However, it might come as a shock that as per the latest WHO health statistics of Pakistan non-communicable diseases (NCDs) account for almost as many deaths in the country as infectious ones, and several times more than headline-grabbing infections such as bird flu.

When we ask questions about why Pakistan has such high rates of NCDs (heart disease, diabetes etc) we come up with simple answers such as ‘overeating’, or ‘not eating well enough’. But we often don’t have very good answers for ‘why’ people overeat, or what eating well enough means. Even doctors end up blaming patients for lack of willpower, rather than being able to un-package what compels people to eat a certain way.

Research has shown that if your parents have chronic diseases, the likelihood of you developing them is much higher. This is not only a genetic issue, but is as much about how we are raised.

The social scientist Anne Murcott identified in 1982 that the very nature of diet is linked to women, specifically mothers. She extensively showed how mothers are central to what is being cooked and why. Moreover, ideas of identity (and by extension, those of ethnicity, language, culture, religion and ancestry) were found to be central to the notions that inform mothers of what choices to make for their families’ diet.

So how does food go from simply being fuel for our bodies, to becoming a parameter — in some cases the only parameter — with which to judge the quality of life? When did food become so charged with the emotional significance of happiness and communal connotations of reward?

Research shows that food is viewed as a vehicle for notions of identity, as well as a means of communication. A study conducted by this writer on Pakistani immigrant mothers in Edinburgh confirmed this view. It was seen that the choices the mothers made on what to feed their families were intimately linked with the kinds of cultural values they wished to impart, as well as emotions that they wished to communicate.

The mothers felt that the food they prepared and served was what helped their children and husbands identify with both their family and their national/ethnic identity.

More importantly, mothers felt that by cooking food that their family liked, they were able to express their own feelings of affection. They believed that doing so would bring them all closer, leading the mother to feel appreciated and loved.

It is clear that some of these lessons can be (cautiously) inferred for the larger Pakistani society as well, although ‘why’ such decisions are taken may differ. In our society, food serves as a primary social and cultural source of identity, entertainment and communication.

Thus we see how when people attend weddings for example, the serving of particular food items and the partaking of a generous helping are synonymous with enjoying the occasion.

Similarly, spouses and parents (mostly women) cook special meals on birthdays, or as a reward to express their happiness.

But beyond celebrations and expressions, the consumption of food also represents health consequences.

In the study mentioned earlier, it was seen that the shocks and pressures of dealing with migration contributed to the desire to deal with emotions through food — often feelings of loneliness and homesickness were sought to be dissipated via a meal, which reminded one of home. When emotional stresses are largely being dealt through food, they have a higher chance of contributing to NCDs.

That being said, it is also important to speak of the dangers of generalising research without arming oneself with the knowledge to make informed decisions. When it comes to research, it is important to remember that an association does not imply causation.

The meaning of this can be illustrated by a brilliant example a professor gave me: if there is a town with many storks and a high birth-rate, it cannot be ruled out that the two are indeed associated.

However, it does not mean that storks are responsible for the numerous babies — the causation for storks could be as simple as multiple chimneys in houses with many families due to a town’s growing economy — leading to more storks in the town, as the birds enjoy sitting atop warm chimneys and nesting near them.

Therefore, although research conducted on a limited group of women in Edinburgh may have implications and similarities to situations women in Pakistan find themselves in, it doesn’t not mean that the ‘causes’ of their similar situations apply to both.

But, it does mean that there are findings in common. And given that they share ethnicity and results, it means that the research is a guide which can help identify certain health problems, and can be generalised to some extent in a larger population of people with the same health problems.

The most important point to note is that this research doesn’t claim that Pakistani eating habits or Pakistani cuisine are directly responsible for NCDs. Rather, it is important to understand that food serves specific purposes of communication and identity, and those purposes leave it vulnerable to abuse.

Issues like stress, lack of communication, and lack of non-food based recreation and celebrations generally make food the only parameter with which to express relaxation and reward achievements and occasions. But in doing so, we condemn ourselves to having the only thing helping us feel better leading to our ill-health.

The writer is a medical doctor with a Master’s degree in public health.

Regardless of which side you took in the debate, it was remarkable to see the level of vitriol and indignation towards the striking doctors prevalent in even the simplest press and television news reports.

And perhaps that comes as no surprise, since a strike by doctors is a far more emotive issue than a strike by, say, road workers or lawyers. Doctors, the logic goes, cannot renege on their duties even in the slightest, for doing so would put lives in danger. But more fundamentally, the reaction was also rooted in a sense of betrayal. Society trusts doctors to cure its ills and take care of it in its weakest physical and psychological states.

