Industry Voice

Working towards Wellness- An Indian Perspective

People in low and middle-income countries tend to develop chronic diseases at younger ages, and suffer for a longer period as compared to their counterparts from the developed world.

Rajarshi Sengupta

As part of a study that PricewaterhouseCoop-ers (PwC) conducted in conjunction with the World Economic Forum's 'Working towards Wellness' initiative, it examined the challenges facing businesses as a consequence of the growing epidemic of chronic disease, which is the leading
cause of death and disability worldwide.

The purpose of the study was to act as a facilitator and stimulant of greater business engagement to help prevent chronic disease through employee wellness programmes. The goals of this initiative was to engage CEOs and business leaders to commit to improve employee health; help companies take practical steps to do this; and facilitate collaboration between stakeholders to help prevent chronic diseases.

Wellness is commonly defined as an organised set of activities designed to help individuals and their family members make and/or maintain voluntary behaviour change(s) that help reduce their health risks and/or enhance their ability to function.

Purpose

The current report draws heavily on the findings of the report highlighting the findings of the global study conducted by PwC and places the global report in an Indian context. The study conducted globally becomes even more critical for countries such as India; as such chronic diseases are increasingly affecting people in developing countries poised for growth.

In addition, two per cent of the capital spent on workforce is lost to disability, absenteeism and attendance arising from chronic diseases. Combined, these indirect costs are more than the additional direct medical claim costs that some employers incur.

The report, therefore, tries to set the context of how such global findings relate to India, and in particular take a look at case studies around the growing Information Technology (IT) and IT enabled services (ITeS) industry in India. Indian multinationals in this segment have been prominent in using the workplace to promote long-term health behavioral change to the measurable benefit of themselves, their employees and local communities.

Deriving from these experiences, and its experience worldwide, the current report first examines the nature of the problem in India, and then suggests a framework to corporations adopting wellness programmes, geared towards making these initiatives effective.

What is a Chronic Disease?

The US National Center for Health Statistics defines chronic disease as one that persists for a long time i.e. for three months or more. The major contributors to chronic diseases are health damaging behaviours ranging from tobacco use, lack of physical activity and poor eating habits. Chronic diseases such as cardiovascular diseases, cancer, diabetes, obesity are fast becoming the leading cause of death and disability in both the developed and developing world.

In particular, in regions such as India, with a growing urban population that is increasingly susceptible to such life-style diseases, chronic diseases are expected to cause a greater number of deaths than non-chronic diseases.

Chronic diseases, however, are among the most preventable diseases. Adoption of healthy behaviors such as eating nutritious foods, being physically active, and avoiding tobacco use can prevent or control the devastating effects of these diseases.

Who is Affected?

Traditionally, chronic diseases have been associated with the wealthy and elderly sections of society. However, it has now been proved that all sections of the society and people from different age groups including those who are in the working age are equally vulnerable to chronic diseases. The diseases cut across boundaries and people from both developed and developing nations are affected. In low and middle-income countries, approximately 80 per cent of all disability-adjusted life years (DALYs) are lost due to chronic disease before the age of 60. The impact of chronic diseases and related risk factors have far reaching implications ranging from consumption and saving decisions, labour-market performance, and human-capital accumulation. Evidence shows that chronic diseases have had a significant negative impact in terms of economic growth in high-income countries. There is a growing realisation among the policy makers in the developing countries that measures would have to taken to ensure that economic development does not get hampered due to the ill effects of chronic diseases.

Key Findings

• In 2005, an estimated 35,000,000 people across the world died from diseases which included cardiovascular disease (stroke and heart disease), cancer, chronic respiratory diseases and diabetes. This is double the number of deaths from all infectious diseases like HIV/AIDS, malaria, tuberculosis, maternal and peri-natal conditions and nutritional deficiencies put together. It is also estimated that of the 64 million estimated deaths in 2015, a staggering 41 million will be from chronic diseases.
• Deaths from chronic diseases are expected to increase by 17 per cent over the next 10 years, from 35 million to 41 million, caused largely by an ageing population and increasing numbers of people exposed to risk. Deaths from infectious diseases, maternal and peri-natal conditions and nutritional deficiencies combined are projected to decline by three per cent over the same period.
• Chronic disease is not restricted to developed nations or older populations, it is growing fastest in low-income countries; almost half of those who die from chronic diseases are below 70 years of age.
• Only three per cent of all health expenditure in the member countries of the Organisation for Economic Co-operation and Development (OECD) was directed at prevention and public health in 2004.
• Many business leaders and policy analysts acknowledge that prevention is not adequately financed.

