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EDITORIAL
Year : 2014  |  Volume : 58  |  Issue : 3  |  Page : 143-146  

Implication of the Seoul declaration on public health of India


1 Professor, Department of Community Medicine, Maulana Azad Medical College, New Delhi and Secretary General, Indian Association of Adolescent Health, India
2 President, Indian Public Health Association, Professor and HOD of Community Medicine, Pinnamaneni Siddhartha Institution of Medical Sciences and Research Foundation, Chinoutapalli, Gannavaram Mandal, Andhra Pradesh, India

Date of Web Publication13-Aug-2014

Correspondence Address:
Jugal Kishore
Professor, Department of Community Medicine, Maulana Azad Medical College, New Delhi and Secretary General, Indian Association of Adolescent Health
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-557X.138614

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How to cite this article:
Kishore J, Kumar J R. Implication of the Seoul declaration on public health of India. Indian J Public Health 2014;58:143-6

How to cite this URL:
Kishore J, Kumar J R. Implication of the Seoul declaration on public health of India. Indian J Public Health [serial online] 2014 [cited 2019 Nov 20];58:143-6. Available from: http://www.ijph.in/text.asp?2014/58/3/143/138614

Observing epidemiological transition of various diseases throughout the world, it is quite apparent that the burden of noncommunicable diseases (NCDs) is a major concern. In this era of globalization, developing countries, including India cannot remain untouched from the threats and major developments in the field of international health and NCDs.

The fifth Asia-Pacific Conference on Public Health was organized with the theme "Multidisciplinary Approaches to Emerging Challenges" in Seoul, Korea on April 10-11, 2014. Considering the growing burden of NCDs, in Asia, the Seoul Health Declaration [1] on NCD prevention and control was proposed, whereby an emphasis was placed on the need for a "multi-sectoral, whole-of-government and whole-of-society approach to stem the "rising tide of lifestyle-related diseases" by providing strong and sustained political support for NCDs prevention and control, ensuring a supportive government policy environment and a coordinating mechanism to mainstream the response to NCDs, reducing the common modifiable risk factors, strengthening and integrating health systems to ensure that NCDs prevention and control is part of a funded, coherent, balanced, realistic and comprehensive health planning process, prioritizing human and financial resources and infrastructure to ensure equitable coverage of evidence-based NCDs prevention and control interventions and providing integrated, but practical monitoring and accountability systems and a small number of quantified, timed targets and indicator to assess progress nationally.

The Seoul Health Declaration has significant implications on India's strategy for prevention and control of NCDs because of its location in Asia and its disease contribution to the whole world. The Seoul Health Declaration comprises of the problem statement in the region and 11 articles specify actions, which are as follows:


   At the Local and National Level Top


Preventing and controlling NCDs by:

1. Increasing, prioritizing and supporting multi-sectoral action on preventing and controlling NCDs by reducing the risk factors: Alcohol use, unhealthy diets, tobacco use and physical inactivity

2. The health sector is working in collaboration with other sectors such as the environment, education, transportation, food industry and others to ensure a healthy environment for the public

3. Increasing health education, especially to the aging society, to reduce the impact of chronic disease to the elderly and creating exercise-friendly environments to motivate toward active and healthier lifestyles

4. Establishing and mobilizing action for food and beverage advertising that targets the priority population, especially children, promoting positive and healthy messages on dietary practices and physical activity, through civil society organizations that are independent of fast food industry advocating effective food, drug and alcohol control policies

5. Increasing awareness and understanding of the burden of suicide and attempted suicide by integrating, nongovernmental organizations (NGOs), nonprofit organizations, community health and social services for both suicide prevention and advocacy, through counseling services, help lines, research, conceptualizing and implementing public education programs and working with media

6. Supporting, and strengthening evidence-based prevention outlined in World Health Organization (WHO) global strategy-restrict access to means of self-harm/suicide, develop policies to reduce harmful use of alcohol as a component of suicide prevention, assist and encourage the media to follow responsible reporting practices of suicide, gatekeeper training, identification and treatment of mental disorders, management of persons who attempted suicide or who are at risk, monitoring and evaluating intervention should be evaluated-in order to protect those at risk from suicide.


   At International Level Top


7. Improving the social condition of new mothers and new-born by eradicating extreme poverty and hunger through economic empowerment, inexpensive public health intervention, newborn care, breast-feeding, immunization, clean water and sanitation in the poorer countries of the region

8. Mobilizing global and regional movements and support of civil society groups and organizations for economic empowerment for the poor nations whose high-mortality rate is linked to poorer socioeconomic condition

9. Prioritizing critical issue of air and water quality and human health, with a need for more effective framework to manage ecosystem services, such as air and water that go beyond administrative and political boundaries

10. Dampening the rise of inequality by prioritizing the advancement of universal care, in the face of the challenges of aging populations, globalization and rapid economic growth

11. We, the Public Health Associations of the Asia-Pacific region, please communicate and promote the Seoul Health Declaration to our respective national public health communities.


