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The silent killers~I

Jaydev Jana |

If someone wishes for good health, one must first ask oneself if he is ready to do away with the reasons for his illness, only then is it possible to help him.

~ Hippocrates

Diseases are adverse health conditions which can impact the overall well-being of an individual and can occur by ‘chance’ or ‘choice’. For centuries, communicable diseases (CDs) were the main factors responsible for deaths around the world. Life expectancy was often limited by uncontrolled epidemics. The fight against AIDS, as well as tuberculosis and many other CDs, is far from over in spite of medical research and achievements in terms of vaccination, antibiotics and improvement of life conditions. While CDs continue to grip many parts of the world with fear, research by the World Health Organisation (WHO) and leading epidemiologists has identified another global epidemic and the biggest killers.

These are not contagious or chronic diseases. They can be prolonged and are usually the result of a combination of genetics, physiological, environmental and behavioural factors. The other stark feature of these disorders is their ability to affect any human being world over without barriers of geography, race, ethnicity, region or religion. The ‘noncommunicable disease’ (NCD) cases ~ heart ailment, stroke, obesity, Type 2 diabetes, cancer, respiratory diseases, etc. ~ all share common risk factors, including unhealthy diet, a sedentary lifestyle, smoking and chewing tobacco, and a huge consumption of alcohol. Though the risk factors for many of these illnesses also rooted in our DNA, the trigger to their early onslaught and unmanageable is definitely one’s lifestyle. Most of the NCDs are referred to as ‘lifestyle’ diseases which are not restricted to adults alone, they have started affecting children as well. The shift in purchasing power and the advent technology have changed our way of life. With less physical activity, greater availability of resources and little or no time to spare, we have become vulnerable to ailments that were unheard of in the 1960s and Seventies.

There is evidence that the poorest members of society and malnourished children are at risk. For some, vulnerability begins in the womb. Dr. David Barker’s theory, coined as Barker Hypothesis by the British Medical Journal in 1995, states that “maternal dietary imbalances” at the critical period of development of the womb can trigger an adaptive redistribution of the foetal resources in such a way that such adaptation and metabolism predispose individuals to NCDs like heart diseases, obesity and diabetes later in life.

According to WHO’s Global Status Report on Noncommunicable Diseases 2010, NCDs are sweeping the world and appear to be the leading factors behind death, killing more people every year than other causes combined. In the introduction to the report it is also mentioned that “of the 57 million deaths that occurred globally in 2008, 36 million ~ almost two-thirds ~ were due to NCDs, notably cardiovascular problems, cancer, diabetes and chronic lung diseases. The combined burden of such ailments is rising fastest among lower-income countries, populations and communities, where they impose large, avoidable costs in human, social and economic terms. About one-fourth of global NCD-related deaths take place before the age of 60.”

Going by the updated statistics of WHO, NCDs kill about 40 million people each year, equivalent to 70 per cent of all deaths globally. And four groups of the most common diseases ~ cardiovascular, cancer, respiratory ailments and diabetes ~ account for over 80 per cent of all premature NCD deaths. The ailment not only affects health but also productivity and economic growth. It appears from the latest fac-sheet of WHO that every year 15 million people die from NCDs between the ages of 30 and 69 years; over 80 per cent of these ‘premature’ deaths occur in low and middle-income countries. Premature deaths, illnesses and disabilities at a young age impact heavily on socio-economic development and productivity. By 2020, it is predicted that NCDs will account for around 80 per cent of the global burden of disease, causing seven out of every ten deaths in developing countries, compared with less than half today. It is also feared in the report that among the poor people of low- and middle-income countries ‘a vicious cycle may ensure: poverty exposes people to behavioral risk factors for NCDs and ,in turn, the resulting NCDs may become an important driver to the downward spiral that leads families towards poverty. As a result, unless the NCD epidemic is aggressively confronted in the most heavily affected countries and communities, the its mounting impact will continue and the global objective of reducing poverty will be undermined.

The first health-of-the-nation report, India: Health of the Nation’s States, prepared as part of the Global Burden of Disease (GBD) Study 2016, has recently been published. The report provides estimates of the impact of 333 disease conditions and injuries and 84 risk factors for every state from 1990 to 2016. In 2016, NCDs, which include heart ailments, cancer, diabetes, chronic respiratory diseases and mental disorders, accounted for 61.8 per cent of the total deaths. CDs, maternal, neonatal and nutritional diseases accounted for 27.5 per cent and injuries accounted for the rest. NCDs took the heaviest toll in all states, but relatively more in Tamil Nadu, Kerala, Punjab and Goa. In the Partnership to Fight Chronic Disease (PECD), India has stated that NCDs account for 53 per cent of the “disease-burden” in the country and more than six out of ten people die from NCDs. It is reported that roughly 5.8 million Indians die every year due to NCDs; it has been projected that by 2025 roughly 7 million Indians will die. The pertinent question that arises is: Are Indians more susceptible to many of the lifestyle disease?

Over the years, much work has been done towards estimating the human toll of NCDs, but work on assessing the economic toll is far less advanced. However, a report titled The Global Economic Burden of Non-Communicable Diseases 2011 of the World Economic Forum and the Harvard School of Public Health states that NCDs already pose a substantial economic burden and over the next 20 decades the burden will be more than $30 trillion, representing 48 per cent of the global GDP in 2010 and pushing millions of people below the poverty line. Although high-income countries currently bear the biggest economic burden of NCDs, the developing world, especially middle-income countries, is expected to assume an ever larger share as their economies and population grow.

The writer is a retired IAS officer

(To be concluded)