Heart health: Way to India's well-being
Heart disease is the leading cause of death globally, both in men and women. There has been a 42 per cent increase in deaths caused by it from 1990 to 2013 and more than 80 per cent of these deaths are in developing countries, including India.
According to WHO and the recent Global Burden of Disease(GBD) Data, heart disease, diabetes, stroke, and road injury contribute to the largest cause of Indians living with disability and premature death.
The good news, however, is that more than 50-60 per cent of heart disease, diabetes andstroke incidences can be prevented if the causative three major risk factors are targeted appropriately – tobacco, physical inactivity and unhealthy diet.
The bonus is that these are equally powerful for prevention of cancer, arthritis, lower back pain and osteoporosis. They can also leapfrog the health of infants and youth, maternal and child health, health of the unborn child, and prevent susceptibility to contracting or deaths due to tuberculosis.
The common tendency for us all – doctors, healthcare provi-ders, communities, the government and others – is to hold the ‘individual’ responsible for it. At the policy level the common practice is to hold the ‘health ministry’ responsible for it.
The reality is that individuals and the health ministry have the least contribution to it, as they are a function of the environment; while all ministries outside the health ministry determine and are responsible for these environments – the physical, social and economic. Let’s look at the three risk factors.
Tobacco use, both smoked and smokeless, active and passive needs to be eliminated. A total ban of tobacco use in public places, coupled with large pictorial warnings on all tobacco products; raising of taxes, and total ban of its use in films, direct and surrogate (indirect advertising) is needed without delay and without compromise.
Physical activity, considered as the “miracle drug” by world’s leading scientific journals, benefits all communities across socio-economic classes and gender.
Firstly, we need to make physical activity in our daily lives safe (from road accidents, injuries and falls), and then desirable, accessible, and comfortable (trees on both side for shade) while travelling to work places and educational institutions, at schools, offices and homes, while going to the market and for leisure.
Wide pedestrian pathways, and cycling bylanes with trees will increase the health of entire community. These are also known to increase walking, decongest the traffic, promote walking the last mile, promote the use of public transport and also decrease sitting time. Each additional hour of sitting time increases risk of heart disease, high blood pressure, high cholesterol, stroke and obesity.
Context specific solutions
We need context specific, long-term solutions to traffic jams. The recent ‘car-free’ day initiatives on a weekday in Gurgaon, although laudable, was more of a gimmick as traffic jams were worse and the elderly, children and women were required to walk or cycle on roads without useable pedestrian pathways amongst chaotic traffic and rowdy drivers.
The third risk factor is unhealthy diet. Heart health and prevention of diseases requires a daily consumption of fresh fruits, vegetables, whole grains (instead of refined grains and sugars), decrease of salt and sugars, and replacement of nuts for unhealthy fats. A national ban on transfats will benefit the poor and the marginalised communities as it is the most straightforward public health strategy for rapid improvements in health.
Healthy food need to be available at worksite, educational institutes, near home and must be safe, chemical free, affordable, accessible and desirable. Farm produce and cold chains for fresh fruit and vegetables need to be enhanced. Farmers need to be given know-how to grow multiple crops, vegetables and fruits and make their produce economically viable.
While selling to customers, healthy food need to be made cheaper than unhealthy foods. The taxes on unhealthy foods can help to subsidise the healthy ones. Advertising unhealthy food to children needs to be curtailed. Food labels should be pictorial and colour coded.
Unless appropriate steps are taken, India is estimated to lose $2.17 trillion due to heart diseases and strokes between 2012-2030. With common risk factors across the spectrum of chronic diseases, ‘heart health’ can lead the way to alleviate diseases in India.
We need multi-sectoral, multi-disciplinary and multi-level action by various ministries to promote the health of India. Let this “World Heart Day” be the beginning and realisation of a new era. National policies across sectors should become the instruments of health, health for all, and health for the poor. And “Let the welfare of the people be the ultimate law”.
(The writer is Additional Professor, Indian Institute of Public Health, PHFI, New Delhi)