   Current Scenario of Burden of Diseases in India Top


Noncommunicable diseases are the leading cause of deaths globally. Available data demonstrate that nearly 80% of NCD deaths occur in low- and middle-income countries. [2] NCDs are emerging at epidemic pace especially in developing countries. Worldwide, NCDs currently represent 43% of the burden of disease and are expected to be responsible for 60% of the disease burden and 73% of all deaths by 2020. Over a period of 30 years, the burden of disease from NCDs is expected to rise by more than 60% by 2020 in developing countries as compared with a rise of <10% in developed countries. [3] According to WHO statistics for 2011 in India, NCDs, including cardiovascular disease (CVD), cancer, diabetes are estimated to account for 53% of all deaths and 44% of disability-adjusted life years, respectively in India. [4],[5]

The global burden of diseases study reported that the mortality from coronary heart disease (CHD) in India was 1.6 million in the year 2000. [6] A total of nearly 64 million cases of CVD are likely to occur in the year 2015, of which nearly 61 million would be CHD cases. Deaths from this group of diseases is likely to amount to be a staggering 3.4 million. [7] India leads the world with the largest number of diabetic subjects earning the title as "diabetes capital of the world." According to expert opinion the number of people with diabetes in India is likely to rise to 69.9 million by 2025 and to 79.4 million by 2030. [8] In India, hypertension is the leading NCD risk and estimated to be attributable for nearly 10% of all deaths. [9] Adult hypertension prevalence has risen dramatically over the past three decades from 5% to between 20% and 40% in urban areas and 12% and 17% in rural areas. [10],[11] The number of hypertensive individuals is anticipated to nearly double from 118 million in 2000 to 213 million by 2025. [11]

Cancer and mental disorders are also rising at an alarming pace in India. Cancer burden will rise more rapidly with ageing populations and changes in lifestyles associated with economic development. Cancer mortality in India is around 0.55 million in 2010. More than 30% of can be prevented. [12] A study conducted by National Commission on Macroeconomics and Health stated that at least 6.5% of the Indian population had some form of the serious mental disorders, with no discernible urban-rural differences and women having slightly higher prevalence as compared to men. [7]

The modifiable behavioral risk factors such as dietary habits, physical activity levels, tobacco, and alcohol abuse and high-stress levels precipitate the development of physiological risk factors such as obesity, raised blood pressure, deranged blood glucose and dyslipidemia leading to the ultimate progression to disease outcomes like CHD, stroke, diabetes, etc. [13]

Smoking, a major risk factor for NCDs, is already responsible for one in five deaths among men and one in 20 deaths in women. Tobacco accounts for almost 6 million deaths every year (including over 0.6 million deaths from exposure to second-hand smoke), and is projected to increase to 8 million by 2030. About 3.2 million deaths annually can be attributed to insufficient physical activity.

Approximately, 1.7 million deaths are attributable to low fruit and vegetable consumption. Excessive intake of saturated fats, refined sugars, trans-fatty acids, is associated with obesity, hypertension, CVDs and diabetes. Half of the 2.3 million annual deaths are from harmful drinking. [14]

About 1 million people commit suicide every year worldwide, global mortality rate of 16 per 100,000, or one suicidal death every 40 s. [2],[3],[15],[16] Worldwide, suicide rates have increased by 60% over the last 50 years, and the increase has been particularly marked in developing countries. In India, total 0.384 million accidental deaths occurred in the country during the year 2010. A total of 0.678 million cases of "un-natural accidents" caused 0.359 million deaths and rendered 0.503 million people injured during 2010. [17] China, India and Japan-because of their large population-may account for up to 40% of all world suicides. [2],[15] 0.134 million in the country lost their lives by committing suicide during the year 2010, that is, 15 Suicides took place every hour. [4],[17] It was found that higher percentage of school adolescents seriously contemplated suicide and made an attempt to commit suicide. [9],[18]


