Over 90 Million Indians are at Risk of Vascular Diseases

 

With over 90 million Indians being at risk for various types of vascular diseases including stroke, peripheral arterial disease (PAD), carotid artery disease and aortic aneurysms, this high incidence of vascular diseases is  a matter of great concern for the country.

This concern was raised by none but the Union Minister of Health & Family Welfare, Ghulam Nabi Azad, at Jaipur on 28th September, 2012.

Addressing the 19th Annual Conference of Vascular Society of India as Chief Guest, Azad said that his his Ministry has already launched a national programme to prevent and control Cancer, Diabetes, Cardiovascular Diseases and Stroke in 100 backward districts of the country.

 

Over 10 million persons of 30 years and above have been screened so far for diabetes and hypertension. Out of this, 7.27% are suspected for diabetes and 6.44% for hypertension. In addition to this, a cardiac care unit is being set up in 100 districts of the country where funds for infrastructure, equipment, human resources and drugs will be provided by Health Ministry.

According to the World Health Organization, of the 58 million deaths globally, approximately 35 million were due to chronic non-communicable diseases.

 

In India, NCDs like CVDs, diabetes, chronic obstructive lung disease, cancer and injuries have already become the dominant cause of disease burden contributing about 2/3rd of the total disease burden.

 

The number of deaths attributed to chronic diseases was 3.78 million in 1990, i.e. 40.4% of all deaths and is projected to reach an expected 7.63 million in 2020, i.e. 66.7% of all deaths. About 38 million persons were affected with Cardio-vascular diseases in 2005 and the number may go up to 64 million by 2015.

 

High blood pressure is as common as 10-15% in the adult population, more so in metros and large cities.

During UN General Assembly Special Session on NCDs, held in September 2011 in New York, all countries of the world made a commitment in the Political Declaration to combat key NCDs including cardiovascular diseases which shows that the whole world has united in the struggle against the rising incidence of such diseases.

Shri Azad said that India has only about 59 doctors for every 100,000 people, which is much less than the ratio prevailing in developed countries. Despite that Indian doctors are taking care of a huge population and disease burden.

 

Vascular surgery as a speciality has grown in India by leaps and bounds in the last decade, which has helped many needy patients. However, despite that many lives and limbs are still lost due to the non-availability of timely assistance and expertise, Azad said.

 

 

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 implements NCDs control measures

Under the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases & Stroke Programme (NPCDCS) launched earlier by the Indian Ministry of Health several initiatives have been taken over the last two years. Efforts have been made to implement various programmes for prevention and control of NCDs, and even provide financial help to patients unable to bear the cost of treatment.

Free Treatment for Cancer Patients

As per the latest estimates projected by National Cancer Registry Programme of Indian Council of Medical Research, the prevalence of cancer in the country is about 27 lakhs. The incidence of new cancer cases every year in the country is about 11 lakhs.

Treatment of Cancer, wherever available in the Government health care delivery system is mostly subsidized. Under Rashtriya Arogya Nidhi, funds are given to states illness assistance funds/ societies to provide assistance to all 'below poverty-line' patients suffering from life threatening diseases. The quantum of support is upto Rs. 1.5 lakhs per case.

Under the same scheme, Ministry gives grants to revolving funds of hospitals under control of Ministry of Health and Family Welfare to provide financial assistance upto Rs. 1 lakh in each case to patients suffering from lifethreatening diseases.

Further, under the same scheme, the Health Ministry directly gives financial assistance in cases where assistance sought is more than Rs. 1.5 lakh in each case. However this assistance is available only for 'below poverty-line' patients taking treatment in Government hospitals.

Under the Indian government's Health Minister’s Cancer Patient Fund, entire fund is distributed to 27 Regional Cancer Centres for providing assistance to  cancer patients falling under 'below povertline,  taking treatments, in each case Rs.1 lakh.

In addition, financial assistance is given to poor indigent patients, maximum upto Rs. 50,000 each case, from Health Minister’s discretionary grant to defray a part of the expenditure on hospitalization/treatment in government hospitals in cases where free medical facility is not available.

