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!

When we talk about cancer prevention, the conversation usually turns to individual choices. Whether someone smokes, what they eat, how much they exercise, or how regularly they visit a doctor. These are important considerations, but they do not tell the whole story. A person's surroundings can influence their health in ways that are not always immediately apparent. The air they breathe every day, the conditions in which they work, the food they can afford and the healthcare available to them can all have a bearing on their risk of developing cancer.

In clinical practice, cancer rarely has one identifiable cause. It develops through a combination of factors, including age, genetics, infections, lifestyle and environmental exposure. Some of these can be modified. Others are tied to circumstances that people have little control over.

The air we breathe and the work we do

Air pollution is generally discussed in the context of respiratory and cardiovascular illness. Its association with cancer, particularly lung cancer, deserves equal attention. Fine particulate matter from vehicle exhaust, industrial emissions, construction dust and waste burning can remain in the air people breathe over long periods. Indoor air quality is another concern. In homes where wood, coal or other biomass fuels are used for cooking, poor ventilation can expose families to harmful smoke over many years.

The workplace presents a different set of risks. Construction workers, miners and employees in certain manufacturing industries may regularly come into contact with substances such as asbestos, silica dust and diesel exhaust. Prolonged exposure to these carcinogens is associated with specific cancers. The risk is not simply a matter of the nature of the job, but also the conditions under which it is performed. Protective equipment, adequate ventilation and routine workplace monitoring are therefore essential, not optional safety measures.

What ends up on the plate is not always a choice

Diet is another area where personal circumstances matter. What a person eats is influenced by affordability, availability, working hours and household responsibilities. A consistently poor dietary pattern, particularly one high in processed meat and low in fibre, is associated with an increased risk of certain cancers. Excess body weight is also linked to several cancers, including colorectal, endometrial and postmenopausal breast cancer.

This does not mean that eating a particular food will cause cancer, or that avoiding one ingredient will prevent it. The concern is with patterns that develop over time, alongside other risk factors. Advising people to eat better is only useful when that advice considers what they can realistically afford and access.

Why some communities face greater challenges

The same health advice does not translate into the same opportunities for everyone. People living in congested neighbourhoods may have limited control over their exposure to pollution. Workers in informal or unregulated sectors may not have access to adequate protective equipment or occupational health services.

These circumstances can also determine how quickly someone receives a diagnosis. A persistent cough, unexplained weight loss, a breast lump or unusual bleeding may initially be dismissed. For someone who has to travel long distances, lose a day's wages or pay out of pocket for investigations, seeking medical attention is not always straightforward. By the time they reach a specialist, the disease may have progressed.

Early detection, therefore, is not just about recognising symptoms. It also depends on whether people can access a doctor, undergo the necessary investigations and complete their follow-up care.

Prevention has to go beyond individual choices

There are established ways to reduce cancer risk. Avoiding tobacco, limiting alcohol, maintaining a healthy weight and staying physically active all matter. HPV and hepatitis B vaccination can help prevent cancers associated with these infections. Screening for breast, cervical and oral cancers should be undertaken as recommended, based on age and individual risk. A persistent or unusual symptom should always be evaluated rather than left unattended.

But prevention cannot stop at the doctor's consultation room. Cleaner air, safer workplaces, better housing and affordable diagnostic services need to be part of the larger conversation.

A person's risk of cancer is shaped by more than the choices they make. It is also influenced by the conditions in which they live, work and seek care. Recognising this is important because prevention becomes meaningful only when people have a fair opportunity to act on it.

(Dr Rajesh Shinde - Director – GI (HPB–Colorectal) & Thoracic Surgical Oncology, Apollo Cancer Centre, Western Region, Apollo Hospitals)

Winter brings a significant rise in respiratory problems, particularly among people living with asthma. Increased air pollution, falling temperatures and exposure to dust and other airborne irritants can trigger inflammation in the airways, leading to symptoms such as coughing, wheezing, chest tightness and breathlessness.

While these factors can make asthma more difficult to manage, many patients also make treatment-related mistakes that can worsen their symptoms and increase the risk of an asthma attack.

One of the most common mistakes is discontinuing inhalers when symptoms improve. Asthma is a chronic inflammatory condition, and the absence of symptoms does not necessarily mean that the underlying inflammation has resolved. Controller inhalers, particularly those containing inhaled corticosteroids, help reduce airway inflammation and prevent flare-ups.

Stopping these medications without medical advice can leave patients vulnerable to sudden exacerbations, especially during periods of high pollution.

Another concern is the excessive reliance on rescue inhalers. These inhalers provide quick relief by relaxing the muscles around the airways, but they do not necessarily address the underlying inflammation. Frequent use may indicate that asthma is not adequately controlled and that the patient's treatment plan needs to be reviewed by a doctor. Patients should not increase their medication dosage or frequency without appropriate medical guidance.

