The Holy Grail Of NCDs Is Prevention: Nalini Saligram
In a conversation with Harbinder Narula of BW Healthcare World Nalini Saligram, Founder & CEO, Arogya World talks on preventive healthcare, non-communicable diseases, the role of technology and public-private partnerships to improve healthcare in India
India has always been a reactive market in healthcare rather than preventive, how did you think about preventive health when the market wasn’t ripe before the pandemic?
Short answer is you cannot treat yourself out of the Non-Communicable Diseases (NCDs) crises, it’s just is so big 4 billion people in the world live with chronic diseases and these diseases as WHO classifies them as non-communicable, it includes heart disease, diabetes, chronic lung diseases and cancers and its so big that you cannot make available the cholesterol medicine to everybody who needs it.
But there is a smart solution to its called prevention. According to the WHO and other clinical studies as well, 80 per cent of heart diseases, 80 per cent of diabetes, and 40 per cent of cancers can be prevented by just three things, it requires us to eat right, exercise and avoid tobacco.
Indians get diabetes one or two decades earlier than the people in the west, so at the peak of their productive years, Indians are getting diagnosed with diabetes. In their 30s and sometimes in even 20s and teens they are getting type two diabetes.
And in the US and people in the west it’s the people in their 50s and 60s who get it, so 10-20 years earlier people are getting diabetes here. It was enormity of the problem that brought me to it and I knew the holy grail of the NCDs was prevention, and that if we could get behavioral change established, It would really solve the problem.
How are the NCDs affecting our healthcare system?
Diabetes and other NCDs, once you get them at age say 30, you are going to live with the disease for decades, its truly chronic, so the drain on the healthcare system is huge, one needs to visit a doctor every six months if not every three months, you need care, you need supplies, there is a real constant use of the healthcare system.
The other aspect is diabetes doesn’t stay static. It worsens overtime, you get heart disease, complication of uncontrolled diabetes are severe which are heart disease and stroke and foot amputations, kidney disease, blindness and even oral decay, so there is so many complications of diabetes.
The healthcare system itself has huge pressure from chronic diseases. So, the system has to be boasted at the primary healthcare centres but more than that I feel making prevention happen everywhere is very smart.
What do you think the government or healthcare providers need to do to have a balance between the NCDs and the communicable diseases?
Hopefully in the post Covid era that we are entering into, I think we should really promote healthy living and prevention because the country rallied around Covid, we built networks and grassroots and frontline workers, everybody pitched in the NGO sector did the private sector did, the government did and everybody rallied around this but those networks exist and now I think we should use those networks to build India back better.
So, the government should now invest in the NCDs prevention through healthy living and that’s possible because there is already such a big infrastructure built, the investment made in the frontline workers, that just the extra bit of training for them, as they go about their work in rural areas as well as other communities, they spread the word about eating right and exercise and avoiding tobacco.
I think we as people will benefit and we as generation will lead the world to a healthier place.
Do you think in a country like India where there are areas where even basic healthcare is not addressed, a public-private partnership is needed?
I am a firm believer in the power of partnerships, my non profits work a lot with partners, I personally feel that public-private partnerships are the wave of the future and that all players whether it is NGOs, private sector or the government, all must play with each other and collaborate to build India back better.
For instance, in the NGO world there are so many that do education or livelihoods or skilling, and healthy habits are something that can be taught to that adolescents, that same 12-13 year old can learn to read and learn about health at the very same time.
Health needs to be piggybacked on all sorts of networks, the onus is not only on the private sector even we as nonprofits need to learn so much from each other, because then we can transform the health of so many communities by just collaborating with each other, using infrastructure that we have built to advance our own missions, use that to advance the health of the community and the future success of all those adolescents who are coming to schools or to read.
What more do you think needs to be done to use technology to make the advances when it comes to public health?
Prevention should be tackled at the population level, so 1.4 billion people have to be able to use prevention, and one of the best and smartest tools is the mobile technology because truly it’s the most powerful public health tool there is, it is in your hands, you have to confront that message, especially if you have signed up for it, which I think is very good way to going about it to find motivated consumers, you should not thrust or force the messages on people, it will never work but if they are motivated and they sign up for it because their father has diabetes or somebody else has the kidney disease, they really want to learn more about how to improve their own health.
What would define an Arogya city. What are the parameters a city needs to surpass to become a Arogya city?
We are doing just that, establishing an Arogya city, for us, control of NCDs is one of the key parameters this year. We are trying to establish a baseline of obesity and diabetes and risk factors, physical activity levels and let’s say wouldn’t it be wonderful if we could improve the walkability score of a city, its going to have an impact. If we can screen people early, if we can provide them diabetes prevention education, and if we do this continuously with a collective society, an individual or one organisition cannot do it. But if a big number of entities make pledges and commitments and if we make those public so that people everywhere can watch than that would definitely help serve the goal.