Causes of death data can be obtained from the statistical records of Medical Records Departments of medical colleges, hospital records, post mortem records and the Registrar of Births and Deaths. These records are not merely numbers. They form a health atlas of society, reflecting the disease burden and the prevailing medical scenario.
The author conducted a research study in 2008 over a ten-year period at Goa Medical College and continues to pursue this work. The study of causes of death helps health administrators identify priorities, frame preventive strategies and implement health education programmes and screening schemes. When properly analysed, such data enlightens the public to take corrective and preventive measures for themselves, their families, friends and the community at large.
The changing disease burden over the decades has occurred due to multiple factors. Infectious diseases have been better controlled because of powerful antibiotics, improved hygiene and cleanliness, better healthcare systems and advanced diagnostic methods. Imaging techniques, genomic and molecular diagnostics, targeted therapy, personalised medicine, integrated diagnosis, newer molecules, advanced technology, information technology, automation, robotics and artificial intelligence have transformed medical practice. Vaccines have also played a crucial role. Yet despite these advances, death remains the only constant in life. What modern medicine has achieved is the ability to prolong longevity and delay death.
The causes of death identified in the author’s study at Goa Medical College include heart diseases and cardiovascular diseases such as myocardial infarction, hypertension, cardiac failure, arrhythmias and stroke. Emerging infections such as tuberculosis, viral and fungal infections, HIV, sepsis, leptospirosis, malaria, dengue and rabies remain significant contributors. Alcoholic liver disease and cirrhosis are major causes, along with diabetes and its complications which can affect any organ from head to toe. Cancers and their complications, respiratory and pulmonary diseases also contribute substantially.
Trauma and external causes form another group, including road accidents, head injuries and polytrauma. Substance abuse including narcotics, alcoholism and pan consumption is another factor. Drowning, snake bites, burns, fires, stampedes, wars, earthquakes, murders and suicides also account for deaths. Pollution related pulmonary and respiratory diseases are rising. Old age itself remains a natural cause. Floods, famines, congenital anomalies, genetic diseases, plane crashes, metabolic and electrolyte abnormalities and neurological conditions such as Alzheimer’s disease further add to the spectrum.
In the majority of cases, lifestyle factors coupled with hormonal, environmental and genetic influences play a major role. Therefore lifestyle modification is central to prevention. A proper diet rich in vegetables, fruits, nuts, seeds, lentils, micronutrients, vitamins, minerals and proteins from fish and chicken is recommended. Dal and fibre are important. Adequate hydration and plenty of water are essential. Regular walking, exercise, adequate sleep of seven to eight hours, meditation, a calm mind and meaningful social interactions with spouse, family, friends and well wishers are vital.
Processed foods, fast foods, cream rich preparations, refined foods, aerated drinks and sugary drinks and red meat should be avoided. Oils must be limited and olive oil is considered a healthier option. The Mediterranean diet, similar to that followed in the Blue Zones, is widely regarded as beneficial. Prolonged sitting is harmful and has been described as the new smoking. After every hour of sitting, one should walk, drink water and get exposure to sunlight. Happiness is of paramount importance. One must do what one likes and like what one does. Time spent in nature among greenery, beaches, hills, rivers and ponds is beneficial. Screen time must be limited.
Periodic medical checkups are essential. Blood tests, imaging, ECGs, tumour marker evaluation, Pap smears, breast screening, pelvic evaluation for women and PSA evaluation for men must be undertaken as advised. Those with a family history of cancer should begin screening at an earlier age. Stool examination for occult blood and colonoscopy should be performed periodically based on medical advice. Regular monitoring of blood pressure and other parameters is important. Medical reports and records should be preserved carefully just as passports, PAN cards and Aadhaar cards are preserved.
New risk factors for lifestyle diseases include loneliness, global warming, pollution, microplastics, mobile phones and excessive screen viewing. Post Covid 19, various immunological alterations have been observed due to the disease, vaccines and medical interventions. Changes in immunity, coagulation abnormalities, thrombosis and long Covid effects must be kept in mind. Respiratory diseases such as asthma, chronic bronchitis, chronic obstructive pulmonary disease and interstitial lung diseases remain concerns. Infections must be tackled with vaccination and appropriate therapy.
Calamities such as burns, drowning, fires, stampedes and road accidents require coordinated efforts involving government, administrators, society and NGOs. Alongside healthy lifestyles, discipline, honesty, sincerity and strict implementation of laws and regulations are necessary.
For society to be happy, people must be healthy and fit. Youth must limit screen time, cultivate good habits and hobbies, avoid smoking, alcohol and narcotics, play outdoor games, sleep well, drink sufficient water and manage stress. Stress releases cortisol which adversely affects health. Young people must respect parents, elders and teachers and be educated in ethics, morality and good conduct. Longevity can increase as seen in Blue Zone populations only through sustained positive lifestyle practices.
A positive attitude and healthy habits are the keys to delaying disease and promoting longevity. As society advances rapidly, it must ensure that health advances with it.
(The writer is a Professor of Pathology, former Head of Department at Goa Medical College, former Dean of Goa University, and the current President of the Asian Society of Cytopathology)
