Noncommunicable diseases (NCDs), including heart disease, stroke, cancer, diabetes and chronic lung disease continues to be a major public health challenge. Chronic diseases like heart disease and cancer not only account for 63% of deaths in India but are expected to cost the country $3.55 trillion in lost economic output between 2012 and 2030.
Since 2000, Centre for Chronic Disease Control (CCDC) has been leading efforts to transform public health and empower public health professionals to combat the growing challenge of chronic diseases across India and low-and-middle-income countries (LMIC).
In an interview with Financial Express.com, Prof. (Dr) D. Prabhakaran, Executive Director, Centre for Chronic Disease Control (CCDC) talked about ongoing innovations in chronic disease control, role of personalized medicine and precision healthcare, challenges among others. Excerpts:
What are the various types of chronic diseases prevalent in India?
Chronic disease conditions most prevalent in India include hypertension, diabetes, heart attacks and angina, , stroke, cancer, mental illness, lung, liver, and kidney diseases. These are called non-communicable diseases (NCDs). Some communicable diseases are also chronic and these include HIV and TB. Two-thirds of deaths in India are attributed to chronic diseases. What is more, heart diseases and diabetes account for more than half of India’s chronic disease burden. Chronic diseases no longer affect the affluent preferentially. It is widely prevalent across all socio- economic strata, and when it affects the poor it has devastating consequences due to poor access and debilitating health care costs.
What are the factors that have contributed to increasing incidences of chronic diseases in India?
Several factors have led to the burgeoning chronic disease burden. Smoking is one of the leading causes of chronic disease. While cigarette smoking has declined, beedi smoking is widely prevalent. Further, the sale of cigarettes is not regulated in India, and anyone, of any age can access them more easily than they can access life-saving medicines! Smoking when started during the teens can reduce overall life span by 10 years but also decrease the quality of life. The numerous chemicals present in cigarettes, pipes, cigars, beedies, and even vapes can trigger heart disease, stroke, and lung diseases such as chronic bronchitis, chronic obstructive lung disease, or lung cancer. Repeated attacks of bronchitis, result in a very poor quality of life. Not very well recognized that among males it is an important reason for infertility and impotence. Air pollution has also emerged as a factor equivalent to smoking. It has increased exponentially in the last few decades and we now have robust evidence linking hypertension, diabetes, coronary heart disease, and other chronic diseases. Our day-to-day lifestyle also plays a major role in increasing chronic disease risk.
These include the right diet. We are inundated every day with conflicting and contradicting messages regarding diet and nutrients so much so that it resembles a mad hatter party. The simplest is to be moderate in our diet. This means however much we are fond of a particular food, stopping eating when we are 80% full and reducing the consumption of four white substances: sugar, white flour, white rice, and salt. In addition, deep-fried and processed foods are laden with trans fats needing extreme moderation. Sendeteriness and lack of physical activity are also major reasons for the rise in chronic diseases. Finally, alcohol consumption and substance abuse are important reasons for the rise in chronic diseases. However, many believe that age, gender, and genetic risk are important contributors to chronic diseases. While this may be true to some extent they often lead to fatalism so we don’t do anything to address these. We have to bear in mind genetic risk is like a loaded gun and needs a trigger to go off. The triggers are our lifestyle. Many Indian languages have this adage which says that destiny can be altered by intelligence. Similarly, lifestyle can trump genes.
What are the challenges concerning the treatment and management of chronic diseases in India?
In India, challenges in the diagnosis, treatment, and management of chronic diseases are plentiful. Lack of awareness of the causes and symptoms of disease, poor access to primary healthcare, the prohibitive cost of treatment, inadequate patient-to-public healthcare facilities ratio, an increasing shortage of healthcare professionals, inadequate social support systems, and difficulty in ensuring that treatment is followed as instructed by the physicians are some of the challenges that are faced regularly. Further, many people living in rural areas are not accustomed to the idea of preventive health check-ups, screening, and early diagnosis due to a variety of reasons. As a result, oftentimes diseases do not get diagnosed or treated until it is too late.
There have been a lot of medical advancements in India in recent years. Do you think there is a need for innovations in chronic disease control to address evolving health challenges and improve public health outcomes?
India offers international standard healthcare at a much more reasonable cost than anywhere else in the world. Our healthcare industry is geared to scale up and meet the needs of the hour, as was seen while disbursing the COVID-19 vaccinations. Starting with the Ayushman Bharat Digital Mission (ABDHM), as an example, healthcare in India has witnessed a host of innovations in recent years. Telemedicine has the potential to revolutionize healthcare by providing physician consultations online, without the hassles of traveling great distances and waiting in long queues at a clinic. This can be a boon for women who are often unable to pay attention to their health because of their caregiving responsibilities. Several innovations, including health and wellness centers and neighborhood clinics, are being introduced and evaluated for primary care. In many of these primary health care centers, workers carry out the initial examination and assessment, thereby freeing up the physician’s time for the more specialized care requirements. Today, we have trained home healthcare staff for the infirm and elderly. We have quite a few Indian apps that ensure home delivery of medicines.
