Preventive health care in India: Are we doing enough

Abstract

“An ounce of prevention is worth a pound of cure.” –Benjamin Franklin Preventive health care is the road to reduce the risks for diseases, disabilities, and death, but the irony is the lack of equitable distribution of the preventive health care among the different sections of society. With aging population susceptible to multiple chronic conditions has resulted in the targeted prevention of additional complications and hospitalizations. Preventive health care has encompassed attention obesity and tobacco smoking in addition to vaccinations and cancer screening, for example, breast cancer screening, which are presumed to be the key to keeping people of all ages healthy. However, many people are still deprived of the apparent preventive services they need. Preventive health care exhibits the Iceberg Phenomenon. Vaccinations; screening programs for diabetes,cancer, hypertension, blindness; awareness programs for road safety etc., constitute the tip of the iceberg,while base of the Iceberg constituted by lifestyle behavior, physical activity, personal hygiene, and dietary habits. A large proportion of the preventive strategy needs to be endeavoured which has remained obscured. Preventive health care is a continuum of care beginning from the womb to tomb. However, ironically, the apparent preventive care has been self-declared as complete assuming life as a race and immunizations; cancer, diabetes, visual screening activities as hurdles which needs to be jumped to reach the destination. The rise in chronic diseases which are a major cause of death and disability is associated with increasing health care expenses. Preventive health care encompassing four levels of prevention – Primordial, primary, secondary, and tertiary; the primordial level of prevention is the most neglected entity. Preventive health care by large also includes counseling on topics such as m-cessation (mobile phone-based intervention to tobacco users where they will be counseled to kick the habit of smoking), obesity, eating healthy, treating depression, reducing addictions, regular well baby, and well-child visits. Unfortunately, as evidenced by a study in South India, the prevalence of hypertension has dramtically increased among young adults in the age group of 20–39 years from 7% in 2011 to 11.2% in 2022.This is due to acculturation of western culture, nutrition transition and concentration of preventive health related activities for population >40 years.[1] With the nutritional transition of replacing the traditional Indian diet with junks and processed food, change in occupations from a job involving physical activity to geek computer programmers has resulted in a steep ascend of core health behaviors such as smoking, vaping, abdominal obesity, hypercholesterolemia, diabetes, and ischemic heart diseases further intensifying the morbid scenario. The problem has taken a grim form by contributing to rise in heart attack rate by 2% every year since 2000AD. Peer pressure and social media have been stressors too. In accordance to the study report “India: Health of the Nation’s States-The India State-Level Disease Burden Initiative in 2017 by the Indian Council of Medical Research (ICMR),” there has been a projected increase in the proportion of deaths due to noncommunicable diseases (NCDs) in India from 37.9% in 1990 to 61.8% in 2016.[2] Cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes, which share four behavioral risk factors – Unhealthy diet, lack of physical activity, and use of tobacco and alcohol have emerged as the leading NCDs.[3] However, interventions aimed at these behaviors can yield impressive results. “National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke” was launched in 2010. The prevalence of diabetes mellitus and impaired fasting blood glucose in India was found to be 9.3% and 24.5%, respectively, in “National Noncommunicable Disease Monitoring Survey” conducted by the ICMR.[4] There are currently close to 80 million people with diabetes in India and this number is expected to rise to 135 million by the year 2045.[5] Price to be Paid for not Preventing Diseases Keeping in view the increasing costs of health care, the strategies have been formulated to control the same. However, the reckoned rise in the prevalence of the NCDs is both a cause for concern and an opportunity for intervention. With the advancement of medical care, technology, and increase in the life expectancy, the prevalence of chronic disease now shows rising trend, thereby building up pressure on the health-care spending. As per the reports of “Agency for Healthcare Research and Quality 2008,” early detection of certain cancers and other chronic diseases through screening has resulted in decrease in mortality from these conditions by 15%–20%. Summing together, the potential leverage of prevention in calibrating the morbidity and costs associated with chronic disease is substantial, potentially averting 70% of such cases (Centres for disease control and prevention, 2004).[6] The leverage of disease prevention has been enhanced by obesity epidemic as it is a prominent risk factor for NCDs such as cardiovascular disease, diabetes, and other major contributors to mortality and costs. According to economists,if obesity is not addressed costs will increase by 34% (Lakdawalla et al., 2005)[7], a forecast not lost on policy-makers. Despite the efforts to prevent the rising trends of the NCDs, the achievements are questionable and are incapable of preventing the possible anticipated NCD pandemic. With the rise in employment opportunities and women empowerment, delaying marriage and first child birth to beyond 30 years have resulted in a 3-fold increased risk of bearing autistic offsprings and other behavioral issues among children.[8] Present day modern world is witnessing a rise in partner promiscuity and increase in teenager indulgence in sexual activity. This has resulted in an increase in the sexually transmitted diseases. Though the HIV Epidemic is under control, the incidence of cervical carcinoma is on rise. Affordability to HPV vaccine is always an issue for the poorer section of society where the prevalence of cervical carcinoma is more. The question raises its head as in even though the risk factors for the NCDs have been proven, how proactive is the younger youth generation to accept healthy behavior. Psychosocial issues such as depression, substance abuse, and suicides have shown an increasing trend in recent years. Mental health issues cannot be prevented but can be addressed to reduce the severity. These problems can be resolved with medical assistance and family support but question arises: are the efforts put on by parents and councellors sufficient to stop accidents from occurring? Suicide prevention and protective strategies to include individuals, families, and communities by making them aware of the warning signs, promoting prevention and resilience, educating and teaching problem-solving skills, parenting skills to improve family relationships, supporting socioemotional learning programs, and introducing yoga and meditation can help in escalating the preventive health care.