July 08--For over a year, Madhuben Savabai Nayak took medicines from the local primary health centre (PHC) for a discomfort in her pelvic area. It didn't help.
She then went to the block gynaecologist, the civil hospital and PHC, took numerous medicines, but her health continued to deteriorate.
Her suffering continued until one day Nayak, head of the Devgadh Baria Mahila Sangathan, fainted during a Fargia village council meeting due to excessive bleeding.
Once again she was taken to the nearest PHC and transferred to Baria Civil Hospital from where she was sent to the Godhra Civil Hospital. The bleeding didn't stop and she was eventually transferred to MP Shah Cancer Hospital in Ahmedabad.
Here she was diagnosed with cervical cancer--the second most common cancer, after breast cancer, in women. Nayak was a victim of what is described as a non-communicable disease (NCD), previously a killer in urban India, but now rapidly making inroads into rural areas too.
The World Bank estimates that in 2004, nearly six out of every 10 people died due to NCDs such as cardiovascular diseases, cancer, chronic respiratory diseases and diabetes. It is likely to get worse.
According to the World Health Organization, cardiovascular diseases will be the largest cause of death and disability in India by 2020. Its Global Burden of Disease (GBD) study estimates 52% of cardiovascular diseases deaths occur below the age of 70 in India compared with 23% in established market economies, which adversely affects the working population in the country. The number of people with hypertension, one of the leading causes of cardiovascular diseases, is expected to increase to 213.5 million in 2025, from 118.2 million in 2000.
Similarly, a report published by the International Diabetes Federation (9th edition, 2009) projects the number of diabetics in the age group of 20-79 in 2010 to be around 50.7 million--the highest among all the countries covered by the study. No recent statistics are available with the government.
The country also has the largest number of oral cancers in the world due to the widespread habit of chewing tobacco; it is the world's second largest producer as well as consumer of tobacco.
According to the GBD study, low-income populations are most affected by risks associated with poverty, such as undernourishment, unsafe sex, impure water, poor sanitation and hygiene, and indoor smoke from solid fuels; these are the so-called traditional risks.
As life expectancies improve and the major causes of death and disability shift to the chronic and NCDs, populations in developing countries such as India are exposed to a new class of health risks: arising from physical inactivity; overweight and obesity, and other diet-related factors; and tobacco and alcohol-related risks. As a result, not only are they struggling to deal with traditional health risks, they have to also now divert resources to tackle the new menace.
India falls in the category of these countries that are only beginning to prioritize NCDs. It is not surprising, therefore, that the government does not possess an official count on the diabetics in the country.
"Facilities for testing diabetes such as blood sugar are usually available at community health centres and primary health centres. However, many people remain unaware that they could be at risk for diabetes and do not seek investigations or treatment," said Union health minister Ghulam Nabi Azad in a statement to Parliament.
The ministry of health and family welfare had planned to launch a programme targeting NCDs as part of the National Rural Health Mission. It has formulated a national programme for prevention and control of diabetes, cardiovascular diseases and strokes. In March, the programme was approved at an estimated cost of Rs499.38 crore and launched on a pilot basis in 10 districts in 10 states.
However, some states have already launched similar initiatives. "Before the national programme came into place, we had some initiatives taken by the state (Tamil Nadu). We are now trying to integrate the various aspects of the state and national programmes," said Arun Murugan, nodal officer for the NCD cell set up two years ago.
As part of its programme, the state has diabetes and hypertension focused clinics at PHCs, where patients are diagnosed and treated for the diseases. It also has multi-specialty health camps in which specialists from higher facilities come to the village level to diagnose diabetes and hypertension cases.
"Every year, we see about 700,000 women being tested for diabetes. Once they are tested and we find them to be positive for gestational diabetes, then they are counselled on their diet, etc. And if that doesn't work, then they are put on insulin...this is the first initiative taken through the National Rural Health Mission," explains Murugan.
Similarly, in Ahmedabad, MP Shah Cancer Hospital recently launched a health passport--a passport-sized booklet that disseminates information related to NCDs and also informs the current health status of the passport holder.
It is clear then that there is a structural change in the pattern of diseases in India, with NCDs now a matter of concern even in rural areas. The trick, according to Anoop Misra, director and head (department of diabetes and metabolic diseases) at Fortis Hospitals, is to intervene in schools to force a change in lifestyles: Prevention of NCDs is easier than cure.
Vidhya Sivaramakrishnan in Chennai contributed to this story.
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