India should focus on its health promotion policies

On the face of it, it seems that the young Indian population is healthier and has access to a wider range of health-supporting tools and techniques. Gyms and health workout spots in urban centres around the country are often chock-a-block with youth sweating it out to retain the body they crave for. Yet, recent studies say, nearly 10-30 per cent of youngsters suffer from health impacting behaviours and conditions that need urgent attention of policy makers and public health professionals. Healthy lifestyle and health promotion policies and programmes that are central for the health of youth, driven by robust population-based studies are required in India which will also address the growing tide of NCDs and injuries. Nutritional disorders (both malnutrition and over-nutrition), tobacco use, harmful alcohol use, other substance use, high risk sexual behaviours, stress, common mental disorders, and injuries (road traffic injuries, suicides, violence of different types) specifically affect this population and have long lasting impact. Multiple behaviours and conditions often coexist in the same individual adding a cumulative risk for their poor health.

Many of these being precursors and determinants of non-communicable diseases (NCDs), including mental and neurological disorders and injuries place a heavy burden on Indian society in terms of mortality, morbidity,disability and socio-economic losses. Many health policies and programmes have focused on prioritized individual health problems and integrated (both vertical and horizontal) coordinated approaches are found lacking. The rising rates of stroke in young people largely appear to be driven by things we can change. A large international study identified ten modifiable risk factors which accounted for around 92 per cent of strokes that occurred in people aged under 55 years. These factors included high blood pressure, physical inactivity, high cholesterol, poor diet, obesity, smoking, heart problems, diabetes, alcohol consumption and psychosocial factors (such as stress or poor mental health). High blood pressure alone accounted for almost half of the strokes that occurred in people aged 55 and under. Lack of regular exercise accounted for more than a third. Stroke is often seen as a condition that only normally affects older people. Yet the incidence of stroke in older people has fallen in recent decades. At the same time, rates of stroke in under-55s have been on the rise.

For instance, research found that under-55s with diabetes were about 3.5 times as likely to suffer a stroke or mini stroke as those who didn’t have the condition. Those with high blood pressure were about 2.5 times as likely. But these factors don’t explain everything. Around half of strokes in young people that were caused by a blood clot had no clear cause. Research also shows a growing number of the strokes experienced by young people have no known risk factor. Researchers are now investigating alternative risk factors, including air pollution, autoimmune conditions and illicit drug use. Stress and overworking are also increasingly being linked to a higher risk of stroke in young people. Lack of awareness is part of the problem, too. People who don’t see themselves as at risk are less likely to visit their doctor or change their lifestyle. Alongside risk factors that already go undetected, this may partly explain why stroke rates in younger adults haven’t fallen as they have in olderpeople.

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The Hans India