With the Wuhan Coronavirus claiming over a 1000 lives, the spotlight of the world is on communicable diseases and preventing their outbreak. A few years earlier, the world’s attention was on Ebola, which claimed over 20,000 lives when it was at its peak in 2014-16. But, the thing about pandemics, be it Ebola or Coronavirus, SARS or H1N1, is that they, because of their virality and risk to the population, get attention, resources and a way of combat and control. Right now, there are thousands of scientists across the world, burning the midnight oil, to find a vaccine for coronavirus.
However, when it comes to non-communicable diseases (NCDs) – cardiovascular disease, diabetes, and others – there isn’t a similar warlike effort to combat and control them. According to a recent World Bank report, over 38 million people die each year, 16 million of them under the age of 70, because of non-communicable diseases. Furthermore, it has a huge impact on a productive lifestyle for those who survive. Across the world, governments and creaking public health systems have made the tackling of non-communicable and chronic diseases such as heart conditions and diabetes a primary target.
In India, we are seeing people under 40 succumb to heart attacks, be afflicted by paralysis – we see 20-year-olds declared diabetic – and all of these have a cost not just on the individual, but on the economy. While India has traditionally focused on malnutrition, and health issues that are triggered by it – with an increase in income, over the last two decades – lifestyle diseases are catching up. In India, 63 percent of all deaths are due to non-communicable diseases. According to a study in the Lancet, cardiovascular diseases were responsible for 28.1 percent of all deaths, and 14.1 percent of DALY (disability adjusted life years).
Two decades ago, these were all lifestyle diseases afflicting the middle class and the rich. However, with Indians moving up the income ladder, and food habits changing, these lifestyle diseases have percolated from the richer sections of society – where they were more endemic – to all sections of society. With more and more healthcare being made available and paid for by the state the economic burden of these diseases, and the increase in their prevalence, has become an issue to be tackled by policy.
At the core of these policy changes is the need to provide primary health care that would enable medical professionals to raise the alarm early enough and begin treatment. However, in many countries including India – the rate at which Primary Health Care (PHC) is growing, and the coverage that it is providing is not fast enough to stem the rise in these diseases. While India is investing in the physical infrastructure of primary health centres, their effectiveness is severely hampered by the sheer numbers of patients, and the massive shortage of trained medical staff. It is estimated that India has 7 doctors per 10,000 people – if we looked at rural India by itself, the number will be much lower. It is estimated that we have a shortfall of 600,000 doctors and 2 million-plus nurses.
At the second level, there needs to be a focus on food habits and nutrition. Even at the turn of the century, lifestyle diseases were primarily an urban and
well-to-do phenomenon. However, that is changing. Obesity is on the rise in rural India and in economically weaker households in urban India. A study last year in Nature looked at the trend of increased body mass index (BMI) in rural areas across the world and found that obesity is on the rise – and with it, all the associated lifestyle diseases. The main reason for this seems to be the move away from natural and traditional foods to processed foods; as well as increased mechanisation of farm work and the availability of transport.
So, while we combat Coronavirus, Ebola, Nipa and other exotic pandemics – it is important for the country as a whole to look at fundamental lifestyle changes that enable better health and living. The prime minister has done his bit on advocating fitness and a healthier lifestyle. However, these initiatives have to go beyond being a photo opportunity, or a social media hashtag – and have a long-term roadmap in terms of health, nutrition, and overall wellness. Just labelling centres as wellness centres is not going to be effective, if they are not followed up with policies that educate patients on a healthy lifestyle. And, those have to be localised, or even hyper localised – because, in a diverse nation like India everything changes in the next locality.
We are on the precipice of a public health disaster. According to the WHO, the cost of non-communicable diseases to the Indian economy in the period 2012-30 is $6.16 trillion. One way of ensuring that we reach the $5 trillion mark as an economy is to make sure that our people are healthier. And, fixing that needs not just Instagram videos and twitter memes, but a focused, planned approach to public health.-CNBC18