Janapadodhvansa

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Janapadodhvansa (also spelled as janapadodhvamsa) means destruction of communities due to a common cause. The affliction of diseases in society disrupting the physical, psychological, social health of community is phenomenon observed since inception of life on the earth. The pandemic and epidemic situations are considered to be as old as human evolution. Ayurveda texts have thus also extensively mentioned the pandemic conditions at various places commonly referred to as janapadodhvansa, maraka or janamara. Acharya Charak has explained the concept of janapadodhvansain vimana sthana of the treatise Charak samhita. The concept of janapadodhvansais thus reference point for the description of disease origin and spread in the population highlighting the principles of epidemiology in ayurveda.

Contributors
Section/Chapter/topic Concepts/Janapadodhvansa
Authors Bhojani M. K. 1,
Joglekar Aishwarya 2
Reviewer Basisht G.3,
Editor Deole Y.S.4
Affiliations 1 Department of Sharir Kriya, All India Institute of Ayurveda, New Delhi, India
2 Department of Department of Samhita Siddhant, All India Institute of Ayurveda, New Delhi, India
3 Rheumatologist, Orlando, Florida, U.S.A.
4 Department of Kayachikitsa, G. J. Patel Institute of Ayurvedic Studies and Research, New Vallabh Vidyanagar, Gujarat, India
Correspondence emails meera.samhita@aiia.gov.in,
carakasamhita@gmail.com
Publisher Charak Samhita Research, Training and Development Centre, I.T.R.A., Jamnagar, India
Date of publication: May 16, 2023
DOI 10.47468/CSNE.2023.e01.s09.137

What is janapadodhvansa?

Janapadodhvansa is defined as a phenomenon in which a large population is inflicted with one particular disease irrespective of their prakriti (phenotype), ahara (dietary habits), dehabala (innate immunity and strength), satmya (behavioural habits and lifestyle) and sattva (mental conditions), vayasa (age group) (Cha.Sa. Vimana Sthana 3/6)

Etymology

Janapad refers to group of people/inhabitants or community while uddhwansa refers to the destruction of the community. Thus it is a condition where large group of people or entire community is destroyeddue to the natural or artificial phenomena.

Synonyms of janapadodhvansa

Janapadodhvansa is quoted as janamara by Acharya Bhela and Maraka by Acharya Sushrut (Su. Sa. Sutra Sthana 6/19) indicating the prevalence of epidemics in those times as well.

Causes of janapadodhvansa

Two types of causes of origin of diseases (vyadhi-utpatti hetu) are described. Common aetiological factors (sadharana hetu) can produce diseases in almost all the beings (bahujana sadharana).Specific etiological factors (asadharana hetu) are personalized and differ from individual to individual. (Chakrapani on Cha. Sa. Vimana Sthana 3/3)Janapadodhvansa chapter deals with the common causes of disease occurrence in large community.
The four main environmental factors like vata (vitiated air or atmospheric factors), jala (vitiated water), desha (geographical factors or those related to vitiated land and soil resources), kaala (seasonal and climatic conditions)are focused to cause epidemic situations. (Cha. Sa Vimana Sthana 3/6). These can be summarized as given in the table below: (Table No. 1 – Entity causative of janapadodhvansa and its interpretation in present context)

