In many Asian countries, unhealthy lifestyles have led to both the rich and the poor eating loads of junk food resulting in an explosion of non-communicable diseases (NCDs), a top regional health official said. “People are eating mindlessly, without thinking. It’s not only the poor who tend to eat whatever they get due to poverty [...]


“The rich are going berserk on junk food”

NCDs rapidly increasing in Asia, says WHO Regional Director for S.E. Asia

In many Asian countries, unhealthy lifestyles have led to both the rich and the poor eating loads of junk food resulting in an explosion of non-communicable diseases (NCDs), a top regional health official said.

“People are eating mindlessly, without thinking. It’s not only the poor who tend to eat whatever they get due to poverty and affordability but also the rich who are going berserk on junk food,” Dr. Poonam Khetrapal Singh, World Health Organisation (WHO) Regional Director for South-East Asia, told the Sunday Times in an exclusive interview. “While the poor need to be taught how to choose wisely from whatever is available that they can afford, the rich too must be given some lessons. There is a need to teach them to exercise and eat healthy food. This is the only way to prevent high cholesterol and diabetes.”

Dr. Anoma Jayathilaka of the Colombo WHO Office explains a point to Dr. Khetrapal Singh at the Medical Clinic of the Castle Street Hospital where mothers are given advice on diabetes and other diseases. Pic by Athula Devapriya

Dr. Khetrapal Singh, the first woman elected to this prestigious post, told the Sunday Times in an interview on Friday amidst a packed Sri Lanka schedule that in the South-East Asia region there is 54% mortality from NCDs.

Citing the example of cardiovascular disease, she was quick to point out that the region is losing young healthy lives, while every second person seems to be having diabetes.

Some people are prone to these diseases genetically, according to her, but that’s different and they need treatment. But the NCD epidemic that is looming can be handled with prevention. This is an area where Sri Lanka can show the way.

NCDs are a huge issue, stressed Dr. Khetrapal Singh, while pointing out that even though communicable diseases are under control, even in this area, issues like drug resistance in the treatment of malaria and tuberculosis (TB) and also co-infections between HIV and TB are cropping up.

This is why ‘Addressing the persisting and emerging epidemiological and demographic challenges’ is at the top of Dr. Khetrapal Singh’s “ambitious” ‘1 by 4’ plan clearly enunciated in her vision statement, after she took up duties as Regional Director in February this year.
Focusing on another crucial area, she says that the WHO is geared to quickly help any country in her region facing a major disaster, with emergency aid within 24 hours (of a crisis) even on an e-mail appeal. The organisation is able to provide US$350,000, in two tranches of US$ 175,000 each, from the Health Emergency Fund, until the relevant government is able to channel its own funds to meet emergency needs.

Her mandate is the 11-member region that comprises Sri Lanka, Bangladesh, Bhutan, Democratic People’s Republic of Korea, India, Indonesia, Maldives, Myanmar, Nepal, Thailand and Timor-Leste. These countries are vulnerable to floods, cyclones, earthquakes and tsunamis, she points out, explaining that “no matter how hard one tries, people die. Preparedness is essential and communities should be resilient.” She stressed that there is a benchmark for preparedness for disasters that a country needs to follow.

While ‘Strengthening emergency risk management for sustainable development’ is another prong of her plan, the others include ‘Advancing universal health coverage and robust health systems’ and ‘Establishing a strong regional voice in the global health agenda.’
It was during a short stop to have a piece of kiribath with some spicy katta sambol, after which it was a luscious rambutan, at the Castle Street Hospital for Women in Colombo that the Sunday Times had a quick chat with her on her vision for the region.

Her visit was linked to the many celebrations held in Sri Lanka as the country hosted the World Blood Donor Day Global Event at the BMICH yesterday.

Dr. Khetrapal Singh’s two-day visit included not only a courtesy call on Health Minister Maithripala Sirisena and the launch of the World Blood Donor Day Global Event by the Health Ministry yesterday but also inaugurating the International Symposium at the National Blood Transfusion Centre at Narahenpita; a walkabout at the Castle Street Hospital; and field visits to the Maharagama office of the Medical Officer of Health (MOH), the Pannipitiya Central Dispensary and the WHO Collaborating Centre on Occupational Health at the Colombo University on Friday.

