NEW DELHI - As if a crippling medical manpower crunch - with just one
doctor currently available for every 10,000 Indians - wasn't bad enough,
India is also poised to hold a whopping 60% of the world's heart disease
patients by 2010, according to a recent study by the British journal The
Lancet.
The groundbreaking study, conducted by a team of researchers led by Dr Denis
Xavier of St John's National Academy of Health Sciences in Bangalore,
studied 21,000 heart attack patients admitted to 89 hospitals in 50 cities
across the country. It found that while the cardiac risk factors in India -
excessive tobacco consumption, high lipid levels in the blood due to
fat-rich diets and hypertension - weren't dissimilar to those in other
nations, what disadvantaged Indians further was the time it took for them to
access medical help.
On average, it takes 300 minutes - five hours - for an Indian heart patient
get to a hospital, twice the time taken in developed nations. What's worse,
very few of these patients are ferried to hospitals by an ambulance due to
financial constraints and must use private or public transport. Also,
poverty precludes a sizeable chunk of Indians from obtaining routine
treatment, including surgical procedures.
While it has long been known that South Asia tops the world rankings in
acute coronary syndrome cases, this is the first comprehensive research
which quantifies the magnitude of the problem. "The study shatters the
biggest myth that heart disease is an ailment of rich nations," says New
Delhi-based cardiologist Dr K K Gupta. "It's a wake-up call for Indians to
re-assess their lifestyles, work habits and diets. Most of us seem to have
swapped the traditional healthy lifestyle for junk food loaded with trans
fats, no physical exercise and 15-hour [a day] work schedules. This is an
open invitation to heart disease and death."
According to research, heart disease kills about 8 million people globally
each year. However, while Western nations have seen a 50% plummet of heart
attack-related deaths since the 1960s - due to growing health awareness and
an increase on government funding for health - Asian countries have, on the
contrary, witnessed an upward spiral in such deaths and currently account
for 80% of the world's heart disease-related deaths. By 2020, ischeamic
heart disease (leading to brain strokes) will ratchet up by 137% for men and
120% for women over three decades in poorer nations, compared with 30-60% in
rich economies, according to The Lancet.
Another huge disadvantage India faces in this context is its abysmal gross
domestic product (GDP) spending on health. While most Western nations
currently spend at least 6% of their GDP on health, India's figure is a
negligible 0.9%. "It's almost like in a country of a billion-plus, putting
food in people's mouths is far more important than their health concerns,"
says a senior bureaucrat at the Ministry of Health. "But this is a myopic
view, as sickness can be a huge drain on resources which can in turn hamper
the government's plans to feed people. It's a classic Catch-22 situation."
Complicating India's scenario further is a severe shortage of doctors which
has literally paralyzed the state health machinery, severely impacting its
billion-plus population, a third of whom subsist on a meager US$1 per day.
According to a Planning Commission report released last month, India is
short of a phenomenal 600,000 doctors, 1 million nurses and 200,000 dental
surgeons. There is also a huge paucity of paramedical staff including
radiographers, X-ray technicians, physiotherapists, laboratory technicians,
orthopedists and opticians.
The situation is so bad that in some government hospitals untrained medical
staff are being pressed into service to assist doctors. It's common that
untrained staffers are asked to administer important functions like
injections and stitching up wounds without any supervision while the harried
doctors attend to critical patients.
Nationally, the glaring shortfall manifests itself in an abysmal
patient-doctor ratio. India compares dismally with countries like Australia
which provides 249 doctors for 10,000 people, Canada which offers 209,
Britain 166 and the United States 548.
It is no surprise then that due to ill-equipped hospitals and unhealthy
lifestyles, rates of coronary disease among urban Indian populations have
surged from 4% to 12% over the past decade. Worse, obesity currently plagues
about 30% of all urban Indians, most of whom have a [body mass index] BMI in
excess of 25 as against the recommended limit of between 18 and 24.
Moreover, according to a recent Women and Child Development Ministry survey,
13% of New Delhi's kids are obese and hence at an enhanced risk of heart
disease, diabetes and obesity in adulthood.
This can be catastrophic as Indians, say doctors, already possess elevated
levels of LDL (low density lipoprotein) cholesterol and triglycerides while
being HDL-deficient (good cholesterol which removes fatty deposits from
blood vessels). Environmental factors like low birth weight, malnutrition
and desk-bound jobs further makes them susceptible to an enhanced risk of
insulin resistance (leading to diabetes) and heart failure.
India is also home to 12% of the world's smokers and will witness 930,000
deaths in 2010, according to a study published in the New England Journal of
Medicine. The study estimates that India has about 120 million smokers who
will contribute to deaths mainly from tuberculosis, heart disease and
cancer.
Oncologist Dr Swati Chopra stresses that smoking exacerbates the risk of
heart attack as elevated nicotine levels spike the body's bad cholesterol or
LDL making the blood stickier and the arteries harder. "This enhances the
blood's chances to clot more readily. Sticky blood flowing through hardened
arteries can lead to the formation of a clot and block an artery. A blocked
artery in the brain," informs the expert, "can trigger a brain stroke which
may lead to paralysis or even death."
What also puts Indians at a disadvantage is their genetic pool. In fact a
recent Imperial College, London (UK) study has identified genetic variations
(occurring commonly among Indian Asians) that make them on an average about
three kilograms heavier than people of European ancestry. This, the study
suggests, makes Indians prone to polygenetic ailments (controlled by
multiple genes) like Type 2 diabetes, hypertension and cardiac trouble.
Scientists say that the variants found in a specific gene identified as MC4R
(a protein which regulates appetite and metabolism) and FTO also triggered a
two-centimeter expansion in the waist circumference of adult Indians as
compared to Westerners. This leads to "midriff obesity" which often climaxes
in heart problems.
Vulnerability to heart disease can have devastating economic consequences.
In 2000, for instance, India lost more than five times as many years of
economically productive years to coronary diseases than did the US where
most heart disease victims are past retirement age in any case. Contrarily,
in India, nearly half of heart disease-related deaths strike people below
the age of 70, compared with just 22% in the West.
"But while you can't fight your genes, you can certainly alter your
lifestyle," advises Dr Gupta. Lifestyle modification, asserts the doctor, is
thus the need of the hour. "We're sitting on a time bomb and unless we do
something proactively about it, heart disease can literally kill India."
New Delhi-based independent journalist Neeta Lal has had her work published
in over 70 publications across 20 countries .
Source : Asia Times Online Ltd.