Entity Signs of vitiation Present context
Vayu Vishama vayu - showing characteristics contradictory to normalair conditions This represents the climate change that causes impact on the social and environmental determinants of health.[1]
Atichala – fast blowing winds / squall These are natural phenomena that can cause a loss of human and environmental resources over a large area.[2]
Ati- stimita –stagnation of air Poor air circulation and damp atmosphere promotes the spread of bacteria and viruses.[3]
Atiparusha – excessive dryness This can be correlated with low air humidity resulting in excessive dryness in air especially indoor air.[4]
Ati sheeta- excessive cold air Exposure to cold weather which can occur in the high altitude regions and extremes of climate especially during winter season.[5]
Ati abhishyandi – overt humidity in air An increase in air humidity that triggers rise in the occurrence of diseases.[6]
Ati ushna- excessive heat in surrounding air Excessive hot atmosphere can lead to conditions like heat exhaustion.[7]
Ati kundalinaam- hurricanes or cyclones. Cycloneis a system of storms or winds that rotate at centre of atmosphere with at a very high speed usually associated with heavy rains.[8] It possesses potential to destruct habitations over a large area.
Asatmya gandha – foul smelling Odor pollution is emerging risk factor for the populations exposed to industrial pollution, generalized climate change and environmental pollution.[9]
Containing bashpa (fog), sikta (air pollutant like industrial effluents, solid pollutant particulate matter), panshu (micro pollutants), dhuma (smoke or smog) The particulate matter is mixture of microscopic solids and liquid droplets suspended in air. These include pollutants like acids, organic chemicals, soil, dust particles and allergens.[10]
Udaka
(water) 		Vikruta gandha- altered odour
Vikruta varna- altered colour
Vikruta rasa- altered taste
Vikruta sparsha, kleda bahula – altered consistency. 		These are the indicators of water pollution. All these conditions depict lack of acceptability of drinking water due to the presence of taste and odour which is otherwise absent in water suitable for consumption.[11]
Upakranta jalachara – Devoid of biota and animals due to the death of animals This condition is similar to famine where the lands are devoid of biota as a cause of extreme scarcity of food and water resources.[12]
Upaksheena jalashaya – drying up of water resources- indication of drought Drought is a prolonged dry period in the natural climate cycle. This slow-onset disaster is characterizedby lack of precipitation, resulting in a water shortage.[13]
Apreetikara aapada guna –Water sources having questionable palatability and quality. The water quality is affected by pollutants and particulate matter rendering it undesirable taste, odour, colour and consistency. If the drinking water is not of optimum quality, it threatens the overall health of community.[14]
Desha
(Soil or region) 		Dhoomrapavana – region having polluted atmosphere.
Kshubhita salilashaya – pollution of available water resources. 		This can be compared with environmental pollution, overcrowding, altered quality of soil and water, lack of sanitation and resources.[15]
Vikruta varna – alteration in normal colour
Vikruta gandha – altered smell, presence of odour otherwise absent in the drinking water
vikruta sparsha – altered texture or consistency of water
Kledabahula – excessive water content in the atmosphere or presence of stickiness 		This indicates the soil pollution. It is defined as the presence of toxic chemicals in the form of pollutants or contaminants in soil, in concentrations high enough to cause a risk to human health and/or the ecosystem.[16]
Upasrushta sari srupa vyala mashaka makshika mushaka – having more organisms like flies, snakes, rats etc.
Pratanadi bahula – excess growth of climbers and hyacinth especially in the water resources
Atishushka nashta shasya – withering of crops
Vyathita vividha mruga pakshi - Disturbed ecosystems 		This refers to the disruption of biota and ecosystems and environmental pollution leading to death of plants and animals in the region.[17]
Nashta dharma aachara sheela – loss of sense of humanity and responsibility amongst the civilians Disruption of social conduct and behaviour. These factors determine the effect on the social, behavioural determinants of health.[18]
Pratata ulka pata - area more prone to occurrence of natural calamities like meteors etc.
Bhumikampa – occurrence of earthquakes. 		This refers to susceptibility of region for the occurrence of natural calamities.[19] These are a sudden events in nature that usually results in serious morbidity and mortality. floods ,earthquakes, tornados etc.
Kaala Yatha ritu -viparita lakshana – excessive seasonal variations.
yatha ritu- hina linga, ati linga 		Kaala factor is the seasonal occurrence of diseases. These also indicate the disease conditions arising from the disrupted climate.[20]

Acharya Sushruta states vyapanna ritu (unfavourable seasons) as the primary cause of janapadodhvansa or maraca. Seasonal variations whether gradual or transient lead to disturbance in equilibrium of doshas, thus affecting the health of population. (Su. Sa. Sutra Sthana 6/21)

