User:Subuls/sandbox/GPP105

Sector (Healthcare):
https://en.wikipedia.org/wiki/Healthcare_in_Pakistan (marked that it needs more sources and verification)

https://en.wikipedia.org/w/index.php?title=Wikipedia:New_user_landing_page&page=Malnutrition+in+Pakistan (Page does not exist)

https://en.wikipedia.org/wiki/Poverty_in_Pakistan

Area (Urban/Karachi, Pakistan):
https://en.wikipedia.org/wiki/Urbanisation_in_Pakistan (Connect to slums and poverty, mega cities, GPP 115)

https://en.wikipedia.org/wiki/History_of_Karachi (write about urbanization, mega cities, slums, and relate to GPP 115)

Sector (Healthcare): "Healthcare in Pakistan":
The first thing I really noticed was the fact that there is a section (linking to another page) about suicide in Pakistan, which has a statistic of about 300 over the period of 2 years. It's not that this is not a problem; however, 300 in a country of 200 million is not significant, whereas a significant portion of the population does face malnutrition - about half of children are chronically malnourished according to UNICEF. However, since the page for the latter does not even exist, it makes it seem like Suicide is a more significant problem than malnutrition.

Something distracting is that there is a "Cancer" section and "Cancer Care" section; they are not located next to each other and are both super short paragraph sections with not much content. Potentially combine them and add more info? Cancer is a fairly significant healthcare concern.

Overall there is not too much info, and half of the "info" is just references to other pages. I compared it to the US counterpart (Healthcare in the United States) and the latter has a lot more organized sections, such as overall statistics (for expenditures, insurance, mortality rates, and US context in the world); Regulation and oversight; effectiveness; equity, etc. The main difference is that the Pakistan page seems like there was little planning and forethought, and people just added in some common specific aspects of healthcare that occurred to them (cancer, obesity, etc.).

Because of the limited info, there is not really an imbalance of information (aside from separate pages for suicide, etc. vs nothing for malnutrition). The info that is provided is fairly recent, mostly within the last decade, which is reasonable for healthcare stats.

It's a part of 3 wikiprojects, all of which rated it start-class, but only one rated it high importance. Interestingly, there is someone on the talk page who wanted to delete the whole page, and it was nominated for deletion, but eventually kept. The comment on the talk page about deleting it was a bit harsh - I can't tell if that individual is just very critical and protective of Wikipedia's reputation and doesn't want "bad" pages, or if they just don't care about the country or topic. Personally, I feel like this is a very important page as healthcare is a significant problem in Pakistan, and deleting the page makes me think about how certain narratives are "hushed"; I know that this topic, in addition to being my PE, is more personal, which might be why I feel this way, but I do think it is justified, especially when compared to the "Healthcare in CountryX" pages for Western/developed countries. These countries have very nice, detailed summaries.

Finally, last week when I updated a citation, it took me a while to find the source because the sentence in wikipedia was used in MANY places (the exact same sentence - about the 80% of patients...etc, citation #1). Since the stat was adapted from a Pakistani gov't website, I assume the circulation of the sentence was due to Wikipedia (the sentence used was not directly from the gov't website). This sentence was used in the blurbs of various events as well, which promoted different health conferences. Basically, that means that this wiki page, despite being so basic, is taken as "fact" in a way that could really impact the direction of development in healthcare. So, it is really important to improve it so that the direction of development is most accurate/beneficial.

Specific Things I Can Add
I believe creating a new page ("Malnutrition in Pakistan") might be too hard in the sense that even if I think it's okay, there might be others who feel like the page is not significant enough and want to delete it (similar to how they wanted to delete "Healthcare in Pakistan". By simply adding to the Malnutrition section in "Healthcare" I would be able to have quality, even if the quantity is not enough for a whole separate page. Hopefully, in the future, my section could be used by others to start a new Malnutrition page. The reason I want to focus on Malnutrition in particular is because of the stats (see above), but also because for my Sectors elective I took Public Health 118, Nutrition in Developing Countries and already have some background knowledge on the subject (and wrote a paper on Pakistan for the final).

Additionally, the article is marked that it needs citations, so I plan on checking those. Finally, if I have time toward the end, I will try supplementing another section - probably cancer, because that is another significant problem (significant as I defined earlier).

