Non-communicable diseases posing major threat
Dr Santosh Jain Passi, Akanksha Jain
Our country is afflicted with the dual burden of disease – non-communicable diseases (NCDs) posing a major public health challenge. On one end are the nutritional deficiencies/infectious diseases associated with poverty, deprivation and poor environmental conditions; while on the other are the NCDs caused due to dietary excesses/imbalances and metabolic disturbances. Text Box: Proportional mortality in India (% of total deaths, all ages) The epidemic of NCDs is mainly attributed to modernisation, urbanisation, sedentary lifestyles and longevity. There is an upsurge in the incidence of overweight/obesity, cardiovascular diseases, type 2 diabetes mellitus, cancers, respiratory diseases and mental illnesses. The World Health Organisation (WHO) has highlighted that if “business as usual” continues, globally by 2030, the annual mortality due to NCDs will touch 55 million mark.
As per the WHO report (2015), in India, 60 per cent deaths are caused by NCDs; and that 1 out of 4 Indians are at a risk of dying from one of the NCDs before the age of 70 years. Dr Poonam Khetrapal Singh, Regional Director, WHO-SEAR has remarked that the NCDs are afflicting younger generations and, thus, hampering socioeconomic development. Due to huge loss of potentially productive years (35-64 y), there is massive economic loss at the household, national and international levels.
The NCD burden can, however, be reduced immensely through appropriate preventive/ curative actions. Healthy dietary practices, increased physical activity, weight management, abstinence from tobacco/substance use and alcohol abuse play an important role in their prevention/management. More than 80 per cent of the CVDs and T2DM; and 33 per cent of the cancers can be averted through lifestyle modifications; nutritionally balanced diet being inevitably important.
For maintaining an ideal body weight, total energy intake and energy expenditure need to be balanced; and the diet should be adequate in protein. There is a close link between quality/quantity of dietary fat and NCDs. A high intake of fat/oil – particularly saturated fat, poses profound risk for CHD, cancer, T2DM and hypertension. Replacing saturated fat with PUFA rich oils can significantly lower the CHD rates. Dietary fat also impacts glucose tolerance and insulin sensitivity. Consumption of MUFA containing oils (like olive, mustard and groundnut oils) confer numerous health benefits including reduced risk of CHD and lung/ oesophageal/ breast/colorectal cancer. On the contrary, trans fats elevate CHD risk through
undesirable effect on serum lipids.
In the prevention/management of NCDs, increased consumption of vegetables (2-3 servings/day) and fruits (2 servings/day) is imperative for providing adequate amount of dietary fibre, phytochemicals, antioxidants and various vitamins/minerals. Dietary fibre plays an important role through its impact on atherogenic lipoproteins, blood pressure and thrombogenesis. Regular intake of dietary fibre rich foods not only helps in weight management but also in lowering serum lipids, improving glucose metabolism, regulating blood pressure and reducing chronic inflammation of the tissues. Further, probiotics, prebiotics, and synbiotics improve lipid profile and glycaemic control by selectively supporting the health-promoting gut bacteria. Prebiotics can also prevent colorectal cancer by modifying the composition/ activity of colorectal microflora.
Tobacco (in all forms) and alcohol abuse are major risk factors for NCDs particularly chronic obstructive pulmonary disease. Physical inactivity is one of the leading contributors to global mortality (~6% deaths) and NCD burden. Psychosocial factors and emotional stress (depression, anxiety and chronic stress) also contribute significantly to the pathogenesis of NCDs.
In 2012, the World Health Assembly endorsed the important ’25 by 25 goal’ aimed to reduce NCD mortality by 25 per cent by the year 2025. India is the first in developing specific national targets/indicators for reaching this goal and reducing the number of NCD related premature deaths.
To contain the ever-increasing NCD burden, our government has launched several programmes including National Cancer Control Programme, National Tobacco Control Programme and National Program for Prevention and Control of Cancer, Diabetes, CVD and Stroke (NPDCS). The major objective of NPDCS is prevention, early detection and control of NCDs; awareness generation on lifestyle changes; and capacity building/strengthening of the existing healthcare systems. For major NCDs, diagnosis/treatment facilities will be provided through NCD Clinics and CCUs in district hospitals/community health centres under NHM.
Before end March 2017 (1st phase), population based screening will be conducted in 100 districts (32 states/UTs); operational screening guidelines for diabetes, hypertension and common cancers have been released. Data will be gathered for counselling the at-risk individuals. Subsequently, chronic obstructive
respiratory diseases will be included and the programme will be scaled up.
The Ministry of AYUSH has constituted an expert panel for preparing yoga protocol and its research organizations (Central Council for Research in Ayurvedic Sciences, Central Council for Research in Homoeopathy and Central Council for Research in Unani Medicine) have initiated the integration of Ayurveda, Homoeopathy and Unani with NPDCS. Further, a mobile application – ‘mDiabetes’ has been launched to generate awareness, promote compliance and inculcate healthy dietary habits/lifestyle practices among the masses. The Indian NCD Network has been created for networking scientists from varied fields to support NCD related research/training activities. The current overall health budget (2017-18) has increased from INR 39,879 crore to 48,878 crore (2.27 per cent of the total budget).
It is hoped that adequate resources are provided for generating awareness regarding the adoption of preventive health-seeking behaviours. For primary, secondary and tertiary prevention of NCDs, interventions aimed at lifestyle modifications should emphasise on improvements in dietary practices and physical activity along with cessation of smoking/tobacco consumption, alcohol restriction and appropriate stress management. It is a matter of satisfaction that government is taking various measures to ensure that the people can lead healthier lives coupled with longevity.