Health Statistics of Kerala

08-08-2007Back to Article

 

Health Statistics of Kerala

For a state that has excellent health statistics that can be compared to the west we in Kerala have come a long way ahead from other states in India in controlling our Infant Mortality Rates and Neonatal Death rates. All who belong to south asian origin have been, so to say - cursed with a 4 times more risk in developing vascular heart disease (Coronary Heart disease) than any one elsewhere. This fact has been very clearly demonstrated in numerous studies world wide. It is believed that “Mayo Clinic – USA” at times even advices patients of south asian origin to start taking Aspirin and Statins  tablets as primary preventive measures even when diagnosed normal, owing to this higher risk. Diabetes which complicates many diseases is also on the higher side in this country. It has already been documented that by 2010 the largest number 60% of the world heart disease and diabetic population is going to be in our country.
Our health infrastructure has a major gap in facilitating mass screening of the masses due to various reasons like 1. Shortage of health infrastructure in specific regions – cardiology and Diabetology. 2. Economic constrains of the population at large and no medical insurance cover for 90% plus of the population. This brings us to answer this question – if they cannot afford treatment, to prevent heart attacks, why screen them and put them into more mental dilemma. The enactment of this medical policy has lead to the shocking statistics mentioned below. Heart disease owing to Coronary artery disease (CAD) is completely controllable and the decreasing incidence of  CAD in the west over the last 5 decades is testimony to the most cost effective and life saving strategies that exist in modern medicine. On the other hand over the last 5 decades our incidence of CAD have gone up by more than 50%. The sole reason for this is the focus on secondary prevention rather than primary prevention and the lack of knowledge that prevention is the most economical way to treat CAD than treating the disease after it has occurred.

From Dr C. R. Soman’s article on “The Time Bomb That Ticks” January 2004 Kerala Calling.

 

There Exists an interesting statistics on the population distribution of Kerala. (Please put this table as a link – mentioning click here to look at the population statistics)

 

The following facts comes to light.

1. The infant mortality rate is very low seen from the increasing trend in population over the years upto 20 years.
2. We also see that in 2001 the 20 -30 yrs population has increased but the 40 -60 years – adult responsible population is fast dying out and the numbers are decreasing very fast.
3. This really stops us to think where we should concentrate on health care and which is the most preventable of all killer diseases leading to severe morbidity and mortality.
4. From the earlier statistics of more than 50% dying of heart disease and complicating diabetes – which are both very cost effectively controllable – the question is – Do we still need to loose our most productive population to effectively preventable diseases? What needs to be done to achieve this? Is screening every one with angiographies the right choice? Are there not more simpler cost effective ways in handling this? What did the west do to achieve this effective control?

The western world which we in India follow for most guidelines in modern medical treatment has a very good health infrastructure that what we have here. They have definitive policies and specified protocols for treating each disease. And they definitely have more cathlab facilities than what our state or country has. But they still  do not subject all to screening angiographies.

So what do they really follow.

1. Health Education.
2. Good Medical Insurance Cover.
3. Proper Screening programs.

This leads us to analyze what could be gained by effective screening and also what exactly are we looking at in terms of numbers – as prevalence (presence) of Heart Disease and Diabetes among our population. A study by Indrayan – NCMH Background Papers  : Burden of Diseases in India (Available in the WHO estimated CAD risk in India on the WHO web site) Showed the following prevalence which is quiet shocking.
 

Even if we were to assume that this study could have been grossly overestimating the prevalence by 50%, assuming the diabetics and CAD could co exist – even then the figures when substituted against the Kerala population would be enormous.

Summary

1. There exists a huge undiagnosed prevalence of Coronary Heart Disease and Diabetes which could amount to 50% of the population between 20 – 60 years, at some stage of progression.
2. 50% of patients die from their first heart attack, because they never know the symptoms and were unaware that this could happen to them.
3. Are there cost effective methods of screening if so what would they be? If you like to know more about them click here. 
4. Preventing Heart Attacks and controlling diabetes would actually decrease the mortality rate of our young adult responsible and socially productive population by 50%. This leads to better social well being of family and prevents health related economic crisis. (Specially in an environment that is very minimally covered by medical insurance). 

If you can add the above numbers into a tabular column and calculate the % and convert it to numbers and place it as 2 separate graphs for diabetes prevelance and CAD prevalence with the following caption

The actual estimated prevalence of CAD and Diabetes in different age groups in the state of Kerala. That would be much more appealing. I am not finding time to do it can you.

Please edit off the fonts typed in red.