The Growing Burden of Non-Communicable Diseases – Roundtable 2010
An Initiative by India Health Progress
With liberalization of the Indian economy and the advent of globalization, NCDs (non-communicable diseases) have been rising rapidly among the Indian populace. Cardiovascular diseases, diabetes, cancer and chronic lung diseases are some of the major ailments that now afflict Indians from all regions. According to a 2004 report, NCD deaths in India were twice those of communicable disease.
Besides the impact of NCD morbidity and mortality on India’s social fabric, the second cause of concern is its economic impact. Reviewing various papers that assess the burden of NCDs in India, the Cameron Institute – an independent think-tank – concludes that just three of the most preventable NCDs (heart disease, strokes, diabetes) will cost India’s economy US$237 billion between 2006–2015.
The Roundtable was held under the aegis of India Health Progress (IHP) – an independent initiative launched on 15 August 2010 with the express intent of bringing all like-minded organizations under a common platform to address the longstanding issue of healthcare inaccessibility in India.
Indian health experts met on 21 October 2010 to discuss the rising adverse impact of NCDs on the health of citizens and the national economy.
Mr. Aman Gupta, Principal Advisor, IHP opened the roundtable event by welcoming participants and providing an introduction to India Health Progress. Mr. Ashok Malik, the roundtable moderator, then introduced the expert speakers: Dr. Prashant Mathur, Scientist, ICMR; Mr. Bejon Misra, International Consumer Expert; and Dr. Kamini Walia, Director – R&D, PATH. The speakers addressed the potential role and impact of different sectors and organizations in the fight against NCDs. Dr. Mathur’s presentation focused on the role of the public sector in improving access to healthcare while Dr. Walia highlighted opportunities for NGO involvement and Mr. Misra discussed the role of consumer organizations on health education and policy advocacy in strengthening the delivery system in India.
Following these presentations, additional panellists joined in an hour-long discussion. The panellists included Dr. Ratna Devi, Chief Executive of the Chronic Care Foundation and Dr. Rana J Singh, Technical Advisor from the South East Asia International Union Against Tuberculosis and Lung Disease.
During the roundtable event, Dr. Mathur stressed that the lopsided spread of healthcare infrastructure in India was one of the major reasons for the rise of chronic NCDs. Although more than 70% of the population lives in rural areas, only 20% of the total hospital beds are located here. An Indian Medical Society survey revealed that 75% of qualified consulting doctors practice in urban centres, 23% in semi-urban areas and only 2% in rural areas. Although the Indian healthcare sector is growing, the population at large is not benefiting in equal measure from this growth. Besides, instead of preventive measures, the focus was on surgery, medications and hospitalization. Furthermore, there was emphasis on acute medical care, while chronic, domiciliary and societal healthcare aspects were not given due importance.
Among the multiple solutions Dr. Mathur outlined to address shortfalls, the major ones were to gradually shift the role of the state from being a provider to a purchaser of care for patients, instituting different financing mechanisms to contain costs, providing financial risk protection for the poor while ensuring equitable access to good quality care and creating a competitive environment in secondary and tertiary markets, in particular, to improve efficiency.
Highlighting the needs of consumers in the healthcare sector, Mr. Bejon Misra also discussed how consumer organizations could help the public through health education and policy advocacy. Seconding Dr. Mathur’s views, Mr. Misra spoke about reforms in healthcare where the primary goal was to ensure “invariable choices” for consumers by making the Government a purchaser from a provider. Though various reforms have been in the pipeline for years, they have as of yet to be implemented. Mr. Misra suggested that collaboration between various entities could provide a framework and impetus to effectively implement these reforms.
Some of the solutions suggested were to design an efficient complaint redressal mechanism, ensure regular exit interviews with users to elicit feedback, employ communications tools such as posters, audio and video messages to emphasize users’ rights and responsibilities, making all outcomes public and involve the media in a responsible manner, reward as well as recognize allies, support groups and individuals involved at the delivery level and use tangible, measurable delivery systems based on the expected outcomes desired by end users.
The last speaker, Dr. Kamini Walia, spoke about the “Role of NGOs” in the context of NCDs in India. Recognizing the impact of globalization and urbanization in ushering demographic and lifestyle changes that lead to a rise in chronic NCDs, Dr. Walia stressed, however, that these diseases are no longer “diseases of affluence.” Citing a WHO report, she revealed that the high risk factors for chronic NCDs were high blood pressure, high blood sugar, high cholesterol, tobacco use and sedentary lifestyles.
Among the solutions Dr. Walia cited were the need for “advanced technology to strengthen the system and encourage healthy behaviour”, saving children’s lives by immunization and partnerships with governments, consolidating fragmented efforts, engaging partners outside healthcare and scaling up by pooling limited resources.
The panel discussion was kicked off by Dr. Rana J Singh, who voiced concerns about how increased tobacco usage had led to a rise in NCDs and various initiatives to curb tobacco usage had not worked. In India, an estimated nine hundred-thousand people die annually due to tobacco intake, which means nearly 2,500 deaths per day. The second panellist, Dr. Ratna Devi, spoke about how the age group of diabetes victims had come down from above 50 years to between 15 and 20 years. NCDs caused by sedentary lifestyles now afflicted both urban and rural segments.
After this, moderator Ashok Malik steered the discussion towards the challenges and impact of chronic NCDs on the family. Dr. Ratna Devi spoke about how the burden fell more heavily on low-income families. The event concluded with the panellist and speakers underscoring the importance of implementation, public and private partnerships, changes at the top as well as ground level, the induction of advanced technologies as well as global methods and the spread of awareness to combat NCDs.
India Health Progress - www.indiahealthprogress.in