Emerging Issues in Health

By Dr. Nachiket Mor

This post is based entirely upon my understanding of the material in an eponymous article by Dr. Sunita Kale which was published recently in the India Health Report 2010. Dr. Kale has very carefully assembled some salient facts about the current situation in India that I found fascinating. It would be best to read the article directly to get a full sense of what she is saying, but here are some things that I felt were worth sharing with all of you:

1. While small-pox has been eradicated and polio and cholera are on their way out, Pulmonary Tuberculosis, Acute Respiratory Tract Infections, Pneumonia, Diarrhoea and Malaria now account for maximum fatalities as leading communicable diseases.
2. HIV/AIDS remains a potential threat but its spread has been limited far more quickly than had been previously anticipated (causation is not entirely clear yet.).
3. The Asian Indian Phenotype refers to certain unique clinical and biochemical abnormalities amongst Indians which include increased insulin resistance, greater abdominal adiposity (higher waist circumference despite lower body mass index), lower adiponectin and higher high sensitive C-reactive protein levels. This Phenotype (and not lifestyle issues) is perhaps causally responsible for higher incidence of diabetes and coronary artery diseases amongst Indians (suggesting that medicines may be inevitable and mere diet and lifestyle guidance may be inadequate).
4. Four conditions: (1) Cardiovascular diseases (24.8%), (2) COPD, asthma and other respiratory diseases (10.2%), (3) Tuberculosis (10.1%), and (4) Cancer (9.4%) are the principal causes of premature death in India. While the incidence of Cardiovascular diseases (including diabetes) is high in India (6%) and the death rate is also high, for Cancer the incidence rate is less than 0.1% but premature-death rate is just under 10%. Also while Cancers can be treated (prevented) at early stages (particularly Oral and Cervical), at a late stage this becomes impossible or much-much harder. Both these factors suggest that early detection and treatment of cancer may be a very important thing for ICTPH to focus on.
5. More than 10% of the Indian population consumes tobacco (120 million people) with rural populations consuming over 50% more than urban consumption levels. Cigarettes account for less than 5% of this consumption in rural India with Beedi (50%), Tobacco Leaf (25%) and Zarda (10%) being the dominant forms of consumption. While reduction of tobacco consumption at the individual level is clearly the most important goal of any individually-focussed health management strategy, it is possible that improved oral hygiene amongst tobacco consumers may reduce the incidence of Oral Cancer within this population.
6. At 1-2% of the population the incidence rates of serious mental illness are comparable to those of Diabetes. This suggests that identification and management of these illnesses would be as important as treating other chronic diseases. One small glimmer of hope is provided by some empirical research that suggests that people with Schizophrenia fare better over time in poorer countries relative to those with similar disorders in developed countries (causality is unknown at this point).
7. Drug resistance has emerged as the single biggest problem in the treatment of infectious diseases:
   1. Surveillance of drug resistance in pneumococcal bacteria indicated that the number of strains that are fully susceptible to penicillin has declined by 50%, and in some countries by 75%, as resistant strains have spread.
   2. In India, resistance of Plasmodium Falciparum to chloroquine was first reported as far back as 1973 (in Assam). As a result, WHO’s treatment policy is now to treat all cases of uncomplicated Falciparum Malaria with Artemisnin Combination Therapy (ACT). Interestingly Artemisnin was discovered in the 1970s by the Chinese Army as it is made from a local plant (Artemisia Annua; reference) which may be possible to grow locally in India.

Reference

Author: Sunita Kale, Ph.D.
Chapter Title: Emerging Issues in Health
Pages: 35 to 50
Chapter Number: 3
Book Title: India Health Report 2010
Book Editors: Ajay Mahal, Bibek Debroy, Laveesh Bhandari
Publishers: BS Books
Publication Date: 2010