A worrying trend is looming large: Non-communicable diseases or NCDs. Until some years back, communicable ailments accounted for the most number of deaths in India. Not any longer, however. The World Health Organisation has warned that efforts to control their spread have been found wanting. The NCDs now account for 61per cent of deaths in India, exceeding those of infectious ailments. The WHO’s latest progress report estimated 2017 NCD deaths in India at 5,817,000.
The NCDs are chronic ailments (also termed lifestyle diseases). These include cardiovascular problems (heart attacks and stroke), chronic respiratory diseases, cancers and Diabetes. Even mental ailments and suicides are classified as NCDs. The slow progress in controlling NCDs could scuttle chances of the country achieving its health Sustainable Development Goals by 2030, which aims at limiting premature mortality from NCDs by one-third. With India already afflicted by an NCD epidemic, a sense of urgency in treatment is needed to address the challenge.
Policy reforms and attitudinal changes are also pivotal. A standard approach intackling NCDs should be followed. At present, a piecemeal approach is underway, wherein States are adhering to different modalities in addressing this common threat.
Some of the largest NCD drivers comprise unhealthy diets, tobacco and alcohol. Besides, nutritional deficiencies caused by wrong diets can impact the health of bones, leading to orthopaedic ailmentslike arthritis, knee and elbow problems.
Recently, the Food Safety and Standards Authority of India (FSSAI) formed an expert group to address the issue of high fat, salt and sugar in foods and the associated health risks. The FSSAI later issued draft guidelines titled Guidelines for making available Wholesome, Nutritious, Safe and Hygienic Food to Schoolchildren in India. Though the effort is laudable, more widespread and uniform policy measures are called for.
Meanwhile, another alarming trend compels attention: lifestyle diseases are no longer impacting only the well-heeled or urban residents. Today, rural regions are also registering high NCD rates. The prime reason for this trend is the increasing urban lifestyles adopted by villagers as mobiles and varied manifestations of modern development penetrate India. Although rural development is good, the concomitant unhealthy habits are causing unwanted collateral damage.
These factors make it crucial to launch long-term healthy lifestyle campaigns with strong messaging. As NCDs are affecting all sections and rural areas too, the primary healthcare system needs augmenting and overhaulingin addressing NCDs. Caregivers should be sensitised that long-term care and lifelong management are mandatory in treating these chronic ailments without a cure. Apart from medication and specific treatment regimens, social care, counselling and follow-ups are necessary.
Follow-up treatments are emphasized because some States have launched screening programmes for Diabetes and NCDs. But the initiatives have not always borne fruit because follow-up treatment was missing. A standardised approach across States in diagnosing, treating and following up is essential for success.
Statistics indicate in every State NCDs have overtaken communicable disease numbers. As modern conveniences and mechanisation spread across rural households, there’s a parallel rise in NCDs, including Diabetes, cardiovascular diseases and hypertension. The impact of NCDs is more pronounced among rural India because most are not employed in the formal economy but earn daily wages. Since some chronic ailments cause disability or death, household incomes are affected. Moreover, while several NCDs don’t culminate in death, these can cause disabilities that affect work abilities. Various mental and neurological ailments, anaemia, hearing and vision problems fall within this category.
The burden of disease is higher due to lost disability-adjusted life (DAlYs) years. Premature deaths and the years spent at home without working due to disability results in higher DAlYs. It’s no surprise NCDs comprise three of the top five leading causes of DAlYs lost in India: Coronary artery disease, chronic lung ailments and stroke.
The Writer is Dr Yash Gulati, Orthopaedic Surgeon at Indraprastha Apollo Hospitals,New Delhi