The bottomline is health

We keep hearing about the rise of lifestyle ailments, often referred to as non-communicable diseases in India. With every new survey or study, the number of people suffering from diabetes, hypertension and heart disease appears to be rising steadily.

Undoubtedly, India is currently undergoing a silent transition in which infectious diseases are being replaced with lifestyle diseases as major source of illness and death, in both urban and rural areas. Governments, health advocates and common people are not able to come to terms with this reality.

This is because unlike infectious diseases for which the causative agent or the enemy is known — a bug, a bacteria or a virus — there is no bug to be fought in non-communicable diseases and there are no antibiotics. Lifestyle is the bug.

That’s why it is challenging to devise effective strategies and policies to address non-communicable diseases.

The situation is particularly alarming because chronic ailments such as diabetes, heart disease and cancer have begun to take a heavy toll not just on individuals and families, but on the economy.

Just imagine the economic burden of a diabetic or a cardiac patient who needs lifelong care and costly medical interventions on the society and the country.

Most people affected by the rising tide of NCDs are in their productive age groups. As the National Family Health Survey-III reported, 5.59 per cent of those suffering from diabetes are in the most productive age group of 15-49 years. A recent survey by the Department of Public Enterprises and the Confederation of Indian Industry (CII) revealed that nearly 17 per cent of public sector employees and their family members suffer from diabetes.

Diabetes treatment, according to scientific studies, accounts for around 2.1 per cent of India’s GDP . Of this, only 0.2 per cent is direct healthcare cost, while the indirect cost is almost 10-fold higher. In absolute terms, the economic burden of diabetes in India is estimated to be $20.4 billion. Heart disease is known to occur among Indians 10 years earlier than in people in the West.

In such an emerging scenario, it becomes imperative for businesses and industry to sit up and take note. The traditional approach of administering annual health check up, occasional health camps and some awareness lectures would not work.

In order to tackle non-communicable diseases, underlying risk factors (such as unhealthy food habits, tobacco consumption and physical inactivity) will have to be tackled upfront.

Since we are concerned with lifestyle ailments, the focus should be on modifying lifestyle behaviours. This, surely, can’t be achieved with annual vaccination or just a lecture or a booklet.

The CII survey among public sector undertakings points out that obesogenic environment (which tends to cause obesity) encourages low levels of physical activity and access to energy-rich diets. A bulk of working people is engaged in office work and sedentary occupations.

Even working on factory floors does not require much of physical activity due to increased mechanisation. In addition, food available in canteens is rich in fats, salts and sugars. ‘No tobacco’ policies are hardly enforced. An added factor is work-related stress.

Such workplaces are a sure recipe for breeding lifestyle diseases. The first part of the strategy, therefore, should be to change workplaces into healthy ones and this can be done through small measures as demonstrated in some Indian companies and elsewhere in the world.

Adopting a ‘healthy environment’ policy would mean creating spaces friendly for walking and cycling within factory premises, office compounds and townships, encouraging activity breaks, establishing gyms and fitness centres and integrating them with wellness programmes. Stress bursting activities like playing music or meditation may be introduced during breaks.

Making available healthy food choices in office canteens is very critical. Most canteen contracts are given based on cost basis and the number of items on the menu, without any health or nutrition consideration.

Every organisation should develop nutrition policies to restrict intake of excessive calories, oversized food portions, high-energy and high-sugar beverages as well as bakery products.

Simple change like making available fruit instead of ice creams or other desserts can go a long way. Canteen policies need to be devised and implemented in consultation with employees to ensure greater acceptance.

Services of an external nutritionist or dietician could be hired to encourage healthy eating among employees.

For best practices, we don’t have to look far. Indian Oil Corporation undertook an audit of all its 115 office canteens and kitchens across the country and hired a team of qualified nutritionists and doctors with occupational health experience to devise nutrition policies.

Guidelines for good kitchen practices as well as ‘healthy lifestyle, nutrition and occupational health’ were formulated in 2012 and their implementation is being monitored at local level. Awareness levels have gone up and employees are getting healthier food choices.

Another PSU, Gas Authority of India Limited has developed a ‘Health Index’ tool to keep an eye on health parameters of employees.

The objective of the index is to identify individuals at risk of acquiring lifestyle-related diseases so that they can be targeted for interventions.

This has helped reduce sickness and mortality associated with chronic diseases at workplace. In the long run, technological tools may also be deployed for screening and monitoring of those with ailments like diabetes.

It’s time to move from awareness to action.

The writer is a science journalist and the author of, most recently, ‘Know Your Heart: The Hidden Links Between Your Body and Politics’. He is based in Delhi

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