India must substantially increase the rate of effective prevention and control of chronic diseases, according to the third article of the Lancet series on ‘India: Towards Universal Health Coverage.'
This is imperative for India which has passed the early stage of the chronic disease burden, the article noted. The authors have also called for the integration of national programmes for various chronic diseases and injuries with one another.
With direct relevance to control and prevention, the team recommended implementation of interventions for tobacco control, reduction of dietary salt intake, promotion of healthy diets and physical activity, the use of a combination of aspirin and low-dose drugs to lower blood pressure and cholesterol in individuals at high risk for cardiovascular disease. Specific interventions to change individual behaviour are also important especially for those who already have chronic diseases.
The article, authored by Vikram Patel of the London School of Hygiene and Tropical Medicine, et al, begins with the fact that chronic diseases — cardiovascular diseases, mental health disorders, diabetes, and cancer — and injuries are the leading causes for death and disability in India. The projected increases in their contribution to the burden of diseases during the next 25 years are pronounced.
Although a range of cost-effective primary and secondary prevention strategies are available, the article calls to question their coverage, especially in rural and poor populations. The authors, including S.Chatterji of Health Statistics and Informatics, D.Chisholm of WHO, S.Ebrahim, D.Prabhakaran and K.S.Reddy of Public Health Foundation of India, G.Gururaj of NIMHANS, V.Mohan of Dr.Mohan's Diabetes Specialities Centre, and R.D.Ravindran of Aravind Eye Care System, have suggested setting up social and policy frameworks. These would enable the implementation of interventions such as taxation on bidis, smokeless tobacco, and locally-brewed alcohol.
The article also highlights a couple of interventions in the field level, both incidentally from Tamil Nadu. Aravind Eye Hospital's work on elimination of avoidable blindness in rural India and DMVDSC's Chunampet Rural Diabetes Prevention Project are highlighted in separate panels within the paper. Both interventions have been recognised for their involvement of the community in the programme, one of the key recommendations the authors make in their article. The Madurai-based Aravind Eye Hospital recently established 30 permanent village-based vision centres for primary eye care, with access to telemedicine. The Chunampet project aims at preventing diabetes in 50,000 people in 42 villages around Chunampet in Kancheepuram district of Tamil Nadu. Started about four years ago, within a year of implementation, over 90 per cent of the entire adult population of the villages had been screened. Screening is free, and treatment is free for those who cannot pay. About 60 per cent of patients pay subsidised rates for their treatment. The project has been touted as a “good model for delivering preventive and therapeutic diabetes health care to rural areas.”
