Diverse trends in diseases need state-specific remedies

Non-communicable diseases,infections,maternal

Non-communicable diseases (NCDs) and their risk factors have gone up in every state in India and now cause more disease and death than infections, maternal, neonatal, and nutritional diseases put together in each state, according to the first comprehensive analysis of disease trends and their risk factors in all states from 1990 to 2016.

NCDs, which include heart diseases, stroke, diabetes, chronic respiratory disease, cancers and injuries, are the leading causes of death worldwide, but their co-existence with infectious diseases are leading to a “double burden” of disease in less developed states still battling infections like diarrhoea, lower respiratory tract infections and tuberculosis, among others.

Risk factors for NCDs have increased in every state over the past 25 years, the study shows.

“The rising prevalence in NCDs did not surprise as it validated earlier findings, but the massive change in a relatively short time is of immense concern. Such immense magnitude of change usually occurs over a large period of time… and India needs strong social and policy interventions to slow this telescoping …” said lead author of the diabetes study Dr Nikhil Tandon, professor and head, department of endocrinology, metabolism and diabetes, All India Institute of Medical Sciences.

The less developed states with large, underserved populations have their work cut out because of changing diets that are moving away from traditional foods to packaged foods, rising air pollution, and use of smokeless tobacco, which is pushing up oral and other cancers.

With the ageing of the population adding to the increasing burden of NCDs, these findings emphasise the need for the prevention and early management with policy support that is as high as that for communicable and childhood diseases.

“Recognising the shift from communicable diseases to NCDs, India’s national programme for prevention and control of cancer, diabetes, cardiovascular diseases and stroke established NCD units in each state last year for the prevention, early diagnosis and management of major NCDs at the district level, including screening for high blood pressure and blood glucose and for oral, breast, and cervical cancers,” said Union health minister JP Nadda.

Many risk factors overlap, so controlling high blood pressure, high cholesterol, elevated blood sugar and overweight can lower risk of ischaemic heart disease, stroke, diabetes and certain cancers.

Lowering indoor and outdoor pollution will lower chronic respiratory diseases, cardiovascular disease, diabetes and lung cancer.

“Yes, we need initial diagnosis of cardiovascular diseases but overall management and follow-up has to happen in primary health care centres. We need innovations to strengthen primary health care centres, improve capacity of primary physicians and have multi-sectoral collaborations to reduce consumption of fat, sugar and salt and air pollution to deal with cardiovascular diseases,” said Dr Dorairaj Prabhakaran, vice president (research and policy) and Director, Centre for Control of Chronic Conditions, Public Health Foundation of India.

The Union health ministry is expanding its non-communicable diseases programme by promoting early screening, diagnosis and treatment under the 150,000 Health and Wellness Centres being set up by 2022.

The studies also called for India investing in improved surveillance systems to monitor changing trends in NCDs and injuries, and related risk factors, across the country.

Robust data helps policymakers tailor health roadmaps specific to each state, said experts.

“The heterogeneity in disease trends in itself is important because it will helps us identify the differential burden of risk factors in each state and offer policy makers to tailor state-specific interventions for each state,” said Dr Tandon.

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