12 Sep

Non Communicable Diseases

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Contents

• Introduction
• Key Factors Responsible for increasing NCDs
• Impact of NCDs
• Some Recent Steps taken by India
• Prevention and Control of NCDs
• Blood Pressure / Hyper Tension
• Hypertension Situation in India

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Introduction

• Non communicable diseases (NCDs), also known as chronic diseases, tend to be of long duration and are a result of a combination of genetic, physiological, environmental and behaviour factors.
• There are 4 main types of non-communicable disease are:

1. Cardiovascular diseases (like heart attacks and strokes)

2. Cancers

3. Chronic Respiratory diseases (like chronic obstructed pulmonary disease and asthma)

4. Diabetes

Earlier, mostly elderlies in urban areas were found to be suffering from NCDs. But, now all age groups in all regions (both urban and rural) are increasingly becoming vulnerable to the non-communicable diseases.

Key Factors Responsible for increasing NCDs

• Modifiable Behavioural factors such as tobacco use, physical inactivity, unhealthy diet etc.
• Malnourishment
  • Malnourishment makes children vulnerable to NCDs in later phase of life and is one of the major causes of NCDs in India.
• Pollution has emerged as a major challenge
  • Ambient air pollution and indoor air pollution have an impact on CVD and mortality. Various studies have shown that household pollution is the third top risk factor in low income countries.
•  Increasing Life Expectancy
  • Life expectancy is increasing in India and with it we see an increase in old age population who are more vulnerable to NCDs like high blood pressure, diabetes and cancers.
• Inadequate health facilities
  • It prevents early screening, detection and thus awareness generation about NCDs.

NCDs are increasing in Rural India too:

• NCDS in Rural India is affecting a relatively younger population
  • May be, because of poor nutrition availability during early life. So, there is a need to screen younger population in rural India for chronic diseases
• Very Less awareness
  • This hinders lifestyle changes and preventive methods.
• Poor health facilities
  • In rural areas, on many occasions facilities for diagnosis and treatment are not available resulting in late diagnosis and treatment.
• Lack of systematic mechanism to collect data on NCDs from rural India
  • This hinders efforts at measuring the problem, guiding interventions and monitoring them effectively.

Impact of NCDs

• Largest Cause of Death
  • According to WHO, nearly 61% (63% globally) of all deaths in India are caused by NCDs including heart disorders, cancer and diabetes. According to MoH&FW cancer alone causes more than 5 Lakh deaths in India every year.
• Socio-Economic Impact
  • NCDs worsens Poverty:
    • It threatens fight against poverty reduction and hinders achievement of SDGs.
  • This also burdens government with more health expenditure and reduces economic output of the population.
  • It also leads to heavy burden on India’s healthcare system.
• International Image -> India’s soft power weakens
  • It questions a rising superpowers ability to tackle health problems of its own.

Some Recent Steps taken by India

i. National Health Policy, 2017

• It aims at reducing premature mortality from cardiovascular diseases, cancers, diabetes, or chronic respiratory diseases by 25% by 2025.
• The policy recognizes inter-play of three actions -> Policy & Surveillance, Strengthening of Healthcare systems, and Healthcare Financing.

ii. National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Strokes (NPCDCS)

• Program by MoH&FW, launched in 2008
• It is focused on health promotion for general population and Disease Prevention for the High Risk Groups

iii. India Hypertension Management Initiative (IHMI)

• Launched in Nov, 2017 as a collaborative project between ICMR, MoH&FW, State governments, WHO etc
• It is aimed at strengthening the cardio-vascular disease component of the health ministry’s National Program for Control of Cancer, Diabetes, Cardiovascular diseases and Stroke (NPCDCS).

iv. 1.5 lakh health and wellness centres to be established throughout the country.

• These health and wellness centres will promote early screening, diagnosis and treatment.

v. Awareness Initiatives like the recently launched ‘Eat Right Movement’

vi. Eat Right Mela by FSSAI aims to usher in a ‘new food culture’ by nudging the businesses and
consumers to adopt safe, healhy and sustainable food practices in India.

