Communicable and Non-communicable diseases – HIV, Malaria, Cancer, Mental Health, etc.

[op-ed snap] The health transition

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Mains Paper 2: Governance | Issues relating to development & management of Social Sector/Services relating to Health, Education, Human Resources

From UPSC perspective, the following things are important:

Prelims level: Non-Communicable Diseases

Mains level: Lifestyle changes leading to more NCDs and how its rise can be stalled


Context

UN award for India & rising NCDs

  1. In the last week of September, India’s health ministry received the prestigious UN Inter-Agency Task Force Award for “outstanding contribution to the achievement of NCD (Non-Communicable Diseases) related SDG targets”
  2. NCDs are the leading cause of mortality, globally and in India, and are dominated by cardiovascular diseases, cancers, diabetes and chronic respiratory diseases

Targets for reduction

  1. A Lancet paper by the monitoring group, NCD Countdown 2030 has contended that India will fall short of the NCD targets pertaining to SDGs
  2. The target set for all countries is to achieve the one-third reduction in NCD related mortality between the ages of 30 and 70 by 2030, relative to 2015
  3. The Lancet study reports that high-income countries and several upper middle-income countries are on course to achieve this target
  4. Lower middle income countries, like India, will need to accelerate the rate of decline to reach the target

Method of measuring NCD mortality

The Lancet paper examines global trends in NCD mortality, using three rates:

Mortality between 30-70 years, mortality under 70 years and mortality under 80 years.

  1. The first is the indicator linked to the SDGs.
  2. The second also measures NCD mortality below 30 years of age, which represents a considerable burden in regions like sub-Saharan Africa.
  3. The third regards most NCD deaths before 80 as preventable and premature

Scale needs to be changed

  1. The arbitrary selection of the 30-70 year age range limits consideration of, and action against, NCD deaths in the younger and older age groups outside that age band
  2. As the epidemics mature, the 70-80 age group will pose challenges in many parts of the world
  3. Therefore, the current response should not be a short-term staccato response but one which anticipates and mitigates preventable NCD mortality across the entire 0-80 age range even after 2030

UHC target

  1. Age limits should not become a barrier to the provision of NCD care under a Universal Health Coverage (UHC) programme — another major SDG target
  2. Countries keen on achieving the specified 30-70 age related mortality target may tend to focus their resources on preferential care for that group, especially in the provision of life saving clinical services, neglecting other age groups
  3. This militates against equity and undermines the principle of universality
  4. Reduction of under-80 mortality would be a better measure to judge the overall health impact of UHC

Tracking India’s progress

  1. Reduction in 0-70 mortality would be a reasonable indicator for tracking India’s progress on NCDs while progress in under-80 mortality would be a good indicator for assessing progress on UHC

Measures that need to be taken

  1. Actions to curb tobacco and alcohol consumption will help reduce future risk of NCD in the under-30 age group
  2. Actions related to reduction of blood pressure, control of diabetes and provision of competent primary care supplemented by cost-effective specialist clinical care for treatable NCDs will benefit all age groups, with the highest benefits in the 30-80 age group
  3. Energetic implementation of public health policies and NCD-inclusive health services under UHC are what the country needs

Way forward

  1. It is essential that the government, civil society, academia and media recognise the nuances of health transition which shape the sweep of NCD epidemics as they evolve
  2. This will help create a healthier society which will yield inter-generational benefits well beyond 2030
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