Delivering comprehensive and integrated care in India

‘New @WHO report highlights the increasing use of sophisticated online marketing techniques for alcohol that target young people despite the clear health risks. We call for better enforced and more consistent regulation of alcohol marketing to save and improve young lives worldwide’. – Dr. Tedros Adhanom Ghebreyesus, Director General of the World Health Organization[1] Dear Editor, Bhadoria et al.[2] emphasise preventive hepatology at All India Institute of Medical Sciences (AIIMS) Rishikesh (a district in Uttarakhand state) and discuss delivering comprehensive and integrated care for liver diseases in the northern state of India in their review article published in the January 2024 issue of the journal. There they analyse the most common causes of afflictions of the liver, potential sources of exposure, and then low-cost interventions that may be comfortably/suitably/locally used to reduce the risk of further complications.[2] Nowadays, when there is always a tussle between finite available resources and our infinite ambition/aspiration to reduce illnesses and, thereupon, human suffering, such articles show us the light at the end of the tunnel and mark the way ahead; therefore, our policymakers should lend an ear to them for the maximum benefit to mankind. We – on behalf of the medical community – have unlimited praise for the authors who threw their hats in the ring when liver failure is our common enemy. Nevertheless, to get a better grasp of the mundane affairs of the liver, we believe that we need to pay attention to background noise first. The literacy rate in India has been improving recently yet we are below the world average.[3] What that indicates is that people at baseline are not aware of the harmful effects of these addictive substances, and a brief intervention with motivational interviewing is likely to have limited success. When the population has basic universal literacy, it may have a better sense of evaluating its surroundings – including harmful and unhealthy material. Father of modern medicine – Sir William Osler – said, “The good physician treats the disease; the great physician treats the patient who has the disease. The great physician understands the patient and the context of that patient’s illness”. The great physician understands the patient and the context of that patient’s illness. Utilising this logic, we may easily deduce that general intelligence is more useful than goal-directed one. In this commerce-driven era, surrogate advertising and social media cause more harm to people’s health as they are gullible to the glitz many times and unknowingly fall prey to the fashion of this novel hi-tech arena. Table 3: Community-based assessment checklist shows to ask individuals presenting to the health centre if they smoke at question number 2. Hence, if we want them to know the harmful effects of addictive substances, their general awareness may be more useful than that generated by the health department under special circumstances and in the context of a disease of some specific organ system. On this web page, the World Health Organisation informs us about cause-specific mortality, 2000–2019 in different countries. The page shows ischemic heart disease, chronic obstructive pulmonary disease, and stroke in the top three slots.[4] Incidentally, these illnesses also share some common risk factors for their pathogenesis – smoking, high blood pressure (BP), diabetes, a sedentary lifestyle, alcohol, and obesity. What we need to realise is that general attention to reducing mortality in general requires an approach quite similar to that specified by the authors in the context of liver disease. Our health is a product of the choices we make up to a certain extent. Beyond that, what surrounds us determines our vital signs. Urban planners should pay attention to creating an environment safe from pollutants by having open spaces conducive to physical movement.[5] Exercise is healthy, not only for its known benefit to the liver but also for other organ systems.[6] Similarly, maintaining a body weight near normal helps not only the liver but the heart, muscles and brain too.[7] The authors conclude their write-up by stating the importance of the management of metabolic disorders at the primary care level. However, interventions before their genesis demand several departments of the executive to come along to not just add years to life (life expectancy) but life (happiness) to years as well. Modern science and the practice of medicine have been successful to hand over a few extra years, resulting in an increase in our numbers.[8] It’s up to us to discover ways to make it productive and pleasant until the end.[9,10] The secret to healthy living involves controlling easy-to-control risk factors for most of us. In addition, for that purpose, we need not only a healthy liver but also its associates. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.