India is grappling with increasing neurological disease burden

Neurological diseases and mental disorders have become major public health crises and are emerging as major challenges to health care systems globally. India’s population, in particular, is going through an epidemiological and demographic transition, which has led to an increasing burden of non-communicable diseases, including of the brain and mind. This is also attributed to increasing longevity and changing lifestyles.

According to the Global Burden of Disease Study 1990-2019 published recently in Lancet Global Health, non-communicable and injury-related neurological disorders in India have more than doubled in the last three decades, with substantial state-level variations. As health is a state subject, state-specific measures are urgently needed to address gaps.

Stroke, a major neurological disorder, occurs among younger people in India compared to the West, contributing to 37.9% of the total neurological disease burden in India. While stroke incidence and mortality have been steadily declining in high-income countries, these rates have doubled in India in the last three decades. Additionally, nearly 600,000 stroke survivors with disabilities are added to the population every year. Headache disorders — the most common neurological disorder — add to 17.5% of the total disease burden.

India is also home to 10 to 12 million people with epilepsy. Similarly, India has nearly 800,000 patients with Parkinson’s Disease. Due to an increase in life expectancy to nearly 70 years, the ageing population in India is seeing a steep rise in the number of patients with dementia. The annual cost of dementia-related health care is estimated to be above 150 billion. The geriatric population in India is likely to increase from 7.1% in 2001 to 17% of the population by 2050. This will result in more than 300 million senior citizens by 2050, with a consequent increase in ailments such as dementia.

While neurological disorders associated with poverty and under-development are declining, there is an epidemic of non-communicable neurological disorders. While incorporating neurological care within the ambit of primary care is urgent and necessary, this must be complemented by access to specialised neurological services.

Currently, there are fewer than 2,500 neurologists in the country with 1.4 billion people. This amounts to two neurologists for one million people, a dismal doctor-patient ratio. Moreover, most neurologists are concentrated in the larger cities.

With Covid-19, neurological services have received a further hit. Patients with chronic neurological illnesses such as epilepsy, Parkinson’s Disease, and multiple sclerosis as well as stroke, have suffered due to the disruption/ modification of routine care. Public health measures such as social distancing and social isolation have also had harmful effects on the elderly who need care. The spectrum of neurological involvement in SARS-CoV-2 is still evolving, as long-term neurological effects remain to be seen.

The National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke, which was launched in 2010, is a step in the right direction. More national policies and programmes specifically targeting epilepsy, neuro infections, dementia and neuro-degenerative diseases need to be planned. Also, district hospitals across states are important secondary health care centres, but are a weak link in our public health care system. The fragile district health system in India needs to be strengthened to be well equipped with CT scanners, trained manpower and infrastructure.

The neurological disease burden is glaring at us. This warrants urgent prioritisation of programmes focused on targeted prevention and treatment. Unless preparation, planning, and urgent steps for treatment and long-term care of an increasing population of neurologically affected people are instituted, this grim situation will greatly strain India’s health care system in the coming years. Importantly, capacity-building in terms of training of neurologists with equitable distribution with incentives to settle in tier two and three cities could play a key role in providing quality care to these patients.

Although the number of specialist training positions in neurology has increased from 30 in 1990 to nearly 500 in 2020, it is still not enough. We need more trained manpower to deal with the looming epidemic of neurological diseases. The responsibility lies with all stakeholders — the medical community, scientists, researchers and civil society must take cognisance, create awareness about brain health, and come forward to assist government agencies and non-governmental organisations in providing adequate treatment and prevention of neurological disorders. This will help millions of Indians get access to care and live better-quality lives.

Rajinder K Dhamija is head of the neurology department, Lady Hardinge Medical College and SSK Hospital, New Delhi. He was, formerly, a WHO Fellow at National Institute of Epidemiology 

The views expressed are personal

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