Lifestyle medicine approaches to reduce the burden of non-communicable diseases in South-East Asia

By guest contributors Dr. Rabbanie Tariq and Dr. Amar Saeed

Non-communicable diseases (NCDs) are a major cause of morbidity and mortality in Southeast Asia and more specifically in India. In 2018, NCDs accounted for 75% of all deaths in the region. The main risk factors for NCDs in the region are poor diet, physical inactivity, tobacco use, and alcohol consumption and the prevalence of these risk factors is bound to increase due to various factors such as urbanization, economic inflation, changes in lifestyle, and globalization.

To decrease the impact of NCDs in India, promoting traditional dietary patterns in a contemporary manner is one of the most useful lifestyle medicine strategies. Generally, traditional diets in this region consist of plant-based foods which are typically rich in fibre, vitamins, and minerals while being low in saturated and trans fats. Nevertheless, due to economic inflation there have been negative effects on the diet and nutrition leading to reduced food quality. This has led to an increase in the prevalence of NCDs in the region. 

A mixed model approach of health policy interventions can be used to promote health and reduce the risk of NCDs. These can include conventional forms of lifestyle practices at a population level through walking pathways, bicycle tracks and open gyms which have proven beneficial, and, traditional forms of physical activity can be an effective way to increase physical activity levels and reduce the risk of NCDs in the region.

Tobacco use and alcohol consumption are other major risk factors for NCDs. In many parts of this region, smoking is still widely accepted and is associated with socio-cultural norms, and alcohol consumption is associated with social gatherings and celebrations. Therefore, culturally appropriate interventions to reduce alcohol consumption and address the socio-cultural factors that contribute to alcohol consumption, and appropriate smoking cessation programs that address the social and cultural norms are crucial to reducing the burden of NCDs. These interventions and programs can include educational campaigns that address the social and cultural factors that contribute to these behaviours targeting the current and future vulnerable population easily exposed to poor lifestyles.

Launching open-access, single-cloud-based apps from large credible organizations like government, World Health Organization to raise awareness and capture lifestyle data would help bring data driven approach to lifestyle modifications at a population level which would be a real time data for supporting decision making for the health policies as well as devising strategies. The commonly used approach being the dedicated funds for NCD prevention has to be augmented by social insurance funds, municipality taxes, alcohol and cigarette taxes, while setting up an independent body which coordinates and creates a pool of funding allocation via various sources responsible for increasing burden of NCDs by following a joint budgeting yet flexible funding within health systems. 

Evidence shows NCDs are now on the rise among people of lower socioeconomic status, threatening to make them vulnerable to catastrophic health expenditure, in addition to life-long morbidity and increased mortality. Further, many NCDs go unreported due to lack of clinical symptoms and are deeply related to individual lifestyle and habits. Hence, allopathic evidence-based lifestyle medicine clinics at primary healthcare even in a distance mode is the preferred choice to focus on health prevention and facilitate early screening and pragmatic lifestyle modifications. Identifying implementation gaps in health policies and establishing mechanisms to reinforce already devised strategies is one of crucial steps that needs considerable attention. With the rollout of the National Programme for Non-Communicable Diseases in India, challenges remain for programme implementation; while the current government guidelines indicate sensitization of programme managers in integration of service for effective NCD management. It lacks a proper plan of action in the implementation of prevention and lifestyle modifications. Frontline health workers are not adequately trained in the standards of referral and follow-up for individuals suspected, newly diagnosed, or already diagnosed with NCDs. Although training manuals are available for program managers, comprehensive training for designing and implementing NCD care programs is yet to be provided to program managers across India.

The NCD program should adopt an integrated approach that encompasses community-based lifestyle medicine which aims to promote health, reduce risks, and ensure that healthcare providers and facilities are adequately prepared to provide effective treatment, management, and rehabilitation. Valuable lessons and strategies from existing programs, such the Detect-Treat-Prevent-Build strategy used in the National Tuberculosis Elimination Program (NTEP), can be adapted. Additionally, a trained multidisciplinary team, led by an allopathic Lifestyle Medicine Physician, the use of fixed-dose combinations of drugs, similar to TB drugs, could be implemented in primary care settings. Building a robust support system ,ensuring a continuous supply of medicines, sufficient staffing, ongoing capacity building of the primary care team in NCD care competencies, supportive supervision and mentoring, and a strong data monitoring system, drawing from the TB program.

Implementing an evidence-based lifestyle medicine approach that includes effective screening and addressing root causes will aid in early detection and management of NCDs and identification of high-risk groups within the community. Active engagement with the community is critical, and behaviour change communication activities focusing on NCD risks and prevention strategies are vital for the success of the Lifestyle Medicine program.

Ultimately, investing in NCD prevention and care is an investment in the future health systems, offering significant returns, as long as these investments are made wisely.

About the authors:

Dr. Rabbanie Tariq is a Consultant of Community Medicine, with expertise in epidemiology, implementation research, health protection, cancer prevention, and public health emergency preparedness. He leads initiatives in preventive oncology, disease surveillance, lifestyle medicine and health systems strengthening, and is actively engaged in national and international research, capacity building, and policy-oriented public health programmes.

Dr. Amar Saeed is a Kashmiri doctor currently working as a clinical research fellow in New Delhi. He is passionate about building a career in epidemiology and hopes to contribute to research that stays grounded in the communities it serves.

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