Role of structural inequalities in the incidence of hypertension

Why in the News?

September 29 was observed as the World Heart Day to raise awareness about prevention, detection and treatment of cardiovascular diseases (CVD) and promote heart-healthy lifestyles.

Prevalence of Hypertension in India:

1. National Family Health Survey-5 (2019–2021) revealed that 18.3% of the country’s population has hypertension (high blood pressure).
2. The 2017-18 National NCD Monitoring Survey (NNMS) conducted by ICMR among the 18-69 years age group revealed a higher rate of 28.5%.
3. Both the survey indicates
   1. Low levels of awareness, treatment, and control of hypertension
   2. a yawning gap between awareness and treatment.
4. Only 28% of those with hypertension were aware of it and only 52% of those aware were actually being treated.
5. People with higher levels of education and better-paying jobs had a higher probability of having their BP measured and hence diagnosed early.
6. People living in south India had a nearly two-and-a-half times probability of having their BP measured, an indicator of stronger health systems.
7. Only 27.9 % of those detected with hypertension were aware of their disease status, 14.5 % were under treatment for hypertension and 12.6% had their BP under control.
8. Only 21% accessed treatment from a public facility

Reframing the structural inequalities:

1. The National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS), 2010:
   1. Implemented in all states since March 2016.
   2. The programme is primarily limited to screening and treatment and is also part of the Comprehensive Primary Health Care (CPHC) package.
2. 2018 Astana Declaration on Universal Healthcare and SDGs are a reaffirmation of commitment to the primary healthcare approach. Universal Healthcare’s core functions included:
   1. Service provision
   2. Multisectoral action
   3. Empowerment of citizens. 
   4. Governments must commit more resources to primary health care,
   5. Implementing interventions to retain the rural health workforce,
   6. Training frontline health workers to deliver core health interventions
   7. Engaging them in multi sectoral collaborations.
3. WHO’s Commission on Social Determinants of Health (CSDH) provides credible evidence to show that so-called lifestyle risk factors are not really outcomes of choices, but compromises.
   1. Therefore, socioeconomic influences on CVD  has to be focused that operates across the lifespan of an individual, that includes:
      1. Low birth weight
      2. Growth retardation
      3. Educational and environmental factors
      4. Job stresses in adult life and inadequate medical care, especially for the elderly.