Response to “Health economics in India: The case of diabetes mellitus”

Sir,

Diabetes (predominantly type 2 diabetes), has become a major health challenge of the twenty-first century, together with other noncommunicable diseases (NCDs). It ranks highly on the international health agenda as a global pandemic and as a threat to human health and global economies.[1] China and India are the two nations leading the burden of diabetes. While diabetes has been recognized as a global pandemic, it is India and China, top-two most populated nations, has been also in the forefront of bearing the major brunt of the disease. How well the two countries tackle this burden is a point to ponder with. The following quote from a recent editorial in Lancet “It is to China's credit, in foreseeing the challenge of non-communicable diseases, the country is working towards universal health coverage. By contrast, the absence of a universal system that enables access to care in India, where the number of people who have diabetes is set to grow from 65 million in 2013 to 109 million in 2035, will inevitably lead to productive lives cut short by diabetic complications”,[2] has underscored the basic difference of approach of the policymakers of the two countries and puts a serious question mark on the credibility of health care system in tackling the diabetes burden in India.

In this context the editorial by Sahay et al. is important to ignite this issue for discussion for the better future of India.[3] The editorial starts with “Interdisciplinary exchange”. The United Nations (UN) and the World Health Organization (WHO) have called for a 25% reduction in mortality by 2025 from NCDs among persons between 30-70 years of age, in comparison with mortality in 2010, adopting the slogan “25 by 25”.[4,5] 80% of all NCD deaths occur in low and middle-income countries. 80% of deaths from NCDs were accounted by four disease clusters, viz. Diabetes, cardiovascular diseases, cancers, and chronic pulmonary diseases. Tobacco use, excessive alcohol consumption, poor diet, and lack of physical activity are the four major behavioural risk factors that contribute to the development of NCDs.[6] To be comprehensive, a program for the prevention and control of NCDs must integrate policies to provide health services focused on early detection, as well as cost-effective management of NCDs and their risk factors. For this to be successful, an integrated, multi disciplinary approach to the prevention and management, irrespective of cause, is needed. The professional societies like Endocrine Society of India, Research Society for Study of Diabetes in India, Association of Physician of India, and other societies representing stakeholders from the broad domain of metabolic, nutritional and cardiovascular disorders, these should periodically review the situation, carry out integrated research, and formulate timely and beneficial strategies in conjunction with representatives from Government of India.

It is crucial that in the future, groups with a common purpose communicate and complement each other to maximise the benefit by using the best each organization has to offer. Though, a thorough economic analysis takes place in developed countries and to some extent in developing countries, different health care budgets and different reimbursement policies makes it imperative to take on studies or analysis from nation's perspective as is highlighted by authors.

Another debatable point is economical considerations regarding efforts on prevention vs treatment of diabetes. An inexorable and unsustainable increase in global health expenditure attributable to diabetes makes prevention of diabetes essential. But diabetes tsunami cannot be stopped by disease prevention alone. Lifestyle programs can prevent type 2 diabetes in high risk people, but the widespread practicality of these programs is doubtful, unless communities and governments become involved.[7] The National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) of India is a positive step in this regard. It aims to promote healthy lifestyle through massive health education and mass media efforts, opportunistically screening persons (over seventy million) above the age of 30 years for diabetes and hypertension, establish NCD clinics, develop trained manpower, and strengthen tertiary level health facilities.[8] But to make it effective and sustainable in future, there will be need for more efforts from experts across the specialities. The march leading us to the capital of diabetes should be put to an end, and journey for becoming the capital care of diabetes should begin.