Detection of diabetes & hypertension: Break the ‘rule of half’ and ‘premature deaths’

Dr Balu Mote, CNS Correspondent, India
Photo credit: CNS:
India today is facing a ‘triple burden’ of diseases-- communicable diseases, coupled with maternal-child health diseases that are some time termed as diseases of poverty; diseases like swine flu and dengue that are termed as emerging and re-emerging diseases; and lastly the upcoming burden of non communicable diseases (NCDs) like cancer, heart disease, and diabetes that are called diseases of changed life style and behaviour.

The rule of half says that 50% people around the world are not aware of their own status of being hypertensive or diabetes. Of those who know about their status, only 50% avail medical treatment from healthcare facilities, and only 50% of those who avail the treatment will achieve the recommended targets. This indicates the need of active door to door screening for identification of undetected cases and maintaining follow-up of the same.

According to a WHO report, every year in India 5.8 million deaths are attributed to heart & lung diseases, stroke, cancer and diabetes. Thus, 1 in every 4 Indian is at high risk of dying due to some NCD before the age of 70. 60% of deaths and 44% of disability adjusted life years (DALYs) are because of NCDs. Cardiovascular diseases (CVDs) contribute to 52% of these deaths. Diabetes and hypertension are the leading cause of deaths due to CVDs such as coronary heart diseases and stroke, indicating the need for prevention and control of diabetes and hypertension to address these premature deaths.

"Heart diseases, diabetes, cancers, and chronic respiratory diseases now affect younger and younger people. The millions of productive individuals lost prematurely to NCDs are seriously undermining social and economic development” says Dr Poonam Khetrapal Singh, Regional Director of WHO South-East Asian Region.

Major problem in diagnosis of diabetes and hypertension is that there are no serious early symptoms of these diseases, and symptoms increase slowly and gradually. These two diseases come hand in hand and inter-linkage between them is very common--people with hypertension are on high risk of developing diabetes and vice-versa.

“I sometimes feel tired, weak, and breathless while walking. I do not have any disease and I have not taken any medication throughout my life. Nobody in our family has such type of disease, therefore how can I get it?” said a 45 years old male person, living in Pune (India), who was diagnosed with diabetes and hypertension.

The above remark reveals that people’s perceived susceptibility of NCDs is very low and they generally ignore the early signs and symptoms of NCDs. Though our health care system is not fully ready to address the issue of NCDs, efforts such as ‘The National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke’ (NPCDCS), have been started and they includ hypertension and diabetes as one of the focus areas. The programme is currently being implemented in 100 districts and expected to cover the rest of the country.

The efforts to address the burden of NCDs need to be stepped up, even as Dr Nata Menabde, WHO Representative to India praises the country’s work in this direction-- “It is heartening to see the Government of India taking the leadership role in the prevention and control of NCDs, As a partner to the global agenda on prevention and control of NCDs, we are committed to supporting national efforts towards strengthening the health systems to address the growing burden of NCDs and comorbidities.”

 Way forward to break the rule of half and premature deaths. So for tackling NCDs we need to consider the following:--
  • High taxation on fatty, sugary and salty foods
  • Up-gradation of government health system for dealing with secondary and tertiary care
  • Separate health education programme for controlling risk factors at national level
  • Integration with other activities of other departments (like building walking and cycling paths) to promote health awareness
  • Emulating the ‘Singapore’ model for promoting health education awareness at mass level
According to Dr Rishi Sethi, Professor of Cardiology at King George’s Medical University India, high dietary intakes of saturated fat, trans-fats and salt, and low intake of fruits, vegetables and fish are linked to cardiovascular risk. Frequent consumption of high-energy foods, such as processed foods that are high in fats and sugars, promotes obesity compared to low-energy foods. WHO recommends a population salt intake of less than 5 grams/person/day to help the prevention of CVD.

Dr Sethi advises that, “A healthy diet can contribute to a healthy body weight, a desirable lipid profile and a desirable blood pressure. Elimination of trans-fat and replacement of saturated with polyunsaturated vegetable oils lowers coronary heart disease risk.”

Dr Balu Mote, Citizen News Service - CNS
October 17, 2015