During the current year of 2011, about 2202 cancer patients have been provided financial assistance by this Ministry. Among those receiving support, about 241 cancer patients have been recommended by the Members of Parliament during the year 2011-12, for financial assistance for their treatment.

 

Working Group on NCDs Burden

The working group on Non-Communicable Diseases set up by the Planning Commission for the 12th Plan, recommended development of twenty state cancer institutes as Centre of Excellence, besides three National Cancer Institutes.

NCDs Prevention and Control

In July 2010, 100 districts selected for launching “National Programme for Prevention & Control of Cancer, Diabetes, CVD and Stroke (NPCDCS)” and the “National Programme for Health Care of Elderly (NPHCE)”  (Total cost: Rs.1230 crores):

• A Cardiac Care Unit at a cost of Rs. 1.5 crores will be established at 100 district hospitals.
• NCD clinic will be established at 100 district hospitals and 700 Community Health Centres (CHCs) for diagnosis and management of Cardiovascular Diseases (CVD), Diabetes & Stroke.
•  For life saving drugs, Rs. 50,000 will be provided to each district hospital in 100 districts.
•  Opportunistic Screening for diabetes and high blood pressure will be provided to all persons above 30 years, including pregnant women of all age groups at 20,000 Sub-Centres.
• Home based care will be provided for bed ridden cases in 100 districts.
• Support will be provided for contractual manpower and equipment at 100 district hospitals & 700 CHCs for management of NCDs including health promotion activities.
• Screening for Hypertension and Diabetes in Urban Slums was initiated in 7 Metro Cities in 2010 (Delhi, Mumbai, Kolkata, Chennai, Bangalore, Hyderabad and Ahmedabad)
• Glucometer Strips and Lancets procured under the national programme distributed to States for the purpose of Screening – Rs. 10.51 crores (Cost of a Glucometer Strip approximately Rs.10 at present).
• School health survey has been initiated in selected districts, which includes screening for childhood (juvenile) diabetes.

Cancer: New initiatives during last two years

• Common diagnostic services, basic surgery, chemotherapy and palliative care for cancer cases will made available at 100 district hospitals.
• Support for Chemotherapy drugs will be provided for 100 patients at each district hospital at a cost of Rs. 1.00 crore per annum.
• Day care Chemotherapy facilities will be established at 100 district hospitals.
• Facility for laboratory investigations including Mammography will be provided at 100 district hospitals and, if not available, this can be outsourced at government rates.
• Home based palliative care will be provided for chronic, debilitating and progressive cancer patients at 100 districts.
• Support will be provided for contractual manpower and equipment for management of cancer cases at the 100 district hospitals.
• Sixty five centres will be strengthened as Tertiary Cancer Centres (TCCs) to provide comprehensive cancer care services at a cost of Rs. 6.00 crores each.

Tobacco Control

In the year 2009-2010, the Global Adult Tobacco Survey India (GATS India) was conducted for systematically monitoring adult tobacco use (smoking and smokeless) and tracking key tobacco control indicators.

One of the largest surveys of this kind in the world, it was carried out in all the States and 2 UT’s of Chandigarh & Puducherry.

The entire survey was funded by the Government of India and was conducted by Indian Institute of Population Science (IIPS), Mumbai in technical collaboration with WHO and CDC, Atlanta, USA. The results were published in October, 2010.

The survey revealed that more than one-third of adults (35%) use tobacco in some or the other. Among them, 21% adults use only smokeless tobacco, 9% use only smoke and 5% use smoke as well as smokeless tobacco.

The prevalence of overall tobacco use among males is 48% and among females is 20%. Nearly 2 in 5 adults (38%) in rural areas and 1 in 4 adults (25%) in urban areas use tobacco in some form. The extent of use of smokeless tobacco products among males (33%) is higher than among females (18%).

 The results of the survey are being used to formulate policies aimed at mainstreaming tobacco control strategies with other national health programmes, within the overall framework of the National Rural Health Mission (NRHM).

The GATS India initiative will strengthen the Ministry’s efforts to prevent any further increase in the prevalence of tobacco use, especially among the vulnerable groups such as youth, children and females.

