Sunday, October 1, 2023

The other pandemic

One of the major impacts of the ongoing COVID pandemic has been the inadvertent diversion of attention from other prevailing diseases. This is a global struggle. According to reports, non-communicable diseases (NCDs) such as diabetes, hypertension and cardiovascular conditions account for 41 million deaths each year. That is more than 70% of all deaths globally. Read another way, one person under the age of 70 dies of a non-communicable disease every two seconds across the world; with 86% of those deaths occurring in low- and middle-income countries. In India too, the figures present a grim picture. A report released by WHO titled ‘Invisible numbers – the true scale of non-communicable diseases’ stated that 66% of total deaths in India were due to NCDs. These conditions are currently more prevalent than infectious diseases. Sixty-seven percent occur before the age of 40. Besides being the leading causes of death worldwide, NCDs carry a huge cost to individuals. These also undermine workforce productivity and threaten economic prosperity as a consequence. There have been suggestions that addressing the NCDs problem can also mitigate other challenges like HIV, tuberculosis (TB), maternal and child health, and universal health coverage. Nearly 23% of middle-aged people with chronic NCDs in India have no other way but to curtail their paid work due to illnesses while 7% have to stop working, says the country’s first-ever population-based study. The proportion of people between 45 and 64 years who had stopped or curtailed their work was the highest (21%) among victims of stroke, followed by neurological or psychiatric disorders (18%) and chronic heart disease (13%). In addition, more than 10% of the middle-aged population who took one of the two decisions suffered either from chronic lung disease or cancer. The study by researchers from the International Institute for Population Sciences (IIPS), Mumbai, is the first one that looks at the link between economic productivity of the middle-aged and elderly and the chronic diseases they suffer from. Though a large number of studies estimated high out-of-pocket payment and financial catastrophe due to healthcare costs in India, there are no nationally representative studies on productivity loss due to health problems even though chronic diseases are growing in the world’s second-most populous nation, largely affecting the middle-aged and elderly population, many of them are in the working age. As the burden of non-communicable diseases is on the rise in India, studies in the past have shown that the share of middle-aged and elderly population (45+) has increased from 18.9% in 2001 to 25.1% in 2020, while median age of onset of NCDs is declining from 57 years in 2004 to 53 years by 2018. Evidences from this study on chronic diseases and productivity loss in India are new and staggering, which calls for a demand for policy attention. Closer home in Nagaland, such comprehensive data and surveys are hard to come by. Mid last year, a health campaign in Kohima Town led to the detection of high prevalence of NCD among the people. Out of the 15,100 target population (30 years and above) identified in the 42 colonies of Kohima, 823 persons were detected with hypertension, 710 with diabetes, 107 with kidney diseases, 55 with cancer, and 40 with TB. That is just in one tiny pocket of the State. Perhaps more comprehensive surveys will come up with complete State-wide data. Regardless, these are worrisome findings. NCDs affect all genders, all social classes and all stages of life. Even during the peak of COVID-19 pandemic, severe morbidity and high mortality were associated with prior affliction with NCDs. There have been calls for a concerted global response, which uses policy instruments that have a population-wide impact on tobacco, alcohol, unhealthy foods and air pollution. But even on a local scale, this calls for robust health system programmes that promote healthy lifestyles, detect and control risk factors early and effectively, treat diseases in a cost-effective manner and prevent untimely deaths. NCDs need to be accorded higher priority in financial allocation and health system strengthening initiatives, with strong emphasis on primary care.