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Why Nepalese people must stay physically active to prevent NCD related health complications?

Out of the total 193,331 deaths estimated in Nepal for the year 2019, 137,553 (71.1%) deaths were due to NCDs (Non-Communicable Diseases) alone and a total of 2,352,740.2 (Twenty three lakhs +)YLDs (Years Lived with Disability) were also due to NCDs.

Antah Yog Physical ctivity

Source: Gabin Vallet/Unsplash

Everyone wishes for a good health, but very few succeed in achieving it. There might be many reasons for not being able to achieve that perfect condition of health like lack of access to quality health services, financial issues, busy work schedule, unable to maintain work-life balance etc. 

But, one of the major reason for constantly deteriorating health of the people lies in progressive physical inactivity among the population of all ages. 

Physical inactivity is a major independent modifiable risk factor for noncommunicable diseases (NCDs) such as cardiovascular disease, ischemic stroke, type 2 diabetes, colon cancer, and breast cancer. It is also associated with other important health outcomes including mental health, injuries, falls, and obesity.

What are the different forms of physical activities?

Physical activity can be undertaken in many different ways: walking, cycling, sports, hiking, gym, yoga and active forms of recreation (like dance, zumba etc.). Physical activity can also be undertaken at work and around the home. All forms of physical activity can provide health benefits if undertaken regularly and of sufficient duration and intensity.

Global progress to increase physical activity has been slow, largely due to lack of awareness and investment. Worldwide, 1 in 4 adults, and 3 in 4 adolescents (aged 11-17 years), do not currently meet the global recommendations for physical activity set by WHO. 

As countries develop economically, the levels of inactivity increase. In some countries, levels of inactivity can be as high as 70%, due to changing patterns of transportation, increased use of technology and urbanization. 

Physical activity levels are also influenced by cultural values. In most countries, girls, women, older adults, underprivileged groups, and people with disabilities and chronic diseases, all have fewer opportunities to access safe, affordable and appropriate programs and places in which to be physically active.

Situation of Nepal as of 2019

According to the report of Global burden of diseases for Nepal, a total of 193,331 deaths were estimated in Nepal for the year 2019. Among three broad categories of disease and injury, 137,553 deaths were due to NCDs (Non-Communicable Diseases), 40,691 were due to CMNN (Communicable) diseases and 15,087 were due to injuries.

Out of the total number of deaths reported due to non communicable disease ie. 137,553 (71.1% of total deaths), 74,779 were males and 62774 were females which is much higher as compared to the deaths due to communicable diseases which was 21.1% (40,691) and injuries which was 7.8% (15,087). Also, the mortality due to communicable diseases has been in a declining trend while mortality due to NCDs is increasing rapidly.

The arrow diagram below illustrates deaths due to NCDs, CMNN and injuries of both sexes and all ages

Source: Institute for Health Metrics and Evaluation. (CLICK THE IMAGE TO ENLARGE)

Below is the comparison between the causes of deaths for both the sexes aged 15-49 years and 50-69 years according to the GBD 2019 report.

Source: Institute for Health Metrics and Evaluation. (CLICK THE IMAGE TO ENLARGE)

The above diagram shows how the disease progresses constantly towards old age without rectification.

Expenses of Nepal on Health Sector

Government spending on health as a share of Gross Domestic Product (GDP) has slowly increased from 1.4 per cent in FY 2015/16 to 1.8 per cent in FY 2018/19. 

The health sector budget (MInistry of Health and Population-MoHP and other ministries) has gradually been increasing over the years from 49.8bn Nepalese Rupees (NPR) in FY 2016/17 to NPR 115.1bn in FY 2020/21. 

The gradual increase in the total budget for health is a good news and not so good news at the same time. One of the major reason for that is on the one side there is increase in the total budget for health and on the other hand there is constant increase in number of Years Lived with Disability (YLDs) year after year. 

The YLDs are the number of years that a subject lives with some disease. It depends on the severity of the disability that the disease causes to the affected individual. Chronic disease disables an individual once disease is diagnosed, and the years that he or she lives until death are the number of years lived with disability. 

In 2019, a total of 2,352,740.2 YLDs were due to NCDs. Mental disorders, musculoskeletal disorders, other NCDs, neurological disorders and sense organ diseases were the leading causes of YLDs in 2019. Of the total YLDs, 16.4% were due to mental disorders, 15.9% were due to musculoskeletal disorders, 8.1% were due to other NCDs, 7.9% were due neurological disorders and 7.5% were due to sense organ diseases.

