Moving into a world recently battered by a pandemic, the first lesson we learnt is “health is wealth”, followed by the immediate second, “survival of the fittest”.
The only thing we can do to stay ahead of the so-called “smart” viruses is to keep ourselves fit and healthy.
The skyrocketing sales of multi-vitamin tablets to boost immunity in the past two years is sheer proof that we were afraid for our lives and we wanted to be alive and kicking.
As we seem to move ahead of Covid-19, assuming that the worst is over, it’s time to apply the real and critical learnings from the past two years.
The Indian government’s data shows that the proportion of deaths due to Non-Communicable Diseases (NCDs) has increased from 37.9% in 1990 to 61.8% in 2016. Cardiovascular diseases (CVDs) capture the largest share among the deaths. Reason: Unhealthy diet, lack of physical activity and use of tobacco.
The data, including National Family Health Survey (NFHS) and Comprehensive National Nutritional Survey (CNNS), shows that one in four men or women is overweight and more than half of children aged 5-19 have blood tests that point towards non-communicable diseases.
To put it in perspective, NCDs such as blood pressure (BP), obesity, diabetes, respiratory, kidney and heart-related illnesses were the most common conditions to put individuals at an increased risk of morbidity and mortality.
Now, NCDs, accompanied with long-term side-effects of Covid (as we call it ‘long Covid’), may open an entirely new Pandora’s Box.
GAPS IN DIAGNOSING, TREATING NCDS
It’s time for the Indian government to formulate public policies to improve people’s food environments, along with strategies to diagnose and treat basic issues such as hypertension and obesity in a timely manner.
Establishing a competent primary healthcare set-up – both in urban and rural areas — which leads to early detection and helps in easy access to long-term management holds the key.
Apply the templates formed during the pandemic. For instance: The teams deployed for household screening of Covid-infected people, contact tracing, supported home care can now be diverted to conduct screening for NCDs such cancer, cardiovascular, kidney, respiratory and other diseases.
Pandemic has made us more familiar with the use of real-time data analysis via digital technologies, which can now be used for monitoring health initiatives.
Simple steps can be taken to resolve or manage basic health issues which lead to complicating NCDs further.
For instance: One in four adults in India suffers from high BP, the government data shows. The more serious concern is that only 10% of patients have their blood pressure under control.
The World Health Organization (WHO), in its guidelines on hypertension, has recommended that non-physicians such as nurses and pharmacists can provide drug treatment for hypertension, if given adequate training.
In such scenarios, they can become the drug prescribing authority. Also, community health workers can assist in educating the patient on blood pressure measurement and delivery of medications in rural or remote area set-ups.
Here, tele-monitoring or community-based self-care systems can also help in improving BP control.
SCREAMING WARNING LABELS ON FOOD ITEMS
For years, India has been debating the right kind of food labeling and consumer awareness on what ‘not’ to eat.
Forget awareness on the right kind of food, not many of us know the daily intake limit of salt in food.
According to the WHO, high salt intake is one of the factors leading to the increase in NCDs worldwide. While NCDs are the leading cause of premature deaths in the 21st century, cardiovascular diseases and stroke are two of the main NCDs often related to salt.
Our body needs a small amount of sodium to work adequately and eating more sodium is associated with an increased risk of developing high blood pressure, followed by heart and kidney diseases.
According to the WHO, keeping salt intake to less than 5 gram per day – less than one teaspoon – helps prevent hypertension, and reduces the risk of heart disease and stroke in adult population.
As per the Dietary Guidelines by the US Food and Drug Administration, adults limit sodium intake to less than 2,300 mg per day or 5 gram — that’s also equal to about 1 teaspoon of table salt.
If you consume 100 grams of Maggi noodles, you will end up consuming 1,028 mg sodium (salt), almost half of your full day’s salt intake – hence increasing the probability of exceeding the per-day sodium intake limit as you will consume other regular food items too.
“A food item which is unhealthy will still be given one star as per the FSSAI’s rule. Five stars to healthiest items and one star to the unhealthy item. But still, it has a star. Why? It is completely illogical,” Arun Gupta, a public health expert, told me.
Instead of pushing for movie-like star-rating system on food items (as India is currently doing), bold warning labels on food packets make more sense. The label should warn as well as educate the consumer that the packet contains more than recommended salt/fat/sugar limit.
Sample this: The increase in the prevalence of childhood overweight in Latin America and the Caribbean became a worrying trend. The country took major steps to curb the trend.
Drawing from the example of Latin America and other countries, India can use a warning label system where a black-and-white stop symbol is used in Chile, or the red warning symbol in Israel for each of the three ingredients — salt, sugar and fat.
Countries like Chile, Mexico, Uruguay or Israel designed their own bold labels – black and white octagon shaped labels and if a food is high in four parameters sugar, fat, calories and salt, the packet will have all four different bold warning stickers – clearly repelling consumers from choosing unhealthy food options.
These countries did not bring the salt, sugar or fat content straightaway into the ideal category. Rather, they slowly, but steadily kept down-revising the limits, taking a few years so that consumers can get accustomed to the new taste.
The scientific evidence has shown that front-of-pack (FOP) warning labels can be one of the most cost-effective regulatory measures to contribute to the treatment and prevention of overweight and obesity and hence other related diseases.
“They are clear, easy to understand and allow consumers to make a better selection of food and beverage products at the point of sale,” according to UNICEF.
As government and public health experts figure out ways of fixing India’s non-communicable diseases, public responsibility holds the key to taking charge of your own health.
Start by making a simple move – a move away from “thoda aur namak” to “thoda aur healthy”.
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