India’s speedy – and ominous – disease transition

New Delhi, June 10 (IANS/IndiaSpend) An Indian today has over twice the odds of dying of a non-communicable disease than a communicable disease, according to the World Health Organisation (WHO). About a decade ago, you had a 50-50 chance of succumbing to a non-communicable disease.
The shift is the story of every country treading the path of development. Far from being an exception – as anIndiaSpend exploration of four such diseases linked to changing lifestyles will detail, starting June 11- India is on a greatly accelerated journey of “epidemiological transition,” the process of changes in patterns of disease as societies develop.

By 2012, cardiovascular diseases made up a fourth of all deaths in India. Chronic respiratory diseases accounted for 13 percent, cancers for seven percent, diabetes for two percent and all the other non-communicable diseases for another 12 percent.

Cases of cancer are rising across the country but Bengaluru, in particular, is seeing an explosion driven by fast-changing lifestyles, among other reasons, Dr B Ajaikumar, chairman of HCG Cancer Hospital, a leading cancer-care institution, has said.

With roughly 126 cases for every lakh people (versus 81 cases for every lakh Indians), the city is fast emerging as the country’s cancer capital.

Incidentally, Portea Medical, a company offering home-based medical care to middle-class families across 24 cities, saw the highest demand for home visits for cancer patients in Bengaluru in 2014.

Non-communicable diseases now account for three-fourths of all deaths in the US and other high-income nations. In the West, epidemiological transition shadowed the development of medicine and the creation of welfare states through the 20th century.
“It has taken the developed world a century to complete the transition,” said Nata Menabde, WHO representative in India.

India embarked on epidemiological transition only in 1970, moving into top gear after 1995 – sooner than expected because of rapid urbanisation, industrialisation and fast-paced socio-economic development.

Abdel Omran, an American medical professor who in 1971 first coined the term “epidemiological transition”, listed three ages to the changeover: The “Age of Pestilence and Famine”; the “Age of Receding Pandemics,” as large-scale killer epidemics become fewer; and, as development picks up pace, the “Age of Degenerative and Manmade Diseases”.

The key word is “man-made”. Bad lifestyle choices, experts said, have led to the proliferation of cardiovascular conditions, chronic obstructive lung disease, asthma, cancer and diabetes.

Why India is worse off than the West

Until 1900, the top 10 causes of death in the US, a bellwether for the developed world, were infectious diseases. The average American lived for 48 years (life expectancy is 79 years today). No matter where you lived – the US, India or Timbuktoo – life hung by a hair.

Then, medicine started to evolve, and Western nations provided better health facilities, sanitation and higher living standards. By 1950, the average American could expect to live till 68 – and die of a new breed of killer diseases the WHO branded non-communicable, or illnesses that aren’t caused by an identifiable agent and as such, aren’t contagious.

India’s problem is not just that the transition to these diseases is occurring almost overnight in medical terms. It is that a country with a crumbling health system must deal with the old diseases and the new.

Communicable diseases still loom – “no thanks to the uneven healthcare system, poor sanitation and the country’s tropical eco-biology that supports disease vectors, reservoirs and toxic herbs”, said Vivekanand Jha, executive director, The George Institute for Global Health in New Delhi.

Elderly Indians are particularly at risk. “Mumbai’s elderly suffer because their diseases aren’t managed as they should be, for want of support,” said Meena Ganesh, CEO and managing director of Portea Medical. “Close to three-fourths of our customer base is above 60 years of age.”

Old people in India can expect to suffer from chronic non-communicable diseases and contract an infectious illness, said Perianayagam Arokiasamy, professor at the International Institute for Population Studies, Mumbai.

India also stands out from the rest of the world because non-communicable diseases strike people at an earlier age here. Cardiovascular diseases are affecting Indians a decade earlier than the rest of the world, said the WHO’s Menabde.

Most non-communicable diseases are chronic – of long duration and slow progression. They are likely to call for “catastrophic expenditure”, categorised as out-of-pocket expenses exceeding 40 percent of a family’s non-food consumption expenditure.

Cardiovascular diseases, endocrine and metabolic disorders, neoplasms (cancers), respiratory diseases and mental health and neurological disorders account for 39 percent of India’s health expenditure. Add other non-communicable diseases and, together, they account for 48 percent of health spending.

A nationwide study spanning 50 cities and 20,937 patients found that more poor people died of cardiovascular disease than rich patients-no surprises there. But, only 0.7 perccent of poor patients were prescribed coronary artery bypass graft surgery versus 7.5 percent of the rich ones.

So, economic development has set epidemiological transition in motion in India, but has, so far, failed to give Indians the kind of healthcare that the West – and many parts of the emerging world-have experienced.

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