Way forward: Prevention and Control of NCDs

• The prevention and control of NCDs will require comprehensive approach in which all sectors including health, education, finance, transport, urban planning and others will need to play a role in reducing the risk factors and treating the existing NCDs.
• Promoting healthy diet, physical activity etc
• Reducing both outdoor and indoor pollution will go a long way in fighting against chronic respiratory diseases, cardiovascular diseases, diabetes and lung cancer.
• Restricting use of Sin goods
  • Prohibition or higher taxes on tobacco products and alcohol
  • More duties on unhealthy food
  • Replacing trans fats with poly unsaturated fats
• Effective Policy implementation
  • Government of India has already launched a number of initiatives such as National Health Policy, India Hypertension initiative, establishment of 1.5 lakh health and wellness centres etc.
  • Proper implementation of these policies and programs will go a long way in reducing NCDs in India.
• More Investment in better management of NCDs
  • More facilities for detection, screening and treatment of these diseases especially in rural areas and for providing palliative care for people in need.
  • This kind of investment has huge economic value as it will not only ensure better productivity but reduces cost of treatment on later stages.
• More R&D to fund cost effective solutions and better ways of management of diseases.

Blood Pressure / Hyper Tension

What is Blood Pressure?

• Blood pressure is a measure of how much the blood moving through your arteries pushes against the vessel walls. According to medical standards, the reading on a doctor’s BP monitor going above 140/90 accounts for hypertension. High Blood Pressure (Hypertension) is a serious medical condition that significantly increase the risks of heart, brain, kidney and other diseases.
• A large number of people who suffer from hypertension are unaware of this, therefore it is also
  sometimes referred as a silent killer.
• It is a condition that knows no boundaries affecting people of every age and different socio-economic conditions. It can’t be cured but can be managed through lifestyle changes, medication, and regular monitoring.

WHO Report on Global Impact of High BP

• Hypertension affects 1 in 3 adults worldwide and around 1/3rd of the adults with hypertension are unaware of their conditions. Nearly 4/5 people with hypertension are inadequately treated. Scaling up coverage can avert 76 million deaths between 2023-2050.

The number of people living with hypertension (blood pressure of 140/90 mmHg or higher or taking medication for hypertension) doubled between 1990 and 2019, from 650 million to 1.3 billion.

Hypertension Situation in India:

• As per a paper published in The Lancet:
  • Hypertension is the most important risk factor for death and disability in India.
  • Less than 1/4th of hypertensive patients in India had their blood pressure under control during 2016-2020.
• There is a growing prevalence of hypertension amongst younger adults and those from lower socioeconomic backgrounds.
• NFHS-5 reported a hypertension prevalence of 24% in men and 21% among women, an increase from 19% and 17% respectively from the previous round (NFHS-4)

Key Issues with Hypertension situation in India:

i. Lack of Awareness: As per WHO, 1/3rd of the hypertension patients don’t even know that they are suffering from hypertension.

ii. Limited Access to healthcare services

iii. Inadequate adherence to medication and lifestyle modifications

Way Forward:

• Improving Awareness
• Lifestyle changes: Eating Healthier diet, quitting tobacco, being more active -> this can help lower the blood pressure.
  • Other changes like reduced salt intake, reduce alcohol consumption can also help.
• Early Detection and Effective management have to be prioritized by countries.
  • Hypertension can be controlled effectively with simple, low-cost medication regimens and yet only 1/5 people in hypertension have controlled it.
  • Medication adherence is crucial for control. Forgetfulness among elderly to take medication, medication availability, and affordability pose barriers.
  • Strengthening hypertension control must be part of every country’s journey towards universal health coverage.

Example Questions

• For long NCDs in rural India have been ignored. Suggest some measures to deal with increasing
  cases of non-communicable diseases in rural areas. [10 marks, 150 words]
• Non-Communicable diseases have become the biggest cause of deaths in India. Discuss the key
  causes and consequences of increasing non-communicable diseases in India. [10 marks, 150
  words]