Adharma (inappropriate bahaviour) as a cause

Adharma (inappropriate behaviour) is another cause of janapadodhvansa can be described as not abiding to one’s prescribed duties and responsibilities. (Cha. Sa. Vimana Sthana 3/24) This can be associated with the human conduct and behaviour responsible for the occurrence of diseases. This reflects on the social determinants of health. The researches have proved that human behaviour is equally responsible in occurrence of epidemics as it results in excessive exploitation of natural resources, increase in pollution, increase in incidence of warfare, decreased social harmony, disturbance of ecosystems and deterioration of universal health.[21] Pragyaparadha (intellectual errors), shashtraprabhava (warfare), rakshogana (infectious conditions) and abhishapa (inappropriate social behaviour) are social, behavioral determinants of health. These can be termed as host specific factors for disease occurrence.
Adharma as a hetu of janapadodhvansa can be illustrated in the table as given below (Table No. 2-Hetu of janapadodhvansa in purview of adharma)

Hetu of janapadodhvansa in purview of adharma
Prajnaparadha Prajnaparadha is intellectual mistake or knowingly performing sinful or inappropriate actions. (Cha. Sa. Shareera Sthana 1/102)This can be compared with the imbalance in public health and lack of healthcare management systems, lack of personal hygiene and lack of awareness regarding preservation of health which affects the health of community.[22]
Shashtraprabhava Casualties occurring due to the conditions like war, riots etc. It is the leading cause of deterioration of physical and mental health of many countries.[23]
Rakshogana This represent the microbes that cause the disease.

Most common types of epidemics are of infectious type and have zoonotic spread. For example Spanish flu, Swine flu, Bird flu, Typhoid fever, Severe acute respiratory syndrome (SARS) and COVID-19 that have emerged in the recent times.[24]

Abhishapa These refer to the compromised social and community manners and etiquette guidelines thus decreasing public health i.e. absence of sadvritta palana (code of conduct).[25]

Thus the three majoretiological causes of Janapadodhwans can be featured in the figure as given below- (Figure No. 1 – Major Hetu of Janapadodhvansa)

Figure No. 1 – Major Hetu of Janapadodhvansa

Jwara (fever) as a prime linga (~representative symptom) of janapadodhvansajanya vyadhi

Jwara is characterized as a condition affecting both physical and mental wellbeing. It is the chief disorder amongst all other diseases affecting every living being at the time of birth and death. (Cha. Sa. Nidana Sthana 1/35) Most of the epidemics related to infectious diseases are types of influenza or are almost always associated with fever.[26] Outbreak of Spanish Flu, dengue fever, swine flu, bird flu, typhoid, cholera, and even the present day COVID-19 are examples of jwara that resulted in some or the other form of janapadodhvansa.[27]
Sushruta (Su. Sa. Sutra Sthana 6/21) on the other hand has also explained few other manifestations of maraka like kasa (cough, bronchitis, lower respiratory tract infections), shwasa (respiratory infections, pneumonia), vamathu (gastric disturbance, nausea), pratishyaya (rhinitis, coryza or upper respiratory tract infections), shiroruja (headache)besides jwara. These are also commonly observed infectious diseases posing havoc in the community.
Similarly, Sushruta mentions that the infection can also spread through surface contact with things like beddings, blankets, seating arrangement, vehicles, jewellery and accessories. (Su. Sa. Sutra Sthana 6/21)

Management of janapadodhvansa (Cha. Sa. Vimana Sthana 3/13-18)

