What is missing in Mumbai

Increase in Chronic Diseases in India: In the Thicket of Data

According to the World Health Organization, one in two people in India now dies of a non-communicable disease. But one thing in particular is missing for dealing with it: reliable data.

When it comes to chronic diseases and their rapid increase in India, Prof. Prabhakaran Dorairaj is an expert. Within a few minutes, the managing director of the Center for Chronic Disease Control in New Delhi rattles down the most important figures for the whole country: The prevalence of coronary heart disease is eight to ten percent in the city and five percent in the country. The incidence of diabetes is also around ten percent in the city and five percent in the country. About ten percent of the world's smokers live on the subcontinent - their number is only exceeded by
those in China. Sixty percent of people in India who die from complications from non-communicable diseases (NCDs) are under the age of 70.

The reasons given by the cardiologist for this development are just as prompt: the population is beginning to age, the diet of the majority of Indians is unhealthy, the strategy of the food industry is difficult to break through and - people are moving less and less, even in rural areas . According to Dorairaj, the solutions are obvious: health insurance for all Indians, sensible prevention, advanced training for doctors on how to deal with chronic diseases correctly, and better coordination of existing measures at all levels.

Chronic Illness Expert: Cardiologist Prabhakaran Dorairaj calls for health insurance for everyone and more prevention to contain the new epidemic. Photo: Martina Merten

After less than an hour in the managing director's air-conditioned office, it seems that many questions about the increase in NCDs in India have been answered. The question even arises as to why the international community, which has been advising regularly since 2011 on how to properly deal with the drastic increase in NCDs, especially in developing countries, needs so long to take effective countermeasures.

The Indian Council of Medical Research gives you an initial idea of ​​how much theory is behind the scientist's statements. The Department of Health Research, which reports to the Ministry of Health, has been dealing with NCDs since the 1970s. However, explains department head Dr. D. K. Shukla, it was only the World Health Organization's “Burden of Disease Study” from 2000 that opened the eyes of scientists to the drastic increase in non-communicable diseases. For a few years now, his department has finally had a little more money available for research. The problem: "There are no cohort studies, and community-based studies are almost impossible due to the poor conditions in the countryside," says Shukla. The only thing he and his team could do are interventional studies. Prevalence or incidence studies do not take place. Because: "Doctors in rural areas are interested in treating patients, not in collecting data."

One and a half hours by flight from the Indian capital, in Lucknow, is the Vivekanada Polyclinic & Institute of Medical Sciences. 16 million people live in the metropolitan area of ​​the capital of the state of Uttar Pradesh. The polyclinic is one of the larger state hospitals in the city. More than one and a half thousand people visit the clinic's outpatient department every day, hundreds of them sit, crouch and lie either on the floor or on the few benches. Another 350 patients are treated here as inpatients. Dr. R. N. Rastogi is responsible for the administration of the polyclinic. The phone in his dark room on the third floor rings every two minutes. Chronic illnesses, he says, are increasing everywhere, in the city as well as in the country. When asked for data that could support this statement, he answered nothing. The only document that reveals the incidence of certain diseases is the clinic's annual report. There is no report from the previous year for comparison. The city's chief medical officer, who is responsible for collecting data from all medical facilities in Lucknow, doesn't come regularly anyway, says Rastogi.

Dr. Anil Kumar Shukla doesn't want to say much about data collection. The former chief medical officer made enough money to open a private clinic, the SC Trivedi Memorial Mother and Child Care Trust Hospital in Lucknow. After all, he shares the observation that NCDs have increased here in his city: "Many people who come to us in the city from the country suffer from great stress, which in turn leads to high blood pressure and depression."

Land of contrasts: people waiting in a hospital in Mumbai (left) and visitors to the heart research center in New Delhi. Photo: picture alliance

The village of Museypur is located 30 kilometers from Lucknow, in the Barabanki district. There are several unpaved roads to the entrance to the village. 900 people live here in simple huts. Most are scantily clad. Nobody has more than a dollar a day to live on.

There is a small infirmary in the middle of the village. Simple wooden beds with raffia mats serve as hospital beds. Currently, Dr. Pankay Kumar, who occasionally holds office hours here, most of the patients suffer from infectious diseases. Malaria and dengue are very common in the monsoon season. There are few chronically ill patients, and now and then someone has heart problems. “But we don't even have the option of doing a diabetes test or other tests,” explains Kumar. When asked about the subject of data acquisition and documentation, the villagers just shake their heads in disbelief. “We doctors remember what certain patients are suffering or have suffered from. We do not document data. "

At Dr. Derendra Verma, owner of a small hospital in the neighboring town of Safdarganj, is different. According to his own statements, he has been documenting patient data for many years. Also, says Verma, he noticed that many of his patients suffered from diabetes or high blood pressure. “Nobody has come here to collect my data,” he says.

François Decaillet is program coordinator in the India country office of the World Health Organization. When asked about NCDs, he - like Dorairaj - has a lot to say. However, Decaillet ends his remarks on the occurrence of and dealing with chronic diseases with a sentence that describes the situation much more accurately: "The Indian public health service is not yet able to deal with chronic diseases."

Martina Merten

Research on this article was made possible by a research grant from the US Pulitzer Center on Crisis Reporting, Washington.

India in numbers

  • 1.2 billion people live in India.
  • The gross domestic product (GDP) is per capita
    $ 3,408.
  • Spending on health is 4.2 percent of GDP.
  • The per capita expenditure on health is
    $ 132.
  • Public spending on health is $ 45 per capita.
  • The self-pay benefits for health are 74.4 percent. Eleven percent of the population have health insurance.