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HEART DISEASE AMONGST THE UNDERPRIVILEGED IN INDIA

by The Welthi Bureau 15th July, 2019

heart disease amongst the underprivileged in india
 Image used for representational purpose only

INTERVIEW WITH DR. RAGHU – CARDIOLOGIST, ASTER PRIME HOSPITALS

 

Q.India is poised to have the largest population in the world within the next decade. This needs to be thought of as not just “demographic dividend” as it has immense implications for the health and productivity planning for the community. What are your observations?

 

A.As a Cardiologist, over the past decade, I noticed a demographic transition that heart diseases are no longer a disease of the affluent and are increasingly afflicting the poor. Initially the urban poor, and over the last five years even rural poor, are scourged by cardiac problems. Over the same time period, I have also had the opportunity to look at patterns of heart problems in more impoverished communities across the world viz; Nigeria, Myanmar etc. Though poorer, they do not exhibit the prevalence of heart diseases which I see in my country. Their cardiovascular diseases appear decades later, and they do have resilient cardiac function. At my outreach Cath Lab in a rural setting in India, I do notice that the agricultural farmers who toiled in the fields a decade ago, were not being affected by cardiac ailments, but nowadays, it is quite common for a farmer who does not have high fat food, and doing manual jobs,to suffer from such severe heart disease.

 

I kept asking myself why this is happening in India, and have postulated that Indians are exposed to poor diet choices - especially polluted diet and heightened stress levels. Agrarian stress is also contributing to higher heart attack rates. In addition, another group of people i.e. “techies” are also exhibiting early onset of Hypertension, Diabetes, etc. I did not have the tenacity to unravel the mechanisms by conducting a research on how this is happening.

 

Q.Why are heart attacks more common amongst the poor?

 

A.A recent study from Massachusetts General Hospital, published in the Journal of American College of Cardiology, has studied this in a sophisticated way utilising PET CT - a modality that studies how your tissues are functioning in various parts of the body. It has been found that people who belong to a low socio-economic status had a heightened activity of a specific zone of brain termed amygdala. Amygdala is responsible for controlling the emotional responses to different situations. Those who are poor had increased amygdala activity, leading to increased production of blood cells into circulation. These blood cells are in fact immature and not geared to enter the body, leading to disturbances in the blood clotting mechanisms. This causes increased tendency to form blood clots not only in the heart but also brain and lower limb vessels.

This study has tremendous implications for India, where poverty is high and still rising due to increasing rich-poor disparity. In addition, pollution of environment, diet and lack of exercise spaces, will further lead to increasing Cardiovascular Disease.

 

Q. How should we deal with this issue?

 

A. At the government level, communities should be provided opportunities to work with decent wages, young graduates should begiven jobs, and a culture of entrepreneurship leading to job creation, needs to be encouraged. In addition, creation and strict implementation of adulteration laws, reducing environmental pollution and creating spaces for exercise in towns and cities with greenery are very important. Governments should leave spaces in city centres for these activities, community gyms should be opened in residential areas, and education beginning from childhood about positive diet and exercise habits should be provided. Finally, along with taxing unhealthy choices such as tobacco, fried foods and alcohol, it should provide subsidised healthy foods such as fruits, vegetables etc., at least to the poor people.

 

At an individual level, each one of us can cool down our amygdala by exercising daily, practising meditation, eating natural foods - fruits and veggies;and avoiding pro inflammatory foods such as fried foods, high salt foods like pickles, namkeens, etc.

 

Low Socio-economic status is not a choice but circumstantial. People who are disadvantaged need to aspire to keep their amygdala “cool” by choosing appropriately at the individual level and demanding governments for facilities rather than financial support. Financial ability is an extremely relative thing but choosing how to live as an individual is an absolute decision.

 

Book Appointment: Dr. C. Raghu, Cardiologist, Aster Prime Hospitals, Hyderabad

 


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