In 2013, high blood pressure, high blood sugar, household air pollution from solid fuels, unsafe water sources and smoking were the top avoidable risks associated with health loss and a significant amount of disease burden among Indians in both sexes.
Of the five top risks, high blood pressure, diabetes and household air pollution from solid fuels were estimated to cause 7.8 per cent, 5.2 per cent and 4.7 per cent of the total health loss in India in 2013 respectively.
About 3.3 million premature deaths in 2013 in the country were caused by these three risk factors alone.
These were some of the results of a study that looked at 79 risk factors in 188 countries and published on September 10, in the journal The Lancet.
In contrast, the contribution of unsafe water sources and poor sanitation, as well as child and maternal undernutrition to health loss in India has dropped significantly since 1990. Interestingly, while poor sanitation does not figure among the top ten risk factors for health loss in men in 2013, it is the fifth greatest risk factor for women.
According to Dr. K. Srinath Reddy, President of the Delhi-based Public Health Foundation of India (PHFI) and a coauthor of the study, metabolic risk factors that include high blood pressure, blood sugar and cholesterol, along with unhealthy dietary habits and smoking are responsible for about 5.2 million premature deaths in India every year.
High blood pressure is the number one risk factor for both men and women in India. Yet, even in urban areas, only 40-50 per cent of people are aware of their condition. Alarmingly, only 50 per cent of those aware of their condition are on treatment, and only 50 per cent of people on treatment have the condition adequately controlled, said Dr. Reddy.
“Only 20-30 per cent of people in urban areas have BP adequately controlled and in rural areas it is 5-10 per cent,” he said. Failure of early detection and treatment of high blood pressure and diabetes is a failure of the public health system. You can’t expect everyone to go to tertiary healthcare to get diagnosed.”
“Our national program on non-communicable diseases is low profile, low on resources and inadequately implemented,” Dr. Reddy added.
According to him, men are more likely to have heart attacks due to high blood pressure while more deaths in women would be due to strokes. The main reason for this is the greater consumption of tobacco by men. Higher tobacco consumption in men along with cholesterol and high BP cause heart attacks in men, while high blood pressure is the most important risk factor for strokes in women.
However, early deaths caused by high BP, high blood sugar and other risk factors may reduce when on September 25 India signs the Sustainable Development Goal (SDG) to reduce by one-third premature mortality caused by non-communicable diseases in those aged 30 to 70 years. The reduction is to be achieved by 2030.
Household air pollution
Household air pollution from solid fuels and ambient particulate matter pollution are two of the major risk factors in both men and women in india. “Part of the recognition of household air pollution as a risk factor has been relatively recent, about 10 years or so,” said Dr.Kalpana Balakrishnan, a co-author of the paper and Director of the WHO Collaborating Centre for Occupational and Environmental Health at Sri Ramachandra University, Chennai.
According to Dr. Balakrishnan, the improved chullas, which are supposed to be smokeless, provide very little health relevant exposure reduction. There were one million deaths in India due to household air pollution from solid fuels in 2010 and India accounts for one third of global deaths due to this risk factor.
“But this has not changed significantly even with the improved chullas,” she said. “That is because solid fuel can’t be burnt in relatively inexpensive stoves. There is compelling evidence to move towards cleaner fuels than cleaner chullas.”
The Ministry of Health and Family Welfare had constituted a steering committee to address both household and ambient air pollution. According to Dr. Balakrishnan, who is one of the steering committee members, the committee has already submitted its recommendations.
“Currently, there is enough and compelling evidence from very large volume of in-country studies on household pollution to drive policy change,” she said.