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Year : 2014  |  Volume : 139  |  Issue : 3  |  Page : 478-479

Urbanising cholera: The social determinants of its re-emergence

Translational Health Science & Technology Institute (THSTI) Gurgaon 122 016, Haryana, India

Date of Web Publication9-May-2014

Correspondence Address:
G Balakrish Nai
Translational Health Science & Technology Institute (THSTI) Gurgaon 122 016, Haryana
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Source of Support: None, Conflict of Interest: None

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How to cite this article:
Nai G B. Urbanising cholera: The social determinants of its re-emergence. Indian J Med Res 2014;139:478-9

How to cite this URL:
Nai G B. Urbanising cholera: The social determinants of its re-emergence. Indian J Med Res [serial online] 2014 [cited 2021 May 8];139:478-9. Available from:

Rajib Dasgupta (Orient Blackswan Pvt. Ltd., New Delhi) 2012. 348 pages. Price: ` 1,095.00

ISBN 978-81-250-4660-8

Cholera is an acute diarrhoeal disease caused by the Gram-negative bacteria Vibrio cholerae. To a basic biomedical researcher or a physician scientist working on cholera, the understanding of the biology of the pathogen and the disease typically represents the essence of successful research. Much is known about the ecology, epidemiology, pathogenesis and molecular biology of Vibrio cholerae and on the diagnosis and treatment of cholera. At the last count, 154 whole genomes of a variety of Vibrio cholerae strains have been sequenced and meticulously analyzed and based on this information, among others, the contemporary spread of cholera has been traced with fascinating accuracy. But despite this wealth of knowledge on the pathogen and the disease, there has been a 130% increase in the global incidence of cholera in the past decade (2000 to 2010) as shown by the recent WHO statistics which represents only the 'tip of the iceberg.' Why does increasing knowledge on the pathogen not equate to the elimination of the disease?

The book by Rajib Dasgupta on Urbanising Cholera comes as a 'breath of fresh air' by bringing out a largely ignored aspect dealing with the social determinants that influence cholera. Right from the first line he brings purpose to the book by stating "….the causation of disease involves a lot more than just the bacteria." The book begins with a wonderful exposition of the new era of social determinants as powerful predictors of health, the travails of urbanisation and the resulting urban poverty that urbanisation spawns. The author traces the growth of urbanisation in India from colonial times and to the development of slums aided by definite statistics. In fact, he alludes to these dwellings as the urban sub-proletariat (the Fourth world) characterized by iniquitous living conditions. He brings about a distinction between urban and rural poverty and cleverly interlinks this with prevalence of classical cholera as an 'epidemic' rural disease in the beginning of the last century to El Tor cholera that currently exists as an 'endemic' disease overlapping with the period of accelerated urbanisation in many developing countries. The need to integrate causal pathways at the societal level with the pathogenesis and causality at the molecular level is driven home.

Cholera in Delhi is thoroughly dissected in this book right from urban planning in Delhi, to the Delhi municipal committee and how the Master Plan of Delhi was a plan for the masters bringing to light the unsettling truths of settlement patterns. The planning process of Delhi (and perhaps all cities in India) has not accounted for the needs of the underprivileged including the lack of adequate safe water supply and safe disposal of solid and liquid wastes and its public health consequences. In fact, the persistence of cholera is a testimony to this negligence. The cholera statistics of Delhi is a witness to this neglect with cholera turning from a sporadic and intermittent disease in Delhi to an endemic disease that occurs throughout the year punctuated by periodic epidemics. The thorough analysis taking Delhi as a case in point for the incidence of cholera and the plight of the urban poor who lack basic urban services is well done.

The chapter on time trends of cholera explains the history of cholera pandemics starting from the first recorded pandemic in 1817, the fluctuating seasonality of cholera and the nexus of cholera epidemics with pilgrimages. The rise and fall of the classical and El Tor cholera and the factors which have aided the transmission are succinctly elucidated. The entry of the new O139 variant (now known to be a derivative of El Tor cholera strain) in 1992 in India and its impact on El Tor cholera are elucidated. The incidence of O139 has faded; the factors, particularly social determinants, associated with the disappearance of this new variant are not dissected. An omission is the lack of information on the recent hybrid variants of V. cholerae that exhibit both the traits of classical and El Tor biotypes and what social determinants, if any, may have compelled this. It would have impacted better if this chapter was integrated with the discussion on the social determinants of cholera to drive home the approach of understanding infectious diseases at multiple levels.

The book has traversed important uncharted paths on understanding the transmission and persistence of cholera and provides valuable new insights into the importance of social determinants of the disease. The book is a 'must read' for colleagues working on infectious diseases and those interested in diseases as a whole. One can only wish that this rich volume of information is integrated with knowledge on the intricate molecular aspects of the disease and pathogen biology to yield a fascinating synthesis of how cholera (and other infectious and non-infectious diseases) should be holistically approached to garner information at multiple levels, with each level playing an important role. Finally, the book brings into focus on how poverty spawns cholera and in most low-income communities the pollutant of primary concern is human excreta.


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