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!

India to spend 2.5 per cent of GDP on health

India has an important place in the global prevention and control of non-communicable diseases (NCDs) like Cancer, Diabetes,Chronic Respiratory Diseases,  Cardio Vascular Diseases (CVDs) and Stroke because of its large population and increasing  incidence of NCDs in the country.The success of NCDs prevention in India will have a major bearing on the overall outcome on global efforts. 

The NCDs challenge in India is critical because the public healthcare systems in the country, which mainly caters to the majority of urban and rural poor and the middle classes of country's population, is not upto acceptable standards in terms of infrastructure, facilities, governance and delivery,and markedly differs across different states.

Incidences of inadequate and inappropriate utilization of healthcare funds, sanctioned by the central government to states to run public healthcare, by the state functionaries, and corruption cases in public institutions coming to light leave doubts about effective delivery of healthcare programmes in general and NCD prevention and control in particular.

However, the government's seriousness to give health greater importance is reflected in increased budgetary expenditure for health in terms of GDP percentage. Syeda Hamid, Member of Planning Commission, during International Vaccination Symposium at Surajkund near Delhi said that the country will spend 2.5% of GDP instead of 1.8% of GDP on health sector during the next five year plan period.

Syeda Hamid has said that  this is a very big jump, and the  Planning Commission expects  commensurate results.

Health Pavilion Focus on NCDs

Ghulam Nabi Azad, India’s Union Health and Family Welfare Minister, inaugurated the health pavilion at India International Trade Fair - 2011, recently. The theme of health pavilion organized during the event (14-27 November, 2011) is on ‘Non Communicable Diseases’ focusing on  Diabetes, Cardiovascular diseases, Cancer, Stroke, Mental Health and geriatric programmes, in addition to free health screenings.

Series of lectures on diabetes, stroke, stress, life style, etc. are being delivered by eminent doctors from leading hospitals.

Free diabetes screening is being held for all the visitors during the period from 14 to 27 November 2011. Azad was the first visitor to undertake the diabetes testing at the health pavilion.

During the years ahead India will need extensive programmes for spreading widespread awareness of NCDs among the masses focusing on prevention and control of NCDs.

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.

Fighting Cardiovascular System (CVS) Diseases

It is true that cardiovascular system diseases that are a major cause of deaths globally can be prevented and controlled by simple measures like regular physical activity, avoidance of tobacco use in any form, and adoption of healthy dietary practices.

Over 80% of CVS disease deaths take place in low-and middle-income countries and occur almost equally in men and women. The major cause for this high mortality in those countries is the result of a major shift of tobacco promotion in recent years.

Use of unhealthy fast foods is a growing trend the world over, and the developing countries are no exception. In the developing countries the healthy indigenous traditional food stuffs are being fast replaced by packed commercialized foods whose major victims are growing children and women.

Fighting Cardiovascular System (CVS) Diseases

Besides influencing high incidence of CVS diseases, fast or junk foods add to cost, whereas indigenous foods are healthier and cheaper. Experts believe that traditional foods of a country are more healthy, nutritious and economic. The only issue would be their hygienic delivery and intake.

High blood pressure has no symptoms, but can cause a sudden stroke or heart attack. Diabetes increases the risk of heart attacks and stroke. Being overweight increases the risk of heart attacks and strokes.

Low socioeconomic status increases the chances of exposure to risk factors and increases the vulnerability to develop CVS diseases.

The Economic Costs of CVS Diseases

The CVS diseases have grave effect on individual and country’s levels. These diseases affect many people in middle age, very often severely limiting the income and savings of affected individuals and their families. Lost earnings and out of pocket health care payments undermine the socioeconomic development of communities and nations.

At country’s level CVS diseases place a heavy burden on the economies of countries. It is estimated that over the next 10 years (2006-2015), China will lose $558 billion in foregone

National income due to the combination of heart disease, stroke and diabetes.

Prevention and control of CVS Diseases:

Prevention of CVS diseases is not a difficult proposition. There are measures involving lifestyle changes and those involving giving up habits of tobacco and alcohol use.

The various simple measures, if regularly pursued, can help prevent heart attack and stokes to a great extent:

·         Engaging in physical activity for at least 30 minutes every day of the week

·         Eating at least four servings of fruits and vegetables a day

·         Limiting salt intake to less than one teaspoon a day

·         Maintain an ideal body weight by exercise and eating healthy diet

The habits of tobacco use in any form are harmful and are an invitation to CVS diseases. For a habitual user giving up the habit of tobacco use is a challenge, and it can be left only by a strong will and facing this changeover, as a challenge. Stopping tobacco use reduces the chance of a heart attack and stroke.

Some measures which can be taken at every individual level are:

·         Know your numbers: Use simple charts to determine your risk of developing a heart attack or a stroke

·         Check blood pressure and cholesterol regularly, and keep them under control.

·         If diabetic, check sugar levels regularly and keep it in control

In addition, measures are required to reduce the risks throughout the entire population and by targeting individuals at high risk or with established disease. Examples of population-wide interventions that can be implemented include:

·         Comprehensive tobacco control policies

·         Taxation to reduce the intake of foods that are high in fat, sugar and salt

·         Building walking and cycle ways to increase physical activity

·         Providing healthy school meals to children

·         Making available effective and inexpensive medication to treat CVS diseases

The risk of a recurrence or death, after a heart attack or stroke, can be substantially lowered by adoption of a combination of life style changes and drugs – statins to lower cholesterol, drugs to lower blood pressure, and aspirin to prevent stroke.

For prevention and control of CVDs and other chronic diseases, all governments need to make substantial investment under dedicated national programs, following best management practices and good governance.