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 .
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