Non-communicable diseases rising in UP, instead of declining

Shobha Shukla, CNS
[CNS photos] [हिंदी] The government of India has committed with other governments in September 2015 to achieve Sustainable Development Goals (SDGs) by 2030, one of which is SDG 3.4, which aims to "reduce by one third premature mortality from non-communicable diseases (NCDs) through prevention and treatment..." by 2030. But if we look at the data, major NCDs are rising in UP, not declining. "UP needs to get back on track to achieve the SDGs by 2030 or earlier" said Shobha Shukla, Executive Director of CNS.

Prof Rama Kant
Professor (Dr) Rama Kant, WHO Director-General's Awardee and former Head of Surgery Department, King George's Medical University (KGMU) was addressing select students of Lucknow University and Dr Shakuntala Mishra National Rehabilitation University on the single-largest, preventable and COMMON risk factor of all major NCDs: tobacco.

Not only tobacco consumption and tobacco revenue collected by UP government is on the rise, but heart disease rates are also upping. Commercial tax revenue in UP from pan masala sale went up from Rs 50 crore in 2012-2013 to Rs 255 crore in 2013-2014, a whopping rise of 415%! Likewise heart disease rates shot up too. The Intervention cardiology data compilation done by Professor (Dr) Rishi Sethi, Department of Cardiology, King George's Medical University (KGMU) revealed that over 4500 lifesaving angioplasty procedures and almost 2000 lifesaving pacemaker implantations were performed in 2011-2012 in the state of UP. The number of these procedures had increased by almost 30% over the last year.

Likewise diabetes rates are rising in the state too. In 2013, National Programme for Prevention and Control of Cancer, Diabetes, cardio-vascular Diseases and stroke (NPCDCS) had released its data that 4.32% of UP's population might be at risk of diabetes. Rise of obesity is alarming as well.

The number of cancer cases, as well as cancer deaths, in UP are not only highest in the country but have also risen by almost 10% between 2011 and 2014, as per the state-wise cancer data of Indian Council of Medical Research (ICMR). More than 44% of all people who got cancer in UP succumbed to it in 2014.

According to Global Youth Tobacco Survey (GYTS) data for UP state, average age of initiation of tobacco use in UP is 17.3 years. So if initiation of tobacco use can be prevented then there will be major public health gains in nipping rates of all NCDs.

“Hookah or water-pipe smoking is often mistakenly perceived as less harmful to health than cigarettes. However, the truth is that during a one-hour hookah or water-pipe smoking session users can inhale more smoke than they would from smoking 100 cigarettes. The smoke inhaled by water-pipe contains charcoal combustion products, carcinogenic substances, carbon-monoxide, volatile aldehydes, ultrafine particles and other toxicants. Sharing water-pipes may also transmit infections” said Professor (Dr) Elif Dagli of International Union Against TB and Lung Disease (The Union).

Tobacco smoking was prohibited in public places from 2nd October 2008 as per provisions of India’s Cigarette and other Tobacco Products Act (COTPA) 2003. Why, then are smoke-free laws not implemented in hookah parlours which are mushrooming at an alarming pace in urban areas? Even nonsmokers who are exposed to tobacco smoke are more likely to develop lung cancer due to exposure to secondhand smoke. Also pictorial graphic warnings and tobacco taxes should be applied on hookah or water-pipe as well.

"According to WHO, up to half of current users will eventually die of a tobacco-related disease. Tobacco users who die prematurely deprive their families of income, raise the cost of healthcare and hinder economic development. Stopping all kind of tobacco consumption will certainly reduce the risk of NCDs but merely reducing the consumption of tobacco does not reduce your risk of NCDs. So stop using tobacco to prevent NCDs. Those who have pre-cancerous lesions, should stop using tobacco and get checked by a doctor, to reduce the chance of getting oral cancer” said Prof (Dr) Rama Kant.

“Tobacco users need help to quit. Studies show that few people understand the specific health risks of tobacco use. For example, a 2009 survey revealed that only 37% of smokers knew that smoking causes coronary heart disease and only 17% knew that it causes stroke.  Among smokers who are aware of the dangers of tobacco, most want to quit. Counselling and medication can more than double the chance that a smoker who tries to quit will succeed” said Prof Rama Kant.

UP's health systems are already over-burdened - if we can reduce the lion's share of preventable and avoidable burden of NCDs, it will be a major boost to public health in the state.

(About the author: Dr Raghav Gattani, MBBS, Junior Consultant at Avadh Hospital and Heart Center is also the honorary Medical Correspondent for CNS - Citizen News Service)
12 February 2016