By 2025, will rural India beat the urban chronic disease burden?

Does your fast-paced city life make you more susceptible to chronic diseases than your rural brothers and sisters? Maybe not.

By 2025, in urban areas, hypertension is expected shoot up from 25 per cent to 35 per cent, diabetes from 8-10 per cent to 18 per cent and cardiovascular diseases from 4-5 per cent to 7-8 per cent; while in rural areas, these diseases are expected to increase from 15 per cent to 25 per cent, 5 per cent to 8 per cent and over 30 per cent, respectively.

“After a few decades, there won't be any difference between urban and rural areas,” says Jeemon Panniyammakal, Associate Professor at Public Health Foundation of India (PHFI).

At present, obesity, which is less than 10 per cent, is expected to see a rise in urban areas, though only marginally in rural ones.

The urban incidence of respiratory diseases, which in 2012, was 30 million, will increase to 32 million and the rural incidence, from 14 million (in 2011) to 22 million. While no data on new cases of cancer is available for the rural populace, the urban instance is expected to from 1 million to 1.7 million.

Rural-urban anomaly
While lifestyle changes, nutritional transition from highly rural to urban (packaged and processed food, rich urban food, less consumption of fresh and local produce, etc.) and increase in life expectancy are the main reasons for the rise in chronic disease burden, especially in urban areas; the rate of increase in rural areas (more so in those belonging to developed states) is much quicker due to economic conditions, villagers aping city-goers and very low health awareness. “A recent study we conducted in difficult rural areas of three states suggests that the awareness of hypertension is less than 10 per cent,” adds Panniyammakal. Taking globalisation and export of food into account, going forward, nutritional transition will also depend on access to local produce that is directly correlated to the cost of availability.

Will the trend reverse?
Given that in the urban space, people are becoming more health-conscious and are taking interest in marathon, football and other sports, one would think that at some point the trend of chronic diseases may take a U-turn. But Panniyammakal points out that only a small portion of people have access to such facilities due to the steep decline in the number of available open spaces. And the lack of support to change this scenario doesn’t help either. Director of Centre for Chronic Disease Control (CCDC) and Vice-President of PHFI, Prof. Dorairaj Prabhakaran is more hopeful. He says, “Fifty to sixty years ago, Europe and North America were in a similar place, but the necessary steps taken by them are bearing fruits today; it should happen here too, but one can’t tell when. It will depend on policies and other measures that the governments take.”

Pill of the future
For cardiovascular diseases, polypill seems to be a promising solution. “Polypill combines five or six medicines into one pill. We have found that the adherence level among patients who were given the pill increased by 33 per cent. As these pills are based on generics, they are not so expensive and hence would have a wider reach. The increase in adherence levels will lead to a lower rate of complications and better control of risk,” explains Prabhakaran.

What we’re not talking about
>    A combination of dietary factors—including very little consumption of fruits and vegetables, nuts and whole grains and high intake of sodium and fat—is taking a toll on the health of many. However, so far, the focus has been on individual nutrients, whereas we need to talk about the cumulative effect of multiple dietary factors as they are implicated in one out of five deaths. “We’ve been saying that carbs are bad, fats are bad and so on, thereby confusing people with multiple messages. But what’s important is a balance in diet and the impact of all nutrients as a whole,” emphasises Prabhakaran.

>    For the Western masses, a correlation has been established between chronic conditions (especially cardiovascular diseases) and factors such as air pollution (indoor as well as outdoor) and the use of pesticides, which have proven to be a significant contributor to morbidity and mortality. However, we still have to establish this correlation for India.

What we must act upon
>    Effective policy measures such as taxation of tobacco products, alcohol, sweetened beverages and salt can curtail both morbidity and mortality caused by cardiovascular diseases and cancer to a great extent.

>    We need better access to primary healthcare services and should develop and test innovative, technology-based solutions to improve health in low resource settings.

>    Finally, according to these specialists, we need a concerted collaborative effort in health research, involving not only medical doctors, but also professionals from information technology, engineering, economics, social sciences, agricultural sciences and other life sciences to find new ways of addressing the rising burden of chronic conditions.