Cardio vascular diseases (CVD) form bulk of non-communicable diseases in India, resulting in 2 million deaths every year. The incidence of CVD in India is estimated to be upto four times higher than other countries. The magnitude of it in India has reached pandemic proportions, with CVD accounting for 24% of all non-communicable deaths. According to a review in Heart Asia in 2013, this translates to 6 million individuals with some form of cardiac arrhythmia, or abnormal heart rhythm, out of a population of 1.2 billion.
Cardiac arrhythmia is the main cause of a large number of structural heart diseases, SHD that may remain undetected until the occurrence of severe symptoms or even sudden cardiac death, SCD. Early detection of symptoms of cardiac diseases or of hints to life-threatening cardiac abnormality could potentially save many lives either in patients with yet undiagnoised cardiac disease or with already known cardiac disease as sudden death seems to occur sooner in patients in India with post-myocardial infarction, compared to western population.
Proper identification and treatment of arrhythmia in India is mitigated by limited access to medical care, poor healthcare infrastructure and lack of well-developed financial schemes to cover the cost of medical services.
What is heart disease? The most common type of heart disease is Coronary Artery Disease or CAD. CAD is caused by plaque build-up in the walls of the arteries that supply blood to the heart (called coronary arteries) and other parts of the body. Plaque is made up of deposits of cholesterol and other substances in the artery. Plaque build-up causes the inside of the arteries to narrow over time, which could partially or totally block the blood flow. This process is called atherosclerosis.
Too much plaque build-up and narrowed artery walls can make it harder for blood to flow through your body. When your heart muscle doesn’t get enough blood, you may have chest pain or discomfort, called angina. Angina is the most common symptom of CAD.
Over time, CAD can weaken the heart muscle. This may lead to heart failure, a serious condition where the heart can’t pump blood the way that it should. An irregular heartbeat, or arrhythmia, also can develop.
Since CVDs are life-style related, the best method of prevention is living a healthy lifestyle and keeps the blood pressure, cholesterol and sugar normal. A healthy lifestyle includes eating healthy diet; maintaining a healthy weight; getting enough physical activity; non-use of all forms of tobacco and limiting alcohol use.
India has a burden of 30 million heart patients. Out of this, 14 million are in urban areas and the rest in rural areas, which shows it affects not just the urban and economically well-off but also the rural and under-privileged. If the current trend continues, by 2020, it would surpass that of any other country in the world.
The growth of heart diseases is dependent on a number of interlinked factors such as ageing, changing lifestyles, bad eating habits and rapidly evolving socio-economic determinants like access to healthcare.
According to a research carried out at Tufts Friedman School of Nutrition Science and Policy in Boston, healthier fats could save more than a million lives internationally from heart diseases. The study, reported in the Journal of the American Heart Association, says, global heart disease burden is attributable to insufficient intake of polyunsaturated fats versus higher intake of saturated fats.
Polyunsaturated fats can help reduce bad cholesterol levels in the blood which can lower the risk of heart disease and stroke. Foods that contain polyunsaturated fats include soybean, corn and sunflower oils, tofu, nuts and seeds, and fatty fish such as salmon, mackerel, herring and trout.
About 10.3 % of global heart disease deaths were estimated to be due to eating too little healthy omega-6 polyunsaturated fats. In addition, 537,200 deaths, which represent 7.7 percent of global heart disease deaths – resulted from excess consumption of trans fats, such as those in processed, baked, and fried goods as well as cooking fats used in certain countries.
In India, incidentally the burden of CVD is high amongst the productive age group. In 2000 alone the country lost 9.2 million potentially productive years of life in the age group of 34-64 due to CVDs and it is expected to rise of 17.9 million by 2030, according to a report on India’s Disease Burden by the erstwhile Planning Commission. Since majority of deaths are premature, there is a substantial loss of lives during the productive years as compared to other countries. The economic cost of deaths due to heart diseases, stroke and diabetes during the decade 2005-2015 is estimated to be 237 billion US dollars.
Lifestyle diseases have taken a leap in India in the recent times. An Indian today is twice vulnerable to succumbing to non-communicable diseases than to communicable disease, according to the World Health Organisation, from 50-50 chance a decade ago.
Though the country has seen remarkable progress in the health status of its population, there has been a major transition in the country in the past few years, resulting in serious impact on health. Changes have been witnessed in economic development, nutritional status, fertility and mortality rates and consequently the disease profile has also changed. India is on an accelerated journey of “epidemiological transition,” the process of changes in patterns of disease as societies develop. According to a paper by the national body of trade and industry Confederation of Indian Industry, one out of four Indian is at risk of dying from non-communicable diseases like diabetes, cardio-vascular ailments or cancer before the age of 70.
“Every year, roughly 5.8 million Indians die from heart and lung diseases, stroke, cancer and diabetes. In other words, 1 in 4 Indians risks dying from an NCD before they reach the age of 70,” said the paper.
While many global organisations including WHO have carved out specific strategies to tackle the rising disease burden due to changing lifestyle and food habits, India still is focussed around HIV and tropical diseases. Though there have been substantial achievements in controlling communicable diseases, still they contribute substantially to disease burden of the country. Decline in morbidity and mortality from communicable diseases have been accompanied by a gradual shift to, and accelerated rise in prevalence of chronic non-communicable diseases (NCDs) such as cardio-vascular diseases, diabetes, chronic obstructive pulmonary diseases (COPD), cancers, mental health disorders and injuries.
While available evidence shows CVDs top the disease burden (24%), followed by chronic respiratory diseases (11%), Cancer (6%) and diabetes (2%) and show no sign of relenting. Though these NCDs are posing a serious challenge to healthcare management, the government’s national programme for prevention and control of cancer, diabetes, cardiovascular diseases and stroke could screen only around 6 million people! Unfortunately, this data is missing in the case of several states like Tamil Nadu, Telangana, Delhi and Chandigarh. Of the available data, the maximum cases of hypertension and CVD were found in Gujarat, followed by Maharashtra and Uttar Pradesh.
What is more alarming is the government spending on healthcare is on the decline. The total public expenditure for the year 2012-13 was Rs. 1.08 lakh crore, which was one of the lowest, higher only than Myanmar among South East Asia Region (SEARO) countries. This is also lowest among BRIC countries.
The per capita public expenditure on health in nominal terms has gone up from Rs. 621 in 2009-10 to Rs. 890 in 2012-13. The share of states and the federal government in healthcare expenditure is 33:67 in 2012-13. The share of the federal government in total expenditure on health has been declining over the years, according to the latest National Health Profile, released by the Ministry of Health and Family Welfare.
The increase in costs and decline in public in healthcare have led to inequity in access to healthcare services in India. According to a report by the World Health Organisation, 35% of India’s rural population do not go to any facility in case of illness, as they could not afford even the basic cost of medicine. This being the case, arresting the disease burden in India will remain a far cry, without effective state interventions to provide healthcare facilities to the poor, especially in cases of non-communicable diseases, for which treatment costs are unaffordable to a sizeable population.