Strap up that fitness-tracker and get going! Walk. Run. Push the pedal on your bicycle. Give your daily petrol-guzzler a break, more often than you do. Book that wellness screening appointment that’s gathering dust on your to-do list, before its time to renew that new year resolution!
Go on. Roll your eyes at what may seem like yet another cliched blog on fitness. After all, you know the drill to stay on top of your health. But, if you can be with me for another 3 minutes, let’s talk about building a community of practice to help you stay on course. Let’s talk about mobilizing the community, the health system and the policy to help you maintain your health and fitness. Because, your fitness is not about you alone.
The Scenario
The global burden of non-communicable diseases that include cardiovascular disease, stroke, chronic respiratory diseases, cancers and diabetes is much higher than that of communicable diseases, accidents, injuries and maternal morbidity..
With COVID-19 response taking the centre-stage globally, prevention and management of NCDs has slipped further down in the list of priority health interventions, particularly in LMICs. The stakes are disproportionately higher, in low and middle-income countries like India, due to the added financial burden of these diseases. According to the National Health Accounts Estimates for India 2018-19 released in September 2022, non -communicable diseases contribute to 62% of total deaths in India; of concern are the preventable premature deaths, which account for a staggering 48% of mortality.
The NFHS 5 shows an increased incidence of high blood sugar level and elevated blood pressure among the population surveyed as compared to the findings of NFHS 4
Risk Factors
Risk factors associated with NCDs can be categorized into three main types; Biological risk factors that include body mass index, familial traits and genetic predisposing factors; Socioeconomic factors, that include Income poverty, Lack of Education, Gender ( Women are more susceptible) and Rapid urbanization; and behavioral risks such as Physical Inactivity, Unhealthy Diets (diets low in fruits, vegetables, whole grains and high in sodium and salts), Tobacco use (Smoking, secondhand smoke, smokeless tobacco) and Harmful use of alcohol. Besides these, environmental factors such as air pollution are also known to increase the risk of NCDs.
Of all the risks, the ones that are amenable to significant reduction; are the behavioral factors.
A need to step up investments in strategic interventions to prevent and control NCDs
As per National Health Estimates (2018-19) released in September 2022, Preventive care constitutes only 9.4% of the Government’s Current Health Expenditure. The total spending on NCDI by the government is low at less than 0.5% of GDP and a little more than one-fourth of Total Health Expenditure of the country[1].
As noted by WHO a dollar invested in strategic interventions by 2030, can yield a return of upto 7 USD, by saving lives, reducing morbidities, keeping people in the workforce, reducing the financial burden of catastrophic health expenses.
Preventive care for NCDs
Preventive care interventions are designed to risks, delay the onset, progression and severity and severity of disease, as well as to reduce out of pocket and catastrophic health expenditure as well as total health expenditure on secondary and tertiary care to manage NCDs.
These include Information education and counselling to recognize risks, modify behaviours at an early age , regular screening, early detection. In case of individuals diagnosed with NCDs, continuum of care for adherence to therapy, regular monitoring and modification of lifestyle go a long way in arresting disease progression and preventing catastrophic events.
Preventive measures can be effectively implemented at four levels keeping the individual at the centre of the intervention, supported by the community at the next level, the health system thereafter, guided, at the highest level by conducive policy making.
At the individual level
- Seek more information about preventive measures and risk factors
- Practice a healthy way of life (stay away from/reduce consumption of alcohol and tobacco, increase physical activity, eat healthy)
- Undergo regular screening for hypertension, diabetes, cervical, breast and oral cancer
- Seek early treatment and adhere to drug therapy, if prescribed
At the Community Level
- To encourage people to increase physical activity, community spaces should be made available in housing complexes or community halls for practicing group sessions like yoga, organizing health screening camps, or community sporting events
- A cadre of community-based volunteers like ASHAs can be trained to run simple checklists track physical inactivity or increased intake of unhealthy foods and conduct home-based screening and referrals of high-risk cases to primary care physicians (from the public or private sector)within the community.
- Youth volunteers can be trained as peer educators to run school and community based awareness programmes to inculcate safe and healthy practices amongst children and adoelscents.
- Fitness hours should be introduced at workplaces (similar to lunch breaks!), as an employee wellness measure.
- Social behaviour change communication is critical in encouraging people to adopt healthy lifestyles
At the Systems level
- Promote mobile apps like Simple for self monitoring and clinical monitoring of Diabetes and Hypertension under the NPCDCS. Mobile Apps for self-monitoring should be linked to a robust triage system.
- Civil society should participate in the NPCDCS by carrying out app-based self-monitoring of vital parameters.
- High-risk findings should be reported to the local health care provider who should be empowered to offer teleconsultation to triage the case for further management and referrals.
- Private sector HCPs should be encouraged to invest in digital health interventions for rapid triaging and referrals adult citizen must be encouraged to download the self-care app
- Public sector should increase in and maximal utilization of budgets to prevent and manage NCDs
- Reduce information asymmetry, put in place mechanisms to reduce gaps in information about generic medicines, free diagnostic facilities,insurance schemes
At the Policy Level
- Encourage extended prescriptions (avoid the need for frequent visits to health facilities for refills)
- Embed digital health interventions into the health system, as a measure to augment the health systems response to manage NCDs and not just as an alternate model of service delivery when health systems are overwhelmed.
- Subsidize fees payable to government recognized gyms and yoga centres to inculcate a culture of regular physical activity
- Reduce premium on medical insurance in case of a documented practice of health and well-ness monitoring
- Include primary health care measures such as screening and diagnostics under PMJAY.
- Private health insurance schemes should also be extended to cover diagnostsics and screening procedures to reduce out of pocket expenditures.
- India should form a National NCDI Poverty Commission for a fresh, post-pandemic assessment of the incidence and impact of NCDIs on the population, and fiscal allocation required to prevent and mitigate the disease burden, and the resource gaps therein.
To conclude, you can prevent and manage NCDs through awareness, lifestyle modification, self-care and early interventions. Cost of secondary and tertiary care to manage NCDs can be substantially reduced if the cost of quality treatment is subsidized through greater uptake of available insurance schemes in the public and private to cover populations from all socio-economic strata.
[1] Gupta I, Ranjan A. Public expenditure on Non-Communicable Diseases & Injuries in India: A budget-based analysis. PLoS One. 2019 Sep 12;14(9):e0222086. doi: 10.1371/journal.pone.0222086. PMID: 31513623; PMCID: PMC6742225.
manishabhise 