I am proposing to deliver a lecture to the All India Institute of Hygiene & Public Health, Kolkata using my background as a clinical cardiologist and cardiovascular epidemiologist interested in the epidemiological disease transition occurring in poorer, developing countries. The lecture is part of the regular lecture tours organised by Dr Rahul Mukherjee, who is a Specialist Registrar and Honorary Lecturer in the UK with more than five years of experience in promoting Indo-British Cooperation in the area of medical education and training alongside running a voluntary organisation by the name of Calcutta AHEAD (Action on Health, Education And Development).Subject of lecture Do we ever learn from history? What if history were right in front of us? The increase in the prevalence of chronic, non-communicable diseases in now-rich countries from the start of the 20th century has being well documented to have followed their rapid economic growth that began in the 19th century. The increased survival as a result of improved sanitation, nutrition and infectious disease control allowed for longer exposure to sedentary habits, tobacco use and high-fat diets that are associated with urbanisation. India is rapidly developing and urbanising, and urban India shows marked increases in both coronary heart disease prevalence and risk factors when compared with rural settings. Non-communicable diseases have overtaken infectious diseases as the leading cause of mortality and disability. The history of Medicine from the developed world of the 20th century is being played out in India today in the 21st century. So can we use history to benefit present and future populations? Coronary heart disease mortality rates have declined by around 60% in the last 30-40 years in rich nations, mostly attributed to population-wide improvements in the major risk factors, particularly smoking, cholesterol, and blood pressure, rather than modern medical management. The Interheart study revealed that the risk factors for myocardial infarction are those that were already known, and that these were consistent across populations. Thus, it is likely that lowering these risk factors in the population is likely to reduce the incidence of disease be it in India or the US. The history of 20th century medicine in Japan points to substantially lower mortality rates from coronary heart disease than in Western countries, attributed to a diet low in saturated fat and lower rates of smoking. The case of Japan illustrates that cardiovascular disease is not inevitable with increased economic development. Is it possible for a country like India to develop economically without developing the disease trajectory experienced by rich countries? For this to be possible, present-day public health policies in poorer countries must take on board the medical history of the epidemic of coronary disease in rich countries. A multi-disciplinary population approach to primary prevention that takes into account the vested interests that conflict with the prevention of non-communicable disease, such as those of the tobacco industry and multinational fast-food companies, is needed to achieve a leftward shift in the normal distribution of disease risk. Political action, including changes in urban planning, education, and policies regarding the agriculture, food, and tobacco industries are needed and can in part be based on historical evidence from rich countries. In developing countries, any increase in the proportion of government spending spent on health should not be used to imitate the western healthcare model of high-risk and secondary prevention as history suggests this is not the most effective nor the most cost-effective way. Using the much-studied history of one non-communicable epidemic may allay another epidemic in today’s poor and developing countries, affording an opportunity for history to not repeat itself.Outcome The talk will target public health professionals in India who are involved with health policy. This lecture tour will impact on government sector health professionals and previous lecturers from the UK on this tour have had audiences with deans & directors of reputed Government Institutions, World Health Organisation officials, Governors and Secretaries of Health and Secretaries of Science & Technology in various states of India. Dr Mukherjee confirms that this will be of great importance and of interest not only to the government sector health professionals but also to the numerous health workers and rural practitioners who are trained by Calcutta AHEAD’s beneficiary organisations that are active in this process. This is particularly significant in view of the common knowledge that much of India’s health care delivery is by unqualified rural practitioners, confirmed at 75% by research done by the Poverty Action Lab in Washington and published in the BMJ. Therefore, in summary, this lecture tour is set to impact both on the government sector and the civil society initiatives in public health in India.
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