A recent large-scale study in adults aged 25 to 64 in 11 villages in Tamil Nadu has driven home a strong message — hypertension is growing at an alarming rate in rural areas. The prevalence of hypertension — one of the risk factors for a few non-communicable diseases — in the 10,500 adults studied was 21.4 per cent. Studies in other rural areas too have recorded a prevalence rate of nearly 20 per cent. A 2010 study of nearly 7,500 people in Thiruvananthapuram district found the risk factor prevalence in urban, rural and slum areas to be 34.9 per cent, 32.5 per cent and 30.6 per cent respectively. The study found the “high burden” of non-communicable disease risk factors — hypertension, cholesterol, abdominal obesity, and tobacco and alcohol use — was comparable with that of the U.S. The prevalence of hypertension has been steadily growing in the past 10 years, and the gap between urban and rural prevalence rates is narrowing sharply. For instance, a meta-analysis of studies published between 1995 and 2002 found only 15.7 per cent prevalence in the rural population. Little wonder that non-communicable diseases account for over 50 per cent of all deaths, and the disease burden continues to increase. As a paper in The Lancet indicated, India has already “passed the early stages of a chronic diseases epidemic.”
Unfortunately, the country lacks the basic comprehensive nationwide data on both behavioural and biological risk factors for non-communicable diseases. According to the World Health Organization, tobacco use and body mass index (BMI) were measured for the first time only in the 2005-2009 national survey. Though the quality of survey undertaken showed improvements over the previous period (2000-2004), there is much more to be done. If data collection is poor, implementation of cost-effective strategies to control and prevent risk factors is “low, particularly in rural areas.” Incidentally, many of the risk factors are collectively responsible for cardiovascular diseases and diabetes, two of the high-burden non-communicable diseases. Controlling and preventing these risk factors will go a long way in reducing the overall non-communicable disease burden. Continuous messaging to get people tested for biological risks, which are asymptomatic, is essential — about 75 per cent of rural people studied in Tamil Nadu were unaware of their hypertension status. While it is worthy to note that Tamil Nadu has already started screening people for hypertension, the Centre must tackle the various facets of the growing epidemic with more urgency than it has shown so far.