Indian J Med Res 131, January 2010, pp 14-16

Commentary
Prevention of non communicable diseases (NCDs): Holistic approach needed

The main objective of the study by Thankappan

et al1 in this issue was to assess the burden of NCD risk
factors in Thiruvananthapuram district, Kerala, and
based on this to infer what will happen in future to the
rest of India since Kerala being a forerunner for India
for many events.

Recent studies in India from different sites show higher

risk of coronary heart disease among people with lower
socio-economic level indicating that the disease pattern
is shifting from the affluent to the poor4.
The impact of NCDs will rapidly increase in
countries in view of the rapid health and demographic
transition. Public health experts have predicted a global
epidemic of cardiovascular and other chronic diseases
in the developing world by 20205.

Significantly, this study was carried out at a time

when India is facing enormous morbidity and mortality
problems due to NCDs, akin to the situation faced by
most of the advanced countries of the world a few
decades back.

The increasing trend of various NCD risk factors

including blood lipids in Indian population have been
well documented in recent years6-9. Unhealthy diet and
physical inactivity as well as tobacco use, recently
highlighted in the World Health Report 200210, are
major global determinants of NCDs. Examples from
several countries show that changing these determinants
is possible and it can have a strong effect on the trends
in NCDs11.

The authors provide evidence that population of

Kerala State is having a high prevalence of major risk
factors for chronic NCDs1. This situation would result
in further increase of high morbidity and mortality
burden to the State and to resultant rise in medical
expenditure for the State.
Inadequate diet, overweight, abdominal obesity,
hypertension and smoking among men were high.
High prevalence of all these factors gives a definite
possibility of increasing the burden of NCDs in the
State. This study calls an urgently for prevention of
NCDs, and other chronic diseases to save the population
from prolonged illness and financial difficulties to the
patients also need continuous treatment.

Most studies in other countries have shown that

physical inactivities and unhealthy diet are the two
most important factors for NCDs. Comprehensive
studies on these two factors can be specifically
conducted in Kerala and other states to determine
balanced diet and to arrive at the criterion of optimum
physical activity required for varied categories of
individuals.

An epidemiological transition is taking place

in most of the states in India with a decline in
communicable diseases and an increase in chronic
NCDs that has resulted in more than 50 per cent of total
deaths in India in 2005 due to chronic diseases2. The
major NCDs in India include diabetes, hypertension
and other cardiovascular diseases.

Evidence from clinical practice and literature

suggests that approximately half of most chronic
diseases are undetected, and that half of that detected
are not treated, and that half of those treated are not
controlled. The primary care work load would increase
manifold if all the common and important chronic
disorders were fully detected, treated and followed
up. This rule still applies to the Indian population12 as
shown from the Kerala study also1. This is a crucial
factor in surveillance mechanism also.

With the enormous number of diabetes cases, India

is considered as the Diabetes Capital of the world3.
Hypertensions also have the same status and it may be
reasonable to call India as the capital of hypertension3.
14

Sugathan: Prevention of non communicable diseases (NCDs)

15

The authors1 have presented an alarming scenario

of NCD risk factors in this community based-study in
Thiruvananthapuram district. As demonstrated in other
sociological changes and developments, Keralas present
situation is can be considered a forerunner of what will
happen in future to the rest of India on this issue also.
Further in depth studies need to be conducted to chalk
out the policies and programmes by the concerned for
reducing the eventualities of high mortality and morbidity
rates prevalent due to the NCD risk factors stated in this
study1 and in earlier studies conducted by Centre for
Survey Research & Management Services (CSRMS),
Cochin, covering the whole of the state of Kerala13.
It may be remembered here that exhaustive studies on
prevalence as well as prevention of NCD risk factors are
being routinely carried out in the developed countries for
the past so many years. The rewarding results are there to
be seen everywhere in American and European nations
which were facing very similar problems decades back.
Using various initiatives and follow up actions they
could bring down their high mortality and morbidity
rates substantially14. Unfortunately such measures are
not occurring in Kerala or in other States of India where
NCDs are rising at a faster pace than anywhere else in
the world.

In addition to the commonly known risk factors of

NCDs , vitamin D deficiency is also cited as another
notable risk factor. Low vitamin D status has been
implicated in the aetiology of autoimmune diseases
such as multiple sclerosis, rheumatoid arthritis,
insulindependent diabetes mellitus and inflammatory
bowel disease16. Other investigations also indicated
its important role as a risk factor of cardiovascular
diseases17. Correcting this deficiency may provide
a positive contribution towards preventing and
controlling these diseases.

Therefore, studies to obtain the crucial and critical

data on NCD risk factors need to be initiated at regular
intervals in Kerala and other States of the country for
setting up States as well as National level NCD risk
factor surveillance mechanism.

References

The World Health Organization has stressed on

this imperative surveillance mechanism, focusing on
the collection of data and statistics on key NCD risk
factors continuously in order to design communitybased interventions targeted at the reduction of these
risk factors and for monitoring the effectiveness of such
interventions and its sequential phases and results15.
It is strange that for NCDs, lifestyle diseases are
noticed to be the major culprit for the high mortality
and morbidity rates in Kerala where paradoxically the
other health indicators such as high expectancy, very
low fertility rate, high literacy, a reasonably good health
care system in both government and private sector,
match closely with the developed countries. However,
various behavioural risk factors such as unhealthy
diet, sedentary life, routine stress at home and work
place, high consumption of alcohol, lack of physical
activity, life in polluted ambience, etc; are observed to
be the major causes of this situation of unprecedented
mortality and morbidity amongst Keralites13.

An unexplored methodology for prevention,

directly and indirectly, of onset of certain NCD risk
factors and control of diabetes was recently observed in
those practising Suryayog18. New scientific strategies,
alternate systems of medicine, holistic life sciences,
etc. (which are exceptionally cost-effective also), may
be considered seriously for control and prevention of
diabetes and other NCDs.
T.N. Sugathan
Centre for Survey Research & Management Services
Kochi, Kerala 682 025, India
drsugathan@vsnl.net
csrms@vsnl.com
1.

Thankappan KR, Shah B, Mathur P, Sarma PS, Srinivas

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