India continues to face a twin burden of diseases, both communicable and non-communicable diseases (NCDs) as is evident from the list of top 10 causes of death in the country. Cardiovascular diseases (CVDs) are the leading cause of death in India as they are globally. Diarrheal diseases come next.As per data, the top 10 causes of death in India are:Cardiovascular diseasesDiarrheal diseasesNeonatal disorders
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India continues to face a twin burden of diseases, both communicable and non-communicable diseases (NCDs) as is evident from the list of top 10 causes of death in the country. Cardiovascular diseases (CVDs) are the leading cause of death in India as they are globally. Diarrheal diseases come next.
As per data, the top 10 causes of death in India are:
Chronic respiratory diseases
(Source: World Bank India, Population Reference Bureau (2017) India)
The major risk factors for CVDs include high BP, abnormal blood cholesterol, tobacco and alcohol use, diabetes, obesity, unhealthy diet, sedentary life, psychosocial stress.
The factors responsible for the rising prevalence of type 2 diabetes are again unhealthy diet, lack of physical activity, harmful use of alcohol, over-weight/obesity, tobacco use etc.
Common mental disorders such as depression, anxiety often coexist with other NCDs and they share many risk factors. They occur not only as an outcome of NCDs, but mental disorders are also associated with behaviors (alcohol use, tobacco smoking, unhealthy diet, reduced physical activity), which increase the risk of other NCDs.
Unintentional injuries are an important cause of death in India. Road traffic injuries, falls and drowning constitute the three leading causes of deaths due to unintentional injury. Diabetes is an important cause of falls in the elderly.
The traditional risk factor for chronic respiratory disease such as COPD, asthma has been tobacco smoking. But, now, non-smoking risk factors such as air pollution, occupational chemicals and dusts are emerging as important contributors to chronic respiratory diseases in developing countries like India.
Air pollution has now emerged as a major environmental risk factor for health. It is a major potentially modifiable risk factor for chronic diseases as well as acute disease events such as stroke, acute heart attack and acute bronchial asthma.
When we talk of communicable diseases, the major risk factors for diarrheal diseases, the second largest cause of deaths in the country include poor sanitation and lack of hygiene. Around 1.1 million children die each year in India, including approximately 1.1 lakh deaths due to diarrhea. Although other factors such as low socioeconomic status, poor maternal literacy, low birth weight, inadequate breastfeeding, malnutrition also contribute the disease burden.
Enlisting the risk factors shows that poor sanitation and lack of hygiene are the major risk factors for communicable diseases. While, most NCDs such as heart disease, diabetes, cancer, respiratory diseases share common behavioral risk factors (lack of physical activity, unhealthy diet, tobacco use, excessive intake of alcohol) and metabolic risk factors (obesity, hypertension, dyslipidemia, diabetes).
The INTERHEART study published in the September 3, 2004 issue of the Lancet identified nine traditional risk factors for an acute heart attack: Abnormal lipids, smoking, hypertension, diabetes, abdominal obesity, psychosocial factors, consumption of fruits, vegetables, and alcohol, and regular physical activity. As per the study, more than 90% of the global risk for acute MI is predicted by these nine traditional risk factors.
Hence, preventive strategies for NCDs must focus on these overlapping risk factors. Diarrheal diseases can be tackled via safe drinking water and improving hygiene and sanitation.
Much of the disease burden in the country can be prevented by behavioral changes and adopting a healthy lifestyle and practicing good hygiene.
Swachh Bharat mission, which promotes hygiene and sanitation and also aims to make India completely Open Defecation-free (ODF) by October 2019, is a step to reduce the burden of diarrheal diseases in the country. A WHO report in 2018 estimated that at least 1.8 lakh diarrheal deaths have been averted in rural areas since the launch of Swachhta Bharat Mission (TOI).
India has a National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS). In the interim budget, the budgetary allocation for NPCDCS, national mental health program, tobacco control program were reduced.
India will soon elect a new government.
It remains to be seen if the next government will have the political will to tackle the epidemic of NCDs in the country and according increase the budgetary allocation when they present the full budget.
Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania (CMAAO)