| PYQ Relevance: [2022] The increase in life expectancy in the country has led to newer health challenges in the community. What are those challenges and what steps need to be taken to meet them? [2020] Critically examine the role of WHO in providing global health security during the Covid-19 pandemic. |
Note4Students:
Prelims: NA
Mains: Hypertension, WHO’s HEARTS Strategy, India’s Hypertension Control Initiative (IHCI)
Mentor’s Comment: Hypertension, a major but overlooked risk factor for heart attacks and strokes, causes 10.8 million preventable deaths annually, surpassing risks like tobacco use and high blood sugar. The WHO’s 2023 report reveals that 1.3 billion adults globally have hypertension, with 46% unaware of their condition. In India, 311 million adults suffer from hypertension, triple the number with diabetes.
Let’s learn___
Why in the News?
Over the past three years, the COVID-19 vaccine has attracted significant public attention as a potential risk factor for blood clot formation, leading to sudden cardiac arrest.
| What is Hypertension? Hypertension (high blood pressure) is when the pressure in your blood vessels is too high (140/90 mmHg or higher). It is common but can be serious if not treated. Eating a healthier diet with less salt, exercising regularly and taking medication can help lower blood pressure. |
WHO Report on Hypertension
- 2023 WHO Report: In 2023, the World Health Organization (WHO) released its first-ever report on hypertension titled “Global Report on Hypertension: The Race against a Silent Killer.”
- Silent Killer: Hypertension is often called a silent killer because people are usually unaware of their high blood pressure until they develop complications.
- Leading Cause of Death: High blood pressure causes more deaths than other leading risk factors, such as tobacco use and high blood sugar.
- Rising Numbers: The number of adults with hypertension nearly doubled since 1990 to reach 1.3 billion.
- Awareness and Control: Globally, an estimated 46% of adults with hypertension are unaware of their condition, and less than half (42%) are diagnosed and treated. Only one in five adults (21%) with hypertension has it under control.
Hypertension in India
- Prevalence in India: The Indian Council of Medical Research-INdia DIABetes (ICMR-INDIAB) study estimates that in India, 311 million people (or one in every three adults) have hypertension.
- Comparison with Diabetes: In India, adults with hypertension are threefold of the estimated 101 million people living with diabetes.
Dietary Salt and Hypertension
- Impact of Excess Salt: Excess dietary salt intake (five grams or more per day) is a key risk factor for hypertension and contributed to two million cardiovascular disease deaths in 2019.
- Benefits of Reducing Salt Intake: Research shows that reducing salt intake can reduce cardiovascular disease risks by 30% and mortality by 20%.
- Salt Consumption in India: Indian adults consume on average eight to 11 grams of salt per day, which is approximately twice the WHO-recommended daily intake.
- Deaths Due to High Salt Intake: High salt intake is responsible for an estimated 175,000 deaths in India.
Hypertension across Socio-Economic Groups
- Universal Impact: Hypertension affects all socio-economic groups.
- Health Camps Findings: A Delhi-based NGO, Foundation for People-centric Health Systems, conducted 50 health camps in five localities of Delhi and Gurugram from October 2023 to March 2024, screening and treating around 12,000 people.
- Detection in Low-Income Groups: Many were women, migrant workers, and rickshaws and taxi drivers from low-income groups. A large number were found to have diabetes and hypertension, with most cases detected for the first time in these camps, indicating gaps in awareness, detection, and treatment.
| Back2Basics: India’s Hypertension Control Initiative (2021): Objective: India aims to put 75 million people with hypertension and/or diabetes on standard care by 2025. Initiation and Expansion: The IHCI, a collaborative project of ICMR, Ministry of Health and Family Welfare/Directorate General of Health Services, WHO India, and other partners, was initiated in November 2017 in 25 districts across five states and expanded to 140-plus districts of India in 2023. Strategies: IHCI follows five simple and scalable strategies implemented through primary health care: -Simplified drug and dose-specific treatment protocols for primary-care settings. -Strengthening the drug supply chain by including protocol-based drugs in the State essential drug list, forecasting drugs based on morbidity, and ensuring adequate budget allocation in annual plans. -Team-based and decentralized care. -Patient-centric measures such as dispensing 30 days of medicine during each patient visit. -Use of information systems for program monitoring. |
Programmatic Learnings from IHCI
- Access and Utilization: Nearly six years of IHCI implementation has resulted in two major learnings:
- Simple treatment protocols with fewer drugs, reliable drug supply, linking patients to facilities closer to home for follow-up, and engaging teams increase access and utilization of health services from government facilities.
- Simplified program monitoring makes performance assessment quantifiable and actionable.
- Recognition: The IHCI won the 2022 UN Interagency Task Force and WHO Special Programme on Primary Health Care Award.
Future Goals and Prevention
- Global Goals: Seventy-six million cardiovascular deaths and 450 million disability-adjusted life years (DALYs) could be avoided if countries achieve 50% population hypertension control by 2050.
- India’s Targets: An estimated 4.6 million deaths can be prevented in India by 2040 if half the hypertensive population has its blood pressure under control, helping to achieve targets under the National Health Policy and global commitments like universal health coverage.
Way Forward
- Raise Awareness: Educate the public about the risks and long-term adverse impacts of untreated hypertension. High blood pressure can affect multiple organs, including the heart, kidneys, brain, and eyes.
- Scale Up Evidence-Based Interventions: Expand successful programs like IHCI. Use strategies and lessons from such experiences to design interventions for other lifestyle diseases like diabetes and chronic kidney diseases.
- Focus on Non-Modifiable Risk Factors: Address non-modifiable risk factors such as family history, age over 65 years, and pre-existing comorbidities like diabetes and/or kidney disease. Focus on healthy adults with known non-modifiable risk factors.
- Reduce Dietary Salt Consumption: Implement strategies like “SHAKE the salt habit” under WHO’s HEARTS strategy:
- Surveillance to measure and monitor salt use.
- Harness industry to promote and reformulate foods with less salt.
- Adopt standard labelling and marketing.
- Educate and communicate to empower individuals to eat less salt.
- Support environments that promote healthy eating.
Conclusion: As hypertension continues to exact a heavy toll on global health, concerted efforts are needed to raise awareness, implement evidence-based interventions, and promote healthier lifestyles. By prioritizing hypertension control initiatives and fostering a culture of preventive healthcare, we can mitigate the devastating impact of this silent killer on communities worldwide.
With inputs from:
