Union Minister for Health and Family Welfare J P Nadda recently inaugurated a National Training Programme for five major non-communicable diseases (NCDs)—hypertension, diabetes and cancers of mouth, breast and cervix. On May 1, the Indian Council of Medical Research launched the May Measurement Month for hypertension screening, in partnership with the Public Health Foundation of India.
These two initiatives highlight the growing threat of NCDs in India which account for 63 per cent of all deaths in India. About 40 per cent of these deaths occur below the age of 65 years, in the productive prime of midlife. NCDs strike at a much younger age in India, with heart attacks, diabetes or oral cancer now afflicting people even in their 20s and 30s.
Hypertension (high blood pressure) and tobacco consumption (any form) are two leading causes of NCD and warrant special attention in a screening programme that aims not only to detect disease but also reduce the risk.
About 40 per cent of urban Indians and 25 per cent of rural Indians above 30 years of age suffer from hypertension which, if undetected or inadequately controlled, leads to death and disability.
It is a major risk factor for heart attacks, paralytic strokes and hypertensive heart failure. It causes kidney failure and is the second commonest cause of dementia, after Alzheimer’s.
Therefore, a broad spectrum of health care providers—from nurses and primary care physicians to a wide range of specialist doctors—need to be trained in the detection and management of hypertension.
Tobacco control, too, acquires great importance in India where 1.2 million lives are estimated to be lost each year due to smoking and smokeless tobacco consumption. Tobacco chewing is presently the commonest form of tobacco consumption in India.
About 26 per cent of adults consume oral tobacco products. It is not surprising that India accounts for 74 per cent of oral tobacco-related global disease burden. Around 80 per cent of oral cancers are due to tobacco consumption—hence the inclusion of oral cancer in the national screening programme. Tobacco consumption can also raise blood pressure and cause blood clotting in the blood vessels of heart and brain. There is evidence that tobacco consumption increases the risk of diabetes too.
Much of the death and disease burden of NCDs can be reduced through protective living habits: regular physical activity; diet rich in fruit and vegetables and low in sugar, salt and unhealthy fats; avoidance of tobacco: abstinence from or limited consumption of alcohol, and effective stress-coping mechanisms. Popularisation of yoga and transformation of health sub-centres into Health and Wellness Centres will help promote healthy living. Screening programmes must not only raise mass awareness of why and how the risk of NCDs should be avoided or reduced, but also emphasise on non-medicinal measures.
Early detection and effective treatment of persons who have developed the disease or are at a risk of doing so, is also important. While mass screening programmes initially serve to detect a large number who are unaware of their condition, its sustainability and cost-effectiveness require that routine screening and continuous care are integrated into all levels of the health system. This is vital in primary care settings and need not be doctor-dependant.
Hence the need to train primary care providers—from technology-enabled frontline health workers and AYUSH physicians to basic allopathy doctors.
Community-based research studies in different states, conducted by the Public Health Foundation of India, have shown that technology-enabled auxiliary nurse midwives and other community health workers can accurately diagnose, provide early advice, appropriate referral and long-term follow-up.
They have achieved very good control rates of blood pressure and blood sugar, armed with point of care diagnostics and hand-held digital tablets which display algorithmic decision support systems. Digital innovation and women power are combining well to combat NCDs.
K Srinath Reddy
President, Public Health Foundation of India