Abstract
History of medicine has in its initial pages, long chapters on the havocs caused by communicable diseases, such as the small pox and plague. Improvement in living conditions along with specific measures like the vaccination enabled us to tackle many communicable diseases. Latest in the series, the SARS-CoV-2 changed the priorities in public health globally, and became the leading cause of death among infectious diseases. Tuberculosis is the the second leading infectious killer and 13th leading cause of death. Multidrug-resistant TB (MDR-TB) poses a health security threat, since only 1 in 3 people with drug resistant TB accessed treatment in 2021. Dengue and other arboviral infections have local, regional and country wide outbreaks in several places and half of the world’s population is now at risk of dengue with an estimated 100–400 million infections occurring each year. In India also, these communicable diseases are public health priorities for prevention and control. However, in terms of burden and mortality, the noncommunicable diseases (NCDs) outnumber the infectious diseases by manyfold. Noncommunicable diseases account for 74% of all deaths globally, out of which 77% are in low- and middle-income countries. Cardiovascular diseases account for most NCD deaths, followed by cancers, chronic respiratory diseases and diabetes. Together, these four groups of diseases account for over 80% of all premature NCD deaths. Health system not only gets overburdened by the NCDs, but they increase the morbidity and mortality due to communicable diseases, especially when there are outbreaks of dengue and leptospirosis. Prevention and control of noncommunicable diseases is the top public health priority for India; through interventions to reduce the tobacco use and harmful use of alcohol and to improve physical activity and healthy diets. Healthy diets are costlier and less appealing in general; hence proactive measures are needed from governments to improve health literacy and to strengthen and reorient the public distribution system, so that deserving population has access to healthy food. High blood pressure has the highest attributable risk for mortality, followed by raised blood glucose and overweight and obesity. We also need to have systems in place to screen for these to facilitate early diagnosis and treatment. In this issue of Indian Journal of Clinical Medicine, we have three original articles; viz COVID mortality in India, estimation based on civil registration; nutrition assessment in chronic kidney disease patients; and adrenal insufficiency associated with low high-density lipoprotein (HDL) in patients of chronic liver disease.
Chronic diseases often necessitate long term medications. The 76th World Health Assembly (WHA), which concluded in Geneva in May 2023, expressed concern over out-of-pocket spending on health catastrophically, which affects a billion people and pushes hundreds of millions of people into extreme poverty. Another notable outcome of the WHA is that the member nations agreed upon a ‘Global framework for integrating well-being into public health utilizing a health promotion approach’. The focus areas are universal health coverage, equitable economies, protecting the planet, social protection systems, digital systems to enable health, and measuring and monitoring well-being. India needs to invest more in mental health. The road to wellbeing is long and complex, but let's strengthen the social determinants of health and implement time bound frameworks for prevention and control of both communicable and non-communicable diseases, with focus on equity and access.