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Non-Communicable Diseases: Deconstructing the Leading Causes of Death Globally

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Happy Valley Tea Estate, Darjeeling

My favorite project with DLRP/Broadleaf is to conduct a needs assessment of non-communicable diseases (NCDs) among tea laborers in Darjeeling. In preparation for this project I’ve been meeting with tea estate managers, tea association members and NGOs that work with NCDs. I’ve also been conducting a literature review about NCDs in India such as heart diseases, diabetes, cancer etc., here are some highlights of this research.

Globally, NCDs are a growing public health problem. Although it was previously thought that NCDs impact wealthy countries and populations, research shows that chronic diseases are disproportionately impacting Low and Middle Income Countries (LMICs), like India. Currently, 7 out of 10 NCD related deaths occur in LMICs. NCDs also kill at a younger age in LMICs, where 29% of NCD deaths occur among people under the age of 60, compared to 13% in high-income countries.[1]

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Whereas before people in the hills would walk everywhere, now it is popular to take shared vehicles to travel even short distances. This habit is limiting people’s daily exercise.

In the next ten years, India is expected to experience more deaths resulting from NCDs than any other country. India’s rapid economic growth coincides with a rise in risk factors, such as unhealthy diet, lack of physical activity and high tobacco and alcohol use.[2] Although risk factors for NCDs are higher among urban populations, they are increasing at a staggering rate in rural populations. [3] The estimated loss of national income resulting from NCDs from 2006-2015 was 237 billion USD. [4] In India, there is not a standard national system to collect data on NCDs. There is also a lack of trained health providers equipped to navigate the growing NCD burden.[5] As a majority of NCDs can be prevented through lifestyle changes reorienting the Indian primary health care system to improve heart diseases and other NCD detection and prevention is vital.[6]

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American fast food like KFC, Pizza Hut and Dominos are all available in Darjeeling. Eating excessive processed, unhealthy foods is a risk factor for NCDs.

The Indian government added the National Program to Control of Cancer, Diabetes, Cardiovascular Disease and Stroke (NPCDCS) to National Health Mission (NHM) and is actively seeking best practices to raise awareness, education and prevention around NCDs.[7] Some researchers suggest that by training the public health workforce to deliver effective community education around NCDs paired with access to free healthcare would control the rising prevalence of NCDs.[8]India’s current health care system is reactive, which results in patients being seen when their illness is very developed and thus more expensive and difficult to treat. Due to a lack of preventative care, it often takes a very serious health event, such as heart attack, stroke, or the need to remove a limb from diabetes, to trigger medical attention.

One of the goals of our future NCD program is to counter this reactive pattern of seeking healthcare. The purpose of our needs assessment is to ensure that we understand the community’s current health situation and can structure the future program around their perceived needs and preferences. We will be surveying tea laborers about their NCD risk factors (diet, exercise, tobacco and alcohol habits) and capturing the current prevalence of diagnosed NCDs.

I based the survey questions on the WHO STEPwise approach to non-communicable disease risk factor surveillance, and translated into Nepali during my language classes. Then, my coworkers reviewed the translation to ensure it was clear and accurate. I’m currently working to finalize our partnership with one tea estate and schedule the logistics of this survey. We are hoping to survey approximately 10% of the total workforce on the estate, which ranges from 100-400 workers depending on the estate.

Due to varying literacy rates, our survey protocol is to administer the surveys verbally. Since we could be surveying up to 400 workers I’ll be working with a team of five people to conduct these surveys. I’m hoping to record the surveys digitally rather than on paper. This would be the first time a survey is done digitally at DLRP/Broadleaf and depending on its success could make digital surveying the norm, which would save on printing costs and significantly decrease the work of inputting data. Once we administer the survey we can analyze the data and start working with stakeholders to workshop a fundable NCD pilot or intervention program.

It’s really exciting that this project is moving forward. I’m learning so much about creating a public health project in India, building stakeholder relationships and the practical barriers involved in managing NCDs. I’m really excited to administer the survey and have been practicing conducting the survey in Nepali, more updates to come!

[1] “TRANSLATING BEST PRACTICES TO NEXT PRACTICES A WHITE PAPER ON PROMISING PRACTICES IN MANAGEMENT OF NON-COMMUNICABLE DISEASES IN INDIA.” The Lily NCD Foundation (2016). Population Services International. Web. <http://www.psi.org/wp-content/uploads/2017/02/Best-Practices-to-Next-Practices-Booklet.pdf>.

[2] Vellakkal, Sukumar, S. V. Subramanian, Christopher Millett, Sanjay Basu, David Stuckler, and Shah Ebrahim. “Socioeconomic Inequalities in Non-Communicable Diseases Prevalence in India: Disparities between Self-Reported Diagnoses and Standardized Measures.”PLoS ONE 8.7 (2013): n. pag. Web.

[3] Nag, Tanmay, and Arnab Ghosh. “Cardiovascular Disease Risk Factors in Asian Indian Population: A systematic Review.” Journal of Cardiovascular Disease Research (2014): 222-28. Web.

[4] Upadhyay, R. Prakash. “An Overview of the Burden of Non- Communicable Diseases in India.” Iranian J Public Health 41.3 (2012): 1-8. Web.

[5] Upadhyay, R. Prakash. “An Overview of the Burden of Non- Communicable Diseases in India.” Iranian J Public Health 41.3 (2012): 1-8. Web.

[6] Nag, Tanmay, and Arnab Ghosh. “Cardiovascular Disease Risk Factors in Asian Indian Population: A systematic Review.” Journal of Cardiovascular Disease Research (2014): 222-28. Web.

[7] “TRANSLATING BEST PRACTICES TO NEXT PRACTICES A WHITE PAPER ON PROMISING PRACTICES IN MANAGEMENT OF NON-COMMUNICABLE DISEASES IN INDIA.” The Lily NCD Foundation (2016). Population Services International. Web. <http://www.psi.org/wp-content/uploads/2017/02/Best-Practices-to-Next-Practices-Booklet.pdf>.

[8] Upadhyay, R. Prakash. “An Overview of the Burden of Non- Communicable Diseases in India.” Iranian J Public Health 41.3 (2012): 1-8. Web.

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