Growing burden of NCDs poses a major public health challenge in India: Dr. Shraddha Bhure, Medical Director at Boehringer Ingelheim India | The Financial Express

Growing burden of NCDs poses a major public health challenge in India: Dr. Shraddha Bhure, Medical Director at Boehringer Ingelheim India

Non-communicable diseases are often a result of long-term lifestyle choices, hence, many of these are recognized as lifestyle diseases. Over the past few decades, several new factors have resulted in the surge of NCDs among the general populace, Dr. Bhure told Financial

Growing burden of NCDs poses a major public health challenge in India: Dr. Shraddha Bhure, Medical Director at Boehringer Ingelheim India
Dr Shraddha Bhure, Medical Director, Boehringer Ingelheim India

Non-communicable diseases (NCDs) are the outcomes of of a combination of genetic, physiological, environmental and behavioural factors. According to the World Health Organization (WHO), the major NCDs are cardiovascular diseases (such as heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructive pulmonary disease and asthma) and diabetes. Every year over 40 million die due to NCDs and it accounts to more than 71 percent of all deaths globally. India shares a huge burden of NCDs across the world.

According to the study report “India: Health of the Nation’s States”- The India State-Level Disease Burden Initiative in 2017 by Indian Council of Medical Research (ICMR), it is estimated that the proportion of deaths due to Non-Communicable Diseases (NCDs) in India have increased from 37.9% in 1990 to 61.8% in 2016.

Experts have pointed out that the burden of NCDs is a major hurdle not only as its impact on the patients but these diseases also affect the socioeconomic development of the country. According to the global health agency, In India, nearly 5.8 million people (WHO report, 2015) die from NCDs (heart and lung diseases, stroke, cancer and diabetes) every year or in other words 1 in 4 Indians has a risk of dying from an NCD before they reach the age of 70.

Financial reached out to Dr. Shraddha Bhure, Medical Director at Boehringer Ingelheim India and she talked about NCDs status in India, impact of COVID-19 on the treatment and diagnosis of NCDs, Boehringer Ingelheim’s role in this segment among others. Excerpts:

What is the status of non-communicable diseases (NCDs) in India? How has the ongoing coronavirus pandemic affected the diagnosis and treatment of these diseases?

The burden of Non-Communicable Diseases (NCDs) has increased exponentially over time, and poses a major public health challenge in India. The share of mortality due to four major NCDs, including cardiovascular diseases, diabetes and hypertension, chronic respiratory diseases and cancers has nearly doubled in less than three decades. In 1990, NCDs accounted for 37.9% of all deaths in India; this proportion has increased to 61.8% in 2016. In fact, cardiovascular diseases are the leading cause of death in India, accounting for more than 1/4th of overall deaths. One of our national health policy goals is to reduce the risk of premature deaths by 25% by the year 2025. In this context, it is essential to focus on health interventions to reduce risk of cardiovascular death.

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Moreover, the pandemic has further led to an increase in the risk factors for NCDs. Pandemic-induced isolation, unhealthy diets, additional stress and lack of exercise are some major factors resulting in an increased incidence/risk of NCDs. This on the one hand, the pandemic has also adversely impacted the management of NCDs on the other. As healthcare systems remained overburdened globally, treatment of NCDs took a hit. There was a decline in people accessing medical care over ‘fear of the pandemic’. From a treatment perspective, greater emphasis on telemedicine and virtual visits was observed. Over the last two years, telehealth and digital health models have opened up new possibilities for NCD care.

What are the possible reasons for the rapid growth of NCDs in India in recent years?

Non-communicable diseases are often a result of long-term lifestyle choices, hence, many of these are recognized as lifestyle diseases. Over the past few decades, several new factors have resulted in the surge of NCDs among the general populace. Rapid urbanization, high stress levels, unhealthy diets, less physical activity, and rising pollution have all had a role to play in the growth of NCDs in India. Besides, the Indian population carries naturally greater risk for certain NCDs – like cardiovascular diseases – occurring in relatively younger age as compared to other ethnic populations. When it comes to certain diseases such as brain-stroke, heart-failure or kidney diseases, low awareness levels are a major barrier to optimum care. In fact, a recent survey by Boehringer Ingelheim India revealed that only one in four Indians were aware of the symptoms of brain stroke, pointing towards a huge awareness gap. Epidemiological studies consistently indicate that diseases like heart failure or chronic kidney disease, remain significantly underdiagnosed in our adult population.

