Editorial 1: Heat stress poses health risks for salt pan workers, finds study


  • A study among salt pan workers in Tamil Nadu has highlighted the impact of heat stress.

The study

  • It found that nine of 10 salt pan workers self-reported heat-strain symptoms, their average water intake was one litre during the workday and a majority were exposed to high levels of heat stress, the study outlined the need for workplace interventions to provide access to water, rests in shade, sanitation and education on the need to hydrate.
  • The study – ‘Occupational Heat Stress and Kidney Health in Salt Pan Workers’ – conducted by a team led by Vidhya Venugopal, professor of Occupational and Environmental Health, Sri Ramachandra Institute of Higher Education and Research, looked at 352 workers between 2017 and 2020. It was published in the Kidney International Reports.
  • The researchers evaluated the workload for different job roles and classified heat stress levels.
  • Key indicators such as pre-and post-shift heart rates, core body temperatures, urine characteristics, sweat rates and kidney function parameters were measured.

Workers at breaking point

  • Every participant had either a heavy or moderate workload, and close to 90% of workers were working above the recommended limits of heat exposure.
  • The wet-bulb globe temperature, a measure of environmental factors affecting thermal comfort, consistently surpassed safe levels in the saltpan.
  • The majority of workers (93%) reported that they had experienced at least one of the self-reported heat strain systems – excessive sweating, thirst, dizziness, muscle cramps, headache, nausea/vomiting, fainting, or prickly heat/rashes.
  • Dry mouth or severe thirst – signs of dehydration – was reported by 59% of the workers.
  • About 77% of the workers reported at least one of these symptoms – changes in urine volume or colour, burning sensations when urinating, rashes and urinary tract infections (UTI).
  • But reported water consumption was low. About 23% of women said they would drink more if they had better toilet access.
  • One out of every five had taken sick leave owing to heat-related health difficulties in the last six months, while a third said they did not finish work on time because of the heat.

Kidney health

  • What was worrying was the impact of heat stress on kidney health: the study revealed a prevalence of low estimated glomerular filtration rate (eGFR), a marker of kidney function, in seven percent of workers.
  • Heat stress has been linked to various kidney-related issues including acute kidney injury, kidney stones, chronic kidney disease and UTI.

Way forward

  • Heat stress poses significant health risks. Urgent action is needed to implement adaptation strategies and improve healthcare, sanitation access and welfare facilities to protect vulnerable individuals.

Editorial 2: ALS patients and caregivers struggle with multiple issues related to disease


  • ALS support groups urge that it be counted as a rare disease to ease eligibility for aid; India’s National Policy for Rare Diseases 2021 states that ‘aid up to ₹50 lakh will be provided to those suffering from any category of rare diseases’ and getting treatment in any Centre of Excellence.

Amyotrophic Lateral Sclerosis (or ALS)

  • ALS is a neurodegenerative disease in which special nerve cells called motor neurons in the brain and spine – which control an individual’s voluntary functions like walking, chewing, talking, moving their arms- are affected.
  • As these nerve cells progressively die, the muscles dependent on them are unable to function or move, due to which they begin to atrophy or waste away.
  • ALS is a progressive disease. Once it involves the motor neurons that regulate respiratory muscles, breathing gets affected.
  • Currently, there is no effective cure for ALS and the best therapies are drugs and other interventions that could lengthen the life of the person with ALS (or PALS).
  • While the disease progresses differently in each individual, the average survival time is three years , according to The ALS Association, a non-profit organisation, or between 20 to 48 months on an average, according to a study by Chio et. al, 2009.

Difficulty with the diagnosis

  • From the onset of symptoms, it takes around 8 to 15 months for diagnosis. That is because there are also no definite biomarkers yet.
  • This amount of time between the onset of symptoms and confirmed diagnosis is agonising for the caregivers and PALS.
  • For ALS, motor cell failure needs to be detected in at least 2 regions of the body; either one of the upper limbs or any of the lower limbs, and one more region like the bulbar region which controls the muscles needed for swallowing, speaking, chewing, and other functions.
  •  Suppose one comes in with just one symptom like one hand not working like before or a leg that drags, then that is not enough for it to be diagnosed as ALS.

Changes in ways of living

  • Being a caregiver is a challenging task for a loved one. Caregivers are completely uprooted from their routine.
  • The mental health of the PALS, and their caregivers is affected severely.
  •  A 2021 study called ‘Prevalence of depression among amyotrophic lateral sclerosis (ALS) patients’ draws the conclusion that there is a high prevalence of depression among people with ALS, affecting their quality of life and mobility.

Infrastructural inefficiencies

  • Out of the many problems that affect the quality of life of a PALS, one of them is the lack of accessibility of those restricted to a wheelchair due to infrastructural inefficiencies.
  • ALS does not distinguish between the rich and the poor, but the financial demands it makes are staggering, if one pursues treatment. There is no insurance cover for persons with ALS.

Rare disease tag

  • A salient feature of the Union Government’s National Policy for Rare Diseases (NPRD), 2021, is that ‘financial assistance up to ₹ 50 lakh will be provided to the patients suffering from any category of rare diseases and getting treatment in any of the Centre of Excellence identified’.
  • The World Health Organisation (WHO) defines a rare disease as an ‘often debilitating lifelong disease or disorder with a prevalence of 1 or less, per 1000 population’.


  • However, the NPRD also states the average prevalence threshold used to define rare diseases is from 1 to 6 in 10,000 people. This amounts to less than 1 in 10,000 having ALS, and thus, should qualify as a ‘rare disease’ in India, as per the definitions stated in the NPRD.


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