Acharya Charaka mentions the need of collection of medicinal herbs and commodities which are important for supporting the life in emergencies or epidemics beforehand, as there can be scarcity of the even most basic life needs during such period. (Cha. Sa. Vimana Sthana 3/4)This denotes the basis of disaster management and organisation of healthcare facilities during epidemics. The hospitals should be well prepared with all the emergency and required facilities to combat the health consequences of disasters.[28]
The principal line of treatment in the management of diseaseslike jwara is pachana (medications enhancing digestion), vamana (therapeutic emesis) and apatarpana (depleting procedures). (Cha. Sa. Vimana Sthana 3/40) Ushnodaka (warm water) helps in achieving all the above criteria. It is also indicated for the treatment of jwara as it pacifies vata and kapha dosha. (Cha. Sa. Vimana Sthana 3/40) It facilitates digestion and relieves anorexia due to its deepana (appetizing), pachana (digestion) properties. It satiatestrishna (thirst), when consumed even in small quantities. Its consumption is especially indicated in management of conditions like kasa (cough), peenasa (sinusitis), nava jwara (pyrexia), shwasa (breathing abnormality), etc. which represent majority of infectious diseases.(Cha. Sa. Chikitsa Sthana 22/58)
The generalized principles for management of janapadodhvansa include the measures for the promotion, preservation and correction of both physical and mental health. The panchakarma is the main line of treatment in these conditions. (Cha. Sa. Vimana Sthana 3/13) Vamana is important for the radical removal of vitiated dosha especially the kapha dosha and helps in pacifying the jwara and nausea (hrillasa) related conditions associated with the infection. (Cha. Sa. Chikitsa Sthana 3/146) Virechana also helps to evacuate the vitiated dosha through the faeces and corrects the agni vitiation. (Cha. Sa. Chikitsa Sthana 3/169) Basti controls the vitiated vata and helps in excretion of the toxins and faecal matter from the bowel region. (Cha. Sa. Siddhi Sthana 1/40) Due to nasya or nasal instillation invading pathogens get adsorbed on the surface restricting their growth and further progressiom. Nasya is thus particularly useful in the treatment and prevention of respiratory tract infections. Snehana (internal administration of ghee or oil) in form of go-ghrita ( ghee). Jwara involves the obstruction of swedavaha strotas ( body channels carrying sweat) hence it will help to expel the toxins by inducing the process of swedana. (Cha. Sa. Chikitsa Sthana 3/130) Deepana pachana treatments play an important role at every step in management as maintenance of agni function is of prime importance in prevention of any disease.
Dhoomapana is a treatment where the particulate matter in dhooma (medicated smoke) has anti-microbial activity and maintains integrity of respiratory tract. It is thus indicated in many respiratory conditions (Cha. Sa. Sutra Sthana 5/27-32).Gandusha (Oil pulling),kavala (gargling), dantapavana (brushing or cleaning of teeth) act as mechanical barriers by avoiding the entry of pathogens through the buccal cavity.Sharira parimarjana (cleaning of body surface) and snana (bathing) measures contribute to cleansing of the body surfaces and also includes hasta,pada and mukha prakshalana i.e. hand and feet sanitization to prevent the spread of disease. (Cha. Sa. Sutra Sthana 5/93-94)
The rasayana chikitsa forms the backbone of treatment of janapadodhvansa as it is pivotal in enhancing the immune response to pathogenic external and internal invasion and stress. (Cha. Sa. Vimana Sthana 3/13)Different rasayana acting on pranavaha, rasavaha strotas, annavaha strotas depending on the dosha and site involvement can thus be implemented for management of janapadodhvansavyadhi. Use of various rasayana like Chyavanaprasha rasayana (Cha. Sa. Chikitsa Sthana 1/1/62-74), Bramha rasayana (Cha. Sa. Chikitsa Sthana 1/1/41-57), Amalaki rasayana (Cha. Sa. Chikitsa Sthana 1/2/9-14) etc. are popular in clinical scenario for of maintenance of health during pandemic conditions.
Other non-pharmacological and psychotherapy based approaches like sadvritta palana (following proper code of conduct) and behavioural attributes like satyabhashana (honesty), bhootadaya (compassion), bali (sacrifice), devata archana (devotion), daana (charity), vriddhopaseva (showing care and empathy towards the elderly) are mentioned to facilitate the social and mental health. Providing support and care to people and families affected with pandemics is of vital importance to balance the psychological components of health especially during the pandemic like conditions. (Cha. Sa. Vimana Sthana 3/15-16)
Sadvritta emphasizes on the spread and containment of the sansargajanya vyadhi (infectious diseases) and their mode of transmission. (Cha. Sa. Sutra Sthana 8/18) The sadvritta focuses on various domains like physical health, social behaviour, psychological state,hygiene, food etiquettes thus providing holistic care.
The treatment and preventive aspects of epidemics in purview of ayurveda can be summarized in the following table-

