Almost half of the death burden in the country is due to NCDs today

Almost half of the death burden in the country is due to NCDs today

Majority of the deaths occur on lower and middle-income countries

New Delhi, 25 November 2017: A recent study has indicated that non-communicable diseases (NCDs) such as heart attack, stroke, chronic respiratory diseases, and cancer account for 6 out of 10 deaths (61.8%) in India. This is alarming given the fact that the figure was 37.9% almost two decades ago. This was also the time when more than half of the deaths (53.6%) were due to communicable, maternal, neonatal, and nutritional diseases. The contribution of the group of risk factors such as obesity and lack of physical activity has increased massively to a quarter of the total disease burden in India in 2016.

NCDs are diseases of long duration and generally slow progression. The four main types of no ncommunicable diseases are cardiovascular diseases (like heart attacks and stroke), cancer, chronic respiratory diseases (such as chronic obstructed pulmonary disease and asthma) and diabetes.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “NCDs currently account for almost 70% of global deaths; majority of which occur in low- and middle-income countries. India too is not untouched by this. Due to rapid urbanization, India is experiencing an epidemiological transition moving away from a predominantly communicable or infectious to a predominantly NCD pattern. Along with tobacco, harmful use of alcohol and unhealthy diet, physical inactivity has been implicated in NCDs as a major risk factor. Modern and advanced technology has certainly made life easy and convenient for us. However, what it has also done is changed our lifestyle pattern at the cost of health; we are less physically active now – sitting at a desk for a long time working on the computer, using social media on smart phones, watching TV or sitting in a meeting, all these activities promote sedentary behavior.”

A recent study has outlined that there is likely to be a steady rise in NCD losses until 2030, and then it will increase sharply. Adding to this, the value of life lost, including out-of-pocket expenditure related to these illnesses, and loss of income will likely double over the next 20 years.

Adding further, Dr Aggarwal, said, “The benefits of exercise on physical health as well as mental health are well-established and known to us all. To control non-communicable diseases and promote physical activity, IMA has proposed a campaign ‘Move Move and Move’. People should move around more often all through the day in addition to regular exercise.”

Here are a few simple ways to increase physical activity both at home and your workplace.

• Take the stairs as often as possible.
• Get off the bus one stop early and walk the rest of the way.
• Have “walk-meetings” instead of “sit-in” meetings.
• Walk to the nearby shops instead of driving.
• Stand up and walk while talking on the phone.
• Walk down to speak to your colleague instead of using the intercom/phone.
• Walk around your building for a break during the work day or during lunch.
• Buy a pedometer.

Walk 80 minutes each day; brisk walk 80 minutes a week with a speed of 80 steps per minute. This is a ‘Formula of 80’ that I have devised and which I recommend to all my patients. 

Deaths due to NCDs see an upward trend in the country

Deaths due to NCDs see an upward trend in the country IMA recommends following a healthy lifestyle to prevent the onset of these diseases New Delhi, 03 August 2017: As per recent statistics, premature deaths due to non communicable diseases (NCDs) such as cancer, heart disease, diabetes, and lung disease have increased to 70% of all global deaths. This is up from the 42% incidence three years ago. As per the IMA, the burden of NCDs is on the rise in India, with one in four at risk of dying from the same before they reach the age of 70. An NCD is a medical condition or disease that is non-infectious and non-transmissible among people. The major NCDs are due to four behavioral risk factors: unhealthy diet, lack of physical activity, and use of tobacco and alcohol. Preventive action against NCDs in India is marred due to a lack of understanding their patterns, the prevalence, and the causes. Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “NCDs are a health and developmental emergency today. They are driven by many external sources including rapid unplanned urbanization, globalization of unhealthy lifestyles, and population ageing. The unhealthy diets that people follow today combined with the lack of physical activity can manifest in the form of high blood pressure, increased blood glucose, elevated blood lipids, and obesity. Called metabolic risk factors, these can further lead to cardiovascular disease, the leading NCD and cause for premature deaths. Reducing the risk factors can help in controlling NCDs to a great extent.” A recent study has outlined that there is likely to be a steady rise in NCD losses until 2030, and then it will increase sharply. Adding to this, the value of life lost, including out-of-pocket expenditure related to these illnesses, and loss of income will likely double over the next 20 years. Adding further, Dr Aggarwal, said, “The medications available to treat most of the NCDs are not very expensive. However, the most effective strategies for reducing the burden of NCDs actually lie outside the health system. It is imperative to take measures such as regulation of advertising, improving access to healthier foods, reducing exposures to tobacco smoke, addressing dietary salt consumption, and encouraging physical activity to combat this group of ailments.” One can follow Dr KK’s Formula of 80 to prevent NCDs. • It is important to keep your fasting sugar lower than 80 mg % • It is best to refrain from consuming alcohol. For those who still wish to drink, they should restrict it to not more than 80 ml of alcohol in a day or 80 grams in a week • To not consume more than 80 grams of caloric solid or liquid food in one meal, rather eat frequent but small meals • Restrict your soft drink consumption to 80ml in one go. The tip is to add soda and dilute it to make it 200 ml • Do not consume tobacco products otherwise you will end up with a surgery bill of over Rs. 80,000 • It is important to keep one’s blood pressure lower than 80 mm Hg and heart rate lower than 80 per minute. • Do aerobic exercises for 80 minutes a week. • Do stretching exercises for 80 minutes in a week. • Consume at least 80 fruits and vegetables servings in a week. • Do not consume more than 80 ml/gram of ghee, oil and butter in a week.

