Invest more to keep India heart-healthy

A tank full of smudge can be cleaned in two ways. One, stop the feeder pipes; two, keep cleaning the tank. The feeder pipes in this instance are, high blood pressure and diabetes mellitus (type-2). If untreated, these will result in life threatening conditions such as heart attack, stroke and ultimately, death. These conditions, termed as cardiovascular diseases (CVDs), constitute the leading cause of death and disability in India.

Generally, one in three Indian adults suffer from hypertension and one in 10 are afflicted with diabetes; both do not show any physical manifestations in early stages (asymptomatic). Unless there is proactive screening for early detection, the doomed common man generally ends up in the hospital with a heart attack or stroke.

Poor health-seeking behaviour also poses difficulty in starting preventive efforts. As an analogy, among 100 adults, nearly 33 will have high BP out of which only 16 are likely to visit a government health facility – and that too if they have any other medical complaints.

Of the remaining 17, it is unsure whether they will go to private health facilities or won’t do anything at all. A large chunk of these people are likely to develop cardiovascular complications over the next 10 years.

If the same situation continues, the governments will have to meet catastrophic expenditures in reimbursing costs of surgeries and rehabilitation. It is diabolical not to prevent people with high BP and diabetes from dying from complications due to CVDs. The country can prevent many of these deaths and disabilities only if such individuals are diagnosed early and are put on medication.

At little over 1 per cent of the Gross Domestic Product (GDP), the government’s spending on health is dismal. Several state governments have started supporting the low-cost surgeries for cardiovascular diseases and even have set up dialysis centres to address the CVDs.

There are several important questions that need attention. While the entire health sector’s aspirations and preventive efforts don’t get the budget they want, how come the support from government for surgeries and medical bill reimbursements are continuously increasing? How can one change the situation?

Also, why are there increased investments only in curative health services? There are many reasons. The private healthcare industry is unambiguously the strongest lobby in the policy-making process. There is nothing wrong with this provided the government also spends on parallel initiatives to prevent people from facing these complications.

Eternally neglected
However, the public health efforts addressing the preventive services are eternally neglected. They also do not enjoy the power or influence, which the private sector has. Governments have to realise that the expenditure on treating complications will only keep increasing if there are no major efforts on prevention.

Increased reliance on advanced technology for diagnosis and high costs of medical expenditure has resulted in great imbalances. In order to reduce future expenditure and ensure a productive healthy workforce, it is highly essential that periodic screening of all the adults for high blood pressure and diabetes be done throughout the country.

According to WHO, India can implement “best buy” interventions by spending as little as $1 per person annually. The governments are not spending significant money to decrease tob-acco use, improve physical acti-vities, regulate food consumption or reduce alcohol overuse.

For a common man, the burgeoning medical expenditure is one of the chief reasons for debts and impoverishment. This can be changed only if there are greater investments made in preventive efforts. The health system cannot cover the entire population in one go. Therefore, the government has to conduct annual/ periodic surveys. While the screening can be facilitated by public health agencies, both public and private sectors can partner for offering treatment.

In the long run, health system should be strengthened in a systematic manner. India has a very ambitious programme called as Integrated Disease surveillance Project (IDSP), which collects data for communicable diseases with outbreak potential. IDSP can also collect data on high BP and diabetes with data linked to provision of drugs and admissions in the hospitals.

Prevention and management of diseases can efficiently be tracked using technology. India is most capable of creating such simple and appropriate technology. This is a win-win situation for all stakeholders and will ensure that the country has a he-althy and productive workforce. 

(The writer is Additional Professor at Indian Institute of Public Health, PHFI, Bengaluru)