Published this week in the International Journal of Epidemiology, the report raises significant concerns for hundreds of millions of individuals living in rural India. The report highlights the need for the development of new health care services to address this huge new burden of chronic diseases.
In line with India’s rapid economic and societal changes, there has been a shift in focus from infectious disease. Diseases of the cardiovascular system, such as heart attacks and stroke, caused 32% of deaths in this region. Death from injury (self-inflicted injury, falls, etc) was the second most common cause (13%). Infectious diseases, such as tuberculosis, intestinal infections and HIV/AIDs caused only about 12% of deaths just ahead of cancer that caused 7% of deaths.
Dr Rohina Joshi of The George Institute said this research shows a new pattern of mortality and highlights areas that require urgent attention. “This ‘causes of death’ data is a key indicator of the health problems now facing rural India. While health systems have been designed mostly to cope with infectious diseases, we now need services that can deliver care and prevention for chronic diseases,” said Dr Joshi.
Professor Alan Lopez of The University of Queensland, who has led similar studies in Asia and Africa, said that the findings were an urgent call for action to control chronic diseases in developing countries. “Far too little attention has been devoted to preventing adult death in poor countries, in part because we have not fully appreciated how common these diseases already are in these countries,” he said.
This new research complements other recent research by The George Institute, which highlights the growth of smoking, high blood pressure, diabetes and other causes of chronic disease in this area of rural India.
“Risk factors for cardiovascular diseases such as heart attack and stroke are common in this community. We have previously shown that over one fifth of adults have high blood pressure, one quarter are smokers and abut the same proportion are overweight. We also know that the management of these risks remains poor,” Dr Joshi added.
Cardiovascular disease is the leading cause of death worldwide, accounting for more than 16 million deaths annually. The majority of these deaths now occur in developing countries such as India, where rates of heart attack and stroke have ballooned in the last few decades. In addition, because cardiovascular diseases occur earlier in life in developing regions, the economic impact is enormous. It is estimated that cardiovascular conditions will trim more that 1% from India’s Gross Domestic Product (GDP) by 2015.
The study involved 45 villages in East and West Godavari Districts of Andhra Pradesh, with a population of more than 180,000. Whilst the villages enrolled in this study are more developed than many rural regions in India, the results are seen to be indicative of the new health issues that much of rural India will face in the coming decade.
Associate Professor Bruce Neal, a Senior Director at The George Institute, explained that “These results confirm the speed with which health problems are changing in even quite rural areas of India. The growth of conditions like diabetes is going to drive a huge increase in heart disease and stroke in regions that are not well equipped to deal with such diseases,” he said.
This study of the prevalence and management of diabetes in rural India was completed as part of the Andhra Pradesh Rural Health Initiative (APRHI). This initiative is a collaboration between The George Institute and The University of Queensland in Australia, the Byrraju Foundation, the Centre for Chronic Disease Control (CCDC) and the CARE Foundation in India. Since 2003, the APRHI group has worked to identify the main health problems in the region and to develop evidence-based methods of dealing with them.
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