   Implication of the Seoul Health Declaration on India Top


Considering the increasing burden of NCDs and common risk factors to major NCDs, Government of India initiated an integrated National Program for Prevention and Control of Cancers, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS). The focus of the program is on health promotion and prevention, strengthening of infrastructure including human resources, early diagnosis and management and integration with the primary health care system through NCD cells at different levels of health system. For measuring trends and pattern of NCDs, NCD surveillance survey has been started in the whole country. Similarly for measuring pattern of cancer, the national cancer registry program was started. The NPCDCS still suffers from weaknesses like no involvement of chronic respiratory diseases, limited involvement of academicians, NGOs and weak health infrastructure. As specified in the Seoul Declaration health promoting activities should be initiated at the community level meaning more risk reduction in schools, colleges and offices; having playgrounds, parks, and places for other recreational activities; change in diet patterns particularly increased consumption of vegetables and fruits and reduction of alcohol and tobacco use. To achieve this health sector has to work with other sectors like the environment, education, transportation, food industry and others to ensure a healthy environment for the public (Article 3). Our policy making and legislative bodies should be proactive for the health sector (Article 4). In younger population self-harm and injuries would be the major cause of disease burden, which should be dealt with WHO global strategy (Articles 5 and 6). For maternal and child health problems, sanitation, environmental pollution declaration has suggested international cooperation and support to poor and developing nations (Articles 7-10). Last article is very significant for all public health associations in the region for their active role in achieving the declaration.


   Recommendation Top


The Seoul Health Declaration stated the problem in region and strategy, which need to be strictly implemented particularly in India by involvement of intergovernmental agencies, NGO networks, national and local governments, academia, civil society, professional organizations, communities, and individuals, at all level. All nations in the region should join hands for collective action to make the declaration a reality.

 
   References Top

1.Available from: http://www.kpha.or.kr/board/view.php?p_code=view&p_mbs=01-01&p_mid=1&p_pkid=1572. [Last accessed on 2014 May 10].  Back to cited text no. 1
    
2.Global Status Report on Non Communicable Diseases 2010. Available from: http://www.whqlibdoc.who.int/publications/2011/9789240686458_eng.pdf. [Last accessed on 2014 May 10].  Back to cited text no. 2
    
3.World Health Organization NCD Surveillance Strategy. Available from: http://www.who.int/ncd_surveillance/strategy/en/. [Last accessed on 2014 May 10].  Back to cited text no. 3
    
4.NCDs Country Profile. 2011. Available from: http://www.who.int/nmh/countries/ind_en.pdf. [Last cited on 2014 May 10].  Back to cited text no. 4
    
5.World Health Organization. Report on Preventing Chronic Diseases: A Vital Investment. Geneva: WHO: 2005. Available from: http://www.who.int/chp/chronic_disease_report/en/. [Last accessed on 2012 Aug 02].  Back to cited text no. 5
    
6.Murray CJ, Lopez AD. Mortality by cause for eight regions of the world: Global Burden of Disease Study. Lancet 1997;349:1269-76.  Back to cited text no. 6
    
7.Burden of Disease in India. Background Papers for the National Commission on Macroeconomics. New Delhi: Ministry of Health and Family Welfare, Government of India; 2005.  Back to cited text no. 7
    
8.Mohan V, Sandeep S, Deepa R, Shah B, Varghese C. Epidemiology of type 2 diabetes: Indian scenario. Indian J Med Res 2007;125:217-30.  Back to cited text no. 8
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9.Patel V, Chatterji S, Chisholm D, Ebrahim S, Gopalakrishna G, Mathers C, et al. Chronic diseases and injuries in India. Lancet 2011;377:413-28.  Back to cited text no. 9
    
10.Gupta R. Trends in hypertension epidemiology in India. J Hum Hypertens 2004;18:73-8.  Back to cited text no. 10
[PUBMED]    
11.Srinath Reddy K, Shah B, Varghese C, Ramadoss A. Responding to the threat of chronic diseases in India. Lancet 2005;366:1744-9.  Back to cited text no. 11
    
12.D′Souza ND, Murthy NS, Aras RY. Projection of burden of cancer mortality for India, 2011-2026. Asian Pac J Cancer Prev 2013;14:4387-92.  Back to cited text no. 12
    
13.World Health Organization. Quantifying selected major risks to health. In: The World health reports 2002: Reducing risks, promoting health life. Geneva: World Health Organization, 2002. Available from: http://www.who.int/whr/2002/en/whr02_en.pdf [Last accessed on 2014 July 25].  Back to cited text no. 13
    
14.World Health Organization. Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013-2020. Geneva: WHO; 2013.  Back to cited text no. 14
    
15.WHO. World Suicide Prevention Day 2008. Geneva: WHO; 2008.  Back to cited text no. 15
    
16.WHO. Mental Health: Suicide Prevention (SUPRE). Available from: http://www.who.int/mental_health/prevention/suicide/suicideprevent/en/. [Last accessed on 2014 May 10].  Back to cited text no. 16
    
17.National Crime Records Bureau, Ministry of Home Affairs. Accidental Deaths & Suicides in India 2010; NCRB, Ministry of Home Affair, New Delhi; 2011.  Back to cited text no. 17
    
18.Sharma R, Grover VL, Chaturvedi S. Suicidal behavior amongst adolescent students in south Delhi. Indian J Psychiatry 2008;50:30-3.  Back to cited text no. 18
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