Trust is an essential aspect of healthcare, but unfortunately most of us look to doctors and the medical system through a narrow, curative lens. People come to doctors when they need cures, but that is not the sole route to health. The majority of deaths in Pakistan, and indeed across the world, are caused by diseases which can be controlled and defeated through measures that nip them in the bud. These ‘upstream’ measures, which stop diseases from reducing us to statistics, are part of a science known as preventive medicine.

Current healthcare resources concentrate mainly on curing and managing the diseases we suffer from and preventive medicine removes a significant burden from them. It does so by dealing with diseases before they require medication or hospitalisation and by halting the disease process from evolving. In most cases preventive medicine allows your body to either develop resistance to a weakened or dead infective organism (a vaccination, for example), or change the body’s habits in order to break a cycle which would have otherwise led to disease (such as exercising to prevent heart disease). But preventive measures also require greater levels of trust and by extension, responsibility. And herein lies the catch — that responsibility is not the purview of doctors alone.

Take the example of cardiovascular diseases (CVDs), which according to the WHO are the leading cause of non-infective deaths in Pakistan. CVDs occur when blood vessels get diseased, damaged or develop clots in different parts of the body, causing a heart attack or stroke, etc which can lead to either death or disease. CVDs may be treated through surgeries or medication, but both carry significant physical and financial consequences and in the case of medications, aren’t even an exact science. Consequently, they are only prescribed as a last resort.

But another reason that their use is delayed is because 80 per cent of CVDs are caused by unhealthy lifestyle choices, and hence the most effective way of treating the disease is to remedy such choices. What that means is that controlling the patient’s risk factors by means of a proper diet and exercise are essential facets of prevention and treatment. To put it simply, preventive medicine saves the cost of expensive procedures and the need to go to a doctor for treatment.

At the same time, though, preventive medical measures also go on to create new webs of trust and responsibilities. Patients not only need to take control of their own health by disciplining their bodies but also need to trust that the medication does its job as well as trusting the food that they buy.

The responsibility for their health is thus further expanded from beyond just themselves to include pharmaceutical companies and even advertisers marketing products under the banner of ‘healthy for your heart’ and other catchy slogans. In essence, a wide network of mutual trust and responsibility is essential for basic health-care practices to be supported and reinforced. Without trust or responsibility, healthcare becomes an increasingly difficult proposition.

Nowhere is this idea of trust (or lack thereof) more clearly elucidated than in the long-standing issue of polio. With no cure available, preventive measures are the only solution and the only hope. Unfortunately, trust in those preventive measures has been eroded due to continuous assaults by a range of actors.

First of all there are the militants who paint the vaccinations as imperialist ploys to render children impotent, spreading these spurious claims via Friday sermons and radio broadcasts. Compounding their efforts was the US government, which was exposed using a hepatitis vaccination programme as a cover for espionage operations, giving credence to the conspiracies hatched by militants.

And even before this recent tit-for-tat between two sides in a state of war, pharmaceutical companies had also greatly contributed to this trust deficit within Pakistan. In 2010, a drug company was caught lying about the contents of its rotavirus vaccine, which prevents diarrhoeal diseases, after it was found to contain traces of pork derivatives — a fact which the pharmaceutical giant first denied and then claimed would not harm the two- to four-month-old children it was meant for, without any proof to support the claim.

Scandals such as these only helped thicken the dense intrigue within Pakistan which now accompanies any debate on polio vaccination. The presence of such conspiracies decimates any sense of trust, which means that preventive medicine is rendered ineffective.

It is important to realise that healthcare is not just a question of available doctors or even the amount of money and resources being used to develop infrastructure. Undoubtedly these issues are crucial, but ultimately trust and responsibility lie at the core of healthcare. The panicked outrage at the doctors’ strike was caused partly because people felt that doctors could not be trusted to provide care. But as the above discussion has shown, trust cannot be placed solely in doctors.

Healthcare solutions rely on a variety of factors, but they must incorporate a sense of responsibility by every concerned stakeholder and trust between each and every one of them.

The writer is a medical doctor and has a master’s in public health.

When we were growing up, listening to the likes of Junoon and Jazba, all I wanted was the repressed passion and misdirected anger I saw all around me to be voiced, so that it could match the feverish pitch of my inner turmoil.

A friend who left for Australia once said: “… the best thing about Pakistan is that nothing ever changes, but that is also the worst thing about Pakistan.”

That is why returning home is such a double-edged dilemma. When you are abroad, you crave the security of “sameness” to support you as you experiment with the uncertain, template-free newness of being abroad – alone and unaccounted for.

However, when you do go back to Pakistan, the shock of the too much sustained on too little, of awkward, fragile angles – be they of buildings, people’s neeyats or the ludday-huay lorry’s on the roads — are all too much for your ‘self’ to fathom, and you find yourself gasping for want of control, a semblance of understanding and most of all – for an escape.

