Syllabus subtopic: Issues Relating to Development and Management of Social Sector/Services relating to Health, Education, Human Resources.
Prelims and Mains focus: about the findings and their causes; about IHCI and its achievements; about non-communicable diseases and steps for their prevention; about National Health Mission (NHM)
News: Noncommunicable diseases like hypertension, diabetes and cancer are posing a bigger challenge in the nontribal rural areas of Madhya Pradesh than in the urban areas owing to a rapidly growing rate of incidence and the lack of awareness, according to the National Health Mission (NHM).
Screening of 30 lakh persons above the age of 30 across the State in December has revealed that Raisen, Hoshangabad and Seoni districts face the highest burden of the diseases.
The State unit of the National Health Mission anticipates urban districts like Bhopal, Gwalior or Indore to fare the worst.
Why more cases in non-tribal rural areas?
More awareness, as in the case of urban areas, translates into patients undergoing treatment despite a high incidence. As a result, the burden is moderate in urban areas, but due to low awareness in rural areas, it is increasing there.
Non Communicable Disease Control Programme
During the screening drive, taken up under the Centre’s Non-Communicable Disease Control Programme, what surprised officials was the low incidence in the 89 tribal blocks in the State, which has largest tribal population in the country, despite the low awareness levels.
The programme, which was launched recently and under which 86% of those screened have been put under treatment, focusses on identifying noncommunicable diseases at the primary healthcentre (PHC) levelitself, and ensuring treatment up to the districtlevel and followups with patients to continue medication.
In the first phase, 1,200 PHCs were roped in. In contrast to patients visiting a health centre, ASHA workers now go doortodoor to draft family profiles and screen them for the noncommunicable diseases, added Dr. Sidana.
Case of hypertension in rural areas
Trans fatty acids when consumed in hydrogenated forms is a major cause of hypertension or high blood pressure levels. Cooking oil is still reused for the purpose in several rural areas.
The India Hypertension Control Initiative, supported by the World Health Organisation, is catering to patients above 18 suffering from the diseases in Bhopal, Sehore, Chhindwara, Seoni, Ujjain and Ratlam districts.
Of the screened persons, 2,55,420 were diagnosed for hypertension.
Of the country’s 100 districts with the highest prevalence of hypertension, 15 were in Madhya Pradesh.
About India Hypertension Control Initiative (IHCI)
The IHCI was launched in Kerala in April 2018 as a multi-partner five-year initiative with the Union Ministry of Health and Family Welfare,Indian Council of Medical Research, State government, and WHO India.
The IHCI was also launched in Madhya Pradesh, Telangana, Maharashtra, and Punjab.
The results from Kerala had been the most impressive so far because of the infrastructure strength of non-communicable disease clinics across the State.
Each patient was given a treatment book and the health card was kept at the hospital.
Every month there was a follow-up on the patient by the hospital over the phone or by visit of an Accredited Social Work Activist.
With the success of the initiative, the government is considering replicating it in other districts too.
About Non-communicable diseases (NCDs)
NCDs are medical conditions or diseases that are not caused by infectious agents. These are chronic diseases of long duration, and generally slow progression and are the result of a combination of genetic, physiological, environmental and behaviours factors.
NCDs are one of the major challenges for public health in the 21st century, not only in terms of human suffering they cause but also the harm they inflict on the socioeconomic development of the country. NCDs kill approximately 41 million people (71% of global deaths) worldwide each year, including 14 million people who die too young between the ages of 30 and 70. The majority of premature NCD deaths are preventable.
According to World Health Organization (WHO) projections, the total annual number of deaths from NCDs will increase to 55 million by 2030, if timely interventions are not done for prevention and control of NCDs.
In India, nearly 5.8 million people (WHO report, 2015) die from NCDs (heart and lung diseases, stroke, cancer and diabetes) every year or in other words 1 in 4 Indians has a risk of dying from an NCD before they reach the age of 70.
In a report “India: Health of the Nation’s States” by Ministry of Health and Family Welfare (MOHFW), Government of India (GOI), it is found that there is increase in the contribution of NCDs from 30% of the total disease burden- ‘disability-adjusted life years’ (DALYs) in 1990 to 55% in 2016 and also an increase in proportion of deaths due to NCDs (among all deaths) from 37% in 1990 to 61% in 2016. This shows a rapid epidemiological transition with a shift in disease burden to NCDs.
Major NCDs and their risk factors
The major NCDs are cardiovascular diseases, cancers, chronic respiratory diseases and diabetes.
Physical inactivity, unhealthy diets (diets low in fruit, vegetables, and whole grains, but high in salt and fat), tobacco use (smoking, second-hand smoke, and smokeless tobacco), and the harmful use of alcohol are the main behavioural risk factors for NCDs.
They contribute to raised blood pressure (hypertension); raised blood sugar (diabetes); raised and abnormal blood lipids (dyslipidaemia); and obesity. Air pollution is also leading risk factor for NCDs in terms of both outdoor air pollution and household air pollution that mainly results from burning solid fuels in the home for cooking and heat.
Although morbidity and mortality from NCDs mainly occur in adulthood, exposure to risk factors begins in early life. Therefore, NCDs and its risk factors have great importance to young people as well.
NCDs are rapidly increasing globally and reached epidemic proportions in many countries, largely due to globalization, industrialization, and rapid urbanization with demographic and lifestyle changes.
Actions to beat non-communicable diseases
The epidemic of NCDs cannot be halted simply by treating the sick, healthy persons have to be protected by addressing the root causes. Reducing the major risk factors for NCDs is the key focus of MOHFW to prevent deaths from NCDs. Tackling the risk factors will therefore not only save lives; it will also provide a huge boost for the economic development of the country.
MOHFW, GOI is already implementing “National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular disease and Stroke” (NPCDCS) with the objective to increase awareness on risk factors, to set up infrastructure (like NCD clinics, cardiac care units) and to carry out opportunistic screening at primary health care levels.
In response to the “WHO Global Action Plan for the Prevention and Control of NCDs 2013-2020”, India is the first country to adopt the National Action Plan with specific national targets and indicators aimed at reducing the number of global premature deaths from NCDs by 25% by 2025. The global action plan has suggested 9 targets for countries to set. But India has taken the unprecedented step of setting a tenth target to address household air pollution. India’s National Monitoring Framework for Prevention and Control of NCDs has committed for a 50% relative reduction in household use of solid fuel and a 30% relative reduction in prevalence of current tobacco use by 2025.
Integration of NPCDCS with the National Health Mission (NHM) resulted into augmented infrastructure and human resources particularly in the form of frontline workers- the ANM and the ASHA. With the active participation of these frontline workers the population-based periodic screening of hypertension, diabetes, and common cancers (oral, breast, cervical cancers) is initiated to facilitate the early detection of common NCDs.
Prevention and management of chronic obstructive pulmonary disease (COPD) and chronic Kidney disease (CKD); and better management of co-morbidities such as diabetes and tuberculosis are also considered under the programme.
Integration of AYUSH with NPCDCS is a further step for promoting healthy life style changes among the population. Health promotion through social media is also being used to generate awareness about prevention and control of NCDs, such as use of mobile technology in applications called mDiabetes for diabetes control, mCessation to help for quit tobacco, and no more tension as a support for mental stress management.
All people should join together to reduce premature deaths from NCDs by one third by 2030, the commitment made in 2015, as a part of Sustainable Development Goals. Young people can contribute in different ways to prevent NCDs such as sharing information/ targeted messages on key risk factors about NCDs on social media; organizing and supporting interventions to ensure healthy lives and promote wellbeing for all people, at all ages.