India continues to face a twin
burden of diseases, both communicable and non-communicable diseases (NCDs) as
is evident from the list of top 10 causes of death in the country.
Cardiovascular diseases (CVDs) are the leading cause of death in India as they
are globally. Diarrheal diseases come next.
As per data, the top 10 causes
of death in India are:
1. Cardiovascular
diseases
2. Diarrheal
diseases
3. Neonatal
disorders
4. Non-communicable
diseases
5. Chronic
respiratory diseases
6. Diabetes
7. Mental
disorders
8. Unintentional
injuries
9. Neoplasms
10. Nutritional deficiencies
(Source: World Bank India,
Population Reference Bureau (2017) India)
The major risk factors for
CVDs include high BP, abnormal blood cholesterol, tobacco and alcohol use,
diabetes, obesity, unhealthy diet, sedentary life, psychosocial stress.
The factors responsible for
the rising prevalence of type 2 diabetes are again unhealthy diet, lack of
physical activity, harmful use of alcohol, over-weight/obesity, tobacco use
etc.
Common mental disorders such
as depression, anxiety often coexist with other NCDs and they share many risk
factors. They occur not only as an outcome of NCDs, but mental disorders are
also associated with behaviors (alcohol use, tobacco smoking, unhealthy diet,
reduced physical activity), which increase the risk of other NCDs.
Unintentional
injuries are an important cause of death in India. Road traffic injuries, falls
and drowning constitute the three leading causes of deaths due to unintentional
injury. Diabetes is an important cause of falls in the elderly.
The traditional risk factor
for chronic respiratory disease such as COPD, asthma has been tobacco
smoking. But, now, non-smoking risk factors such as air pollution, occupational
chemicals and dusts are emerging as important contributors to chronic
respiratory diseases in developing countries like India.
Air pollution has now emerged
as a major environmental risk factor for health. It is a major potentially
modifiable risk factor for chronic diseases as well as acute disease events
such as stroke, acute heart attack and acute bronchial asthma.
When we talk of communicable
diseases, the major risk factors for diarrheal diseases, the second largest
cause of deaths in the country include poor
sanitation and lack of hygiene. Around 1.1
million children die each year in India, including approximately 1.1 lakh
deaths due to diarrhea. Although other factors
such as low socioeconomic status, poor maternal literacy, low birth weight,
inadequate breastfeeding, malnutrition also contribute the disease burden.
Enlisting the risk factors
shows that poor sanitation and lack of hygiene are the major risk factors for
communicable diseases. While, most NCDs such as heart disease, diabetes,
cancer, respiratory diseases share common behavioral risk factors (lack of
physical activity, unhealthy diet, tobacco use, excessive intake of alcohol)
and metabolic risk factors (obesity, hypertension, dyslipidemia, diabetes).
The INTERHEART study published
in the September 3, 2004 issue of the Lancet identified nine traditional risk
factors for an acute heart attack: Abnormal lipids, smoking, hypertension,
diabetes, abdominal obesity, psychosocial factors, consumption of fruits, vegetables,
and alcohol, and regular physical activity. As per the study, more than 90% of
the global risk for acute MI is predicted by these nine traditional risk
factors.
Hence, preventive strategies
for NCDs must focus on these overlapping risk factors. Diarrheal diseases can
be tackled via safe drinking water and improving hygiene and sanitation.
Much of the disease burden in
the country can be prevented by behavioral changes and adopting a healthy
lifestyle and practicing good hygiene.
Swachh Bharat mission, which
promotes hygiene and sanitation and also aims to make India completely Open
Defecation-free (ODF) by October 2019, is a step to reduce the burden of
diarrheal diseases in the country. A WHO report in 2018 estimated that at least
1.8 lakh diarrheal deaths have been averted in rural areas since the launch of
Swachhta Bharat Mission (TOI).
India has a National Programme
for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and
Stroke (NPCDCS). In the interim budget, the budgetary allocation for NPCDCS,
national mental health program, tobacco control program were reduced.
India will soon elect a new
government.
It remains to be seen if the
next government will have the political will to tackle the epidemic of NCDs in
the country and according increase the budgetary allocation when they present
the full budget.
Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of
Medical Associations in Asia and Oceania
(CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of
India
Past National President
IMA