At the Castle Street Hospital, accompanied by Health Deputy Minister Lalith Dissanayake, hospital Director Dr. W.K Wickramasinghe and Dr. Firdosi Rustom Mehta, WHO Representative to Sri Lanka, many were her queries about both the management of diabetes as well as dengue in expectant mothers. The hospital’s Blood Bank was another stop arousing her interest in the field of transfusion medicine, after which she took in the 5-S system of efficient management that the Quality Secretariat elaborated on.

When asked by the Sunday Times how Dr. Khetrapal Singh came up with the ‘1 by 4’ plan, she said that she visited each and every country under her wing in the region and met public health experts, economists, social scientists and high-level government officials including Presidents, Prime Ministers and Health Ministers to understand the health issues from different perspectives. In Sri Lanka, she also met the Foreign Minister and Economic Development Minister.

Next she studied the global burden of diseases and the profile of diseases country-wise, after which it was an in-depth look at the Country Cooperation Strategy, the document which the WHO had prepared to identify priorities.

“Thereafter, I made a matrix and that brought into focus clearly the issues in my region,” she says, adding that the countries in her region are diverse, from big, like India and Indonesia to small like Bhutan and Maldives. Many of the health issues, though, remain common.

Her crusade will also cover the training of human resources in all areas of quality health delivery along with the availability of medicines.

Some countries say their health is free but ‘out of pocket’ expenses of patients are highest in this region. This can be cut in two ways – by looking for generics rather than brands and purchasing in bulk, says Dr. Khetrapal Singh.

She has just concluded three days of intensive discussions in New Delhi on essential medicines at affordable prices and the need for countries in the region to help each other. The countries which are manufacturing medicines in the region should help those who are not, she said.

India and Thailand manufacture medicines. India manufactures 80% of the generics of the world and is known as the ‘generic capital’, points out Dr. Khetrapal Singh, stressing that there also has to be stringent quality checks and manufacturers who have quality failures should be blacklisted.

With regard to establishing a strong regional voice in the global health agenda, she says that lots of good things are happening in the region. Citing programmes like the management of diabetes in expectant mothers through the integration of NCDs into the antenatal programme and the dynamic Blood Bank at the Castle Street Hospital, she urges that good practices need to be documented and given out to the world.

The WHO will not only support countries in the region with health needs but also help them to share good practices. “There is no point if we don’t come forward and support these countries,” adds Dr. Khetrapal Singh.

Sri Lanka hosts global eventThe main World Blood Donor Day Global Event was held at the BMICH in Colombo yesterday with the theme ‘Safe blood for saving mothers’.
Sri Lanka was chosen to host the global event because it showcases a success story, Dr. Firdosi Rustom Mehta, WHO Representative to Sri Lanka, told a media briefing on Friday evening at the Cinnamon Grand Hotel, Colombo.

Within 20 years, Sri Lanka had developed its service from a single room at the National Hospital in Colombo to a throbbing National Blood Transfusion Service (NBTS), with a network spread across the country. The ‘heart’ is the state-of-the-art National Blood Centre (NBC) at Narahenpita.

While Health Services Director-General Dr. Palitha Mahipala explained that in service delivery, the essential components were access and quality, in this case accessibility to safe blood, NBTS Director Dr. Anil Dissanayake pointed out that 100% of the collection of blood was from voluntary donors.

In 2012, Sri Lanka was able to collect 350,000 units of blood while last year it rose to 380,000 units, said Dr. Dissanayake, adding that Sri Lanka has introduced nuclear testing of blood since January this year to further strengthen the safety of blood.Among the activities organised as part of the global event was an International Symposium on ‘Safe blood for saving mothers’ at the NBTS on Friday, organized by the WHO and six co-sponsors, where representatives from many countries with a high maternal mortality rate attended. The result was the Colombo Declaration.

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