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Story Publication logo November 25, 2013

India: A Ticking Time Bomb

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Reasons and Effects of the Increase of Non-communicable Diseases (NCD’s) in India
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Non-communicable diseases cause 63 percent of deaths worldwide. In India, diabetes, heart attacks...

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Media file: p1100425.jpg
Research in the countryside on non-communicable diseases. Here: Museypur, a small town in Uttar Pradesh. Image by Martina Merten. India, 2013.

NEW DELHI, India: The entrance area of the Fortis C-Doc clinic in New Delhi is packed with people, most of whom look more like Americans than Indians. They are dressed in western clothing, and for the most part, are overweight. Fortis C-Doc is a private medical center that deals with the education, training and treatment of Indian patients with metabolic diseases.

"Five years ago, neither the doctors nor the patients were properly informed about such diseases" says Dr. Anoop Misra.

Dr. Misra, a specialist in the treatment of diabetes, is the director of India's National Diabetes Foundation. He wanted to change this lack of awareness in the country and got his ideas and inspiration from the leading diabetes centers in Abu Dhabi. In 2012 he opened Fortis C-Doc. It has been worth the effort. Every day up to 100 patients stream into the Center, and further clinics are being constructed.

According to the World Health Organization (WHO), 50.8 million people in India have diabetes, accounting for 17 percent of the world's diabetics. 10 percent live in urban areas and 5 percent live in rural areas. Diabetes, along with other non-communicable diseases such as cardio vascular problems, cancer, respiratory, and psychiatric illnesses are responsible for 53 percent of deaths in India, 60 percent of these occur before the age of 70.

While the patients who come to Fortis C-Doc either have health insurance or can afford to pay for treatment, the majority of Indians with cardio vascular disease or other NCDs can't pay to see a doctor. Meanwhile, the rate of diabetes among India's poor is growing, says Usha Shrivastava, a colleague of Misra. The reasons for this are unhealthy diets packed with fat, salt, sugar and false carbohydrates.
Rajan Sankar of the Global Alliance for Improved Nutrition (GAIN), a non- governmental organization operating in twelve countries, points out that "most of the food eaten by poor people is unhealthy."
Moreover, decreasing physical activity exacerbates the problem, especially in urban areas. According to Mr. Sankar, for lack of space many city schools don't have playgrounds. And thanks to modern transportation methods and up-to-date household appliances, adults are also less active.

Once a person has diabetes, cancer or cardio vascular disease, its is difficult to treat, adds Prahabkaran Dorairaj, director of the Center for Chronic Disease Control (CCDC) in Delhi. The majority of Indians have no health insurance and can't afford to pay for treatment. Many doctors don't have the proper equipment to correctly diagnose the patients so treatment is delayed.

Relying on Public Transport

Getting to the nearest major hospital can be problematic and, according to a CCDC study, 50 to 60 percent of patients have to use the time- consuming public transport system.

The 900 residents of Museypur, a tiny village 30 kilometers east of Lucknow in Uttar Pradesh, are acutely aware of the problems of using public transport. The villagers live in simple huts or tiny houses and survive on less than one dollar a day.

They cannot afford to visit a doctor or pay for any prescribed medicine. They come to the health center hoping they won't have to pay, explains Dr. Pankay Kumar. Getting treatment at a larger hospital for cardiac problems or other acute complaints can be delayed for several days since there is no ambulance service in the area and hospital beds are scarce.

Additionally, Pankay Kumar confirms what is stated in the study on Aspects of Diagnosis. "Since we don't have a lab to process blood samples we can't run any diabetes tests."

A 2010 study by the WHO, Global Burden of Disease, shows chronic diseases are no longer a problem limited to western countries but have become a ticking time bomb for emerging and developing countries. This has put a lot of pressure on the Indian government to control the drastic rise in chronic diseases.

Since 2010, the government has been gradually introducing a national awareness program for the prevention of cancer, diabetes, cardio vascular disease and stroke to help remedy the problem.
According to Anshu Prakash, Secretary in the Indian Ministry of Health, the main focus is to reinforce peoples' understanding of chronic diseases. "The biggest challenge for us is that many people are unwilling to accept the fact that they have a disease," explains Prakash.

The Delhi-based Country Office of the WHO in Delhi came up with a good idea. If you call, for example, François Décaillet, the Program Coordinator, and he does not answer, the phone switches over to an automated voice before the answering machine is activated. The voice informs the caller about all sorts of measures to prevent chronic diseases — from a healthy diet, to increasing physical activity and leading a stress-free lifestyle. "We want to raise awareness on chronic disease, even among our own employees," says Décaillet. " We have to start somewhere."

INDIA IN FIGURES
– 1.2 billion people live in India.
– The gross domestic product (GDP) per capita is 2,538 Euros.- -Expenditure on health, measured by GDP: 4.2 percent.
– Per capita expenditure on health: 98 Euros per year.
– Public spending, per capita, on health: 34 euros per year.
– Rate of self-pay, measured by the total private expenditure on health: 74.4 percent.
– 11 percent of the total population has health insurance.
– Non-communicable diseases, so-called NCDs, constitute 66.7 percent of the national Burden of Disease.
– 60 percent of the deaths caused by NCDs occur before the age of 70.
– India suffers from a so-called double burden: Communicable diseases such as HIV / AIDS, malaria and tuberculosis are responsible for 38 percent of deaths; non-communicable diseases such as diabetes or cancer account for 42 percent of deaths.
– 17 percent of the global number of people with diabetes come from India (50.8)
– The damage to India's economy, in the period 2012-2030 caused by chronic diseases, experts estimate at 1.9 billion Euros.

This article was originally published in German. Translated for the Pulitzer Center by Anne Thurow.

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