Lifestyle Diseases Issues And Challenges

The colossal advancements in science & technology in the 21st century have not only made us immensely dependent on mechanized gadgets but also ensured that our physical activity gets restricted to a minimal level. Moreover, our modern lifestyle is typically deskbound, tending towards untimely working hours, inadequate rest and unhealthy food habits. This sedentary lifestyle ensures that we fall prey to lifestyle diseases.

Non-communicable diseases or lifestyle diseases as they are commonly termed characterize those diseases whose occurrence is primarily based on the daily habits of people and are a result of an incongruous relationship of people with their environment. The key factors responsible for lifestyle diseases include wrong food habits coupled with increased smoking and alcohol consumption, physical inactivity, obesity, raised blood sugar, raised cholesterol level, wrong body posture and disturbed biological clock. According to the World Health Organisation (WHO), non-communicable ailments are gradually replacing communicable diseases like diarrhoea, tuberculosis.

Lifestyle diseases have been recognized as a clear threat not only to human health, but also to the development and economic growth in many countries. People’s disposable income has increased due to improvement and expansion in employment opportunities. However, this enhancement in the standard of living has increased expenditure on health due to adoption of faulty habits and schedules; so the contribution to the national income on the whole stands meagre. The number of individuals suffering from these diseases has been on a steady rise. These diseases which have been responsible for 63% of all deaths worldwide are now attributed to be the leading cause of mortality in the world. The fact that around 80% of these deaths occurred in low and middle-income countries like India which are also crippled by an ever increasing burden of infectious diseases, poor maternal and prenatal conditions and nutritional deficiencies, is definitely a disturbing situation. Almost 50 % of those who die of chronic non-communicable diseases are in the prime of their productive years, and thus, consequently industry competitiveness is being imperilled.

In case of India the statistics are even more alarming. In India, 23.10 per cent men and 22.60 per cent women over 25 years old suffer from hypertension, says the World Health Organisation’s ‘global health statistics 2012’. The country as a whole is home to 25-30 million diabetic patients. Moreover, increased blood pressure which is a high-risk condition causes approximately 51 per cent deaths from stroke and 45 per cent from coronary artery disease in India.

According to the World Health Organisation Department of Health Statistics and Informatics, by 2030, non-communicable conditions are expected to cause more than three-fourths of all deaths; almost one-third of all deaths will result from cancer, heart disease and traffic accidents. Keeping in mind the above data, one can gauge the impact of such ailments on the health sector by and large. The growing threat of non-communicable diseases can however be combated with existing knowledge and comprehensive and cohesive actions at country level, led by national governments.

BACKGROUND ON NON-COMMUNICABLE DISEASES

Our knowledge had always been restricted to the conventional infectious diseases only till we realized recently that much of the health disorders are linked to the choices that people make in their day to day life. NCDs are defined as diseases of long duration, generally slow progression and major cause of adult mortality and morbidity worldwide in the current scenario (WHO, 2005a [1] ). The four dominant diseases in this respect are considered to be cardiovascular diseases (including heart disease and stroke), diabetes, cancer and chronic respiratory diseases (including chronic obstructive pulmonary disease and asthma). Common, avertable risk factors underlie most of these diseases.

It is important to note that a combination of modifiable and non-modifiable risk factors have been responsible for the rampant spread of non-communicable diseases. The non-modifiable risk factors basically comprise of those characteristics that are inherent (age, sex, genes) and cannot be altered due to individual (or environment) efforts. Although they might not be the prime determinants in the spread of lifestyle diseases yet they define the effectiveness of many prevention and treatment approaches.

On the other front we have the modifiable risk factors which can be transformed by the societies or individuals thereby ensuring amended health outcomes. Poor diets, physical inactivity, tobacco use, have been typically highlighted as the prime causes of lifestyle diseases by World Health Organisation.

Poor diet and physical inactivity

Fixed lifestyles, long working hours, demanding jobs have transformed the eating habits of people to a great extent. The composition of human diets has changed considerably over time, with high demand for readily available pre-cooked food. These foods are found to be ominously high in sugar, salt, unhealthy fats and lack adequate nutrition.

This spread of the fast food culture has resulted in the increased spread of obesity worldwide and has led some people to coin this as an emerging threat. As a result of the above factors obesity and overweight are spreading as "globesity" epidemic.

Tobacco and Alcohol

Tobacco accounts for 30% of cancers globally, and the annual economic burden of tobacco-related illnesses surpasses total annual health expenditures in low- and middle-income countries [3] .

High rates of tobacco use are likely to double the number of tobacco-related deaths between 2010 and 2030 in low- and middle-income countries unless adequate measures are taken now. There are likely to be 6.8 million deaths in 2030 due to tobacco usage.

GLOBAL SCENARIO

The effect of non-communicable diseases (NCDs) has been proliferating worldwide imposing an impediment on human health. 63% of all deaths worldwide (2008) occurred from NCDs. Furthermore, the effect of these diseases has been across all ages and in fact has been primarily affecting people in their productive ages that is, below 60 years. One-quarter of all NCD related deaths are among the people belonging to this age bracket.

Interestingly, what were once considered "diseases of the riches" have now impinged on developing countries also. In 2008, approximately four out of every five NCD deaths happened in low- and middle-income countries [6] .

