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Indian Journal of Community Medicine

Vol. 30, No. 4 (2005-10 - 2005-12)


Emerging Epidemic of Non Communicable Diseases-An Urgent Need for Control Initiative

The increasing burden of Non Communicable Diseases (NCD), particularly in developing countries including India, threaten to overwhelm already stretched health services.The disease patterns of India can be classified into three categories-communicable disease, non-communicable disease and injuries. At the onset of 20th century, communicable diseases including maternal and perinatal causes were the leading killers.The scenario at the onset of 21st century has changed drastically, making NCDs the major killer all over the world. This whole process of shift in disease pattern is leveled as epidemiological transition. Earlier NCDs were thought to be diseases of rich but the NCD epidemics are observed in developing countries also. In recent times, the life expectancy has increased with several undesirable alterations in lifestyle. Hence there is increase in both the dose and duration of risk factors, leading to an increase in lifestyle diseases/non-communicable diseases and their consequences.

It is projected by Murray and Lopez that the overall NCD burden will rise sharply by 2020 in India. About two fifth (40.4%) of deaths were attributable to NCDs in 1990 and it was projected that this will increase to 66% in year 2020. The age group involved in India is mainly between 30-69 yrs, which is a matter of great concern to the society. It is estimated that there are about 25 million cases of cardiovascular diseases, similar number of cases of diabetes, 2.4 million cases of cancer and one million cases of cerebrovascular disease/stroke in our country. The world health report 1999, estimates that in 1998, 78% of the burden of NCDs and 85% of the cardiovascular disease burden arose from low and middle-income countries. However the existing health system in the country is focused on communicable diseases.

Several diseases come under the umbrella of NCD and more common are Cardiovascular diseases, Cancer, Diabetes, and COPD etc. When closely examined, the NCDs have got four common risk factors like tobacco, unhealthy diet, physical inactivity and alcohol.The list of NCDs to be addressed should not be limited but priority should be given to those with common risk factors. And in addressing the risk factors the mentioned criteria should be taken into consideration i.e. the risk factor should be connected to several NCDs, should be important and methods should exist to intervene and to assess the changes.

For prevention of NCDs, a paradigm shift is required from the treatment of risk factor in isolation to a comprehensive risk factors management approach. There are two strategies available for prevention of NCDs-high risk and population strategy. The high risk preventive strategy is a targeted approach for vulnerable individuals hence caters to the tip of iceberg. However, primary prevention based on comprehensive population based programme is the most cost effective approach and seeks to shift the distribution of risk factors in a favourable direction. These two strategies are not mutually exclusive; instead they should be used in combination to address the problem of NCDs. Another important component is to promote evidence based non-pharmacological treatment, operationalizing prevention aided by counseling protocols and promotion of cost effective generic drugs. The patient and the family members should be empowered to cope with a long-term illness through self-management tools.

Unlike communicable diseases, which have multiple individual control programmes, NCD have to be addressed under a common programme as most of the intervention are overlapping. Differences in CD and NCD have to be kept in mind. NCD are having a gradual onset, multiple etiology, long natural history, prolonged treatment and follow up, a multidisciplinary care approach affecting quality of life as compared to sudden onset, single cause, short natural history, treatment and follow up in cases of CDs. Already there is National cancer, Blindness and Mental health programmes functioning in the country. There is a need to include CVDs, Diabetes Mellitus, and COPD etc. Other closely related programme is on oral health, nutrition and health care for the elderly.

Keeping in view current and rising trend on NCDs, there is an urgent need to start NCD programme in India. There could be different models. It could be achieved either by integrating the existing programme on cancer, diabetes, blindness and mental health or as a new policy initiative. However, former would be more cost effective. Interventions should include primary prevention by focusing on risk prevention and risk reduction through policy, implementation of available legislations and health promotion and secondary prevention by early detection with the availability of diagnostic facilities, management and referral services. Implementation strategy could be devised with clear role at central level for guidelines and funding, at state level to monitor and provide technical support and district level for implementation. District NCD Control Programme model need to developed with the objective of surveillance of NCD risk factors, integrated primary prevention of common risk factors and early identification and management of common NCDs at various health facilities. Organizational set up could be a district level committee or society or expanding the scope of the District Blindness Control Society. Surveillance strategy could be linked with recently launched Integrated Disease Surveillance Project (IDSP) or based on WHO STEPS instrument after local adaptatioon. Training and IEC strategy could be an integral part of the routine district health set up. Evaluation of the programme could be done at the national; state and district level with help of programmatic indicators by a designated nodal agency. It is high time to join hands to impress upon the government to start NCD control programme through advocacy and to work for a model, which is feasible, cost effective and sustainable for our country.

Dr. JS Thakur,
Assistant Professor School of Public Health,
PGIMER, Chandigarh-160012
E-mail: [email protected]

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