Heart disease and stroke kill about 17.2 million people each year. Over 80 per cent of these deaths now occur in the low and middle income countries.
Even as age standardized death rates due to these cardiovascular diseases are declining in high income countries,they are rising sharply in the low and middle income countries.
In India too,heart disease and stroke have become major killers,accounting for about a third of all deaths. Nationwide,they now form the leading cause of death. While clearly manifest in urban areas,rural areas too are becoming increasingly vulnerable as the undesirable effects of urbanisation penetrate rural life. In India,many of these deaths occur at a much younger age than in high income countries.
It has been estimated that India lost 9.2 million potentially productive years of life due to cardiovascular deaths occurring in the 35 to 64-year age group,in 2000. This was 570 per cent more than the corresponding figure in the US and 40 percent more than China.
By 2030,the estimated annual loss of productive life years due to premature cardiovascular diseases in this age group would be 17.9 million in India (940 per cent more than the US and 73 per cent more than China).
Deaths and disability due to cardiovascular diseases also extract a huge economic price. The World Health Organization estimated that India lost $9 billion worth of national income due to heart disease,diabetes and cancer.
For 2006-2015 period,the cumulative loss due to these diseases was projected to be $237 billion. At the level of the individual and family too,the consequences can be disastrous.
A recent study in Kerala revealed that about 73 per cent of cardiovascular disease related hospitalisation suffered catastrophic health expenditure,50 per cent had to resort to distress financing and 40 per cent lost sources of income.
The prevention of cardiovascular disease is,therefore,an urgent public health priority. This requires a multi-component strategy that integrates policy measures for tobacco control (such as raising tobacco taxes,banning advertisements and mandating smoke-free public places),promotion of healthy diets (such as reducing salt,unhealthy fats and sugar in processed foods and increasing availability of vegetables and fruit) and physical activity (such as urban design which provides for pedestrian paths and cycling lanes).
Combined with communication to increase health literacy,such measures will enable people to make and maintain healthy living choices. These must be supplemented by health service provisions for early detection and effective treatment of conditions that increase the risk of cardiovascular diseases.
These include high blood pressure,diabetes,overweight,high levels of several blood fats (especially cholesterol) and the tobacco habit.
Several researches have shown that adoption of a healthy lifestyle,supplemented when necessary with appropriate medication,can greatly reduce the risk of death from heart attack or stroke.
The worksite provides an excellent setting for implementing such health promotional policies and healthcare provisions. Whether employed in small-scale offices or large-sized industries,people spend a large part of their waking time at work.
Health education can easily be imparted in such places,through simple messages,without disrupting work.
Smoke-free norms at worksites,healthy food choices in canteens and exercise-friendly stairways and recreational facilities will transform the workplace into a health friendly area.
Such a caring environment will also greatly reduce work stress.
Since many of the industries provide medical services on site,screening for risk factors of cardiovascular diseases can be routinely incorporated. Timely detection and effective therapy for these risk factors will prevent serious health problems and protect productivity. It will also save healthcare costs,which can otherwise be huge,whether borne by the employer or employee.
Evidence that workers are at high risk and worksite health promotion programmes work well to reduce that risk is available from India too.
From 2001 to 2003,a group of researchers I led conducted an extensive survey of 20,000 employees and their family members in ten industries spread across India. The findings were shocking: in this relatively young population of workers (all categories of staff with an average age of 40 years),51 per cent of men and 52 per cent of women were overweight; abdominal obesity was noted in 31 per cent of men and 33 per cent of women; 40 per cent of men and 15% of women consumed tobacco and 40 per cent of men and 34 per cent of women had elevated blood fats.
Overall,27.7 per cent had hypertension but 60 per cent of them were unaware they had it. Similarly,10.1 per cent were found to have diabetes but 48 per cent of them were unaware.
We followed up with a worksite wellness programme,which included policy and education measures to encourage healthy diets,physical activity and restrictions on tobacco use as well as clinical guidelines for detection and management of CVD related risk factors and health problems.
Six industries participated in this programme,while one remained a control site where routine services continued.
When this programme (2003-2007) was evaluated,we found that the worksites which participated revealed a 25 per cent reduction in tobacco use,doubling of physical activity,and 54 per cent reduction in extra salt use. Measured blood pressure,blood sugar,blood fats,body weight and waist circumference levels improved significantly in comparison with the worksite which did not participate in the programme.
The cost of this highly-effective programme was Rs 350 per year per worker. Surely most employers can afford to spend that much to protect their workers and benefit,in return,through increased productivity and reduced absenteeism and healthcare expenditure. With international evidence and Indian experience pointing to the health,economic and social benefits of worksite health promotion programmes,it is time that India Inc. steps up its efforts to make health at the worksite a policy priority and operational reality.
The writer is President,Public Health Foundation of India and chairs the Advisory Board of the World Heart Federation