All systems of medicine should advocate a common lifestyle pattern for lifestyle disorders

All systems of medicine should advocate a common lifestyle pattern for lifestyle disorders Non-communicable diseases (NCDs) such as hypertension, type 2 diabetes, heart diseases, behavioral problems, high cholesterol and obesity are rapidly increasing worldwide, including in India. These diseases are called lifestyle disorders as they have their roots in the lifestyle - habits and behavior - of an individual. An unhealthy lifestyle can contribute to the development of risk factors of NCDs. The epidemic of NCDs in our country is mainly attributed to modernization, urbanization, sedentary lifestyles and longevity (Press Information Bureau, 20.2.17). The WHO’s ‘Global Status Report on NCDs 2014’ has identified four main types of NCDs (cardiovascular diseases, cancer, chronic respiratory diseases and diabetes), four behavioral risk factors responsible for significant proportions of these diseases (tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol) and four major metabolic risk factors (obesity, raised blood pressure, raised blood glucose and raised blood total cholesterol levels). The INTERHEART study published in the September 3, 2004 issue of the Lancet identified nine traditional risk factors for an acute heart attack: Abnormal lipids, smoking, hypertension, diabetes, abdominal obesity, psychosocial factors, consumption of fruits, vegetables, and alcohol, and regular physical activity. As per the study, more than 90% of the global risk for acute MI is predicted by these nine traditional risk factors. All the major lifestyle disorders or NCDs share common lifestyle-related risk factors like physical inactivity, unhealthy diet, tobacco and excess alcohol intake. These risk factors are modifiable i.e. measures can be taken to prevent them. Non-modifiable risk factors are those which cannot be changed e.g. age, family history and ethnicity. Adopting a healthy lifestyle can either prevent or delay onset and progression of these diseases. Because these lifestyle diseases share modifiable risk factors, patients should be advised a common lifestyle, which will prevent all lifestyle disorders. Instead of advocating a lifestyle for individual disease, these lifestyle modifications should be such that they not only prevent heart diseases but also type 2 diabetes, hypertension, overweight and obesity, depression and cancer. Here is my Formula of 80 to live up to the age of 80. • Keep lower BP, LDL ‘bad’ cholesterol levels, resting heart rate, fasting sugar and abdominal girth levels all less than 80. • Keep kidney and lung functions more than 80%. • Walk 80 minutes a day, brisk walk 80 min a week with a speed of 80 steps (at least) per minute • Eat less and not more than 80 gm or ml of caloric food each meal. Follow a healthy diet (high fiber, low saturated fat, zero trans fat, low refined carbohydrate, low salt, high in fruits). Refined carbohydrates are white rice, white maida and white sugar. • Observe cereal fast 80 days in a year. • Do 80 cycles of pranayama (parasympathetic breathing) in a day with a speed of 4 per minute. • Spend 80 minutes with yourself every day (relaxation, meditation, helping others etc). • Do not smoke or be ready to shell out 80 K Rs. for treatment. • Do not drink alcohol; if you do, do not consume more than 80 ml per day for men (50% for women) or 80 grams per week. Ten grams of alcohol is present in 30 ml or 1 oz of 80 proof liquor. • Avoid exposure to >80 dB of noise. • Avoid exposure to PM 2.5 and PM 10 levels <80 mcg/m3. • Take vitamin D through sunlight 80 days in a year. • If you are a heart patient, consider 80 mg aspirin and 80 mg atorvastatin a day.

