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The Rediff Special/Ajit Jain in Toronto

He conducts India's death census

June 17, 2004

Dr Prabhat JhaDr Prabhat Jha and his 16-member team are conducting the world's largest study on the causes of death in India.

Jha, from the Centre for Global Health Research of the University of Toronto, is this year's winner of 'Top 40 under 40' award, sponsored by The Globe and Mail Business Magazine, Air Canada, Birks and  Caldwell Partners, and is given each year to 40 most successful people in different fields who are under 40.

Jha's study is examining the cause of deaths among 150,000 people in India.

"It's the world's largest study as we are contacting six million people in one million households all across India," Jha told 

"There are 800 surveyors, 100 physicians, 17 collaborators," he added.

They have already done the necessary field work on 40,000 deaths. "We need to do field work on 110,000 more," he said.

India first started studying death in 1972, though not the causes. "That is  helpful but we have to study why people die, and what are the underlying causes," said Jha. 

The scope of the study was amplified two years ago, when Jha became the lead investigator with 16 other collaborators.

"The (Indian) government is committed to reducing child mortality and improving public health. This study should enable representative, reliable, routine, low-cost, and long-term measurement of child, maternal and adult mortality in India," said Indian Census Commissioner J K Banthia.

"This is a landmark study, and will transform public health in India," said India's Health Secretary J R V Prasada Rao. "The registrar general of India has shown great vision in mounting this study. They have successfully completed the 2001 census of the living, and will now successfully tackle the census of the dead."

Their two departments are co-sponsoring the study and funding is from several sources, Jha said.

"The study will really have a big impact on public health in India," he said. "The study will bring to light important diseases like tuberculosis and where they are, what populations they occur in and what we can do about them. From there we will build public health programmes, which areas we should place an emphasis on, how important is child morality, and how important smoking-related deaths and tuberculosis are."

If seen "as an honest accounting of the state of health of India in a way that you have financial audit, it is going to have a really big impact," he said.

Jha said diseases like AIDS, tuberculosis, etc "all have specific contributions." However, he declined to reveal the findings and conclusions so far. "I am not at liberty to release the details because they will be released officially when the study is completed next year."

Another piece of information Jha shared with this reporter was that two million children die each year in India. Describing India as a nation with "the world's largest child deaths," he said "these deaths are related to infectious diseases, malnutrition, diarrhea and chest infections."

"Our surveyors are going to the one million households, spread all across the country, and will ask them what deaths have occurred in the family in the last few years. We gather information on how they die so we can understand not just the cause of deaths but also the determinants such as smoking, etc."

Jha, who is also conducting another study, about the spread of HIV in Tamil Nadu and Maharashtra, said, "We found in Tamil Nadu that half the tuberculosis related male deaths are attributed to smoking.  So, what comes out of our study will be relevant to all of India."

The spread of HIV, particularly in Tamil Nadu and Maharashtra, has taken an epidemic form and "it could really be a disaster," said Jha. About 4.5 million people are currently infected but "we really don't know. One of the things our
study will do is to get much better information of  the spreading of HIV through the population."

"Think of it as a road map to prevent HIV," he said.

"This study has just started as we were awaiting permission from the governments to proceed. Those clearances have now come and we will have some results ready by the end of the year," he said.

The study, Jha said, is being funded by the Canadian Institute of Health Research, World Health Organisation, and others.

Jha is the founding director of the Centre for Global Health Research, St Michael's Hospital in Toronto and associate professor in the department of public health sciences, University of Toronto. He's also professeur extraordinaire at the Universite de Lausanne (Switzerland).

He has also worked as a senior scientist at WHO in Geneva (1999 to 2002) where he co-chaired the working group on Improving Health Outcomes for the Global Poor for the Commission on Macroeconomics and Health.

He is lead author of Curbing the Epidemic: Governments and the Economics of Tobacco Control (World Bank, 1999) and lead editor of Tobacco Control in Developing Countries (Oxford University Press).

Curbing the Epidemic is said to be one of  the most influential books on tobacco control.

Jha holds an MD from the University of Manitoba and a DPhil in epidemiology and public health from Oxford University where he studied as a Canadian Rhodes Scholar.


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