Health is overmedicalized said someone on a panel I was recently on, and I agree. It is.
We expect the doctor to help the patient who needs urgent medical care and take care of people with chronic diseases such as diabetes, monitor blood sugars every quarter and adjust the medicines they may be on. But isn’t it true that a lot of what keeps our bodies physically healthy and our minds at ease, can easily be delivered to us outside the health system, right in our homes or on our phones?
We know from the WHO that noncommunicable diseases are largely preventable, that 80% of heart disease and type 2 diabetes and 40% of cancers can be prevented with 3 lifestyle changes – one must eat right, increase physical activity and avoid tobacco. NCDs are not inevitable – they are preventable. But the big task at hand is to make prevention accessible.
Community-based approaches make sense
We believe NCD prevention can be taken to people right to their doorstep, where they live, learn and work, to adolescents, men, and women, in schools and workplaces, on mobile phones and on social media, in urban and rural India. We call this approach the Doorstep Health model. Doctors and nurses are overworked and don’t have time to give lifestyle advice. But healthy living is very important and can help us prevent NCDs and also improve our mental health. This community-based approach makes prevention accessible while allowing the country’s limited and precious healthcare capacity to focus on taking care of those who need urgent medical attention.
Doorstep Health is an idea whose time has come. In recent times we have learned of the bizarre links between diabetes, a noncommunicable disease and COVID, a highly infectious one. We have learned, often noting this within our own close family and circle of friends, that people with underlying diabetes and hypertension are the ones most likely to get severe COVID disease, the ones to need hospitalization, and ICU care and unfortunately the ones least likely to survive. So prevention of NCDs through healthy living has become more urgent and important now than ever before. We need to all lead healthy lives, eat simple home cooked balanced meals, and eat more fruits and vegetables, less fried food. This can also help us boost immunity, become more resilient and be better prepared to withstand the next pandemic. We must all become physically active – and that is a habit that starts young.
We must start young
We know for example that 3 out of 4 teens in India don’t move enough (WHO study) and 10% of our children are pre-diabetic. That is indeed alarming. Surely something can be done. We must get children to go out and play, do chores at home and use their pester power to get their families to buy less junk food each week. Let us get our children educated and empowered so they grow up to be healthy, productive, grounded, global citizens.
And educate adults
Consumers are confused about what to eat shuttling between low carb and low fat and high protein diets, not sure if they should experiment with intermittent fasting. It’s time to educate and empower young Indians about what to eat and in what quantities, and get them engaged in regular physical activity. We must commend the efforts of the Food Safety and Standards Authority of India for their Eat Right campaign and the Aaj se Thoda Kam ads that goad us to eat just a little less sugar and salt every day.
Social media and mobile phones are wonderful ways to reach young Indians about prevention, at the population level. Not only will this help individuals prevent NCDs, boost immunity and better withstand the consequences of COVID, it will also help us be grounded and improve our mental health and well-being. In fact, mental illness is one of the biggest long-term fallouts from COVID – there is more overt anxiety now and greater demand for therapy and prescriptions due to greater isolation, uncertainty about futures and jobs, anguish from watching loved ones suffer and die from COVID. Workplaces are increasingly recognized as ideal platforms for promoting health in the real world, for taking care of both the physical and mental health of employees. In COVID times, health has become a key pillar of workplace strategy and is discussed everywhere, from the boardroom to the factory floor.
India is hard-hit by NCDs.
More than 2/3 deaths in India are due to NCDs, and India is a diabetes capital. 77 million live with diabetes and an equal number are undiagnosed and perhaps a larger number pre-diabetic. Also in metros, up to 3 out of 4 adults are either diabetic or pre-diabetic. Moreover, Indians get the disease very early, often by age 30, some 10-20 years before people in the West. And the country is young – the median age is 27 years. So over the next few years, very large numbers of young people will get to age 30 and have a higher risk for developing diabetes. The demographic dividend may very well become the demographic disaster unless we act now.
Prevention is Smart
How can we treat our way out of this seemingly intractable crisis? Prevention at the population level, that does not demand healthcare resources, is the smart solution. The community-based Doorstep Health approach is therefore very exciting, and is being used by Arogya World, (www.arogyaworld.org) the NGO I founded more than 10 years ago. Key elements include –
- Reach adolescents in the school setting (the Healthy Schools program has shown 15% impact being validated with Stanford CARE),
- Young adults in the workplace (evidence from our Healthy Workplace program includes increased gym use, improved biometric data etc),
- Reach people on their mobile phones with text messages and voice calls (Arogya World’s mDiabetes program has shown 20% improvement in multiple health behaviors known to prevent diabetes),
- Leverage social media to educate people on healthy eating (reach for our
MyThali program is in millions and is being confirmed with NielsenIQ).
This surround sound, multi-pronged community-based approach is showing traction and fills me with hope. Do follow us to keep track of our progress.
Tackling NCDs is a must for our country to become a stronger nation, to have a healthy productive workforce, maintain our role as an economic powerhouse on the global stage and meet our SDG commitments especially SDG#3 – health and well-being for all. The Doorstep Health approach looks promising and can help India truly build back better after COVID.
Views expressed above are the author’s own.