Alarming rise in Non-Communicable Diseases - Dr. Palitha Mahipala

By C.I. Munasinghe

While the possible impact of communicable diseases such as turbuculosis, malaria, HIV /AIDS cannot be underestimated, in a health survey's disease projection of 2010-2020, that Non-Communicable Diseases (NCD) will be the leading causes of morbidity, mortality and long-term disability in Sri Lanka over the next decade. The Sunday Observer spoke to Dr. Palitha Mahipala, to find out more on these findings.

"There are 250 people dying due to NCDs" daily, said Additional Secretary to the Ministry of Health Dr. Palitha Mahipala. Dr. Mahipala explained that NCDs such as heart diseases, stroke, cancer, chronic respiratory disease, diabetes mellitus, hypertension, and what are known as acute NCDs, such as accidents and injuries.

Since most of the NCD incidences increase with advancing age and the number of elderly population is high and also increasing the impact of NCD on families, communities and the health services has risen significantly.

In Sri Lanka we have undergone a demographic transition. The implication of the current and anticipated growth patterns is that Sri Lanka's population age structure has moved towards an older configuration. The Annual additions to pre-school, school and adolescent age groups diminish gradually while the middle aged and particularly the elderly increase remarkably rapidly. The age structure of a population largely determines the allocation of resources to various services.

It has been predicted in 20 years that one out of four will be an elderly person by 2015. Sri Lanka has the fastest ageing population in the world even exceeding Japan.

Because we have a very good health system the mortality has declined. When people start living longer you have an elderly crowd. We have experienced the fertility birth rate coming down.

Population pyramid

The population pyramid, has changed. With the high birthrate - with each family had 6, 7 children it was in a pyramid shape. Sri Lanka was introduced to the family planning etc. we were trying to limit the number of children. Finally it has come to two children, a family - that is today become the replacement level. When the father and mother dies they are only being replaced with two others. With that the birthrate came down.

There is no population increase. The pyramid is thus now changing to a barrel shaped structure. The top of the pyramid is bigger. This is what has happened in the West. This is what is known as the demographic transition.

All underdeveloped countries have a pyramidal structure. But Sri Lanka may be the only country having a developing economy and a country which has a large number of elderly people. Naturally they are more prone to the NCDs.

Epidemical transition

Another change taking place is the epidemical transition, the pattern has changed. We had lot of communicable diseases, diarrhoea was rampant. There are diseases that can be prevented by giving a vaccine, tetanus, hepatitis, polio, diphtheria, measles. After the introduction of different vaccines through the very successful national Immunisation programme we were able to prevent lot of deaths and lot of diseases. Because of that communicable diseases have come down, diphtheria is very low now, not seen last few years.

Urbanisation

Lifestyle changes Urbanisation taking place, more people coming into the cities. People are suffering from stress. The children are being pressurised by the parents, for their studies. Mental problem increase due to the tension. The adults are under stress as both parents are working. With tension is more mental health problems are more, no free time the lifestyle change- transition in the lifestyles. So naturally the parents due to high pressure lifestyle make them more are prone to heart diseases and hypertension. Environmental pollution is also contributory.

Food consumption and lifestyle

Changes in the food consumption is another reason. Changes in food habits. We don't have a balanced diet. The good old days we had a balance diet, where nutrition was a priority. Dietary patterns have changed. Eating out is more often done. Less home cooking due to convenience. The lifestyle changes have changed the dietary and food habits as well. Because of all these reasons we see more of the NCDs increasing, This has been gradually happening over the years.

A huge contribution to this prevalence is due to alcohol and smoking. Smoking is directly linked to heart diseases.

The government of Sri Lanka recognises health promotion as a highly cost-effective strategy to foster a healthy nation having considered the current and projected health scenario and health issues. The Ministry of Healthcare and Nutrition have made efforts to develop a national health promotion policy in keeping with the Sri Lanka health master plan for development of health of the people in Sri Lanka.

The government, the Health Ministry has appointed a directorate, for NCDs because we have recognised NCDs is a problem about 10 years back. The Ministry of Health has developed a policy through which we started a massive advocacy and awareness, educational programme. We have taken a lot of steps; appointed medical officers at district level for screening programmes; pilot projects in Kurunegala and Polonnaruwa are on-going with WHO assistance in the Uva province. Identifying risk groups and also identifying schools overweight children and counselling them.

We have to further strengthen this to make it islandwide. There's a section already identified with these diseases. We have to initiate treatment and continue with that.

While we treat this section what is also important is prevention. We have embarked on a prevention programme. For NCDs what is important is lifestyle changes. Based on behaviour or lifestyle changes. The ministry had established an organisation called NATA National Association on Tobacco and Alcohol by an Act of Parliament four years back. Alcohol and Tobacco users are the high risk group.

Reduce the risk

This is known as lifestyle modification. This needs to be promoted collectively and the effort has to be collective to get positive results for this problem. What is the advice as a health professional on the increasing? The answer to NCD is very simple. If we can modify, change the lifestyle.

We have to identify the diseases of people at an early stage if it persists for a long time.

What more action is required to reduce the incidence of NCDs?

We need to strengthen screening. We have to promote the people to come more often for screening of the NCDs. There is no mandatory system only voluntarily. Making them aware at community level. Rather than them coming to the hospital. This screening has started in different places, pilot projects and Kurunegala with the WHO. There should be more awareness prevention we have to talk about the changing the behaviour.

The private sector involvement is very important. Healthy settings can be easily implemented.

Some legislation regulation perhaps to lower the salt level may be considered, lowering the fat content etc of locally produced food. For example Poland had to reduce prescribed intake of salt specially in those frozen food, after 10 years they have seen the statistics have come down.

Health is defined in the World Health Organisation constitution as 'A state of Complete Physical Social and Mental well-being and not merely the absence of disease or infirmity', We must strive to achieve this balance.

4.9 million people die due to tobacco use. 2.6 million people die as a result of being over weight or obesity. 4.4 million die due to high cholesterol and 7.1 million people die due to high blood pressure.

Everyday 6,000 people die due to lack of sanitation. The WHO report describes the amount of disease and death in the world today that can be prevented by adopting a healthy lifestyles.

In 2005 it was estimated that chronic diseases will account for 35 million deaths worldwide.

It is estimated that China will forgo 558 billion USD during the next 10 years as a result of premature deaths due to heart disease, strokes and diabetes.