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There are a few steps one can take to combat NCDs. Firstly, health must be recognized as an essential priority for good life. Individuals must adopt healthy lifestyle practices, including good dietary habits, regular physical activity, avoidance of tobacco, restricting alcohol consumption, and consulting the doctors appropriately. On a macro level, interventions like public-private partnerships to support more holistic approach to healthcare, facilitating access of care at multiple levels, and importantly, building awareness on NCDs and their adverse implications to facilitate prioritization of health, can be some fundamental efforts to help address our country’s rising NCD burden.

How Boehringer Ingelheim has contributed to the treatment of NCDs in India? How have the trends of various diseases changed in recent years?

With a vision of bringing value through innovation, the Boehringer Ingelheim India team has pioneered several efforts to combat the problem of NCDs, since the Company’s inception in India in 2003. Our innovator drug, Jardiance (Empagliflozin), is one remarkable intervention in the field of type-2 diabetes and cardiovascular diseases. Empagliflozin has been the first glucose-lowering agent, to be approved for reducing the risk of cardiovascular death, in people with type-2 diabetes and established cardiovascular diseases. Apart from this, Empagliflozin is also approved for the treatment of heart-failure, regardless of type-2 diabetes. In fact, Empagliflozin is also the first medicine to demonstrate, and be approved for improving disease-outcomes, in patients with heart failure and preserved ejection fraction. Jardiance thus impacts the lives of millions of patients through the treatment of type 2 diabetes, as well as of heart failure.

Apart from our innovative efforts in improving the patient care from holistic cardio-renal-metabolic perspective, we are also committed to improve the stroke-care in India.

For stroke, our Actilyse and Pradaxa, solutions have addressed critical unmet needs across acute ischaemic stroke treatment and stroke prevention in patients with atrial fibrillation. As the NCD burden in India continues to grow, Boehringer Ingelheim has been at the forefront, combatting these challenges and making lives healthier. Our recent nationwide study uncovered a huge gap in awareness about stroke as a condition and its multiple symptoms. We have been advocating for better stroke care infrastructure and patient access to high-quality medical care that can transform lives.

What has been Boehringer Ingelheim’s role in diabetes, cardiovascular, stroke and respiratory diseases segments in India? According to you, what needs to be done by pharmaceutical companies and other stakeholders to combat these diseases?

Boehringer Ingelheim has been working towards improving NCD care in the areas of diabetes, stroke, cardiovascular and kidney diseases. Our innovator drug Jardiance has consistently been one of India’s leading innovator therapies for type 2 diabetes, as well as for heart failure. Boehringer Ingelheim has continually supported initiatives for knowledge and skill-enhancement, for medical diagnosis of cardiovascular risk, metabolic status, heart-failure, as well as kidney disease, in collaboration with scientific expert groups in India. Beyond diabetes, with Actilyse and Pradaxa, we have contributed significantly to addressing critical unmet need across acute ischaemic stroke treatment and stroke prevention in patients with atrial fibrillation. We have also been working to create more and better stroke-ready centres across the country through the ANGELS initiative.

With the likely increase in prevalence of diabetes, stroke, cardiovascular diseases and chronic kidney diseases in India, we will continue focusing on improving access to breakthrough therapies that transform the lives of patients. To combat NCDs, stakeholders from both private and public sectors must come together and work towards building public awareness on the kinds, risk factors and symptoms of prominent NCDs. People require to be made aware of the treatment options available. Especially in the case of stroke, this knowledge can save precious time and help save lives. Post an episode of stroke, receiving treatment at a stroke-ready centre within the ‘golden period’ can help achieve desired health outcomes while reducing the likelihood of mortality. In addition to awareness building, fuelling R&D expenditure and enabling an ecosystem of holistic care can help combat rising NCDs in India.

What are the key takeaways from COVID-19 that can be implemented in the battle against NCDs?

The COVID-19 pandemic severely impacted the ability of nations to respond to the global NCD burden. As resources were directed towards managing the surge in COVID-19 cases, health systems found themselves overstretched and often unable to address the requirements of NCD patients. As NCDs are chronic, they require prolonged care and interaction with the health system. Additionally, research studies also found strong casualties between NCDs and COVID-19 infections and fatalities. Indeed, many succumbed to COVID-19 were also suffering from underlying conditions of diabetes, heart failure, among others.

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COVID-19 has reemphasised the need to invest more in public health systems to help manage future emergencies and also offer improved treatment options for NCD patients. The “syndemic”, as it is appropriately recognized in the context of pandemic-related surge in non-communicable disease risk, calls for attention towards this priority! Substantial investments are needed to manage NCDs, especially in middle to lower-income countries, since they comprise the majority of the global NCD burden.

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