NCDs also account for 48% of the healthy life years lost as opposed to the 40% which are lost due to maternal and perinatal conditions, nutritional deficiencies, and communicable diseases and1% due to injuries [7] .

The number of deaths due to NCDs will rise substantially in the coming decades. There are two prime causes behind this, firstly, the world population is rising at an alarming rate and there will be approximately 2 billion more people by 2050. In addition, the occurrences of these diseases are expected to accelerate in the future due to increasing pervasiveness of the key risk factors.

Source: WHO- World Health Statistics

MAJOR NCDs

Cardiovascular disease (CVD)

CVD basically refers to a group of diseases involving the heart, blood vessels, poor blood supply due to a diseased vascular supply. CVD has been the largest cause of death worldwide causing nearly 30% of all deaths and about 50% of NCD deaths. The behavioural risk factors comprising of physical inactivity, tobacco use and unhealthy diet have been identified as the prime causes of nearly 80% of the CVD related NCD deaths.

Cancer

Cancer is the rapid division of abnormal cells in the body. These cells outlast the normal cells and have the ability to metastasize, or attack parts of the body and quickly spread to other organs. Different risk factors are attributable for spread of different types of cancers in different sites.

Recent literature projected the number of new cancer cases in 2009 to be at 12.9 million, and this number is likely to rise to nearly 17 million by 2020. 13% of the deaths (7.6 million deaths) worldwide are caused due to cancer which is the second largest cause of death globally.

Chronic respiratory diseases

Chronic respiratory diseases are associated primarily to the airways and other structures of the lung. Some of the most commonly known CRDs are asthma, chronic obstructive pulmonary disease (COPD), respiratory allergies, occupational lung diseases and pulmonary hypertension, which collectively account for 7% of all deaths worldwide (4.2 million deaths).

Diabetes

Diabetes which is one of the major risk factor for other causes of deaths is a metabolic malady in which the body fails to regulate the level of sugar appropriately, mainly due to insufficient production of insulin by the pancreas.

Diabetes is not directly a cause of mortality but is definitely a major contributor to other life threatening diseases such as cardiovascular disease, kidney disease and blindness.

Mental illness

Mental illness basically refers to a set of medical disorders that affect a person’s thinking ability, feelings, mood, ability to relate to others and daily functioning. Mental health conditions/ or neuropsychiatric disorders, commonly christened as depression, affected 154 million people in 2002. Approximately, 25 million people suffered from schizophrenia and over 100 million people suffered from alcohol or drug abuse disorders.

Economic Implications

It is expected that in the near future health care expenditure will increase due to increased life expectancy, high cost of pharmaceuticals and increasing lifestyle diseases, expensive treatment for the same. In India only a small fraction of the population close to 5.51 %of the population have insured themselves under some health insurance schemes, the rest spend from their pockets.

The developed countries spend a higher proportion of their GDP on health as compared to the developing countries like India where only 2.5% of the GDP is kept aside for health related activities. With limited resources being allocated for the heath sector on one hand and rising demand for health services on the other hand the country is bound to have developmental pressures. This might prove to be a hurdle in its growth path.

In order to improve the situation, the Indian government like in the developed countries will have to shift some of the resources or increase spending on prevention, screening and early detection of such ailments. Lifestyle ailments can be avoided if taken care at the right time. As it is seen the major reasons for such diseases are smoking, alcohol consumption, fixed lifestyle and an unhealthy diet; reducing the fat composition of diet, engaging in regular physical exercises and restraining from indulgence in excessive alcohol consumption can help improve the situation.

Cost of treatment for an oral cancer patient is estimated to be about Rs 4,00,000. Most oral cancers are preventable by avoiding the use of tobacco and tobacco products. Cost effective preventive interventions are the need of the hour in an environment of resource scarcity. Such an approach will be a relief to most Indian families that meet 70 per cent of their health expenses out of their own pockets. 

Conclusion

The growing burden of NCDs is likely to grow even further in the coming years. The health community and the business community are both equally likely to be effected by the same.

First, in economic terms, NCDs matter ominously. At the global level, world’s economic leaders – top government officials, including finance ministers and their economic advisors – who control large amounts of spending at the national level and who have the power to react to the tremendous economic threat posed by NCDs, should now earnestly map the consequences of this growing chronic disease and take requisite steps.

Second, at the national level, the human and economic burdens of NCDs can both be confined by dedicating resources directly or indirectly towards prevention, screening, treatment and care. Health spending needs to be seen from the point of view of an investment that yields a handsome rate of return in terms of increased productivity.

There are many factors which puts a heavy pressure on the demand of health care services in India. The population growth has slowed down but it still remains very high. It is also observed that the growth of population in the bracket of 60 years and above is increasing. This change in the population pyramid coupled with a better standard of living and health awareness is expected to fuel the demand for healthcare in general, particularly lifestyle diseases. It is the need of the hour that India’s health industry is better equipped with improved facilities, an effective delivery mechanism and awareness programs on Lifestyle diseases.

Non-communicable diseases can be tackled to a large extent by simple modifications in our lifestyle. Dietary changes (for example, reduced intake of salt and increased consumption of fruit and vegetables); improved physical activity; cessation of smoking and detrimental use of alcohol (perhaps by increased tobacco and alcohol taxes, and through information, education and communication crusades); and transforming medical training to address the altering nature of disease burdens are all options to prevent and manage NCDs.