[Editorial] A reductionist approach

NCDs

Context

Increasing longevity, unhealthy diets and sedentary lifestyles have led to an increase in non-communicable diseases (NCDs) such as heart disease, diabetes and cancers in India, which now account for 64% of the disease burden in the country.

What the editorial is about?

Population-level interventions are missing in India’s approach towards tackling non-communicable diseases (NCDs).

Most probable and repeated topics of upsc prelims

Population health VS Health of individuals

  • Population health is more than just the health of all individuals. Suicide rates are an example of the distinction between population and individual health.
  • While every individual case of suicide has its own unique aetiology, population rates of suicides tend to display remarkable stability over time, ceteris paribus.
  • While individual and population health are inexorably linked, the causes, and thus the interventions required to address them, tend to be different.
  • Trying to improve population health with merely individualistic strategies is foredoomed to failure and inefficiency.

Individualistic policy measures

  • In the previous decade, the government acknowledged that the focus of Indian public health remained near-exclusively on maternal and child health and infectious diseases for too long.
  • The peg was proposed to be moved over to non-communicable diseases (NCD) and chronic illnesses, whose rising prevalence portends huge economic and productivity losses.
  • What followed were a set of essentially individualistic policy measures in the form of enhanced NCD screening and management infrastructure, wellness and lifestyle interventions, patient referral mechanisms, and so on.
  • What makes the array of population-level determinants of NCDs that are deeply intertwined with social, economic, and political dimensions still remain unanswered.
  • To reflect the enhanced policy attention to NCDs in contemporary times, population-level representative surveys seem to be embracing an expanded set of indicators including blood pressure and blood sugar.

The Indian approach to NCDs

  • With Health and Wellness centres, publicly financed health insurance schemes, and vertical NCD control programmes, the entire initiative to address NCDs has been subsumed into a largely biomedical paradigm with scarce vestiges of the social sciences.
  • The private sector has come to complement this with a large array of self-tests, over-the-counter products, and lifestyle-change gimmicks.
  • This is while overarching public interventions, which could also help raise much-needed revenue for health, such as sin taxes, attract hesitancy.
  • This reductionist approach rides the crest of an undue reliance on medical and healthcare professionals for all public health solutions, and a policy myopia that fails to appreciate that tackling NCDs warrants action across a range of sectors besides health.
  • The bigger menace is that this approach is entrenched in political and public health tradition.
  • This even reflects in the way it impacts our research priorities for NCDs, which remain concentrated on lifestyle and individual-level NCD determinants and solutions.

A flawed perception

  • In under-resourced systems in particular, what is readily actionable gets actioned and what isn’t so is softly swept under the rug.
  • The elusive nature of social determinants has traditionally drawn funders and policymakers towards the better defined, easily actionable, albeit short-lived and inefficient technocratic solutions to mass health issues.
  • These technocratic approaches have resulted in a flawed perception that social action for health is a high-order initiative reserved for affluent countries. The reverse is only true.
  • Developing settings like India can gain far greater health for every rupee spent, by investing in social determinants.
  • The same makes for a strong ethical case as well, by ensuring equitable distribution of such gains.

Way Forward

  • For India, NCDs will be a long-drawn challenge. With projected losses due to NCDs in the order of multiple trillions by 2030, the case for investing in inter-sectoral, population-based, socially embedded approaches is ripe.
  • This requires a total galvanisation of different departments and sectors to the importance of population health.
  • The push for digitisation must be mobilised to generate enough evidence for resolute action on social health determinants.
  • Government policy pronouncements will need to enshrine actionable points and explicit mandates to address social health determinants and political circles will have to outgrow the predominantly biomedical paradigm of health.
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