KARACHI: Representatives, Experts from different sections of the society which included Town planner’s engineers, healthcare professionals, and researchers besides those involved with Special Olympics participated in a Dialogue on Non-Communicable Diseases organized at Aga Khan University on December 04, 2023. They highlighted the importance of prevention and control of NCDs, Healthy Homes, Green spaces and tackling environmental issues including Air Pollution and control of Tobacco use in different forms.
Prof. Sameen Siddiqui was the keynote speaker at the meeting who made a presentation on “Systems Approach to Tackling the Silent Epidemic of Non-communicable diseases in Pakistan”. He suggested establishing an NCD Prevention and Control Unit at the Federal Health Ministry, making available the needed resources and initiating implementation. He also suggested training of primary healthcare personnel in prevention of Non-communicable Diseases, strengthening surveillance and research in NCDs. Yet another suggestion he made was to opt for multisectoral collaboration for interventions.
He commended the efforts being made by Aga Khan University in training the future leadership in prevention and control of NCDs and the research work it was under taking in this area. He was of the view that we need to look at the broader perspective. Giving a global perspective of NCDs Prof. Sameen Siddiqui said that over forty one million deaths due to NCDs occur annually before the age of seventy years and 80% of these premature deaths take place in Low and Middle Income countries. The economic burden accounts for over thirty Trillion US Dollars. Major NCDs include cardiovascular diseases, Diabetes Mellitus, Cancer and Chronic Obstructive Pulmonary Diseases. The risk factors for NCDs, he said, are well known and it includes tobacco use, unhealthy diet, physical inactivity, harmful effects of Alcohol which may not be a major problem in Pakistan, air pollution. With effective measures it is possible to achieve one third reduction in premature mortality.
The Sustainable Development Goals include checking the ever increasing prevalence of diabetes, control of obesity, high blood pressure. He then shared the twenty five indicators of global mortality framework. Speaking about the NCDs in Pakistan, he quoted studies which showed that over fifteen lacs people die annually of which over eighty three thousand are due to NCDs though the actual figures may be much more. Of these deaths, almost 40% die due to cardiovascular diseases. Studies have also showed that prevalence of NCDS is increasing in all the provinces of Paksitan and deaths due to Covid also increased all over Pakistan. Cardiovascular, Ischemic Heart Diseases, breast cancer and oral cancer besides lung cancer are the major problems.
Data from Health Insurance related to payment made through Sehat Card in KPK showed that major admissions were due to Ischemic Heart Disease, Diabetes Mellitus, Chronic Kidney Disease, cerebral infarction, cardiomyopathy, essential hypertension, heart failure and asthma. He pointed out that we need to shift from Illness oriented approach to Wellness oriented approach. Tackle the risk factors, promote regular physical activity, use of balanced healthy diet, salt reduction, prevent and control diabetes, heart diseases besides other appropriate measures. We know all this, have the knowledge but the problem is that we do not know how to do it. Insufficient political and financial commitments for prevention and control of NCDs are the major problems. NCDs are not included in primary healthcare. Healthcare professionals are not trained and there is lack of private sector engagement in prevention and control of NCDs. There is inadequate surveillance and inadequate focus on intersectoral interventions in NCDs and mental health by Ministry of Health. The previous government, he said, had taken some initiatives, started a scheme of essential health packages. We need to start intervention for NCDs at the district level, increases taxes on sugary beverages and tobacco, he added. Responding to questions during the discussion, he said, technology can also be used for prevention of NCDs.
Dr. Gerald Bloomfield from Global Health Institute, Duke University USA was the other invited guest speaker at the conference. He gave an overview of “The Aga Khan University Pakistan Initiative for Non-communicable Diseases Research Programme.” Speaking about the disease burden, he quoted a study undertaken at AKU wherein hospital based data showed there has been seven fold increase in patients admitted with Acute Myocardial Infarction. This is a complex problem which needs multipronged solution. Issues related to Tobacco use, obesity, and hypertension needs to be tackled. Speaking about a NCDs Pakistan perspective he said you need to develop a sustainable pool of Pakistani research experts. The training programme has thirty member faculty which includes twenty one from Pakistan and nine from USA. It has twelve females and eighteen male. Forty people were enrolled in Research Certificate, two in PhD programme and four in Masters Programme. There are different programme directors. We teach fundamentals of research in Non-Communicable Diseases. Career development and Mentoring workshops were also organized for the enrolled candidates. This AKUPI-NCD Research Training Programme is being run in collaboration with Duke University. The objective is to train the next generation of leadership NCD research. It is funded by the Fogarty International Center, National Institute of Health in USA.
Earlier in their welcome address Dr. Ayesha Almas and Dr. Ayesha Kamal highlighted the importance of engagement and multidisciplinary dialogue. This initiative started in 2018. It started as a Think Tank and this is the second conference on NCDs. They also commended the guidance and contributions of Prof. Zainab Samad to the programme.
