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Journal of Postgraduate Medicine, Vol. 52, No. 3, July-September, 2006, pp. 171-172 Expert's Comments Risk factors for non-communicable diseases: Getting beyond data Mathur P Division of Noncommunicable Diseases, Indian Council of Medical Research, Ansari Nagar, New Delhi Code Number: jp06057 Related articles: jp06056, jp06058 It is now well established that most of the major noncommunicable diseases (NCDs) are linked through a ′cluster′ of risk factors, and are responsible for the causation of disease. Knowledge about the distribution of these risk factors provides an opportunity to intervene. The comparatively high number of deaths in developing countries at younger adult ages (15-59 years) is a matter of concern. In India, based on current trends, it has been projected that the number of deaths from these conditions would rise from 3.78 million in 1990 (40.4% of all deaths) to 7.63 million in 2020 (66.7% of all deaths). This huge disease burden puts an enormous load on the country′s health care infrastructure. A healthy workforce is essential in the context of optimal productivity and enhanced competitiveness. Hence, the International Labour Organisation (ILO) has identified food at work as an important pillar for the social protection of workers.[1] In this issue, a study on profile of NCD risk factors in a selected industry has again highlighted the high prevalence of important risk factors. The spectrum of derangement was mostly uniform in all categories of workers, though detailed analysis with work and income profile would have been useful in understanding the ′lifestyle′determinants. The prevalence of tobacco consumption is comparable to that obtained from free living population of Gujarat.[2] Inspite of the state having a predominantly vegetable consuming population, the per capita consumption of fruits and vegetables was very low. Some of these results would be influenced by the method adopted for dietary assessments, as has been pointed out by Kaaks et al .[3] The findings point to high cholesterol: HDL cholesterol ratio, which is a bad cardiovascular risk factor. Similar results have been reported in an industrial setting in northern India.[4] This is an opportunity for discussion on the need of undertaking such activities in a ′settings′ mode. The question to be addressed is how much would the NCD risk factor profile of these workers be different from the ′free living′ population within the catchment area of the industry that are not influenced by working environment? Most of us understand that the health or ill-health of workers in an industry is related to the hazards posed by the occupational environment. Lifestyle diseases would not necessarily have much significant bearing on the work environment alone, rather their are likely to be similar to those outside the working environment. But in a way, the industrial worker is ′captive′ whose major lifestyle gets adapted to his/her work needs. Researchers have hypothesized the usefulness to study NCD risk factors, since the workers have better access to health care facilities. However, results have shown that 41.4-55% never went for a health check up. This would limit the rationale of screening these workers for NCD risk factors unless these activities are strongly linked to continuous and holistic health promotion programs. These issues have been laid down in the technical and ethical guidelines of the ILO for industrial workers.[5] Studies in such settings should develop long-term understanding with the management for implementation of effective intervention strategies to reduce the NCDs prevalence and keep them under surveillance. In absence of such strategies, each study would remain an academic exercise without influencing policy. References
Copyright 2006 - Journal of Postgraduate Medicine |
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