The Indian Context

• In 2005, it was estimated that chronic diseases in India accounted for almost 53 per cent of all deaths and 44 per cent of DALYs. It is estimated that deaths from chronic diseases would register a sharp increase from 3.78 million in 1990 to 7.63 million in 2020 accounting for 66.7 per cent of all deaths.
• India's loss in terms of losing potentially productive years due to deaths from cardiovascular diseases in people aged between 35-64 years is one of the highest in the world. By 2030, the loss is expected to rise to 17.9 million years which is 940 per cent more than the loss estimated in the USA.
• In India, diabetic nephropathy is expected to develop in 6.6 million of the 30 million patients suffering from diabetes.
• Number of people with hypertension is expected to see a quantum leap from an estimated 118.2 million in 2000 to 213.5 million in 2025.
• The projected foregone national income for India due to heart disease, stroke and diabetes during the period 2005-2015 is estimated to be more than $200 billion.
• The dominant form of cardiovascular diseases in India includes coronary heart disease, stroke (ischemic >50 and hemorrhagic).
• Between 2000-2030, India is likely to experience more deaths of people in the age group of 35-64 than USA, China and Russia.

As globalisation and urbanisation converge in India to make chronic disease a significant problem, the corporate sector needs to take a close look at effective workplace wellness programmes (WWP) to tackle the situation along with the Government.

Chronic Disease and WWP

The WHO report entitled 'Preventing Chronic Diseases, a vital investment' points out that at the moment four out of five chronic disease-related deaths happen in the low and middle-income countries. It also highlights the fact that people in these countries tend to develop chronic diseases at younger ages and suffer for a longer period and die sooner in comparison with their counterparts from the developed world.

Traditional beliefs and myths surrounding chronic diseases are fast being broken around the world, especially in the low and middle-income countries. It has been proved that:

• Chronic diseases are not restricted to the developed world, nor do they affect the elderly people only.
• Economic burden from the diseases are manifold and affects all levels of society including individuals, families, communities and the nation.
• Economic consequences from the chronic diseases justify increased public-policy interventions from an efficiency perspective.
• Effective interventions are possible at a reasonable cost and emphasis should be on primary prevention which occurs even before the disease has been detected to improve health standards without heavy reliance on a sophisticated health system, which is often not available in developing countries.
• There are still a lot of gaps in existing knowledge in relation to the developing countries and there is an urgent need to find out more on the economic consequences of the diseases, public-policy rationales and the cost effectiveness of interventions.

Dr Anbumani Ramadoss, Minister of Health & Family Welfare, Government of India in the same report acknowledges that the country's public health advocacy till date has concentrated mainly on infectious diseases. He does mention, however, that the Government is aware that almost 66 per cent of all deaths in 2020 are likely to be from chronic diseases. The Government has now decided to address the issues related to chronic diseases with equal energy and focus and is keen to involve and work together with the private sector and the civil society with a goal to prevent chronic diseases and save millions of lives.

Role of Private Sector

The role of the private sector in India in prevention of chronic diseases is of paramount importance at this moment. India's total health care expenses as per cent of its GDP is much lower than the world average of around nine per cent. The country's public expenditure on health as a per cent of the total health expenditure is lower than countries like China, Pakistan and Bangladesh and is far lower than the world average.

India, today, bears the burden of both communicable and non-communicable diseases. Along with the existence of infectious diseases like tuberculosis, malaria, pneumonia, HIV/AIDS, hitherto neglected diseases like diabetes are likely to take endemic proportions. It is expected that the country would have a population of around 57.2 million diabetic patients by the year 2025 many of whom would be adults of working age.

In a country like India, the two fundamental aspects of a household's consumption associated with chronic diseases are:

• Direct spending on availing treatment on one hand and on goods like alcohol and tobacco on the other, which are primarily responsible for poor health.
• Ability to keep consumption levels constant in the face of 'health shocks' from disease.

It has been found that disease related spending could have detrimental effects on the other important household consumptions. Treatment of chronic diseases requires drug and inpatient treatment over a much longer period than many other communicable diseases, thereby increasing the risk of becoming impoverished. In India, medical costs of diabetes care from private healthcare providers could be as high as 15 per cent and 25 per cent of the total household income.

The ability to keep the overall consumption at a constant level is also relevant, as failure to 'smooth' consumption (through formal means or, as in most developing countries, informally) is traditionally considered as a welfare loss that justifies public policy intervention from an economic perspective.

A 2005 study (Bonu et al. 2005) highlighted that in India, the risk of distress borrowing and selling increases exponentially for patients who smoke and who are hospitalised. The risk is even more for those who do not smoke but are from households where others smoke.

The writer is Executive Director Technology Advisory Services PricewaterhouseCoopers Pvt Ltd