Drone delivery of medicine and life-saving equipment has been piloted recently. Indian start-ups have developed apps that offer personalized nutrition tracking services, and fitness plans for the fit and unfit. India also now manufactures wearables that leverage AI and Big Data to collect information, analyze patient health, provide tools for patient engagement, and allow remote patient monitoring. Portable radiography devices that diagnose and monitor patients with chronic diseases; Bioimpedance devices that measure body composition and fluid shifts and aid in early detection of heart failure; The Internet of Medical Things (IoMT) which allows connected devices and sensors to monitor patients with chronic diseases real-time, remotely; the Biofortification of plants leading to the production of staple crops rich in micronutrients that provide individuals with diabetes an option of diabetes-friendly food…these are all innovative technologies that are revolutionizing healthcare and improving health outcomes. However, when we consider the magnitude of the problem, I believe that a lot more has to be done, quickly. We need more health centers, better research and development facilities, more funds allocated for healthcare and health research, and more trained staff to attend to critically ill patients. We also need to consider solutions that address the issues of awareness, affordability, and access.
How personalized medicine and precision healthcare can improve treatments and prevention strategies for chronic diseases?
Personalized healthcare is a system where the healthcare provider provides treatment or advice based on an individual’s unique health profile. For example, family health history can reveal a patient’s predisposition to a particular disease. If an individual has one parent with diabetes or a heart attack at a young age, there is a good chance that it might run in the family. This information can help the physician to recommend necessary check-ups starting from an earlier 35 and prescribe
a heart-friendly lifestyle. Smart devices monitor health data in real-time through mobile apps, track food intake, calculate calories, and record physical activity, and blood pressure easily. Users get timely alerts to become aware of potential health issues. Pharmacogenomics aids doctors in prescribing the most effective drug and dosage based on a patient’s gene profile, as individual responses to drugs vary. This approach ensures a more tailored and safer treatment.
What has been the role of the Centre for Chronic Disease Control (CCDC) in the area of chronic diseases in India? As the incidences continue to rise, what are your key focal areas?
The Centre for Chronic Disease Control (CCDC) is at the forefront of efforts to reduce the burden of chronic diseases in India and low- and middle-income countries (LMICs). We have conducted various research projects and studies to understand the causes and mechanisms of these chronic diseases by establishing extensive longitudinal studies. These have become internationally well-recognized examples of understanding the complex mechanisms of these diseases. The CCDC has established a large body of research to study and identify low-cost solutions to combat these diseases by novel and innovative methods, including task shifting and pairing digital technologies, including electronic health records, decision support systems, and telemedicine solutions. We specialize in clinical research focusing on chronic non-communicable diseases (NCDs) like cardiovascular disease, diabetes, vascular diseases, cancers, and mental health. CCDC is also expanding efforts in other cross-cutting sectors, including environmental, reproductive, nutrition, and digital health. Our research has produced significant insights into the epidemiology, developmental origins, and biomarkers of CVD and diabetes in India. We promote frugal, innovative scientific solutions including ones such as amalgamating traditional practices such as yoga with modern medicine.
There has been an increasing incidence of heart attacks among youngsters. According to you, what are the possible reasons?
Unhealthy lifestyle like bad dietary habits, smoking, alcohol intake and other substance abuse, sedentariness, and low physical activity stress are the leading causes of heart attacks among youngsters. Video and smartphone-based activities have replaced active and contact sports resulting in low physical activity. Long periods of sitting are a major but unrecognized risk factor. By contrast extreme physical exertion in unacclimatized individuals can trigger a heart attack. Stress is also widely considered the primary cause of heart attack by many. Stress is difficult to measure but it is hypothesized that emotional stress can cause microscopic injuries and inflammation in the blood vessels which then leads to plaque formation and cholesterol deposits in the arteries, resulting in a cardiac arrest. However, certain forms of “stress” such as suppressed hostility (that you hate someone but are unable to do anything about it), lack of control over one’s life (a secretary may have no control over their time as compared to their bosses), and clinical depression masquerading as stress are all important elements in increasing heart attack risk. Adequate and regular sleep (7-9 hours per night) is an important protector against heart attacks.
What more needs to be done to improve the status of treatment and management of heart diseases and diabetes in India?
Before getting into treatment and management, we first need to build awareness about the causes and symptoms of CVD and diabetes. Sustained communication among vulnerable groups is of utmost importance. Screening at several touchpoints, both in rural as well as urban India will help us get a grip on the magnitude of the problem that we are facing. Once this is done, we will need to implement frugal, easily accessible treatments and technologies to manage the condition and prevent further deterioration. Specifically in terms of air pollution and climate change which have received widespread attention and though their mitigation is related to broad policy measures such as phasing out fossil fuels, regulating polluting industries, and construction activities, improving public transport, and behavior change to reduce stubble burning as individuals, we as individuals can incorporate environment-friendly activities in our daily life.
