Non-Communicable Chronic Disease: The Battle Comes to India
By Ratna Devi
Globally, non-communicable chronic diseases (NCCD) are proliferating at an alarming pace in both the developed and developing world. The growing number of reported instances of heart and kidney diseases, diabetes, obesity and other preventable and treatable NCCDs are severely taxing already hard-pressed global health care resources and health care delivery systems. While these and other conditions have long been the object of concern for health care planners and professionals in the developing world, their present and potential future impact on developing and middle-income countries has been both striking and brutal.
In fact, a 2005 study by the World Health Organization (WHO) detailing the growing impact of chronic diseases in low and middle income countries found that as much as 80% of the premature deaths in these countries is now attributable to otherwise treatable chronic conditions. WHO further reported that up to 60% of deaths worldwide were the result of untreated or under-treated chronic conditions, and nearly half of those deaths were directly attributable to cardiovascular disease.
The WHO study also found that preventable chronic diseases are rising throughout the developing world and at rates similar to those found in the developed world. WHO concluded that the incidence of diabetes in the developing world for example, increased more than 2.5 fold, from 84 million in 1995 to over 228 million as of 2005. The principal reasons, the study found, included the convergence of global economies and the influence of Western culture – particularly diet.
Especially troubling was the current and projected costs of treating these conditions as well as the impact that lost wages and the lack of adequate health coverage has for both patients and developing health care systems in both middle and low-income countries. The cost of NCCDs falls heavily on the underprivileged in every country and they are far more likely to shoulder the costs and health consequences of NCCDs as a result of low income, lack of awareness as well as poor access to health care generally.
As awareness of the growing problem posed by NCCDs increases among global health policy makers and planners, so too has awareness that new and better solutions to prevention, diagnosis and treatment must be found in order to both improve patient treatment as well as disease prevention.
Work now being done in India stands as one example of new efforts now underway to both blunt the growing negative impact of NCCDs and decrease the incidence of new diseases.
In recent years, India has both experienced significant economic growth as well as the growth of a number of attendant health problems in the form of NCCDs. Throughout India, great disparities exist between patient access to care for populations living in rural versus urban settings. Additionally, there are many concerns about the ability of existing healthcare facilities to meet both current and growing medical needs in both urban and rural settings.
The WHO study found that India faces dire healthcare consequences if steps are not taken to address the growing NCCD epidemic. For instance, WHO found that chronic diseases can be expected to claim 7.63 million lives in India annually by the year 2020. Also, a Price Waterhouse report further predicted that the proportions of death from long-term maladies will skyrocket from 53% in 2005 to nearly 67% by 2020.
Further, WHO found that cardiovascular, respiratory diseases, cancer and diabetes today account for 53% of early deaths in India – more than those caused by infectious diseases. These potentially preventable deaths join the 4.9 million deaths due each year to high blood pressure; the 4.4 million deaths from obesity, poor nutrition and other causes.
In other words, India faces a looming healthcare crisis but has yet to mobilize people and resources needed not only to fully assess the problem but also to propose and implement practical solutions for patients. There is, as yet, no well-defined national strategy or guidelines for medical care and health insurance for India’s underprivileged and under-served populations now suffering or potentially threatened from chronic conditions. In short, the Indian healthcare system is under tremendous pressure to provide services to a large population and neither the public nor private sector is capable of addressing current trends.
In an effort to mould solutions appropriate to the many challenges India confronts, the Chronic Care Foundation was established by patient groups, the provider, community, business and labour organizations along with healthcare policy experts and leaders in India’s emerging healthcare industry. The CCF aims to impact the availability, accessibility and affordability of healthcare in India by ensuring medically approved best practices are widely adopted, patient safety is safeguarded, supportive policies leading to reduced health risks are put in place by government and speedy execution at all levels involving all stakeholders.
The CCF also strives to raise general awareness of policies and practices that can help save lives and reduce health costs through more effective prevention and management of chronic diseases.
Specifically, the CCF seeks to advance sustainable efforts to prevent disease, promote early prevention and management models throughout the health care system and public health infrastructure. The CCF also seeks to encourage and reward continuous advance in clinical practice and research that improves the quality of care for those with prevalent and costly chronic diseases; accelerate improvements in the quality and availability of health information available to patients and throughout the healthcare system; reduce health disparities by focusing on barriers to access and to good health; and promoting healthy lifestyles and disease prevention and management in every community. As a critical first step in these efforts, the CCF has conducted an extensive, India-wide survey of both rural and urban healthcare systems and their current ability to meet the growing medical needs of patients suffering from NCCDs. The study found that NCCDs, once found mainly among urban elites, have now percolated down to rural areas as well. In addition, there is a significant lack of awareness throughout all populations of both the risks of NCCDs as well as of prevention and treatment strategies.
Among the survey’s key conclusions included a finding that India’s healthcare system, generally, is under tremendous pressures as a result of both demographic and epidemiological shifts as well as rapid urbanization and changing lifestyles. These pressure are only likely to grow more intense as development continues and if development of infrastructure and if national care and treatment efforts fail to keep pace with the growth of NCCDs.
In order to jump-start discussion of how best India can meet the emerging NCCD challenge, the CCF has made a series of recommendations. These include a new, higher emphasis on preventive healthcare and building greater awareness of the risks and treatments of NCCDs. Improve secondary interventions such as clinical treatment of NCCDs as well as making tertiary care more broadly available in both urban and suburban settings.
In addition, the CCD concluded that there needed to be greater public awareness of insurance programs, especially in rural areas, as part of the effort to manage both the personal and systematic costs of NCCDs for patients and the broader healthcare system.
Policy makers also have an important role to play by encouraging and supporting the pro- motion of healthy nutrition, physical activities, by reducing tobacco and alcohol consumption.
Finally, looking to the future, the CCF determined that more must be done to build and maintain a health care infrastructure at both the primarily and secondary level that is better able to meet the growing needs of NCCD patients. This includes things such as better training of health care personal as well as building better partnership between public and private health care facilities - especially in rural areas - to improve both prevention and treatment opportunities.
Efforts like the CCF - bringing together in partnership a wide array of health care system stakeholders - can play an important role in helping rapidly developing economies like India to better manage and prepare for the health care challenges that result from economic growth. As the CCF's work demonstrates, understanding t he extent of the current and potential problem is a critical first step to finding and implementing workable solutions targeted to meet India's particular health care needs and especially as it relates to preventing and treating NCCDs.