India needs to do more on hypertension: Lancet survey

Marginal increase in the number of people living with the ailment but diagnosis, treatment and control still need to catch up with best practices

India provides a mixed picture in the diagnosis, treatment and control of hypertension, finds a global survey of the ailment covering a 30-year period published by Lancet.

The number of people living with hypertension has doubled globally in the past 30 years, but the increase in India has been marginal. At the same time, diagnosis, treatment and control of the ailment in the country needs to catch up with best practices.

Doctors and scientists from the World Health Organisation, Imperial College London and University of Sydney researched the subject and authored the report. It’s the most comprehensive analysis of its kind encapsulating 200 countries.

In 1990, the prevalence of hypertension in India in the 30-79 age group was 28 per cent among men and 29 per cent among women. This rose to 32 per cent and 30 per cent, respectively, in 2019. Avula Laxmaiah, a leading scientist at the National Institute of Nutrition in India, who contributed to the assessment, explained: “A significant improvement in the diagnosis was observed from 12 per cent in 1990 to 32 per cent in 2019 among men and from 19 per cent in 1990 to 42 per cent in

2019 among women. Similarly, treatment and control levels were also significantly improved.”

“However,” he added, “diagnosis, treatment and control levels are still low when compared to developed countries.”

Among low- and middleincome countries — where detection, treatment and control have generally faltered —

Costa Rica, Chile, Turkey, Kazakhstan and South Africa are listed as exceptions and as countries that have adopted best practices. India is clearly not one of them. Hypertension among men in neighbouring Bangladesh is strikingly low.

The government under Manmohan Singh recognised the problem. “The Government of India has been implementing (the) National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) since 2010 up to district level under the National Health Mission,” Laxmaiah pointed out. “NPCDCS is focusing on awareness generation for behaviour and lifestyle changes, screening and early diagnosis of persons with high levels of risk factors and their referral to appropriate treatment facilities,” he elaborated.

He inserted a caveat by saying: “To accomplish this, there is a need to improve infrastructure facilities and (have) trained manpower at primary health centre and sub-centre levels.”

In India, healthcare has consistently been underfunded in Union Budget allocations. Narendra Modi’s philosophy, previously in Gujarat and thereafter at the Centre, has apparently been to get the job done by the private sector. Therefore, Finance Minister Nirmala Sitharaman’s “137 per cent increase” in expenditure in the health sector announced in her proposals in February unsurprisingly made headlines. She committed ~2.23 lakh crore as compared to the ~94,000 crore estimate in her 2020-2021 projection.

Dileep Mavalankar, director at the Indian Institute of Public Health in Gandhinagar, though, drew attention at the time to the figures being misleading. He cited that the allotment of funds to the Ministry of Health and Family Welfare (MOHFW) and the Ministry of Ayurveda, Yoga, Naturopathy, Unani, Siddha and Homeopathy represented only an 11.42 per cent increase. He, in fact, claimed there was an 11 per cent decrease compared to the revised estimate for 2020-2021. In other words, Sitharaman had combined disbursements to various other ministries to conjure the 137 per cent figure.

The ~36,575.50 crore or 49.47 per cent of the sum given to MOHFW was for the National Health Mission. This was a 4 per cent enhancement from the last financial year. It is under this scheme that hypertension has in the past been tackled. Yet, the National Urban Health Mission under this award got a mere ~1,000 crore. By and large, there is a shortage of primary healthcare centres or community healthcare centres — which dispense medicines at low cost — in Indian cities.

In 1990, the prevalence of hypertension in India in the 30-79 age group was 28 per cent among men and 29 per cent among women. This rose to 32 per cent and 30 per cent, respectively, in 2019