Incorrect inhaler technique is another frequently overlooked problem. Patients may use their inhalers too quickly, fail to coordinate inhalation with medication release or neglect to hold their breath briefly after inhaling. These mistakes can prevent the medicine from reaching the lungs effectively. Regularly reviewing inhaler technique with a healthcare professional and using a spacer, where recommended, can significantly improve drug delivery.

Many patients also underestimate the importance of continuing their prescribed treatment during symptom-free periods. Some turn to steam inhalation, home remedies or over-the-counter cough medications instead of following their asthma management plan. Although certain supportive measures may provide comfort, they cannot replace prescribed asthma medication. Hot steam can also cause burns and should not be used as a treatment for asthma.

During winter, patients should monitor local air quality, reduce prolonged outdoor exposure when pollution levels are high, avoid tobacco smoke and other respiratory irritants, and keep their prescribed medication accessible. Wearing a well-fitting mask outdoors may help reduce exposure to particulate pollution, although it does not eliminate the risk.

Most importantly, people with asthma should have an individualised asthma action plan and attend regular follow-ups. Worsening breathlessness, difficulty speaking in full sentences or symptoms that do not respond to the prescribed reliever require urgent medical attention. With correct inhaler use, consistent treatment and timely medical review, most patients can manage their asthma more effectively even during highly polluted winter months.

(By Dr. Arunachalam M, Sr. Consultant and HOD-Pulmonology, Yatharth Super Speciality Hospital, Noida)

Changes in stride like a slower walking pace, fewer steps or a change in the way your arms move may be considered as signs of ageing. However, an emerging study suggests that minor differences in walking patterns could be subtle, early indicators of Parkinson’s disease. According to the study, these signs can can emerge years before Parkinson's diagnosis.

Published in the Journal of Neural Transmission, the study analysed movement data from more than 73,000 participants in the UK Biobank. Researchers found that certain changes in walking behaviour could indicate a future Parkinson’s diagnosis, surfacing up to 6.8 years beforehand.

The findings indicate that Parkinson’s disease may begin developing long before its more familiar symptoms like tremors and stiffness, become noticeable.

Findings From The Study

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Researchers examined data from 73,413 people who wore wearables that track movement for seven days. Their health records were then followed for up to 10 years. Of the participants without Parkinson’s at the time of the movement assessment, 314 were diagnosed with the disease during follow-up.

Using a digital analysis tool called Watch Walk, researchers examined 17 characteristics related to gait. They identified five walking characteristics that were consistently linked with a subsequent Parkinson’s diagnosis:

• Fewer steps each day: Participants who later developed Parkinson’s recorded lower daily step counts than those who did not.
• Slower walking speed: People who were diagnosed later tended to walk more slowly, including at their maximum walking speed.
• Shorter walking periods: They also spent a lesser amount of their time walking in longer, continuous stretches.
• Changes in step regularity: Their steps showed less consistent rhythm, indicating alterations in the regularity of their walking pattern.
• Reduced natural arm swing: They spent more time walking with their arms in a static position instead of swinging naturally.

Effects Of Parkinson’s Disease On Walking

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Parkinson’s disease is a progressive neurological disorder that affects movement. It occurs due to the loss of nerve cells that produce dopamine in a brain region called the substantia nigra. Dopamine helps regulate movement, coordination and other functions.

As dopamine levels decline, the brain's ability to coordinate movement is affected. This can lead to bradykinesia, or slowness of movement, rigidity of muscle, tremors and balance issues.

These changes can also affect gait. A person may take smaller steps, walk more slowly, experience difficulty moving or reduced swinging arms.

The study's findings suggest that some of these motor changes may be detectable in everyday movement well before the condition is formally diagnosed.

Changes in walking speed, balance, step length or arm movement can occur for several reasons, including ageing, joint problems, injuries, medication effects and other neurological conditions.

Parkinson’s disease is, however, diagnosed through a clinical assessment, which considers a person's symptoms, medical history and neurological examination. Other symptoms that may warrant medical evaluation include:

• A tremor especially when the affected hand or limb is at rest.
• Slowness in everyday movements like dressing or getting up from a chair.
• Muscle stiffness or rigidity.
• Problems with balance.
• Smaller handwriting or changes in speech volume.

Early Detection Of Parkinson’s Disease

Although there is currently no established treatment that stops or reverses the underlying progression of Parkinson’s disease, an earlier diagnosis can help people manage symptoms, access rehabilitation and support sooner.

Exercise, physiotherapy and medical care can help maintain mobility, balance and quality of life. Early assessment can also help doctors distinguish Parkinson’s from other conditions that may cause similar movement difficulties.