Kathmandu (The Kathmandu Post/ANN) - In their research paper published in Indian Heart Journal (Issue no. 6402), Abhinav Vaidhya, Ramji Prasad Pathak and Mrigendra Raj Panday show that the prevalence of hypertension has increased at least threefold during the last 25 years. In 1980 when Mrigendra Samjhana Medical Trust carried out "the first scientific HTN (hypertension) survey" in Bhadrabas village, around six per cent of the villagers were found to have had high blood pressure.
By 2006, when a repeat survey was done in the same village, the number had shot up to 18 percent-based on the standard of measurement used by the World Health Organization in 1980. Since then the standard has been revised and according to the latest standard in use, the actual prevalence of hypertension is as high as 33 percent. We may not have comparable studies in other places, but we can make an educated guess that things might not be different in other places across Nepal.
What has gone wrong? The study explored the changes in the amount of salt intake, body weight and level of physical activity among the study-participants. The level of physical activity has gone up and, therefore, the culprits, according to the research, must have been increased salt intake and increase in body mass index. The intake of over five grams of salt, considered the cut-off range for an adult, had indeed gone up from among 55 per cent of the villagers to 89 per cent during this period. Similarly, people had gotten fatter.
While this study strongly indicated dangerous increase in hypertension in Nepal, its explanations, however, are inadequate for serious public policy interventions for two reasons. First, the increase in salt intake itself requires different levels of explanations. The study conjectures that the consumption of processed food might be behind this. The consumption of readymade noodles and a variety of chips has indeed shot up across the country. But we also need to explore how the food processing industry has been able to use dangerous levels of salt. That takes us to the power this industry wields in society. The increased consumption of processed foods in Nepal has coincided with the expansion of mass media. The newspapers, television, radio and, lately, internet has flourished. Advertisements of processed food items have become one of the major sources of income for most of the private sector media. In major media houses, the marketing department is watchful of news and views that might harm revenue generating potentials. The products are routinely advertised among children as full of vitamins and other nutrients. If this trend continues, we can easily expect that this trend will continue into future.
Second, the paper has also failed to explore many other plausible explanations for the rising trend of hypertension. Two among them are particularly important in Nepal. One, the air people have been breathing in Nepal's towns and cities and a lot of villages has become increasingly polluted. There have been several studies that have shown the direct link between hypertension and pollution. In a study carried out in 2008 among mice at Ohio State University Medical Center, it was found that the blood pressure level was directly affected by the level of exposure to air pollution. When the first study was carried out in Bhadrabas in 1980, it was a relatively unpolluted village and so was Kathmandu. Now things have changed drastically. Kathmandu has become one of the most polluted cities on the Earth and Bhadrabas is not far from Kathmandu. Moreover, we can safely guess that people in Bhadrabas are increasingly exposed to Kathmandu pollutants (and many other things) as they travel in and out.
The study showed that hypertension was much less prevalent among women than men. Was it natural variation? Or was it because men, because of their increased mobility outside of the village, are exposed to more city pollution-sound and air, particularly-than women? It could also be that men have been eating more processed foods as they travel outside of home.
There is another aspect of Nepali society which deserves further exploration. In a study done among white and black Americans, William Dressler found in the mid-1990s that prevalence of hypertension was much higher in blacks even after neighbourhood locations, wealth and professional standing were controlled. The discrimination based on colour, it was found, accounted for this. The historical experience of discrimination had led to disproportionately high level of psychological stress among blacks, leading to increased level of hypertension. We don't know if Bhadrabas study involved data among different social groups.
It is hard to untangle the individual causal factors involved in non-communicable diseases, but by now it has become clear that they cannot be effectively tackled without addressing the quality of food we eat, the air we breathe and the social relations we enter into. This then takes us directly to the heart of our political life. What happens to our bodies is not our individual thing alone, although some of us in society might be able to exercise greater control over our bodies than others. Our individual bodies and the body politics are intimately connected.
