Sunday, October 17, 2010

Classes on Lifestyle Diseases

AIPSC 2010, the national level peoples’ science congress, is reached at the threshold , which is in the last week of December, 2010. To spread the message of the Science Congress, the Sub Committee (Classes) is conducting “One Thousand Classes” related to public health in November in all the Grama Panchataths and Municipalities in Thrissur District.

Topic selected for the class is "Lifestyle and Health". High morbidity of lifestyle diseases is the main reason for selecting the subject for the class. Also, the mortality rate due to the diseases is raised to 95% of the total deaths. It is the biggest threat that the State now confronts in social arena.

( Lifestyle Diseases – A time bomb is ticking ….

Kerala’s achievements in health have been universally recognized and praised. The dramatic decline in fertility and child mortality during the last four decades has given Kerala reputation as the healthiest state in India. Our female life expectancy has touched

76 years while male life expectancy is languishing at 70 years. During the last decade, crude death rate has shown a steady rise from an all time low of 5 per hundred to the current levels of 6 per hundred. The increase cannot be solely accounted for by the shift in age while male life expectancy is languishing at 70 years.

During the last decade, crude death rate has shown a steady rise from an all time low of 5 per hundred to the current levels of composition alone; rather it suggests an increase in mortality in the middle age group. Kerala has experienced a health transition from that of a high child mortality- high morbidity picture to that of low child mortality- high adult morbidity situation in just over one generation time. In other words our health picture has taken a quantum leap from that of an under developed society to that of a developed, urbanized society. The paradox is that by western standards we are still a low consuming society both in terms of food consumption and economic consumption. Our per capita income is still around 500 US Dollars as against 30,000 Dollars plus in the west! The striking similarities in the profiles of death between Kerala and the United States of America is seen in the Table.

The data presents a frightening scenario in terms of its implications to the society of Kerala. When cardiovascular deaths contribute to nearly half the deaths in a population, the state of health of the people is far from satisfactory. The tale that the dead tells is a picture of highly morbid society, weighed down by heart disease, stroke, high blood pressure, cancer and diabetes. Collectively, these diseases are called modern lifestyle diseases, denoting the negative side of westernization of our culture. Health Action by People, an NGO, working in Kerala is involved in delineating the health profile of Kerala through rigorous field studies.

The studies were initiated in 1998 and are continuing. The information so far gathered is alarming necessitates corrective action on a war footing. The emergence of the silent epidemic of lifestyle diseases poses disastrous consequences for our state. The prevalence of diabetes mellitus and high blood pressure in Kerala is much higher than the reported estimates in thewest. While about eight percent of adults are diabetic in Kerala, the proportion in Kerala ranges from six percent in rural areas to nearly 20 percent in the cities. The only exception for high prevalence of diabetes is the coastal sea-going fisher folk among whom the prevalence is as low as three percent. The lessons that we learn from the protective factors will certainly help in evolving strategies to combat the diabetes epidemic in other communities.

By a most conservative estimate there are about 1.5 million diabetic subjects in Kerala. These people need lifetime management involving lifestyle modifications, drugs and diet. The economic cost of managing diabetes in Kerala is mind-boggling. When we learn from our studies that most of the diabetic subjects are getting irrational and unscientific management in our state, we can only shudder at the thought of future increase in numbers of people suffering from advanced renal failure, and blindness two dreaded complications of diabetes.

Recent surveys in different categories of subjects in Kerala reveal that one out of three adults in Kerala is a hypertensive. Unlike in the case ofdiabetes, where most persons are aware of their sickness, most cases of hypertension are detected the first time during screening programmes. Hyper tension, the insidious killer contributes to heart attacks, stroke and kidney failure in addition to eye complications.

Hypertension too is a lifelong disease and needs careful sensible management throughout life. The alarming increase in heart attacks and strokes in Kerala is partly the contribution of the high prevalence of hypertension in our society.

