a higher case fatality rate in the country.

One in seven stroke patients in India are young adults aged below 45 years, with hypertension leading as the major risk factor, according to a study by the Indian Council of Medical Research (ICMR).

The Global Burden of Disease Study 2021 identified hypertension, air pollution, tobacco smoking, high cholesterol, increased salt intake, and diabetes as the leading risk factors of stroke.

Incidence of stroke is increasing significantly in low- and middle-income countries (LMICs), especially in India, due to population growth, aging, and greater exposure to risk factors.

Wine Reduces Your Risk Of Strokes

A new global study suggests that moderately drinking wine can decrease your risk dying from cardiovascular disease by 21 percent.

A group of Chinese researchers who analyzed 340,924 adults in the UK between 2006 and 2022 classified a 12-ounce beer, a 5-ounce glass of wine or a 1.5-ounce shot of liquor each contains about 14 grams of pure alcohol.

Those who consumed less than 20 grams per week, about 1.5 standard drinks, were classified as never or occasional drinkers. The low alcohol consumption group included men who drank more than 20 grams per week but no more than 20 grams per day, and women who drank between 10 grams per day and 20 grams per week.

They found those with high alcohol consumption were 24 percent more likely to die from any cause, 36 percent more likely to die from cancer and 14 percent more likely to die from heart disease.

Additionally, even low intake of spirits such as beer or cider was associated with a nine percent higher risk of dying from cardiovascular disease compared with drinking never or occasionally.

Researchers at the University of California Riverside have developed a low-cost fake drug detector that can detect fake medicines by studying how pills dissolve in water.

Tested on 30+ medicines, the detector identified drugs with about 90 percent accuracy and could even distinguish between brand-name and generic versions.

William Grover, associate bioengineering professor at the University of California, Riverside explained: "Watered-down or illicit versions of drugs like Botox or popular GLP-1 inhibitors have caused serious injuries or death.

"The theory here is that if it's a legitimate medicine, the manufacturer made every pill identical enough that they'll all behave roughly the same way when they dissolve.

"So if you test a suspect pill, and it dissolves at a different rate than the real thing, this suggests the suspect pill is counterfeit."

Talking about the success of the device, Grover said: "We took Bayer aspirin pills and drug-store-brand aspirin - these are basically identical medicines with the same active ingredient and very similar inactive ingredients but when ran through our tests, we could easily tell the difference between the two products."

Costing as little as $5–$30, the device could help tackle the global issue of fake medicines, which the World Health Organization estimates affect 1 in 10 drugs worldwide.

How Does It Work?

The fake drug detector is essentially a low-cost infrared sensor made for use in toy robots able to follow lines drawn on paper. The researchers repurposed the sensors to instead track the rate at which pills dissolve in water.

All pills of a given drug dissolve or ideally should dissolve at roughly the same rate. Legitimate medications don't necessarily dissolve any faster or slower than counterfeit ones however since, the are made by different people at different facilities and with different ingredients, each drug's dissolution rates form a "fingerprint" that makes them identifiable and different from that of a fake drug.

What Else Can The Fake Drug Detector Be Used For?

Grover notes that he would like to use this method to detect fake antimalarial drugs as they are a major cause of death in many tropical regions. Malaria is treatable with the right medications.

"Unfortunately, bad actors know they can make money preying on the need for antimalarials. They sell pills that have the same packaging as authentic antimalarials, but don't contain the active ingredients. If someone gives these pills to their child, they won't cure their infection."

The expert also hopes to get his tool into the hands of those who can use it to fight fake antimalarials and other fake drugs.

"I can't imagine a more despicable person than someone who would sell fake medicine to a child. I hope our work makes those criminals' lives a little harder."

While multiple studies and experts sound the alarm over the dangers of bad lifestyle habits on heart and brain health, doctors are also warning against these secret habits that may be causing serious damage to your kidneys.