Below is the table illustrating comparison between ranking of YLDs for both sexes and all ages between 1990 and 2019

Source: Institute for Health Metrics and Evaluation. (CLICK THE IMAGE TO ENLARGE)

It is actually the disabilities that gradually lead to other serious complications before causing death of an individual. Any individual experiencing disabilities do have visible symptoms of illnesses. But, ignoring the symptoms and not engaging in any physical activities further worsens the symptoms and leads to degraded quality of life and in some cases irrepairable losses of lives. 

Both the physiological and psychological complications are responsible for deterioration of the health of an individual. Physiological illnesses can result into some psychological problems but psychological illnesses can result into major physiological problems. For example, prolonged stress alone can affect your nervous, cardiovascular, endocrine, digestive and respiratory organs and systems.

Therefore it is advised to be both physically and mentally fit. Physical fitness is understood well but many people lack the concept of mental health. Mental health includes emotional, psychological and social wellbeing. Your mental health decides how you deal with your everyday stressors, resolve minor or major issues in daily life and is able to switch back consciously to parasympathetic dominance mode of the nervous system.

Poeple often confuse mental health with momentary happiness gained through engagement in pleasurable activities or aquiring material stuffs. Staying physically active can ward off all the possibilities of future health related issues.

Our health is 'our' responsibility

There are many risk factors associated with an illness. The three major such risks are bheavioral, metabolic and environmental risks. In Nepal, behavioral and metabolic risks are the major risk factors for the number of deaths every year. 

Below the diagram shows the top seven risk factors that are associated with people themeselves. Both sexes, all ages, YLDs risk factors.

Source: Institute for Health Metrics and Evaluation. (CLICK THE IMAGE TO ENLARGE)

Both metabolic and behavioral risk factors can be controlled by involving in certain physical activities and regulating our diet and nutrition in day to day schedule. These risks indicate lack of awareness, unscientific lifestyle and unhealthy eating habits as well.

Even if people have a busy schedule today, however, it is possible to allocate at least 1 hour everyday for physical activities which can keep us healthy in many ways. Lack of need to visit the hospital doesn’t indicate everything under our skin is healthy enough to keep us going for a considerable amount of months or years without complications.

It’s not only about physical fitness, engagement in mind-body-soul practices such as yoga can benefit us in multiple areas of our health and wellbeing. A robust mental health is one of the biggest advantage of engaging in yoga practices daily which can prevent NCDs such as cardiovascular, respiratory, endocrine, digestive and neurological problems.

Sources:

Katzmarzyk, P. T., Friedenreich, C., Shiroma, E. J., & Lee, I. M. (2022). Physical inactivity and non-communicable disease burden in low-income, middle-income and high-income countries. British journal of sports medicine56(2), 101–106. https://doi.org/10.1136/bjsports-2020-103640

Dahal, S., Sah, R. B., Niraula, S. R., Karkee, R., & Chakravartty, A. (2021). Prevalence and determinants of non-communicable disease risk factors among adult population of Kathmandu. PloS one16(9), e0257037. https://doi.org/10.1371/journal.pone.0257037

Pedisic, Z., Shrestha, N., Loprinzi, P. D., Mehata, S., & Mishra, S. R. (2019). Prevalence, patterns, and correlates of physical activity in Nepal: findings from a nationally representative study using the Global Physical Activity Questionnaire (GPAQ). BMC public health19(1), 864. https://doi.org/10.1186/s12889-019-7215-1

Lee, I. M., Shiroma, E. J., Lobelo, F., Puska, P., Blair, S. N., Katzmarzyk, P. T., & Lancet Physical Activity Series Working Group (2012). Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet (London, England)380(9838), 219–229. https://doi.org/10.1016/S0140-6736(12)61031-9

About the Author

Picture of Sanjeev Yadav, M.A. Yoga, P.G. Psych., DNHE
Sanjeev Yadav, M.A. Yoga, P.G. Psych., DNHE

Mr. Sanjeev is a yoga professional specializing in applied yoga, psychology, and human excellence with over more than 8 years of experience as a health and life coach, well-being trainer, and psycho-yogic counselor. He is completing his Ph.D. dissertation in Yoga.

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