Other measures to ensure the promotion of health
Promotion of mentalandsocial health
Behavioural attributes
  • All these include the promotion of mental health during epidemic conditions which affect all the strata of the society.
  • Mental and social health is as important as the physical health as epidemics result in massive disruption of all aspects of health.[29]
Practice of sadvritta
  • Sadvritta is the righteous code of conduct representing different aspects of hygiene, social conduct, morals and behaviour.
  • These measures include regular cleansing and trimming of nails (nakhakartana), hygiene and regular cleansing of external orifices (malayana shodhana), daily bath (snana), use of fragrances (gandhopasevana) in order to arrest the foul odour, to cover ones face while experiencing sneeze, laughter or yawn and avoiding touching of face and nasal area.(Cha. Sa. Sutra Sthana 8/18-19)
Shivanam upasevanaam
(using means of protection)
  • Shivanam upasevanam can be understood as the usage of means of protection against the spread of diseases.
  • These can include the mechanical, chemical and remedial measures.
  • For instance, to arrest the spread of novel corona virus, WHO has suggested measures like the usage of protective material like PPE kits which include gloves, surgical face masks, goggles, face shield, and gowns etc. and routine cleansing and disinfection of environmental and other frequently touched surfaces including hand sanitization.[30]
Bramhacharya palana
(Following safe sexual behaviour)
  • Sexually transmitting diseases (STD) spread through sexual contact and can affect healthy individuals unaware of the spread of such diseases. These can subject a disastrous impact on the health of women and infant.[31]
  • Acquired immunodeficiency syndrome (AIDS) being the most prominent example of potential spread of such morbidity inducing diseases in the community.[32]
Dharma shashtranaam katha
(Recreational measures)
  • Epidemics result in quarantine and isolation of families thus reducing the social contact and depleting the mental health.[33]
  • Recreational measures are hence important to avoid panic and maintain the mental health during the epidemics. WHO also suggests in the same context as self- care, using coping strategies such as ensuring sufficient rest during work or between shifts,consumption of sufficient and healthy food, regularly performing physical activity, maintaining the social and mental wellbeing by staying in contact with family and friends. [34]
Measures according to Sushruta Samhita
Sthana Parityaga
  • It refers to leaving the place afflicted with disease or getting transported to infection free space for containment of disease
  • Quarantine and isolation of those suffering from the infective conditions is necessary to contain the further spread of infection and disease
Shanti Karma
  • This includes the spiritual and religious measures for the protection from rakshogana (antimicrobial)and negative afflictions.
Prayaschitta
  • As the adharma is considered to be important aspect in causation of janapadodhvansa, the papakarma(..)can be alleviated through some form of prayaschitta or good deeds
Japa (meditation),
homa (sacred offering to fire),
Ijya (sacred offerings)
  • This again includes performing the religious deeds and offerings to sacred fire which help to curb the negativity in the atmosphere and mind.[35]
  • Recent researches have proved its positive effects on health
Anjali namaskara
(greetings with folded hands,
avoiding personal contact)
  • This again includes the spiritual awakening promoting the positivity in mind
  • This also implicates avoidance of personal contact during greeting or welcoming the strangers
Tapa (following spiritual path),
dana (charity),
niyama (following proper regulations),
daya (compassion),
diksha (rites),
guru abhigama (serving the elderly and teachers)
  • These include the measures followed for mental and social decorum facilitating the mental health.
Management of janapadodhvansa