Section: General Intro
Add in chart with leading causes of mortality, for children and adults perhaps separately - data from WHO/World Bank

DRAFT Section: Malnutrition
Malnutrition is one of the most significant public health problems in Pakistan, and especially among children. According to UNICEF, about half of children are chronically malnourished. National surveys show that for almost three decades, the rates of stunting and acute undernutrition in children under five years of age have remained stagnant, at 45 percent and 16 percent, respectively. Additionally, at the “national level almost 40% of these children are underweight...and about 9% [are affected] by wasting”, diseases where muscle and fat tissues degenerate as a result of malnutrition. Similarly, women are also at risk, with about half suffering from anemia, which is commonly caused by iron deficiency.

A significant contributing factor to this issue is food insecurity; The World Food Programme estimates that nearly one in two Pakistanis are at risk of food insecurity. This in turn can be attributed in part to the rapid urbanisation and mass migrations caused by the Great Partition of India and Pakistan, and the resulting issues with infrastructure and government, as well as other factors.

For example, contamination of water sources affects water and food security, and also over a long time contribute to stunting and underweight measurements, caused by deficiencies of nutrients, lost through diarrhea, dysentery, and other water-born diseases.

Some limitations to interventions and aid are due to the limitations in peer-reviewed literature on this specific topic. According to the director of the nutritional science program at Pakistan’s Dow University of Health Sciences (DUHS), and president of the Pakistan Nutrition and Dietetic Society (PNDS), Dr. Safdar, “only 99 papers of nutritional research were published in Pakistan between 1965 and 2003”.

''-Lots of stats on how bad it is, and not as much about causes. Is it fine if I find individual niche papers to make some points? Or do they need to be review papers?''

-Suggested that I take out the last paragraph?

-''Do I need to have a citation for like every sentence? I know this is not a research paper, but kind of like a lit review, can I take what several papers say and connect them all together? To make a bigger picture. Not to create my own assumptions.''

''-For some things, there are papers that seem not necessarily academic, but kind of at the same time, on government pages. They are not peer-reviewed but are they as "reliable" as literature, or are they considered more like news sources?''

Things to do:

-This paper says not connected to poverty as much as illness, mother's nutritional status, environmental/community factors

-Pakistan ranked as a country for these stats

-Causes - socioeconomic; food production due to climate; urbanisation; poverty

-Socioeconomic Effects: A. Affects development, which affects education, employment, etc. - These affect the next generation - cycle repeats

-Existing Programs (Literature Review, NGOs, government)

Bibliography (currently, just academic sources)
"Street Children in Pakistan" : Discusses street children's health in a sociopolitical context to understand their health. Important because it is specific to the urban poor which will be my focus for PE.

"Water Pollution in Pakistan and Its Impact on Public Health" : A review paper (good for Wiki) that discusses a lot of social, political, geographical, and other forces affecting water sanitation and how that affects health overall.

"Stop stunting: Pakistan perspective on how this could be realized" : Overview of a lot of malnutrition-related statistics about children and women specifically, and correlations with literacy and other sociopolitical factors.

"Association of Socioeconomic Position with Under- and Overnutrition in Pakistan" : Title is pretty self explanatory - but I will be focusing on undernutrition, since that is correlated with the poor, while overnutrition is a more significant problem for the wealthy. However, it might be good to add in comparison stats as a reference.

Area (Urban/Karachi, Pakistan): "Urbanisation in Pakistan"
The first thing I notice after reading this (short) article is that although the page is called "urbanisation" it is more about large migration patterns in the last century. Urbanisation, after having taken GPP 115, forces me to think of push and pull factors causing migration; slums and poverty; unemployment and health; politics regarding acknowledgement of squatters, or alternatively, bribing systems in place by officials, and more. None of these are mentioned. In fact, I would go so far as to say that changing the name of the article to "Migration Patterns/shifts in Pakistan" would be more accurate.

Similarly to the last article, there is just so limited information that there is not imbalance of views or bias. The citations appear to be reputable, recent, and relevant, and the links to other Wiki pages are much better here than in the healthcare article.

It is currently a part of 2 wikiprojects, both ranking it start-class and mid-importance. Interestingly, there is nothing else on the talk page. This does make sense, because urbanisation is not as commonly considered important (compared to say healthcare) but at the same time, it is surprising: namely because one of the more significant pushes toward urbanisation, specifically in Karachi, was the Great Partition of 1947, which is a highly contested/controversial topic with many passionate individuals on all sides.

