Globally, massive strides have been made in the last few decades to improve both the quality of and access to healthcare, but this progress has been lopsided. While certain forms of healthcare such as maternal and child healthcare have greatly improved, others such as mental healthcare play laggard in achieving SDG coverage targets.
The WHO estimates that 25% of the world suffers or will suffer from a mental health issue at some point in their life . Closer to home, the National Mental Health Survey 2015-16 revealed that nearly 15% India adults need active intervention for one or more mental health issues and one in 20 Indians suffers from depression. It is estimated that in 2012, India had over 258,000 suicides, with the age-group of 15-49 years being most affected. Covid-19 has only ended up exacerbating the already grim situation.
India was already not equipped to handle the initial case load; let alone the additional increased burden of the pandemic. The ideal psychiatrist to population ratio is about 1:8,000 to 10,000. According to estimates by professionals, in India, there is only one psychiatrist for every 2-lakh people. The shortfalls for other mental health professionals is also staggering: the need of Clinical Psychologists is 20,000 and there are only 1,000 available; for Psychiatric Social Workers, the requirement is 35,000, but only 900 are available, for Psychiatric Nurses, we need 30,000 and only 1500 are available.
To its credit, the government has put into motion the framework to help solve for this issue in the long run. In 2017, the Parliament of India passed the Mental Health Care Act , which puts the onus on the government to build up human resource capacities to ensure that mental health services are available in each district in the country. Unfortunately, the on-ground effects of these measures are at least a decade away.
With close to 250,000 suicides a year across the country, a decade is a luxury that India does not have. Other avenues of government policy can be explored and operationalized to reduce the burden of depression and anxiety in the short-run, and to increase general well-being levels among the population. To achieve this, one of the areas that the government can lean on is food policy.
Food is one of the biggest causes of illness and the consequent economic burden it places on families, societies, and countries alike. However, it can also be the solution.
Over the past few decades, the diet of middle-class India has shifted from a primarily cereal-based diet for highly processed convenience foods, rich in refined sugar and trans fats .These foods are a contributing factor to increased rates of obesity and non-communicable diseases - caseload of diabetes in India has increased from 3% of Indian adults in 1970 to 11.2% in 2017. Research also reveals that the degree of hyperglycaemia in individuals with Type 1- and Type 2- diabetes is positively associated with risk of depression , and poor blood sugar control may harm mental health by increasing gut and brain inflammation, in turn compromising mental health. In fact, several components of the industrialized diet, disrupt the gut microbiome.
There is now a substantial body of evidence pointing to the existence of a strong relationship between the gut and one’s mood ; it is one of the reason’s we experience sensations such as butterflies in the stomach when we’re nervous/excited about something. Similarly, the gut is abundant with serotonin receptors ; shifts in gut health can impact our mood. A precarious balance of good and bad bacteria living in our gut can have major impacts on our daily experience. This is the reason medication like anti-depressants can impact our bodily functions and have warnings for side-effects such as diarrhoea and other gastrointestinal issues. As such, the food we consume is a critical ingredient in balancing our emotions. Consumption of whole food diets heavy on fruits, vegetables and unprocessed foods is linked to higher levels of well-being, while ingesting junk and processed foods heavy is a precursor to lifestyle diseases and has been linked to depression . Sugar and trans-fats , key ingredients in processed foods, have been found to cause emotional instability and dysregulation. Further, they contribute to inflammation, which is the root cause of several diseases and known to be associated with schizophrenia.
To effectively use these findings for improving the well-being of the population, the government needs to take a multi-pronged policy approach, which include mandatory limitsand awareness about reading labels. In this regard, there are already regulations in the pipeline, which need to be notified. The regulations limiting the amount of trans-fats in edible oils and processed foods have been pending notification for over a year and are nearing the government’s own set deadline of being implemented by January 2021 . While the government launched a trans-fat free logo last year, the same is one part of the puzzle. Labelling of high fat/sugar/salt (HFSS) has been in the works for over two years, with no indication of a deadline for completion . Such a regulation would be necessary for consumers to make informed choices that would impact their own well-being.
The mental health and chronic disease epidemics demand to be treated with the urgency they deserve. This will require a massive shift with a focus on public health as a national priority. It would be essential for individuals, communities and both private and public healthcare sector to come together with a clear public health message. At the government level, one cannot take a one-size fits all approach; it is necessary to continuously look at the relevant science and keep expanding the umbrella of activities. Nutrition is a low-hanging fruit that has already been on the government radar from a physical health perspective. All that needs to be done is to expedite this process.
(Kripa Jalan is a professional nutrition consultant, Founder of Burgers to Beasts and a graduate student at the Harvard T.H. Chan School of Public Health. Sharang Shah is a policy consultant with Chase India)
As featured in: Outlook Poshan