Contemporary and applied aspects of janapadodhvansa

The concept of janapadodhvansa incorporates various aspects leading to causation of large number of diseases in large population or community. This further applies to the basics of public health or community health as mentioned in the Ayurveda texts. Thus striking similarities can be found in principles of epidemiology and concept of janapadodhvansa or maraka according to ayurveda. Some of these features are as mentioned below:

  1. Endemic nature of diseases: In janapadodhvansa chapter it is mentioned that Punarvasu Atreya assembled with his disciples including Agnivesha at banks of the river Ganga in Panchal Pradesh (present Northern India including regions of Uttar Pradesh). This is important to understand the region specificity or occurrence of the endemic diseases in the area. Endemic disease is the one which is predominantly present in the population in the given area e.g. chickenpox, malaria.[36] This concept can thus be correlated with medical topography which is the systematic surveying, mapping, charting, and description of specific geographical sites, with reference to the physical features that were presumed to influence health and disease.[37] Some diseases are more prevalent in northern hemisphere,, some in southern, some occur more commonly in tropical region. For instance, Plasmodium falciparum is the type of vector of malaria that is geographically located in the tropical and subtropical areas and is the most common cause of disease.[38] Charaka Samhita also describes three types of topographical conditions by dividing the desha into jangala, anupa and sadharana. (Cha. Sa. Vimana Sthana 3/47-48). Jangala desha (dry land) has less biota, scarce water resources, more wind and sunlight while anupa (marshy land) has abundant biota and flora, stagnant or scarce winds and lacks sunlight. Climatic conditions in jangala desha are considered optimum for health and reduce the disease occurrence than those in anupa desha.
  2. Seasonal diseases: The discussion was held in the months of spring and summer seasons (gharma maasa i.e. in the jyestha and aashadha maasa vis a vis vasanta and greeshma ritu). This evidence suggests that there was a possibility of outbreak of some kind of communicable disease in that particular time and season in the described region.These seasons are homologous to spring and summer season which even in the present era witness the outbreak of various exanthemata’s, allergic conditions and different type of fever annually.[39]
  3. Epidemiological triad: Causative factors of janapadodhvansa can be compared to epidemiological triad which involves the external agent, susceptible host and environment. Interaction of these three components always leads to disease causation in large population and can be applied to both communicable and non-communicable diseases.[40] The concept of janapadodhvansa is similar to that of epidemic or pandemic, where epidemic is a condition affecting or tending to affect a disproportionately large number of individuals within a population, community, or region at the same time.[41] Pandemic is the condition occurring over a wide geographic area and affecting an exceptionally high proportion of the population.[42] According to epidemiology, the causative factors affecting the contraction of disease in population are similar to those mentioned in the chapter which includes geographic location (desha), climatic factors, biotic biological factors represented by plant related and zoological factors (vriksha (flora), mriga- pakshi (fauna)etc.) and abiotic or socioeconomic factors (janapada). The seasonality of diseases is important factor for the epidemicoutbursts throughout the globe.[43] The kala factor does play an important role in disease manifestation. Deshaas mentioned earlier is important while considering the epidemiology, as outbreak of some diseases are region specific and their spread or progression also depends on the geographical, demographical and climatic conditions. It is helpful to understand the prevalence and incidence of diseases in the particular area.
    The description of vitiated air (vishama or vikrita vayu ) indicates climate change that increases the vulnerability of the populations to climate sensitive health risks like injury, mortality, temperature related illness (both hyperthermia and hypothermia), respiratory illnesses, zoonosis, vector borne diseases, malnutrition, communicable diseases, mental and psychosocial health etc.[44] Both atichala and atikundalinam vayu can be understood as fast blowing winds, cyclones, hurricanes or tornados that can result in public health emergencies like storm related mortality, injury, infectious diseases, impairment of mental wellbeing due to socio-economic factors like displacement, unemployment, disruption of ecosystems etc.