The frenzy of a country like ours can be mapped onto miniscule points on a line, looping unto each other in a knotted mess of black, knarled graphite strokes marring a tiny piece of white paper, shiny grey at best, leaving smudges all over your already clogged mind.

But having said that, The Harvest makes one realize that Pakistan as a whole, has changed, and continues to do so.

For one thing, new Pakistani music is the brilliant blue of a positive litmus test which proves that the attitude toward our music and those who partake in such delights – has shifted. But this is not a change that has happened overnight.

It’s stirrings began to be felt in people like Rushk and Abbas Ali Khan, these were then articulated more definitively by Sajid & Zeeshan their first time around, considered in places like Ali Azmat’s Social Circus, refreshed by the delectable dabs of Zeb & Haniya, stunningly evoked in the works of Mekaal Hasan and the furious, back-arching Overload, reaching an apotheosis of sorts in Coke Studio, and existing amongst the provocative (and highly underrated) fringes in the works of the internet dwelling Asfand, Poor Rich Boy, //orangenoise, Mole, Positive, Usman Riaz, Natasha Ejaz, Talal Qureshi and Zoe Viccaji.

This music, this new Pakistani music, stems from our own evolution.

We have grown from a need to internalize all that is external – an ambition tripping forward over it’s own eager feet. Instead, we now crave self-contained exploration, one which yearns to slow down and relish it’s pleasures and pains in a retrospection of yore. An introspection where simple pleasures take root and are held onto as the bigger picture crumbles or zooms out into a pixelated mess that we are soon unable to discern.

Even when comparing Sajid and Zeeshan’s previous album – One Light Year at Snail Speed –  with the new one, you feel a change, or rather, you are aware of the changes within your self.

That’s why this new album is best heard when one is on their own. I’m not saying listen to it in solitary confinement — well not the physical variety, anyway.

I am talking about listening to it in the lonely places where we live in our own minds, amongst a bheer of beeples in a waiting area, during our daily commute, whilst roaming aimlessly in the transits of our life. I am talking about the time one finds themselves caught in a transition, the way one waits for The (aptly named) Harvest.

Music of this kind, which builds itself in the times we discount from ‘the measure of productivity’ of the day, the times when we just take a deep breath to brace ourselves with all we’ve gone through thus far, and let it out in the thandi saans spaces of now. ‘The Harvest’ lets us exist in a place where as Plato – the failed wrestler – wistfully noted, “everything is becoming, nothing is.”

There is a tired refrain in the criticism being faced by new Pakistani music that other luminaries around the world have done such sort of songs and albums before. But while Kraftwerk, Pink Floyd, Radiohead, and countless others may have used such digitization to portray the musical agenda of their times, Sajid and Zeeshan, like other new Pakistani music manage to colour in ‘our own’ musical narrative. They have, within their own time, betrayed a crystallized clarity, a need for white noise, a need for escape which is not seeking denial but actualization.

Of course, the album is not without its flaws. There are moments where the lyrics feel dated, or the music does not feel it has settled in its new form, or hasn’t shed enough of it’s previous incarnation in the first album.

But those flaws are apparent in light of the album’s most rewarding facet – the audacious yet carefully constructed, and somehow comfortably positioned transitions. The end of each song goes hand in hand with the next one’s continuity so beautifully in this album, that the stitching together of songs effortlessly sweeps you off your feet without forcing you to feel any-which-way, except to explore your own musings. And listening to Sajid’s clear voice – tone and tenor – you chew your intellectual cud like a cow does: in slo-mo ruminations.

Sajid & Zeeshan are themselves artists whose work marks the ‘change’ in Pakistani music that we keep searching for, but not seeing. Theirs is a farq which we older types can relate to and yet accept as an evolution to internalise. And perhaps their in-between nature is what allows them the insight into the importance of continuity, of a patchwork seamlessly sewn into our consciousness afore, yet one harkening a newly, quilted whole.

What’s the difference between a waitress and a doctor? Safieh Shah is finding out.

The views expressed by this blogger and in the following reader comments do not necessarily reflect the views and policies of the Dawn Media Group.

To Kia Hua – Bilal Khan:

The sound of this song is clean and fresh, akin to crisp mornings atop mountains (surly Karachites are deprived of this morning feeling). The phrase ‘jamais vu’ kept creeping up and jabbing at my linear sense of time, during this song, because Bilal Khan sounds like a younger reincarnate of the Vital Signs in our now, with a similar use of lyrics profound in their simplicity. As a first track it was well-placed, because it doesn’t set a tone for anything in specific per se as it is a precursor – the morning drift of hovering around your body before a bout of thoughts seat your personality within its defines once more. To Kia Hua effortlessly conjures mature mournful clouds, with perchance the silver lining of hope.

