Pledge on NCDs : Meeting the year 2012 Targets?

This post is in continuation of the previous post. The September 19, 2011 witnessed the whole world united on one front, the control of non-communicable diseases (NCDs). Under the august world body, the United Nations, the countries discussed and debated on NCDs as "Deemed Development Challenge", a challenge of "Epidemic Proportions". The UN Sixth General Assembly (GA/11138) had adopted a "political declaration" during this landmark session.

But prevention and control of NCDs is no easy task, leave alone the endeavor to do it globally. All those factors that influence greater incidence of NCDs are on move risking their greater adoption by people. The people of developing world are uprooted from their cultures which had been more labor intensive, controlled nature driven food sources. Their staple diets comprised whole grains, raw vegetables. But now they consume more of refined wheat flour, polished pulses, packaged purees of tomato and garlic, refined and super-refined vegetable oils which have lost the natural health promoting ingredients.

The question is how we will counter the technology on one hand promoting innovation to produce value added food stuffs for greater profits and technology to counter NCDs. At the current times, the human endeavors are multiplying problems, and then finding solutions to further add problems, and then debating their control. The vicious circle goes on and on and getting tangled within themselves. And in this vicious circle of non-communicable diseases we are concerned with, NCDs are not separable from the communicable ones. But there is one simple solution always, awareness and education!

Therefore our focus to get NCDs under control must base on mass awareness and education. Health must assume center stage in primary and undergraduate education; however, it should relate us as a responsible partner of the sustainable development, a partner that cares for the overall ecosystem and manage climate, environment, and biological diversity in tune with development. Any forces that challenge this must be stalled?

Of course there are already many initiatives and efforts, by nations, in the area of NCDs prevention and control. Several large organizations are making sustained efforts for control of NCDs, besides several Alliances of organizations are coordinating among themselves for more productive outcome. But the challenges are formidable. Since the September 19th meet, sometime has elapsed. At this summit governments had pledged to adopt by the end on 2012 targets to combat heart disease, cancer, diabetes, lung diseases and work on reduction in consumption of tobacco, high salt, sugar, fat contents in food.

To remind those interested in prevention and control of NCDs, and to educate and motivate the public to raise their concern for effective implementation of the declaration's guidelines by their governments, and for my own records on this blog, I have reproduced through the previous posting  complete release which was issued earlier by the News & Media Division, the UN Department of Public Information.

Achieving 'health literacy' necessay to control NCDs

Health in general is an area where the objectives of achieving good health are best achieved by following some basic principles: proper nutrition, hygiene and regular exercise. In  the present times the changes in our lifestyles have compromised all the three principles of good health.

Advances in control of once dreaded communicable diseases, thanks to anti-infective, vaccines and diagnostics, have had a positive effect on prolonging the average life-span of people all over. But the advent of changed lifestyle marked by reduced physical activity, excessive use of trans fats in food, fast-foods deficient in essential nutrients, increased consumption of sugar-salt-alcohol-tobacco, have together played a role in triggering high incidence of non-communicable diseases (NCDs), in particular cardiovascular diseases, diabetes, obesity, cancer, chronic respiratory diseases.

The problem of NCDs growing incidence in the developing world is particularly alarming, where  incidence of NCDs increase cause double burden of diseases on already impoverished population. The causes may be again found to be associated with a combination of those NCDs promotion factors: lack of hygiene, poor nutrition, living conditions, high salt intake, tobacco and alcohol. Topped on this are open sale of low quality fats commonly used in food products,  adulteration of food items of common use sold in the  markets.

There are legislations, rules and regulations to prevent food adulteration, or for control of tobacco. But there is a big gap in regulations, and implementation of rules. For example, in Lucknow, we can easily find even now  a  shop next door to a school or hospital selling tobacco products. The governments do not implement total prohibition on sale of tobacco on ground of loss of revenues; this seems to be farse, as the same governments have to foot the health budget for NCDs control. There is somewhere a basic error in human endeavour to handle health, be it at national level or at  international level.

During those few months I have been communicating on issues of NCDs through this blog , I am convinced education and communication of health is the single most ammunition that alone can effectively check on the problem of growing NCDs. I remember someone had described literacy of four types: alphabetic literacy, science literacy, geographic literacy and health literacy. The last of these, the health literacy is best achieved by popular communication on health and diseases, and it enables an individual to take appropriate decisions to control his health. We must strive to achieve health literacy of masses!

About the control of NCDs in India, the Indian health minister Gulam Nabi Azad had recently said:“Our goal is to develop a health system that is capable of preventing, diagnosing and managing NCDs in each district of the country. Towards this our efforts, in the coming years, would aim at providing universal access to basic services required for managing NCDs". Besides the above plan, what we need is to increase budget for health awareness, especially among school children.