[45] Atiparusha vayu or overly dry air indicates lack of humidity or excessive dryness in air contributing to the physical health related symptoms like dry eyes, itching of skin, dry throat etc. The stress on the nasal mucosa to humidify the entering air is intensified leading to be a major cause of respiratory disorders.[46] Atisheeta vayu or excessive cold air like that in air conditioned environments also poses a threat to increase in respiratory infections.[47] Epidemics like influenza have known to show a marked wintertime seasonality with over 2-3-month period within the months of November and March thus underlining the presence of cold air in atmosphere.[48] Atiabhishyandi or excessively humid air can intensify the heat and perspiration and trigger the respiratory conditions like asthma and COPD.[49] Ati-ushna vayu indicates the excessive rise in temperature which can cause heat stress related conditions like heat exhaustion and can also be a resultant of climate change and heat waves. It can also result in excessive dehydration.[50] Asatmya gandha indicates theodour pollution which is not only a determinant of environmental pollution but can also affect the physical health of community. It can result in occurrence of symptoms like wheezing, asthma, cough, headache, nausea and even mental stress related outcomes like mood changes.[51] The particulate matter or presence of pollutants in air is pressing problem due to advent of globalization and industrialization can also be correlated with asatmya gandha. Exposure to particulate matter can lead to reduced lung function, development of lung diseases like COPD, occupational lung diseases and even death.[52] Dushita Jala (impure water) also acts a carrier or cause of many epidemiological and endemic disorders. Most intestinal or enteric diseases are water borne infections. These are transmitted through faecal waste when the water is polluted by faecal matter.[53] Minamata Bay disease is excellent example of possible outbreak of severe disease through water pollution.[54] Many water borne bacterial infections can result in occurrence of disease like Typhoid(caused by Salmonella typhi), bacillary dysentery (caused by Shigella), viral infections like infectious hepatitis(Hepatitis A), Cholera(caused by Vibrio) and protozoal infections like amoebiasis, giardiasis etc. Upakranta and upaksheena Jalashaya indicate occurrence of famines and droughts. Droughts have far fetching consequences on the quality of public health resulting in the rise in infectious and nutrition related diseases. It results in shortage of drinking water and poor waterquality and lack of hygiene.[55] Access to safe and quality drinking water is the prime necessity for livelihood. WHO has put forth guidelines and standards to rectify the quality of drinking water to safeguard the health of population. Waterborne diseases resulting from consumption of unhealthy drinking water poses a great threat to the high risk population like children, geriatric population, pregnant women and those suffering from debilitating diseases. The water quality can be affected by microbial content, presence of impurities like heavy metals, faecal matter and other solvents making it unsafe for consumption.[56] Desha dushti the third factor leading to causation of janapadodhvansa can be understood as soil pollution that results from exposure to soil with altered quality as there can be ingestion, inhalation or dermal absorption of the pollutants present in the soil.[57] This factor is also affected by over- crowding which leads to the lack of hygiene and sanitation increasing the risk of spread of infectious disorders. It can result in overburdening of healthcare facilities and lack of sustainable development, further intensifying the environmental pollution. Ecosystems have direct or indirect impact on health as they are major source of food, water, supplies and even livelihood for the population.[58] Disturbed ecosystems lead to the outbreak of various Zoonotic diseases. For instance, the overabundance of vectors like makshika (flies), mashaka (mosquitos) can relate to the spread of vector borne diseases like dengue and chikungunya. The natural disasters like ulka patina (meteors) and bhoomikapana (earthquakes) indicate the emphasis of Acharya on the physical, mental, social, economic burden caused by such mishaps on the millions of people increasing the incidence of morbidity and mortality due communicable diseases as well.
    Kala factor is the most important amongst the aforesaid factors as it directly indicates the climate changes which is beyond intervention by human efforts. As mentioned earlier the spread and cause of infectious diseases follows a cyclic or calendar pattern and seasonal changes can lead to sudden rise of epidemic outbreaks.[59]



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