Taming the biggest killer in health sector
Lionel Wijesiri
The person that takes medicine and neglects appropriate lifestyle and
diet, wastes the skills of the physician — Chinese Proverb
Non-communicable diseases (NCDs) are increasing countrywide. When
Minister of Healthcare and Nutrition, Maithripala Sirisena said recently
that 350 die daily due to NCDs, the statement took everybody by
surprise. This figure amounts to more than two third of all deaths per
day in Sri Lanka. If we look at few of the available statistics, the
fact becomes clearer. Hospital admission rates due to ischemic heart
disease (IHD) stand at 330 admissions per 100,000. Hospital admissions
due to cerebrovascular diseases and related causes are around 210,000.
Prevalence rate for hypertension is 20% in Sri Lanka, with little
difference between men and women. One in five adults in Sri Lanka has
pre-diabetes or diabetes, and one third of them were found to be
undiagnosed. Prevalence of bronchial asthma among adults in Sri Lanka
varies from 20% to 25%. The prevalence of smokers among adult male is
23%.
These are indeed startling statistics. We have a big crisis in hand.
We do have a big killer to tame.
In the wake of these revealing facts, the Government has taken
initial action. A few weeks ago, a committee comprising 20 experts was
appointed to implement the National Policy for NCDs.
Addressing a news media Dr Palitha Karunaperuma of the Health
Ministry, said that the most common NCDs in Sri Lanka are hypertension,
stroke, diabetes and chronic respiratory diseases. He further added
that, three major reasons for the deaths in Sri Lanka due to NCDs can be
categorised as Change in lifestyles, increasing stress and tobacco and
alcohol consumption
The World Health Organization/Food and Agriculture Organization (WHO/FAO)
report “Diet, Nutrition and the Prevention of Chronic Diseases” is
central to WHO’s strategy for diet, physical activity and health, as it
provides a solid scientific basis for policy decisions and action items.
The report’s proposed strategy to prevent NCDs — prevention is far more
cost-effective than treatment — must consider the impact of issues such
as urbanization, and the unhealthy diets and sedentary lifestyle it
tends to promote. Interestingly, this prevention could follow much the
same policy in both developed and developing countries: healthier diets
and enhanced daily physical activity.
Programs
Scientific evidence has clearly shown that NCD can be prevented. To
achieve this, we must utilise a strategic approach with emphasis on
health promotion and disease prevention activities; such as creating a
health-promoting environment which encourages a healthy lifestyle,
increasing awareness of NCD through health promotion and education, and
early NCD risk factor identification and intervention. Some time ago, I
have seen how at Thiruvananthapuram in Kerala a program to initiate
community-level interventions to tackle NCD was launched. The program
was conducted by the National Rural Health Mission who used a large army
of Accredited Social Health Activists (ASHAs). The project involved
training ASHA personnel and deploying them in the community for NCD
awareness generation, detection, risk factors monitoring and for
suggesting necessary interventions at the community-level, for which
they will be given additional incentives.
ASHAs visited every house in their assigned area — one ASHA covered
about 250 to 300 houses — and the details of all persons above 30 years
of age were collected in a prescribed format. All these persons (above
30 years) were be asked to report at a medical camp at the sub-centre.
All screening tests were done free at the medical camp after which
doctors suggested lifestyle modifications or put the patient on
medication or, if necessary, refer the patient to a higher medical
centre for detailed investigation. All medicines, including those
prescribed for diabetes and hypertension, were supplied free through
ASHAs from the sub-centre. ASHAs were scheduled to conduct follow-up on
patients diagnosed to be diabetic or hypertensive at least four times in
a year. Those found to be at high risk for developing these conditions
later on will be followed up every six months.
Taking a cue from such experiences, it obvious that what we need is a
community-based model for NCD surveillance, detection and prevention.
The challenge now is on us to face the challenge head on, bearing in
mind that many of the underlying determinants of NCD are actually
outside the direct domain of the health sector. There is therefore an
urgent and important need for inter-sector involvement and collaboration
for an effective NCD prevention and control response. By inter-sector,
it is not meant just the different ministries and departments of the
government, but also the NGOs, professional organizations, the private
sector including the food and beverage industries, the media and civil
society.
To be continued |
