In this post, Professor Kesavan Rajasekharan Nayar discusses complexity with respect to the public health profile of Kerala, considered as one of the healthiest states in India. This complexity is indeed worrisome and a humanitarian perspective which addresses the psychological and economic fallouts of the health scenario is required.
Societies which have been proclaimed as healthy in a comparative perspective are going through several public health crises. For instance, the Kerala society which gained ‘health without wealth’ and which attracted international attention due to its better health and demographic profile as well as better health care services is passing through health crises. While the people face the onslaught of fevers of different kinds in epidemic form during the monsoon season, they are also struck by a wave of non-communicable diseases. Without being ambiguous one can state that it is a strong wave which has affected the rich and the poor and which has swept away the economic foundation of many families. Prominent among them is Type 2 diabetes (T2DM), once a rich man’s disease but which now does not discriminate between social classes. This, along with cardio-vascular diseases and persisting seasonal communicable diseases, presents a very complex but worrisome epidemiological scenario. The Global Burden of Disease study has already identified Cardio-Vascular Disease as contributing to around 28 percent of the mortality. The state of Kerala stands high in the list of different states in India1. The State-level health policy does recognize this complexity when it identifies rising life-style diseases, recurrent outbreak of infectious diseases, geriatric and mental health problems despite its dominant economistic and curative orientation.
The studies available globally show that there is a strong association between dietary habits, especially eating out at fast food or quick service restaurants, and its impact on health. Some of the associated health outcomes include being overweight or obese, having cardio-vascular disease or diabetes, binary health outcomes with a perceived poor health status and higher body mass index 2, 3. The food culture in Kerala could be one of the contributing factors for the high prevalence of non-communicable disease, especially diabetes. This food culture has changed dramatically in recent years with more people opting for eating out and take-away joints and most of these foods can be classified as unhealthy junk food.
Our own exploratory studies show that psychological impact due to diabetes is a serious issue. Sexual dysfunction is a serious concern and people especially are worried about a reduced libido. Lack of interest in sex is an important after effect of the disease. Women who are aware of such impacts in their spouses hope to adjust to the changed scenario. Depression due to the disease is another major issue. People show disinterest in normal life-events. Some expressed an empty feeling and disorientation, and reported that for them the future is uncertain and they are constantly under tension and stress4. In addition to this, the serious economic fallout due to the high cost of treatment is also mentioned.
It is certain that there exist substantial behavioral and attitudinal components with respect to disease causation. Given the impact pattern which cuts across socio-economic strata and the social and behavioral causes, as well as outcomes which mirror the same dimensions apart from economic impacts, a technology-driven/curative approach alone may not serve the purpose of controlling the epidemic. What is needed is a humanitarian approach which can address complexities. Evidence-based counselling protocols and behavioral guidelines could be developed for this purpose.
Professor Kesavan Rajasekharan Nayar is with the Global Institute of Public Health and Santhigiri Research Foundation, Thiruvananthapuram, Kerala, India
. India State-Level Disease Burden Initiative CVD Collaborators. The changing patterns of cardiovascular diseases and their risk factors in the states of India: the Global Burden of Disease Study 1990–2016. Lancet Glob Health 2018; 6: e1339–51.
Cohen, DA and Story M. Mitigating the Health Risks of Dining Out: The Need for Standardized Portion Sizes in Restaurants. American Journal of Public Health 2014; 104 (4): 586–590.
Jiao, J., Moudon, AV., Kim, SY., Hurvitz, PM. and Drewnowski, A. Health Implications of Adults’ Eating at and Living near Fast Food or Quick Service Restaurants. Nutrition & Diabetes 2015; 5 (7): e171.
Nayar, Kesavan Rajasekharan., M Shaffi et al. The ‘Without Syndrome’: A qualitative exploration of Diabetes in Kerala. Journal of Health Systems 2017; 2 (2): http://jhs.healthequity.co.in/2017/11/the-without-syndrome-a-qualitative-exploration-of-diabetes-in-kerala/ accessed 12.11.2018