Shahid Akhter, editor, ETHealthworld, spoke to Dr Latha Palaniappan, Professor of Medicine and Internal Doctor, Stanford Hospitals, California, to know more about the challenges associated with NSD risk management and the way forward.
World Economic Forum stated that in 20 years, NCDs would cost more than US$ 30 trillion, representing 48% of global GDP in 2010 and pushing millions of people below the poverty line. What are your views on the same?
Claiming 63% of all deaths, NCDs are the world’s silent killer, with 80% of these deaths in low- and middle-income countries. Unfortunately, a sizeable portion of individuals who pass away from chronic NCDs are in their prime productive years. When you look at this alarming situation, you can perceive it as a clear threat to human health, development, and economic growth.
Preventing NCDs is a social good. We must consider the myriad effects of NCD prevention, not only on the known benefits on the individual level. NCD prevention helps individuals, families, communities, cities, states, and nations live longer, healthier, and more productive lives, vastly improving social good.
Indians get diabetes 10 years earlier than Westerners, in their 30s/40s at the peak of their productive years, making the public health impact staggering over the next few decades. How can we address this concern?
Despite its dense public health agendas around infectious diseases, maternal and childhood mortality, and malnutrition, India is mainly affected by NCDs. Approximately 77 million people have diabetes, the same number has not been diagnosed, and it is said that there are equal if not more number of pre-diabetic patients. In Metro, 3 out of 4 adults have diabetes or prediabetes while overall, 10% of Indian children are prediabetes. Twenty-five percent of the low-income family’s income goes to one family with diabetes, which pushes the family deep into the abyss of poverty.
Given the known higher risk in Indians – Indians must maintain an optimal lifestyle to prevent diabetes. Maintain a healthy weight with a BMI of 23 or lower (link to BMI calculator). Fortunately, most of these diseases are preventable. 80% of type 2 diabetes and heart disease and 40% of cancer can be prevented with three lifestyle changes – Exercise daily, don’t smoke, eat plant-based food.
Indians are at higher risk for diabetes despite normal weight, even with optimal lifestyle. Therefore, we recommend screening for diabetes at least once after 35 years of age with fasting glucose or HgBA1C (an average of your blood glucose over the last 3 months), and repeating screening every 3 years.
Do you think that technological advancement, real-time NCD risk assessment, sophisticated AI algorithms, insight boards, and subsequent diagnosis will enable quick decisions and timely clinical intervention?
Yes – we are at the cusp of an AI revolution in health. Artificial intelligence (AI) and related technologies are increasingly applied to healthcare. These technologies are truly disrupting the ecosystem. More importantly, these technologies can transform many aspects of patient care and administrative processes within providers, payers, pharmaceutical organizations, patients, and public health (5P’s of healthcare).
Technological advancements can positively affect every aspect of daily life to encourage healthy living. These technologies will also transform the way doctors and patients interact to predict, prevent and treat more personally.
Prevention is better than cure. Do you think in the sanctity of this statement, and are there any organizations making an impact across demographics in diabetes prevention?
Absolutely – prevention is better than cure to the NCD crisis and this is where organisations like Arogya World play an important part. Founded a decade ago, Arogya World works on diabetes preventive approach through well-designed, science-based, real-world programs and establishes its effectiveness. Impact measurement is part of their thinking from the beginning.
Further, their aim is to bring the benefits of prevention to Indian communities through a suite of well-designed programs to benefit populations where they live, work, and play. From mDiabetes, to Healthy Workplaces to school-based curricula and MyThali – Arogyaworld’s programs impact families in a surround-sound approach where mothers, fathers, sons & daughters receive age-appropriate foundational knowledge on NCD prevention across the lifespan to benefit their communities.
Do you think enough impact and evaluation studies have been conducted around NCD and its aftermath? If not do you think the government must set aside or create a fund that focuses on sponsoring these researches.
We move what we measure. It is important for the government to assess baseline health statistics in all populations, and work with partners to implement programs to address health disparities, and continuously assess the success of programs to ensure scalability and reach.
What is the role of PPP (Public-Private Partnership) in addressing the NCD epidemic?
Public Private partnerships are key to solving all problems that improve social good. Private public partnerships can provide access to finance through private capital. PPP can also provide access to technology, people & skills, transfer of risk, investment, and business development opportunities. Public private partnerships (PPP) can catalyze prevention of noncommunicable diseases by providing complementary strengths. PPPs can overcome constraints on government budgets and obtain innovation through the private sector’s enhanced capability and networks.
Let me give you an example – Arogya World through its Healthy Schools Program is working with a Government School in Karnataka about NCD prevention. Its their two-year school-based program for diabetes awareness and prevention education with compelling age-appropriate activities for 11-14-year-olds (6-8 grades) and utilises influencers such as teachers and peer leaders to reach and educate students about diabetes and its prevention. The comprehensive program includes classroom and school-based activities, as well as outreach efforts in students’ homes and communities. When I asked the students to imagine what they would do if they were the Prime Minister, to reduce diabetes and heart disease in India. The answers were fast and furious- “ban cigarettes”; “tax sugary beverages”; “make vegetables more affordable”; “put gyms everywhere”. I was amazed at how aware these students were and moreover ready for a life in public policy to assure that all Indians live longer, healthier lives! All thanks to the efforts of organisations like Arogya World who are preparing and educating the next generation of health leaders!
I firmly believe PPPs will be crucial to addressing the NCD epidemic.