Making India fit

Yoga Day should kick off a wider personal health campaign

Prime Minister Narendra Modi's leadership at the International Yoga Day celebrations early this week may have helped India wield its global soft power, but it should not deflect attention from the enlightened public health messaging embedded in this annual event. It is also possible to equate Mr Modi's annual public callisthenics as a projection of his personal power just as Mao Zedong's publicised swim in the strong currents of the River Yangtze in 1966 during the controversial Cultural Revolution. Like the Chairman in his heyday, Mr Modi is a powerful influencer for a broad swathe of the rising middle class. This is the cohort that stands the greatest risk of suffering lifestyle-related health issues. In that sense, the prime minister's insouciant demonstration of awesome flexibility and fitness at age 65 is certainly instructive for a nation that is notoriously unfit and, in urban India, mostly overweight. If the "demonstration effect" encourages more Indian men and women to step on the yoga mat regularly, it can only be considered a positive outcome.

Mr Modi clearly senses the opportunity; this year, he did well to highlight the well-established benefits of yoga asanas in controlling diabetes, one of the most underestimated public health crises in India. A recent study in the respected medical journal Lancet showed that the absolute number of adults with diabetes in India increased from 11.9 million in 1980 to 64.5 million in 2014. India follows only China as the country with the largest number of diabetics in the world. Although the high numbers may be a function of better diagnosis, they are nevertheless worrying because, unlike a high-diabetic country like the US with its ageing population, India is a young country where people are expected to lead more active lives.

A more unambiguous statistic correlated to diabetes is the incidence of obesity. In 1975, India had 0.4 million obese men and 0.8 million obese women. By 2014, the numbers were up to 9.8 million men and, most shockingly, 20 million obese women. India may not rank high in the Olympic medals tally but in terms of obesity its men ranked at number five and women at number three in the global rankings. Growing obesity is admittedly a common symptom of developing countries. But this outcome is certainly a matter of regret when India has long possessed the indigenous knowhow - and a low-cost one - to combat the problem. Yet few governments have leveraged this natural advantage. The memorable yoga programmes on Doordarshan anchored by Dhirendra Brahmachari, Indira Gandhi's mentor, are a distant memory. Mr Modi's government could well transform this effort into a more intensive public health awareness campaign - India has a record of successes here, with its campaigns to eradicate smallpox, tuberculosis, polio and even the use of tobacco and gutka.

Swachh Bharat, Mr Modi's other eye-catching signature campaign, provides another opportunity to influence public health outcomes. It is no coincidence that India leads the world in the number of underweight adults - a stunning 200 million-plus. Poor diet is certainly a big contributor to this depressing statistic but the link between growth and hygiene is now well established. The average Indian's immune system works overtime to combat diseases spread through public spitting and other random forms of expectoration, open-air defecation and urination. Swachh Bharat's extreme focus on toilet construction has yielded sub-optimal results principally because the intended beneficiaries are unaware of its health benefits and, consequently, unwilling to use toilets even when they have one. More effort on campaigns explaining the consequences of disciplined public hygiene would go a long way towards controlling the spread of communicable diseases. Mr Modi's government is well positioned to make this work.