This was followed by brief address by Syeda Sarwat Gilani Brand Ambassador Special Olympics Pakistan and Mrs. Ronak Lakhani Chairperson of Special Olympics Pakistan. A short Video on Special Olympics which started in 1968 was also shown to the participants. Children suffering from ADHD, Cerebral Palsy, Autism, Down’s syndrome and other intellectual disabilities participate in these Olympics. To begin with they pointed they had five hundred children registered but its number has now increased to thirty five thousand athletes from four hundred ninety eight families. They are selected for international games and training camps. These special children need special care and acceptance by the society. Father of three special children also shared his feelings and pointed out that it is because of them they were now also accepted. My children are now doing well. Once we identify them, they can be groomed. It was also pointed out that now Health Curriculum for these special children of the word is also being developed. They highlighted the power of sports in transforming the lives of these special children.
Sustainable Urban Design for Healthy Environment
The next session was devoted to panel discussion on the above mentioned topic. The panelists included Ms Soha Macktoom, Mr. Shahzad Qureshi, Mr. Arif Hassan, Dr. Adam Abdullah and Dr. Sohail Khan. It was moderated by Namra Aziz.
Mr. Arif Hassan in his presentation spoke about designing cities and healthcare facilities. This he said, depends on location of the HCFs. Since physical activity reduce NCDs, green spaces, segregation of Pedestrians and vehicular traffic is important. They should be separate as far as possible. There should be track of jogging and cycling. There should be one primary school for four hundred families. Community facilities, parks which can become hub for all activities. Link them with each other and existing cities. While designing new healthcare facilities, make sure to accommodate people and patients in any epidemic. Studies have shown that there has been 40% reduction in green space in Karachi over the years. For healthy urbanization, health building standards are needed. We must ensure social environmental justice, take care of climate change, long term health risk like respiratory diseases and cardiovascular diseases, kidney diseases and effects on other organs of body must be kept in mind otherwise it will become very difficult to live, he added.
The panelists also pointed out that it is the cities which make people healthy. Habits of the people also matter. Level of income, environment, standard of infrastructure and what population we are looking at is important. We need more open spaces in the cities, Dr. Adam stated.
Dr. Sohail Khan said health is a basic human right. Our cities are not walkable. We need to encourage physical activity. While designing building, we must ensure natural light and air, ramp and green space. Issues related to food supplies, quality of air breathing were also discussed. Dr. Shahzad highlighted the haphazard planning of cities. Drastic changes, he opined, are needed in our planning. It is said one should be able to see three trees from the house window and ensure 300-500 meters for walking.
The Urban designer in the panel referred to the principles to be followed for healthy cities. We must ask the opinion of the community which is living in the area. Cultural sensitivities should be considered. Air quality, weather safety is important. Our major problem it was stated is lack of implementation. Unless we listen to the end users, we will not find a solution to our problems. Now there is hardly any space between the houses. Family members are increased and there is scarcity of water used for plants as it is consumed for domestic use. The Mafia of Builders also needs to be tackled. Mr. Arif Hassan remarked that housing in the cities are determined by needs and not by policy.
Ms Jasmine Sharif, an Athlete from Special Olympics delivered a Lightening talk and sharing her life story and received tremendous applause from the audience. She was suffering from Soto Syndrome. She also gave details of this syndrome which was discovered by Dr. Soto in 1964. These children she said, have special features, have special problems, fast physical growth, large head, shin face. She discussed how in the school she was hit and bullied, was not accepted. Speech and Physiotherapy helped me. I have successfully overcome my intellectual disability. Now I get chance to travel and attend conferences. I have gained confidence and live a normal life. These children who suffer from intellectual disabilities can be successfully rehabilitated through Special Olympics, can get jobs and earn money to enjoy. Inside human body heartbeat, she said, is the same, she added.
Dean Prof. Adil Hyder in his brief speech said we are not so bad as regards per capital GDP. We need to use the resources and win the war against NCDs. This is the area in which we are going to work to control NCDs, he remarked.
Cardiovascular Health
The next panel discussion was devoted to Cardiovascular Health in Pakistan. The panelists included Prof. Javed Akbar Sial, Prof. Abdul Basit, Dr. Ziaul Haq, Dr. Sara Saeed Khurram and Dr. Gerald Bloomfield.
The panelists stressed the importance of judiciously using the scarce resources. We are faced with complex problems and no programme for prevention of NCDs including heart diseases and diabetes exists. There is a need for creating awareness, advocacy, and disease registries to generate local data which is essential for planning. The importance of using Telemedine in rural areas, involving the GPs, Family Physicians, special care of women and children, need to seek medical help at the earliest rather than once the disease becomes serious and complications occur were also highlighted. People usually go to the doctor or hospital when they are sick, there is no concept of seeking advice of doctors before the disease leads to complications. Taking care of maternal and child health is extremely important which at present remains neglected.
It was also suggested that primary care centers should be linked to secondary and tertiary care centers. We also need to look for private public partnership to prevent diseases and promote wellness programmes. Primary prevention starts before the baby is born. The prevalence of diabetes in rural areas is as much as in the cities. We need to target village population and semi urban areas from where the patients are coming.
Dr. Zafar Mirza former Advisor on Health to the Government pointed out that we need to change our health system for which some drastic revolutionary changes are needed. Every fresh medical graduate wants to become specialist and no one is interested in primary healthcare. We need to incentivize primary health care and engage the private sector.
