Tending to the heart

The reinvention of the wheel can be painful. Taking lessons from those who have already run the wheel several revolutions and tweaking those lessons for domestic conditions might not be a bad idea. For India, there is indeed valuable learning from the results of the Prospective Urban Rural Epidemiology (PURE) study published in The Lancet this week. Studying the situation in 21 countries across five continents, categorised by income levels, researchers showed that while cardiovascular disease (CVD) is the leading cause for death overall, there have been some transitions, particularly in the high-income countries, which have managed to reduce the number of deaths from CVD. In low-income countries, including India, however, CVD is still the top killer, with death three times more frequent than that due to cancer. What flies in the face of logic is that the risk burden of CVD-linked mortality is inversely proportional — lower risk but higher mortality in low-income countries, and higher risk but lower mortality in high-income countries. PURE’s analysis concluded that the higher mortality in poorer countries was likely due to other factors, including ‘lower quality and less health care’. Access to affordable, quality health care is still a dream in many pockets in India. A great amount of out-of-pocket expenditure (according to Health Ministry data for 2014-15, nearly 62.6 % of India’s total health expenditure) often frustrates continuation of treatment, or adherence to drug regimens. While some States have shown limited successes with government-sponsored health insurance schemes, the Centre’s Ayushman Bharat Yojana will have to take much of the burden of hospitalisation for complications of non-communicable diseases. National and State schemes running on mission mode, including the National Programme for Prevention and Control of Cancer, Diabetes, CVD and Stroke will have to step up efforts to target people at risk with life-saving interventions.

While most of the predominant risk factors for cardiovascular disease present no startling medical revelation, it is significant that the single largest risk factor is a low education level. It is no doubt part of the job description of the National Programme to modify this risk factor. However, governments will have to muscle up to tackle a rather startling finding — ambient air pollution and indoor air pollution have an impact on CVD and mortality. Household air pollution is the third top risk factor in low-income countries, according to the study. The need of the hour is out-of-the-box solutions combined with inspiration from models of those who seem to have belled this particular cat. Any plans that target the risk factors and prevent the onset of non-communicable diseases will clearly have to be truly game-changing, and incorporate the environmental angle as well.