Medical, Socialogical and environmental issues in cardiovascular disease epidemiology, prevention and rehabilitation.

To create awareness, develop educational and preventive programs, I started a society in Minnesota (South Asian Society on Atherosclerosis and Thrombosis) in 1993. We have been organizing international symposiums in India every year since 1993. We tried to net work with WHO as a partner and failed. They do not recognize our organization as the name of our organization is regional (South Asia) and not international.

By now every one knows that South Asians (Indians, Pakistanis, Bangladeshis and Sri Lankans) have the highest incidence of diabetes (type-2) and coronary artery disease, compared to any other ethnic group in the world. Hence we had to use South Asians in naming our society. Dr. Clarence Clottey rightly expresses that sound explicit government-wide policies are vital to effective prevention and control of chronic diseases. Integrated approaches that encompass comprehensive public health action are needed. India some 50 years ago recommended to the WHO to initiate a program for the prevention of Cardiovascular diseases. Yet, India has no national platform nor any definite action plans. I raised this issue during the preventive cardiology conference at Delhi some years ago. Since nothing has come out of our concern, I wrote to two letters (2003, 2005) explaining the immediate need for explicit government-wide policy to The President of India, Hon APJ Abdul Kalam. He wrote back in 2003 that an integrated study and treatment is essential for Heart, Mind and Body. He informed me that my letter will be forwarded to the appropriate authorities. I got a similar reply from his secretary Mr. P.M. Nair for my recent letter to the President. He suggested that I contact Union Health Ministry. In the recent publication on "Preventing Chronic Diseases: a vital Investment"  Dr. Ambumani Ramdaoss, Union Health Minister writes, "In India as in many developing countries, public health advocacy to date has been mainly devoted to infectious diseases. However, we have major health issues due to chronic diseases that need to be addressed with equal energy and focus". In the text he specifically mentions diabetes and coronary artery diseases and agrees with the global health burden of diabetes in India. The only spokesperson that I know at the national level is Dr. Srinath Reddy of All India Institute of Medical Sciences, New Delhi. I have raised this issue with him both at the conference in Milan last year and at Brasil this year. His answer is the same as what Dr. Ramdoss makes in his letter to the WHO Forum: An integrated national programme for the prevention and control of cardiovascular diseases and diabetes is under development.

We have tried to bring in WHO into the picture several times and have failed, as they only work at the Government level and not at the level of professional societies. I am writing these experiences to sketch to you the complexities that exist when the government is not committed or has no political will.  Since I started working in India through SASAT, three or more Health Ministers have come and gone. We still have only one spokesperson at the national level. The number of staff at the non-communicable division of WHO has remained unchanged for years, in spite of the increasing demand. Therefore, as I have expressed many a times, we do need a committed Government in the developing country which recognizes the threat of the chronic diseases and addresses the issues related to the prevention in all earnest. At the same time we need better cooperation from all the parties working to alleviate these chronic diseases.


Gundu H.R.Rao
Professor, Lillehei Heart Institute, University of Minnesota
Founder, Secretary General SASAT, USA