I believe this article should definitely be improved, since a lot of current national problems stem from the rapid urbanisation/migration following the Partition. Because of this unnatural shift, as well as a few others (influx of Afghan refugees, etc.) there are many problems with infrastructure which highly affect employment, health, and other topics. Without this background, those will not make as much sense.

Specific Things I Can Add
First of all, I need to get used to writing "urbanisation" and not "urbanization" - because of Wiki's guidelines on spelling. I need to make sure I don't accidentally type the z and forget it later.

Additionally, I think there are two main directions I can add to this article. One is by addressing the factors causing urbanisation - this includes the Partition, as well as lasting colonial effects on farming and agriculture, and more recently, war and conflicts. This topic I feel will be harder, partly because it has more political components to it. It might be overly too contentious for me to correctly do in the time we have for this class. The direction I'm leaning toward is the effects of urbanisation - specifically on health and healthcare, but also sanitation, infrastructures, slums, etc. This can draw on some basic knowledge from GPP 115 as well.

Section: Causes of Urbanisation
I want to try to rename this section to something related to history - e.g., "History of Urbanisation in Pakistan"; "Urbanisation Causes and Trends Over the Years" etc. However, I may not be able to do this until I create a section about the more current causes of urbanisation. Alternatively, I could just incorporate the more recent causes into it, and leave the title as is. For now, I will write about the current causes, and see if they can be combined. If so, I will do that and leave titles as is, but if not, I will add my section, and rename the other.

DRAFT: RENAME Section: Historical Causes of Urbanisation
The British relinquished control of the colony in 1947 with the Great Partition of India and Pakistan, leaving the region in turmoil because of the vacuum of power, and the resulting mass migrations. The repercussions can still be seen today, as many still lack basic food and housing security in both India and Pakistan. Much of this was caused by the loss and destruction of property - and therefore capital and financial stability - during the migrations. Additionally, this rapid movement to and overcrowding of cities has led to the emergence of slums, known as the "katchi abadis" in Karachi.

DRAFT: Tentative New Section: Effects of Urbanisation on Public Health
With the proliferation of slums comes a plethora of related issues, such as public health, infrastructural, and sanitation issues. The infrastructure cannot support the population size, and in the rural areas, plumbing/wells/etc. often cannot be afforded, leading to water contamination. Many water sources are highly contaminated because of the lack of regulations and monitoring by the government. As a result, there is industrial waste and sewage contaminating water sources, as well as high fluoride and arsenic contents, which is further exacerbated by monsoon flooding, thus causing many epidemics throughout the years. Studies have shown that there are critically high levels of nitrates and chlorides in Karachi's water sources as well as other water-born pathogens causing diarrhea and loss of nutrients, exacerbating the existing problem of malnutrition. Specifically, 1 in 5 "street children" in Pakistan were shown to be stunted, and 1 in about 8 were wasted.

-Does this section - urbanisation on public health - fit under area?

''-Are there other area topics you think I should consider? Or any other subsections to add in this article?''

Things to do:

-Still a significant rural population, bring them up as well

-More general stuff from Davis's paper "Planet of slums"

-Draw from sources and a few more to discuss effects on health and sanitation

-Discuss water sources and contamination, and the resulting water-born diseases and pathogens

-Discuss how existing infrastructure interacts with the population

-Have links to other wiki pages such as "Healthcare in Pakistan", the other article I'm working on.

Bibliography (currently, just academic sources)
"Street Children in Pakistan" : Overlapping source with other article, but this paper does cover both aspects - urban poor and health - and is relevant to both. This can help with urbanisation's effects on health

"Planet of Slums" : A nice general overview of problems that occur with urbanisation. Does a good job in explaining general push and pull factors and can be applied to Karachi.

"City profile: Lahore, Pakistan - Urbanization..." : Although Lahore isn't where I want to focus, a lot of factors affecting urbanisation, and the problems resulting from it will overlap. This will help supplement knowledge specifically about Karachi.

"An overview of the effects of urbanization on the quantity and quality of groundwater in South Asian megacities" : Karachi is one of the megacities examined, and this also helps to understand effects of urbanisation, on water, health, and sanitation.