To check NCDs globally, as well as in India, let us say the principal objective should be prevention and control by achieving total health literacy among school children. There are several  NGOs in India which are working hard with dedication to promote health awareness. The one I know closely is Cancer Aid Society (Lucknow, India) which has been running a school-based promotion of cancer awareness for several decades, besides working on promotion of measures for mitigation of  severe pain in advanced  cancer patients as an intervention of palliative care and even providing limited financial support to poor cancer patients.

My communications through blogging, and tweets on NCDs and their issues on Twitter I believe besides keeping me busy over the later part of the year 2011, have played in serving some role in spreading the message on NCDs prevention and care. What I relish more is the following now I have of  some very  educated, experienced and dedicated organisations, and individuals. 


Not the least, I have learnt some art of blogging, thanks to Blogger, and the Google resources, for easily available information resources on blogging. If the search engine optimization (SEO) had baffled me in the beginning, I am now comfortable with those terms and Alexa, as the great navigation tool. I wonder how this human ingenuity to continuously strive, build and improve to this high end intellectual revolution.


But in all this journey the health of people should not become a casualty.

I wish my friends, well wishers, the Google and Twitter staff teams, my followers and those I follow on Twitter, a very bright and fruitful new year, the year 2012. Blogging is a peasure that only a webmaster finds by seeing his creation in a website!

Why should there be ‘e-Cigs’?

In my mail box I had an advertisement promoting ‘e-Cigs’. What baffled me was not this new version of cigarette, but the very purpose of developing it when the whole world is concerned with the harmful effects of smoking.

This particular innovation I believe is the outcome of misplaced need to make fast buck. Smoking has two major components one behavioural giving rise to  addiction to smoking per se and the other, addiction to nicotine.

My first reaction is condoning this innovation, fearing this will attract new smokers and addicting them. I shrug out of fear of any activity that promotes smoking in one way or the other, for the dangerous relationship tobacco has with the occurrence of non-communicable diseases.

The advertisement promotes advantages of the product such as it does not need a flame to lit it, and that it does not release smoke, tar, carbon monoxide. It allows smoking in public places like airport, hotels.

The gadget includes interesting components like a stainless steel atomizer, lithium rechargeable battery, nicotine cartridges, plastic carrier cases, among others components.

It seems the product has no approval from FDA. At a time when NCDs are our major concern, the introduction of this gadget and its promotion through internet needs control. Even if smoke related hazards are lesser, or nil!  

India Curbs Displaying Tobacco Products in Movies, TV Programmes

According to a press release, the Indian Ministry of Health and Family Welfare has notified the rules for Cigarettes and other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) [second amendment rules] 2011. These rules will be implemented from 14^th November, 2011. The rules have been notified after consultation and taking into account the views of Ministry of Information and Broadcasting to make is more practical and implementable. 

As per the Rules all the old movies and TV programmes i.e. produced before the 14^th November displaying tobacco products or its use shall have to mandatorily display:-

(i) anti-tobacco health spots or messages of minimum thirty seconds duration each at the beginning and middle of the film or the television programme.

(ii) anti-tobacco health warning as a prominent scroll at the bottom of the screen during the period of such display.

And such programmes will be telecasted at such timings that are likely to have least viewership of minors.

For new films and TV programme a strong editorial justification for display of tobacco products or their use shall be given to Central Board of Film Certification (CBFC)  along with UA certification, and it will be accompanied by the following:

1. a disclaimer, of minimum twenty seconds duration, by the concerned actor regarding the ill effects of the use of such products, in the beginning and middle of the film or television programme;
2. anti-tobacco health spots or messages, of minimum thirty-second duration each at the beginning and middle of the film or the television programme;
3. anti-tobacco health warning as a prominent scroll at the bottom of the screen during the period of such display:

There will be a representative of MoHFW in the CBFC.

In order to restrict blatant display of tobacco brands in old films  and TV programmes  these rules  make it mandatory to crop /mask display of brands of cigarettes or any other tobacco product or any forms of product placement, closeups  and for new films and TV programmes  such scenes shall be edited/blurred by the producer prior to screening. The ban on display of tobacco product or its usage also extends to promotional materials and posters as well.

India has the largest film producing industry and films have played a key role in process of social change and  in  influencing the Indian culture. Thus, for the tobacco industry, films provide an opportunity to convert a deadly product into a status symbol or token of independence. The role of movies as vehicles for promoting tobacco use has become even more important as other forms of tobacco promotion are constrained. This investment is part of a wider and more complex marketing strategy to support pro-tobacco social norms, including product placement in mass media, sponsorship and other modalities.