Indian Government Asks State Functionaries for Effective Implementation of NCDs Related Programmes

The Indian Union Minister for Health and Family Welfare Ghulam Nabi Azad urged recently during a review meeting with the State functionaries for effective implementation of programmes funded by the Government of India.

The programmes under reiew were the National Programme for Prevention & Control of Cancer, Diabetes, Cardio Vascular Diseases and Stroke (NPCDCS), the National Programme for Health Care of the Elderly (NPHCE); the scheme for delivery of contraceptives at homes; scheme for promotion of menstrual hygiene and the Mother and Child Ttracking System for ensuring full immunization and maternal benefits coverage.

Azad was addressing the State Health Secretaries and functionaries in New Delhi in a day long review meeting for ensuring better participation by State Health Departments. Minister of State for Health & Family Welfare, Government of India, Sudeep Bandyopadhyaya, Union Secretary of Health & Family Welfare, P.K. Pradhan and senior officials of the Ministry of H&FW were present in the review meeting.

Azad said that in the coming years, a comprehensive approach is being planned to prevent and control major Non Communicable Diseases (NCDs) and their risk factors. “Our goal is to develop a health system that is capable of preventing, diagnosing and managing NCDs in each district of the country.

To achieve this  goal efforts, in the coming years, would be to provide universal access to basic services required for managing NCDs. He urged whole hearted cooperation of  State governments’  in this venture, without which the best of Government of India’s intentions will not be translated into practice, Azad said.

Azad said, “it’s time that this monumental challenge is taken seriously and we act together to prevent and control NCDs by providing information and care to those who have or are at risk of suffering from these diseases”. Shri Azad emphasized that these programmes should be accorded the priority they deserve by the health functionaries at various levels.

The Minister said “It is important to remember that the burden of NCDs is increasing exponentially and early screening and treatment are critical tools we have to combat these life-long ailments”. Azad warned that NCDs like diabetes, cancer, cardiovascular diseases and chronic respiratory diseases are reaching epidemic proportions worldwide and India is no exception.

NCDs have silently emerged as the leading cause of death, disability and disease the world over, including India. In India, NCDs like heart disease, diabetes, chronic obstructive lung disease, cancer and injuries have already become the dominant cause of disease burden contributing about 2/3rd of the total disease burden. The number of deaths attributed to chronic diseases was 3.78 million in 1990 (40.4% of all deaths) and is projected to reach an expected 7.63 million in 2020 (66.7% of all deaths).

Azad informed of the Government's awaress of the challenge of combating NCDs, reflected by the fact that the Government of India launched the “National Programme for Prevention & Control of Cancer, Diabetes, Cardio Vascular Diseases (CVDs) and Stroke (NPCDCS)”in the year 2010. The National Programme for Health Care of the Elderly (NPHCE) was also initiated at the same time to address health issues affecting our elderly population.

Azad added “we aim to expand the programme in all 640 districts of the country in the 12th five year plan and, therefore, are eagerly looking forward to the feedback from all of you in order to learn from field level implementation issues”.

He reiterated that the basic objective of the national programme is to ensure early detection and, therefore, treatment by creating facilities at Tertiary Care Centers, Districts Hospitals, and Community Health Centers and at Sub Centre level.

Under NPCDCS, the Government of India is providing the Glucometers, Strips and needles while the State Governments have to provide the manpower. Covering 20,000 rural sub-centers and urban slums, the target is to screen about 15 to 20 crore (150-200 million) people by March 2012. The Centre has provided support at the rate of Rs.1 lakh per patient for major components of the programme.

Funds have been released to states for various components of NPCDCS and NPHCE, Azad informed. The Minister added that under the cancer component of the programme 65 tertiary cancer centres (TCC) are proposed to be established. He asked the state health secretaries to send their proposals for TCCs at the earliest, and for taking urgent steps to establish tertiary cancer centres.

Under the National Programme for Health Care of Elderly, eight Regional Medical Institutions have to establish Regional Geriatric Centres for providing tertiary care to elderly, and these have been sanctioned Rs. 20 million each by Government of India for 30 bedded facility. The Minister urged the State Health Secretaries to expedite proposals for utilizing the grants in full.

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)