An interesting feature that has emerged recently in Kerala is the alarming increase in overweight and obesity. Overweight and obesity are indications of an increasingly indolent society. Our bodyweight is a reflection of the balance between food energyi ntake and expenditure. Physical activity determines the total energy output of an individual. When intake of energy exceeds output, the extra energy is stored as fat. Over years extreme corpulence sets in and invites a host of medical problems.

Obesity is a risk factor for heart attack, hypertension, breast cancer, and diabetes and joint problems. Obese people are also prone to chronic lung diseases. In other words most of the lifestyle diseases that we mentioned earlier are woven into the fabric of overweight and obesity that exists in our population. The accumulation of fat in our population is strikingly different in our people. We suffer from “apple obesity” or truncal obesity unlike the western population in whom the fat is more generally distributed. The abdominal obesity that characterizes our people is causally implicated in the emergence of diabetes. Recent studies on the urban and rural people of Kerala suggest that nearly fifty percent of women in Kerala are overweight, of which 15 percent are frankly obese.

Heart attacks constitute over 21 percent of all deaths, followed by stroke (13 percent) Infectious diseases do not contribute more than 6 percent of the deaths, while two decades ago it contributed to more than twenty percent of deaths. The most tragic picture is the alarming rise in suicides deaths in our state. 8 percent of deaths is from suicides. If we add on accidents and violence it will rise to 13 percent, and jump to second place among important causes of death. The tragedy of Kerala is that the suicide rate of women in Kerala, which stands at 31 per 100,000 women is the highest reported anywhere in the world! A tragic reflection of the mental health of our people! The median age of deaths from suicides is only thirty years in women, while the age is 75 years for deaths from all causes.

Fortunately for Kerala, cancers contribute only about 10 percent of deaths. This is likely to rise in future. Already there are disturbing trends. Breast cancer has emerged as the leading cancer among both sexes. More over, women suffer from breast cancer nearly

ten years earlier than in the west. In the context of the established relationship between breast cancer and obesity, the future does not augur well unless we act fast. What, then are the lifestyle factors that have given rise to this disturbing picture? Is it diet or is it indolence? One who knows the Kerala society do not have to look for new and mysterious factors? There is no doubt that the single most important contributor to the modern ills of Kerala is lack of physical activity. Indolence breeds heart attacks; it invites overweight and obesity and creates a favorable milieu for diabetes and hypertension.

Walking has become a reassured memory for the Keralite, for anyone with means walking is unfashionable. Children will be discouraged from dangerous activities like running! This morbid fear of physical activity has become pathological in Kerala. We eat less, but spend energy lesser still, resulting in overweight and obesity. Schools have no playgrounds; those places with playground are the undisputed domain of the canine citizens of India. The increasing use of tobacco as cigarettes and beedis has also contributed to the rise in heart attacks and lung cancer. We have not yet seen the peak of the tobacco related epidemic.

The emergence of overeating and increasing tendency to snacking during TV watching also may contribute to further worsening of the health scene. What then is the solution? Kerala has to undertake a massive lifestyle education programme. The thrust has to be on physical activity, prudent eating and abstinence from tobacco. Early detection through screening for diabetes hypertension and overweight have to be integrated into the culture of theKeralite. Time is not on our side. Only timely action can help defuse the bomb –Courtesy :Wikipedia)

The discussion session was convened on 16th October at Parisarakendram, Thrissur. The inaugural presentation made by Dr. KG Radhakrishnan, State Committee member of KSSP. Dr. K Vijayakumar, Dr. PS John, Prof. M Haridas, KM Baby, P. Radhakrishnan, C Prasad, Sudheerkumar and Sijukumar addressed the gathering.

On November 7, 100 classes are being conducted in Panchayath centres. It is proposed to convene the Meghala Committees on 31st October to plan the VEETTUMUTTACLASS (Courtyard Class), by trained resource persons, inviting the neighboring residents.

By Baby KM, Convener.

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