Move Move and Move: IMA Campaign to control NCDs

Move Move and Move: IMA Campaign to control NCDs Noncommunicable diseases (NCDs) are a major cause of premature and preventable deaths worldwide. According to a WHO Global Survey Report “Assessing National Capacity for the Prevention and Control of Noncommunicable Diseases Global Survey 2015”, NCDs currently account for almost 70% of global deaths; majority of which occur in low- and middle-income countries. India too is not untouched by this. Due to rapid urbanization, India is experiencing an epidemiological transition moving away from a predominantly communicable or infectious to a predominantly non communicable disease pattern. Along with tobacco, harmful use of alcohol and unhealthy diet, physical inactivity has been implicated in NCDs as a major risk factor. All these are behavioral risk factors and are modifiable through lifestyle changes. Modern and advanced technology has certainly made life easy and convenient for us – online shopping, online payments, accessing information, etc., all of which can be done from the comfort of our homes. But, has technology really made our life better? What it has also done is change our lifestyle pattern at the cost of health; we are less physically active now - sitting at a desk for a long time working on the computer, using social media on smartphones, watching TV or sitting in a meeting, all these activities promote sedentary behavior. The benefits of exercise on physical health as well as mental health are well-established and know to us all. But, the level of physical activity among all age groups has decreased, either due to lack of initiative or lack of safe open spaces. A heavy work schedule is often a deterrent to physical activity for many of us. Walking is the best form of exercise, which requires no investment, no special training. Walking in natural environments such as parks also reduces mental stress and fatigue and improve mood via the release of the ‘feel good’ endorphins. This proximity to nature also helps in the inward spiritual journey and shifts one from the sympathetic to parasympathetic mode manifested by lowering of blood pressure and pulse rate. This is also why most of our temples are located in distant places. The silence of the spiritual atmosphere reduces the internal noise and helps us onward in our inner journey. It is important to remember here that ‘exercise’ is not synonymous with ‘physical activity’. Exercise is a planned, structured and repetitive activity while any other physical activity that is done during leisure time, for transport to get to and from places, or as part of a person’s work, also has a health benefit (WHO Fact Sheet, February 2017). To control non-communicable diseases and promote physical activity, IMA has proposed a campaign “Move Move and Move”. People should move around more often all through the day in addition to regular exercise. Here are a few simple ways to increase physical activity both at home and your workplace. • Take the stairs as often as possible. • Get off the bus one stop early and walk the rest of the way. • Have “walk-meetings” instead of "sit-in" meetings. • Walk to the nearby shops instead of driving. • Stand up and walk while talking on the phone. • Walk down to speak to your colleague instead of using the intercom/phone. • Walk around your building for a break during the work day or during lunch. • Buy a pedometer. Walk 80 minutes each day; brisk walk 80 minutes a week with a speed of 80 steps per minute. This is a ‘Formula of 80’ that I have devised and which I recommend to all my patients. Dr KK Aggarwal National President IMA & HCFI

Compulsory columns in a medical prescription

Compulsory columns in a medical prescription A prescription is an integral part of a consultation as it summarizes the instructions of the doctor to the patient. The Free Dictionary has defined a prescription as “a written directive, as for the compounding or dispensing and administration of drugs, or for other service to a particular patient” (http://medical-dictionary.thefreedictionary.com/prescription). Handing over of the prescription by the doctor to the patient marks the conclusion of every consultation, be it a new consultation or a follow up visit. A medical prescription traditionally enumerates the drugs that have been prescribed, along with directions for the patient to follow when taking the drug and the diagnosis. Some significant clinical findings may also be mentioned. There are four parts of a typical prescription • Superscription: Indicated by the sign Rx meaning recipe, take • Inscription: This is the main part of the prescription, contains the names, doses and dosage forms of drugs ordered. • Subscription: Directions for compounding of drugs • Signature: Instructs the patient about how to take the drugs prescribed and is preceded by the symbol S or Sig (signature - Latin) Noncommunicable diseases (NCDs) such as heart disease, stroke, cancer, diabetes and chronic lung disease are a major public health problem now incurring significant costs in their management. The Global Status Report on Noncommunicable Diseases 2010 by the WHO states that “NCDs are caused, to a large extent, by four behavioral risk factors that are pervasive aspects of economic transition, rapid urbanization and 21st-century lifestyles: tobacco use, unhealthy diet, insufficient physical activity and the harmful use of alcohol”. Given the alarmingly high prevalence of lifestyle diseases worldwide, including India, it’s now time to move beyond the confines of the traditional way of writing a prescription. In addition to the demographic data and drugs, a prescription should have some ‘compulsory columns’. • Hygiene • Vaccines • Addictions • Noise pollution • Standard Lifestyle • Rehabilitation: Exercise, job, vacation • Counselling: Diet, mental health, exercise • Point of Care Investigations: ECG, blood sugar, pocket spirometry, urine spot test, hemoglobin, blood counts, coagulation etc. • Noise pollution check • Air pollution check: PM 2.5, PM 10 • Important phone numbers: Police, hospitals, ambulance, fire department, emergency number (Similar to 911 in US, the single national emergency number in India is 112) Adding these components to a prescription is an intervention towards ‘preventive healthcare’, primary prevention or secondary prevention and check the rising prevalence of chronic lifestyle diseases. This way doctors can motivate their patients and support them to make healthier lifestyle choices. Dr KK Aggarwal National President IMA & HCFI