There are experimental and observational studies to show that tobacco use  in films influences young people’s beliefs about social norms for smoking, as well as their beliefs about the function and consequences of smoking and their personal intention to use tobacco. Consistent with the findings of these epidemiological studies, a number of experimental studies have confirmed that seeing tobacco usage in  film shifts attitude in favour of tobacco use , and that an anti-tobacco  advertisement shown prior to a film with tobacco use blunts the effect of smoking imagery.

The Government of India had enacted the Cigarettes and other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act (COTPA), in 2003 with the objective to protect the present and future generation from the adverse harm effects of tobacco usage and second hand smoke, through imposing progressive restriction.

As per Section - 5 of COTPA, all forms of advertisement (direct, indirect/surrogate) promotion and sponsorship of tobacco products is prohibited. However, it was observed that when the advertising, promotion and sponsorship ban went into force, tobacco companies developed new marketing strategies to circumvent the law through depiction of tobacco use scenes and brand placement of tobacco products in movies.

In 2003, WHO conducted a study on the portrayal of tobacco in Indian cinema and its impact on youth audience before the passage of the COTPA. Further in 2005 (post-COTPA ), a second study titled on “Tobacco In Movies and Impact on Youth” by Burning Brain Society supported by WHO/MoH documented increased changes in Bollywood’s tobacco imagery.

Advocating Control of NCDs? Comments invited

Health is a neglected issue, and this neglect leads to human suffering  in terms of morbidity and mortality. The impact of this neglect is much greater in the developing world.

While communicable diseases are fast in their infection and precipitating disease, NCDs primarily develop over a period of time due to the neglect of good principles of health, namely, balanced diet, lack of exercise; addiction to tobacco/tobacco products, alcohol, excessive salt.

The world has realized NCDs' importance and we have to fight it in a variety of ways. Communication in the most important tool. And change of behaviour is required among populations to appreciate and adopt good healthy practices.

So through this blog I shall continue efforts, howsoever small these may be, to advocate the good health measures, through my efforts and with the support of other experts and organisations willing to participate in this endeavour. I invite everyone concerned, and interested, in this serious pursuit to add a comment  or touch upon an issue related to NCDs on this blog, and I shall greatly appreciate this contribution.

Report maps NCDs trend

A World Health Organization (WHO) report released earlier (September 2011) gives baseline data on all NCDs in 193 countries in order to monitor their epidemiological trends and assess the progress made by these diseases in their countries. This report indicates where each government needs to focus in order to prevent and treat the four major killers: cancer, heart disease and stroke, lung disease and diabetes. Updated report is expected in 2013.

The report includes details of what proportion of each country’s deaths is due to NCDs. In a single page per country presentation format, the report provides information on prevalence, trends in metabolic risk factors (cholesterol, blood pressure, body mass index and blood sugar) alongside data on the country's capacity to tackle the diseases.

NCDs are the top cause of death worldwide, killing more than 36 million people in 2008: Cardiovascular diseases were responsible for 48% of these deaths, cancers 21%, chronic respiratory diseases 12%, and diabetes 3%.More than nine million of all deaths attributed to NCDs occurred before the age of 60; 90% of these "premature" deaths occurred in low- and middle-income countries.

One of the findings shows that men and women in low-income countries are around three times more likely to die of NCDs before the age of sixty than in high-income countries. According to these estimates, the proportion of men dying under the age of 60 from NCDs can be as high as 67%. Among women under 60, the highest proportion was 58%.The lowest rates of mortality from NCDs for men under 60 were 8% and for women under 60, it was 6%.

High risk factors like smoking and exercise are important. The profiles report on the proportion of people who smoke and are physically inactive. They also indicate trends for four factors that increase people's risk of developing these diseases, blood pressure, cholesterol, body mass index and blood sugar over the past 30 years.

In the United States of America, for example, 87% of all deaths are due to NCDs. 16% of the population smokes and 43% are physically inactive. On average, blood pressure has decreased since 1980; body mass index has increased; and glucose levels have risen.

Overall, the trends indicate that in many high income countries, action to reduce blood pressure and cholesterol is having an impact, but there is a need to do more on body mass index and managing diabetes.

Based on data from the report, India’s capacity to address and respond to NCDs  need  concerted action in order  to contain impact of NCDs . A national Cancer Registry, specific policy framework for chronic respiratory diseases, and implementation of tobacco Power Measures are areas that need greater focus. In India, NCDs account for 53% of all deaths:  Cardiovascular diseases, 24%; Cancers 6%; Respiratory Diseases 11%; diabetes 2%, other NCDs 10%.

(Source: WHO-Country profile, 2011)