Healthcare needs to move focus to Non-Communicable Diseases

A lot has advanced in healthcare systems and healthcare delivery, across Globe and in J&K. However, despite the advancement, the issues of health confronting the population have not decreased, only transformed.

From the massive burden of communicable diseases just over two decades ago, the onslaught of Non-Communicable Diseases (NCDs) is the new age emergency and no doubt a pandemic that needs an overhaul of policies governing healthcare.

Changing Disease Profile in J&K

It would be imperative to present a few stats about J&K from one of the most comprehensive report on State and Union Territory Wise burden of diseases: India: Health of Nation’s States, published in 2019. J&K data shows:

The life expectancy is around 70 years for both males and females, an increase of nearly 10 years in expected life spans from 1990. In the past 75 years, according to available data, life expectancy has increased massively from 40 years average in India.

Infant mortality has decreased from 100 in 1990 to below 30 between 1990 and 2016, as per the report. It has dropped further down in the past six years.

In both men and women, Ischemic Heart Disease is the number one cause of death. The disease stood at number three in 1990.

Infectious diahorrhea, which was the number one cause of diseases and mortality in the 1990s has slumped to number 8 now. This point needs to be elaborated: In the 1990s, diarrheal diseases, lower respiratory tract infections, tuberculosis, measles, preterm birth complications and neonatal encephalopathy were among the top 10 causes of disease and death. In 2016, Measles went to number 73, tuberculosis to number 15, and neonatal encephalopathy to number 25.

In the reference time, the position of death and disabilities due to Road Traffic Accidents has had a progression of four points, standing at number 3 now in J&K. Road Traffic Accidents are a major killer among men and are the second leading cause of years of life lost in the UT.

Chronic Obstructive Pulmonary Disease, Stroke, Hypertension, Chronic Kidney Disease, Cancers, Diabetes and Self Harm are among the major killers in J&K, and across India.

Among the communicable diseases, tuberculosis and diarrhoeal diseases are the only two contenders for some space among the top 15 causes of death and disability in J&K.

What does it translate into?

GeriatricsThis data, and hundreds of other data sources from J&K show that the number of elderly people in India and in J&K was high and set to grow further.

The huge aging population and the specific diseases and conditions that the population suffers from demand attention, which is nowhere to be except a few papers and photo-ops.

While the J&K Government has recently been talking frequently about the focus on Geriatrics and establishment of Geriatric services in every district hospital, we are very far off from this goal. Geriatrics as a branch of medicine is being taught at only five medical colleges in India.

The dearth of specialists in this specialty has its implications on every scheme and program that is being framed in this arena.Recently, two hospitals in J&K were selected by AIIMS New Delhi for a research project that will help in extending Palliative Care to patients with chronic debilitating conditions. This is just a beginning and needs concerted efforts to augment the help.

Health or Family Welfare?

Outrageous as it may sound to many, the family welfare schemes are passé. J&K has a fertility rate of less than 1.5 Percent according to the latest national family Health Survey.

The percentage is lower than the replacement value of 2.1 percent fertility. It shows the progress and achievements of the family planning and welfare initiatives in the past, higher education and awareness about reproductive health and choices.

What it also shows is that there is no further need to reinforce ‘Hum do Hamare Do’ among people, no more need to spend the manpower and money in carrying the message to the masses through ASHAs, Anganwadi workers and others.

What we need to do instead is start focusing on awareness about metabolic diseases, Body-Mass Index, Cancers, Hypertension, kidney diseases, Diabetes and other conditions that are wrecking a havoc with the population.

No one seems to be doing that here. Many GoI programs on NCDs have fallen flat in J&K. The district level program for early detection of cancers, and the assistance for cancer treatment is one such program. The Healthcare systems need to move ahead of Family Welfare.

Road Traffic Accidents as the major cause of death

Undoubtedly, there is nothing that the healthcare department can do to bring down the incidence of road traffic accidents in J&K. However, what definitely is in its scope of work is making it possible to salvage the lives that are salvageable.

The Trauma Centers, and the talk about the trauma centers are both farce till manpower is made available at these centers. The manpower needs to be trained in saving lives of trauma cases and there needs to be a complete comprehensive team at all hours.

An order was issued recently to ensure Trauma Centers dot the entire network of Highways in J&K. Haven’t such orders been issued in the past? Of course yes. Those, and these, both needed people to save lives. A building set-up at the cost of half a crore needs much more work than just brick and mortar.

Official Speak

Greater Kashmir spoke to Director General Health, Family Welfare and Immunization J&K Dr Saleem ur Rehman, who also holds the charge of Director Health Jammu. We asked about the obsoleteness of a number of focus areas of the department.

This is what he had to say:“Definitely, the context in which many of the schemes that are currently in vogue have changed. India is faced with a great challenge of ageing population and NCDs. What we need to do is build on the learnings from our past schemes and strengthen the delivery of healthcare with the rich data that we have”.

Regarding the focus areas that could bring about an improvement in healthcare delivery, he said, “J&K and every other UT and states, as well as the central health ministry needs data guided policy making. Sustenance of control on communicable diseases and focus on NCDs based on evidence from data is the need of the hour.”

He cited an example for elucidating the AI based technologies: A pilot program was run in a district of Rajasthan where a basic X-Ray was aided by AI. “In just four minutes, the X ray automatically gave 30 possible diagnoses, with 95 percent sensitivity and 80 percent specificity.”

Dr Rehman said that the world in which healthcare delivery operates has changed. “We need to change as well, and the process has begun,” he said.

Disclaimer: The views and opinions expressed in this article are the personal opinions of the author.

The facts, analysis, assumptions and perspective appearing in the article do not reflect the views of GK.