As a thin man with a bad lifestyle, I am deeply concerned. I have just learned that fats don’t spare the thin. Apparently, macrophages go into hunter-killer mode when we gorge on fats, aggravating heart disease, diabetes and cancer in the thin and the obese alike. George Bernard Shaw was way off the beam when he urged us to “stimulate the phagocytes” (The Doctor’s Dilemma). Like the 2010 economy, a stimulus is just what they don’t need.
In fact, prosperity and consumer choice are stimulating the death rate. Pranab-da believes that India will finally become a market growth leader in 2011-12, but unfortunately it’s already leading the world in the incidence of chronic diseases typical of prosperous nations. This is affecting everyone, not just fries-fed city folk and mall rats. In 2006, a study based on Andhra Pradesh Rural Health Initiative data found that rural epidemiological patterns are changing rapidly. Infectious and parasitic diseases are no longer the leading causes of morbidity and mortality. They have been overtaken by vascular disorders, ischaemic heart disease and strokes.
Not surprisingly, self-harm is a major problem, accounting for one-third of all deaths attributable to injury. The whole world has been nattering on about change ever since Obama’s campaign, but rapid economic and social change can be a wild ride. Some people just throw up their hands and say, “No, I can’t,” and drown their sorrows in rat poison.
The medical fraternity and policy-makers in preventive and social medicine will have to recalibrate their response to disease in India, taking into account the rapidity with which lifestyles and the incidence of serious diseases are changing. Leaving the specialists to ponder that problem, I wandered afield on the Internet like a tourist of death’s domain, seeking the great slayers of the 21st century. And I found that in believing that malnutrition and HIV are the biggest challenges we face, we are living in a mass hallucination.
HIV/Aids is only the tenth biggest killer worldwide, well behind cardiovascular problems, infectious and parasitic diseases and cancers. It is slightly ahead of gastrointestinal disorders and diarrhoea, which are slightly ahead of suicide, war and fatal muggings and such. Disturbingly, death due to violence is ahead of death due to lung cancer, though we have come to regard smoking as the biggest preventable cause of mortality. Maybe it’s because more people die of smoking than of violence in the district of Columbia, an area that does more than its fair share in shaping world opinion. Maybe there are too many smokers in Washington and not enough homicidal maniacs. And its Beltway bandits fight their wars elsewhere, raising the rate of violent death on other continents.
Indeed, local flavour causes huge variations. Malaria trails behind heart disease in rural India. But in cities, the anti-malaria drive is in retreat and mosquitoes are a menace. I’m told that last week, a mosquito landed at IGI Airport and the ground crew tried to refuel it, taking it for an Airbus. So, to each his own. Speaking for myself, the thin man who has just learned that he is doomed to be felled by growth-led fats, I’m off to take a hard look at Pranab-da’s growth budget.
Pratik Kanjilal is publisher of The Little Magazine
The views expressed by the author are personal