A recent report on the state of health of Indians investigates and exposes the new and emerging environmental triggers of non-communicable diseases (NCDs) in the country.
Titled: “Body Burden: Lifestyle Diseases”, the report, released on Monday, November 27, 2017 by a panel of eminent medical doctors, establishes that unless environmental risk factors are acknowledged and dealt with, India will not be able to curb NCDs responsible for more than 61 per cent of the deaths in the country.
According to the World Health Organisation (WHO), there are four major risk factors for NCDs – alcohol, tobacco, poor diet intake and lack of physical activity. The WHO says that, by investing just $1-3 per person per year, countries can dramatically reduce illness and death from NCDs.
However, according to Sunita Narain, director general, Centre for Science and Environment (CSE), the investment for India will be much higher.
“We believe the cost is going to be much higher considering that risk factors (in India) are many more than the four identified by the global body. These risk factors have multiple targets and can cause diseases which are not generally linked to them. For example, exposure to pesticides is known to cause cancer, but new data is emerging to link it to diabetes as well,” she says.
Similarly, air pollution is known to cause Chronic Obstructive Pulmonary Diseases (COPD), but there is little understanding on how this can adversely affect mental health. “Body Burden” highlights these linkages.
Says Vibha Varshney, the lead writer of the report: “Targeting environmental risk factors is essential if we want to meet the Sustainable Development Goal 3.4, which mandates a one-third reduction in premature deaths due to lifestyle diseases by 2030.”
“Though the WHO has identified the major risk factors for NCDs, it is still coy in calling out the real enemy – foods that are high in salt, sugar, fat and low in nutrition. It wants to play it as safe as possible so that it does not have to confront the real players and demand a restraint on their products, not through voluntary action but through government policies that restrict and restrain and put a premium on nutrition, not consumption,” says Narain.
Seven major health problems in India
- Obesity: The number of overweight and obese people in India doubled between 2005 and 2015. Among individuals aged between 15 and 49 years, 20.7 per cent of women and 18.6 per cent of men have been found to be overweight or obese. Presence of obesogenic chemicals such as DDT, bisphenol A, MSG and arsenic in the environment were found to be important triggers of obesity. Besides regulating the use of these, marketing of processed foods too needs to be monitored. Increase in taxes on unhealthy foods, adequate labeling, and building an environment conducive to physical activity will be critical in combating the epidemic.
- Mental health: More than 10 per cent of the country’s population over the age of 18 suffers from various kinds of mental illnesses. The lifetime prevalence of such mental illnesses is over 13 per cent. At least 150 million people in the country, affected by mental disorders, are in need of active medical intervention.
Lack of social support, changing diets and economic instability are the main triggers of mental disorders. Increased intake of sugar, too, has been linked to mental illness, making it imperative to find ways of reducing intake. An increase of PM2.5 in the environment by 4.34 microgram/cubic metre can increase the risk of Alzheimer’s. These risks, however, have not been considered in the mental health policies such as the Mental Healthcare Act, 2017.
- Cancer: More than 1.73 million new cancer cases are likely to be recorded each year by 2020 in India. Commonly used household chemicals and cosmetics contain cancer-causing compounds. It is estimated that up to 20 per cent of cancer cases can be linked to environmental exposures of toxins. Tobacco and alcohol, air pollution and diets rich in meat and low in vegetables, are primary triggers. However, these triggers remain largely unaddressed. Moreover, cancer screening and medication remains extremely expensive.
- Heart diseases: 26 per cent of all deaths in India happen due to cardiovascular diseases. Men and young are at a higher risk. In urban India, young and middle-aged people are at risk, while in rural areas, the elderly population is vulnerable.
Lack of physical activity has been identified as one of the biggest triggers of cardiovascular diseases. The easiest way out is to increase physical education. For this, policymakers need to prioritise pedestrian and cycling tracks and promote public transport and green spaces. Depression too has been found to be a risk factor for cardiovascular diseases. Those suffering from depression also experience changes in their central nervous system and hormones, leading to the possibility of disturbance in heart rhythm, which over prolonged periods can be dangerous.
- Respiratory diseases: India had an estimated 22.2 million chronic COPD patients and around 35 million chronic asthma patients in 2016
.Other than air pollution from vehicles and industry, global warming also increases risk to respiratory health. Global warming has extended the duration of the pollen season and altered the timing, production and distribution of aeroallergens. Both pollen and air pollutants have risen simultaneously in the environment, leading to an enhanced airway inflammation, thereby increasing the frequency of respiratory allergy and incidences of asthma. Studies on the relationship between allergic respiratory diseases, asthma and environmental factors, such as meteorological variables, airborne allergens and air pollution are still limited, but important evidences are emerging.
- Hormonal disorders: Every 12th Indian is said to be a diabetic. Data on other hormonal diseases is still not available. Small studies suggest that one in 10 adults suffer from hypothyroidism.
Hormonal balance is very delicate and is easily disturbed by exposure to toxins, air pollution and even food rich in fats, sugar and salt. Understanding of hormonal disorders is poor and this needs to be studied more. However, policies that reduce consumption of processed foods, increase physical activity and minimize exposure to chemicals would help maintain hormonal balance.
- Food allergies: It is suggested that 25-40 million people in India could be suffering from food allergies. About 170 foods reportedly cause allergic reactions. Food labels that provide detailed information about constituents could be important in controlling this. Allergen labelling in India has so far been restricted to infant milk substitute. India does not have a mechanism in place that requires genetically modified (GM) foods to be clearly labelled.