Dr Sridhar Shetty, MBBS, MS (General Surgery), DNB (Urology), MNAMS (Urology), FRTS, FIMS, Apollo Spectra Hospital, Bengaluru exclusively tells Healthandme: "Kidneys have many different functions including filtering out approximately 150-180 liters of blood each day in a healthy adult; removing waste from the body; balancing fluids; regulating blood pressure; and maintaining minerals including sodium, potassium, and calcium.

"Unfortunately, many people don't realize they have kidney issues until substantial damage has occurred. There is now a growing body of evidence that indicates many common habits put unnecessary strain on kidneys over time."

Dr Vikas Agarwal, Director & HOD, Robotic Urology, Aakash Healthcare also added: "Poorly managed high blood pressure and diabetes are among the largest causes of kidney damage and are strictly related to everyday lifestyle, including diet and physical activity, stress levels, the presence or absence of medication taking.

"Not every person is aware that seemingly insignificant lifestyle habits may dramatically predispose an individual to chronic kidney disease in the long-term."

Chronic Dehydration and Kidney Stress

According to Dr Shetty: "One of the biggest impacts on overall kidney health is dehydration due to not drinking enough water every day. Not getting enough fluid requires the kidneys to work much harder by producing concentrated urine to save water within the body; therefore, over time this may contribute to kidney stones or the inability of the kidneys to filter properly.

"Concentrated urine also causes more mineral crystallization which could be a greater risk for developing stones."

The US National Academies of Sciences, Engineering, and Medicine suggest about 3.7 liters (approx. 15.5 cups) for men and 2.7 liters (approx. 11.5 cups) for women daily.

However, if you exercise or live in a hot climate, you should increase your intake. The American College of Sports Medicine recommends adding 12 ounces of water for every 30 minutes of exercise.

Dr Agarwal recommends: "Regular medical check-ups, blood pressure, and blood sugar tests, and urine examination is hence very important in detection of early kidney stress. Early diagnosis enables timely interventions which can be used to slack down or avoid further deterioration."

Excessive Salt Consumption

Speaking about how consuming excessive salt can increase heart strain and end up affecting the kidneys, Dr Agarwal said: "Hypertension or high blood pressure is a condition that causes major damage in the kidney across the world. The kidneys have a system of small blood vessels known as glomeruli that removes wastes in the blood.

"In the event that blood pressure is always high then the pressure exerted on these fragile vessels may cause them to narrow, weaken or even to scar. With time, such damage impairs the effectiveness of the kidneys in the filtration process of blood, causing the gradual accumulation of poison and water in the body.

"Some of the daily habits like consuming too much salt, high processed foods, chronic stress, insufficient sleep and sedentary lifestyle may aggravate hypertension and hasten kidney damage. People who eat packed snacks, fast food, and salty food regularly are not aware that they are putting an extra burden on their kidneys."

As a result, Dr Shetty warns: "Processed foods, instant meals, packaged snacks, and entrees sold in restaurants are generally the primary sources of hidden sodium in most people's daily food intake."

Overuse of Painkillers

Dr Shetty explains: "The regular consumption of everyday pain relievers, like non-steroidal anti-inflammatory drugs (NSAIDs), can negatively impact the kidneys without any visible signs. NSAIDs inhibit the production of prostaglandins, which are chemicals required for proper blood flow in the kidneys.

"Therefore, excessive consumption can lead to a decrease in blood supply to the kidneys, resulting in analgesic nephropathy or damage to the kidneys."

To maintain kidney health, he recommends: "People can protect their kidneys through basic yet regular health practices which include

drinking enough water, eating less sodium, using their prescribed medications correctly, and doing regular tests to check their blood pressure and blood sugar and kidney health.

"Daily knowledge about these habits enables people to minimize their chances of experiencing permanent kidney damage."

Dr Agarwal added: "Eating a balanced diet with minimal amounts of excessive salt and refined sugars is useful in controlling the blood pressure and blood glucose levels. Exercise aids in normal metabolism and enhances the work of the heart, saving the kidneys. Kidney protection can also be achieved through proper hydration, stress avoidance, and healthy body weight maintenance.

"Moreover, patients with hypertension or diabetes are also required to take medications regularly and according to the recommendations of the doctors with references to changes in the diet and style of life."