Kuch Hai – Mizraab:

Faraz Anwar represents a fixed set of components our ears are attuned to – his lyrics, composition, tone, virtuosity is within a certain set of parameters, a set base line or common denominator: formulaic. What Rohail seemingly does here is keep that base line which most songs/singers like Faraz represent, but brings in different moods to each component, breaking down the song and rearranging it as a procession of different moods.

It reminded me of an opera, and that may sound like a square peg, round-hole situation at first, but I maintain that there is an analogy to be drawn here. There are two main parts to an opera: a ‘recitative’ part which moves the plot forward, mimicking inflections of speech in order to emphasise them, and an ‘aria’ which is more faithful to a host of characters singing within a certain melody structure to express themselves. In this song, Faraz’s lyrics and his spells of music are within the ‘recitative’ part, where the song moves forward and therefore on their own – monotonous and done to death stylistically. However, when the chorus and the second vocalist come in and the music provides that topographical relief, it serves the purpose the ‘aria’ does in that the underlying emotions are brought out. But since this is Coke Studio, and its Sufi-inspired fusion, the ‘aria’ comes in the form of ecstatic repetitions, which are the hallmark climax of a Sufi song.

Danha pe Danha – Akhtar Chanal Zahri and Komal Rizvi

Akhtar Chanal Zehri establishes his effortless regality through song – as if it were a lion’s roar personified. He demarcates his sense of self clearly and without the hesitation, of our prevalent identity crises. Listening to his voice feels like a habitual chocolate consumer trying gurr for the first time; there is no processed sweetness to be had, its sweetness instead is ripe and replete with flavour. And when his spoken word resonates at the end, it leaves you rooted – embedded by the daanas of sand now plastered collectively as mud and floored in an awe of identity visceral and soondhi.

As for Komal, when she chose to take on Lal Meri during the BTS I felt a frisson of apprehension run through me like panic. I was worried that something so long held sacred by me was going to be cruelly mocked by someone who didn’t “have the right” to vocalize and utter it. But Komal comes into her own, her fluidity betraying the fun she is having. You can hear the smile in her voice and in the end she rapidly takes on (at least) three distinct notes that highlighted a range and flexibility to her voice which humbled me.

Ik Arzu – Jal

Light, fluffy, digestible (made more so because of the backing vocals angelic, ‘ray of lights’ surr) yet repetitively tiresome, the way you feel when you have to pick coriander leaves off their stalks one by one. But heck, this is Jal doing what Jal does and they stuck to their element like the Urdu proverb about how the snake begets the serpentine.  It wasn’t memorable, but it wasn’t terrible either, and the segue into Thaiyya Thaiyya and then Dam Mast was a good bit of fun – much like a tribute to those who have come before. I guess every singer’s dream is to bless their vocal cords with the phonation of Dam Mast Qalander.

But Jal should consider singing with the Zoe and Rachel Viccaji because their voices make the song flow, saving it. As always these girls are the unsung heroes – the glue bringing every song together by adapting to each song’s style and singer’s personality. They add a value that cannot easily be measured or understood because it is taken for granted, yet one without which we would be all the poorer.

Sighra Aaween Sawal Yaar – Sanam Marvi

I had tried to figure out why people had such a negative reaction to Sanam Marvi from last year, especially because I was oft left struggling foolishly after speaking up for her last year. Perhaps it was because to appreciate her would be to spite our cynicism. She’s a veritable giant in terms of her naked devotion, yet humble and not someone who can be easily pigeon-holed. So she is ignored because if you can’t figure someone out, you would rather pretend they don’t exist so you can avoid feeling out of your own depth around them.

But good as she was last year, this time was when Coke Studio finally, really sunk their teeth into her sound as well. The entire song keeps hovering around a precipice, repeatedly threatening to jump in, but never doing so. You keep circling around and Marvi doesn’t pull you in, and yet doesn’t let you push away either, leaving you frustrated and unsure of whether you felt hot or cold and as if you’ve been deprived of an imminent climax. Perhaps it is because the format lacks the polytonality that the rest bask in – for the music and lyrics were strung, beaded alongside within their own space and time.

I don’t want to tempt fate with a premature proclamation about how excellent the next few episodes would be. But I feel confident that like these songs, they will challenge our musical barriers, they will be crafted with meticulous care and mayhem, and they will continue to make us proud of being Pakistanis.

What’s the difference between a waitress and a doctor? Safieh Shah is finding out.

The views expressed by this blogger and in the following reader comments do not necessarily reflect the views and policies of the Dawn Media Group.