“You have high blood pressure and a borderline cholesterol level,” declared the doctor, to his 30-year old patient. A decade ago, this would have been considered an unusual diagnosis in someone so young. Not today though. According to a recent study in the medical journal Lancet, high blood pressure or hypertension was the most common condition detected in the study of patients seeking primary healthcare across India.
Alarmingly, 21.4 per cent of those with hypertension were under the age of 40. They were unaware that ignoring their condition could lead to a stroke, premature heart attack or heart failure.
The Great India BP Survey released by the Cardiological Society of India (CSI) earlier this year confirms that more than one third of Indian adults have hypertension and over 50 per cent of these patients are oblivious to their problem.
“The survey presents a disturbing picture of the low awareness level of people about the risk factors of heart diseases that include hypertension,” reiterates Dr Ashok Seth, Chairman of Fortis Escorts Heart Institute.
Hypertension aside, Indians are struggling with multiple non-communicable diseases (NCDs) that include heart disease, diabetes, cancer, respiratory disorders, depression, and so on. These NCDs jostle alongside tropical and vaccine preventable diseases – malaria, tuberculosis, typhoid and others – and contribute to 53 per cent of the overall disease burden in the country.
The WHO statistical profile 2015 for India states that the probability of dying between ages 30 and 70, from four major NCDs like cancer, cardiovascular diseases, chronic respiratory diseases and diabetes for both sexes is as high as 26 per cent.
Despite this threat, the national response to NCDs has been slow and scattered. A joint plan of the World Health Organisation and the Government of India, the WHO-GOI 2012-2013 biennial work plan and a more recent blueprint “SANKALP 2015” developed by the Partnership to Fight Chronic Diseases (PFCD), are the current guiding frameworks.
The NCDs find a mention in draft Health Policy Action 2015 (under revision) and specific national targets and indicators have been developed to reduce the number of premature deaths from the NCDs by 25 per cent by 2025. While the global action plan for the NCDs lists nine targets, India has set a 10th – to reduce household air pollution caused by the lighting of wood-stoves or chulas.
There are multiple programmes to manage the NCDs under the National Health Mission: the National Programme for Prevention & Control of Cancer, CVDs and stroke, the National Tobacco Control Programme, the National Programme for Palliative Care, National Mental Health Programme, which operate alongside various NGO programmes for alcohol control, diabetes and hypertension prevention and management, cancer etc.
Integrating these programmes and adopting protocol that would enable disease prevention and management clearly calls for a strategy that engages all stakeholders on a single platform.
Though a NCD unit does exist within the ministry of health, there is no functional multi-sectoral national policy, strategy or action plan that integrates different chronic diseases and shared risk factors.
Evidence based national guidelines/protocols for the management of the NCDs through a primary care approach and a surveillance system to enable reporting against the 10 targets are also missing. Programmes to combat diseases aren’t effective since they are not informed by accurate epidemiological data.
Many factors contribute to the rising incidence of the NCDs; a shift in the eating habits from fresh to processed foods, lack of exercise, rise in pollution, increased smoking and alcohol consumption. The progression of early stage diseases into full blown and chronic conditions is attributable to late diagnosis and lax follow up.
Experts agree that screening for NCDs should be done at the primary healthcare level, and linked to continuity of care arrangements via specialist consultations. Though a Central government’s initiative called the ‘NCD Clinic model’ establishes clinics for screening at the primary healthcare level to promote integrated chronic disease management, this has been adopted by just a handful of states.
Narrow focus
Another problem with the current frameworks and plans to tackle the NCDs is their narrow focus on specific diseases like cardio-vascular diseases, hypertension diabetes and cancers. The NCDs comprise a very broad range of diseases, but the national agenda completely overlooks the need to include screening for conditions such as mental health disorders, respiratory diseases and even deafness and blindness at the primary level. Ignoring these problems will be detrimental in the long term.
Mental illnesses account for a huge amount of disability and premature mortality. While developed countries have acknowledged the gravity of mental health diseases and pushed these into the fore of government health agendas, India lags.
The mental health policy released by the government in 2014 included a recommendation to equip more specialists and institutions to tackle mental problems and integrate them into the primary care system to enable the identification of cases and referrals to experts.
But there is no visible upgrade of infrastructure or human resource requirements for either diagnosing or treating such illnesses in primary health centres or general hospitals, leaving the bulk of people with problems in the lurch.
Healthcare systems must be upgraded to deliver effective and result-oriented interventions to tackle NCDs in the country with the same vigour as has been devoted to infectious diseases such as tuberculosis and polio. Various steps must be taken to achieve this objective. The NCD department within the Ministry of Health and Family Welfare at both state and central levels needs strengthening.
Robust mechanisms are essential to integrate the NCDs management protocol across all departments. Well-equipped qualified and co-ordinated health teams must be put into place to manage the needs of those with chronic diseases. Finally, as SANKLAP 2015 says, spending on NCDs needs to be doubled by 2020 if we want programmes to be effective.
(The author is a microbiologist who writes on health issues)
Published 24 November 2015, 18:02 IST