Editorial: Threat from chronic diseases

Published in The Hindu on May 10, 2011

Cardiovascular diseases, diabetes, cancers, and chronic respiratory diseases account for 63 per cent (36 million) of all deaths globally. This is the finding of the World Health Organisation’s global status report on non-communicable diseases (NCDs) for 2008, and the situation is unlikely to be very different today. The picture also runs counter to the general perception that such deaths are largely restricted to developed countries. In truth, nearly 80 per cent of deaths from NCDs occur in low- and middle-income countries (if Africa is kept out of the picture). Of the four chronic diseases, cardiovascular diseases and diabetes are responsible for 80 per cent of all deaths. High blood pressure turns out to be the biggest risk factor for cardiovascular diseases. It caused an estimated 7.5 million deaths round the world. In India, according to estimates by the Public Health Foundation of India, about two million people die every year from cardiovascular diseases caused directly by high blood pressure. The rate of prevalence of high blood pressure is 24-30 per cent in urban areas and 12-14 per cent in rural areas. But the percentage of people aware of their condition is only 30 per cent in cities/towns and 10-12 per cent in villages. Shockingly, just about 10-12 per cent of those who have high blood pressure in urban areas and a mere 4-5 per cent in rural areas have it adequately controlled for their risks.

The New England Journal of Medicine reported last year that India would lose $237 billion over the next decade owing to non-communicable diseases. Prevention and control of these diseases is achievable, provided the government uses a little imagination to implement some effective low-cost population-wide interventions. Finland reduced the cardiovascular diseases mortality rate by 75 per cent, and Japan achieved a 70 per cent drop in strokes by mandating a reduction in salt content of packaged foods. Many countries have introduced chilling pictorial warnings on cigarette packets and are rotating them annually in keeping with WHO guidelines. But India has taken a retrograde step. Three years after introducing pictorial warnings in India, the warnings continue to be as ineffective as ever. The government recently decided to rotate the pictorial warnings every two years and allow the manufacturers to have the final say in the choice of pictures! As every physician knows, physical inactivity, alcohol consumption, tobacco use, and unhealthy diets figure high in the list of causative factors for NCDs. If individuals can be faulted for not adopting healthier lifestyles, the failure of the government to spread awareness is inexcusable.

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