HOW TO LEAD A HEALTHY LIFE

HOW TO LEAD A HEALTHY LIFE

Dr. Ashok K. Mahapatra
Principal Advisor, SOA Deemed to be University, Bhubaneswar

Introduction

Health and Education are two important aspect of human life. Both are important for growth and development of society and country. Over last 100 years, education and health has improved and life expectancy has increased. In India following independence both the parameters have improved. While at independence the life expectancy of an Indian was meager 32 years today at 2022 life expectancy have reached around 70 years(1-2). Similarly infant mortality rate (IMR) and maternal mortality rate (MMR) are significant decreased as health facilities have improved over last 75 years. In the year 1900 there were only seven medical college, and at the time of independence, 1947, only 15 medical college in India. Currently there are 547 medical colleges enrolling over 83000 MBBS students and over 43500 post graduate students (3-5), a tremendous success story (5-8). Similarly the higher education in field of science and technology and even humanity has made unprecedented progress, all over the world, including India (5-8).

Table 1 (Ref. 4-8)

Prior to Modern Indian Medicine, Started 200 years back, the treatment was by and large by Ayurvedic Medicine, Homeopathy, Yoga and Naturopathy (4). Even today, we realize the significant role of Indian system of medicine in positive health and in keeping people happy and healthy. In 2003, Govt. of India created Department of AYUSH, fully understanding the need and limitation of modern medicine (10). Even though Govt. started a separate department, AYUSH in 2014, it was brain child of former late Prime Minister Shri Atala Bihari Bajpai, who started separate department of AYUSH in MoH 2003.

What is the current problem?

Health is wealth, yet people have no time to look after their own health. Looking at the disease pattern we can divide two categories of disease, (a) Communicable Disease, and (b) Non-communicable Disease (NCD), such as High BP, Diabetes, Malnutrition and COPD, etc. related to life style modification and modernization (11-17).  Recently, over last 20-30 years, disease Pattern in India has changed. It is now 55% non-communicable (NCD) 45% communicable disease. while most communicable disease have disappeared in developed countries, however, India has not been able to get rid of communicable disease, yet we have acquired life style related modern diseases. like High BP, Diabetes, Cardiovascular Disease, CVA, Cancer and COPD.

Bores Committee                    1946

Mudalire Committee                1961

Srivastav Committee               1975

National Health policy              1983

Policy of Health Care               1989

National Health Policy              2002

8th–5th year plan 1992–1997 Lend emphasis on AYUSH. Central Council for Indian Medicine 1970, Central Council for Hospital 1973. 9th – 5th year plan 1998-2002. Dept. was renewed Ayush Nov.2003, in 2005 Ayush integrade to NRHM.

Table 2

Life style related disease

Accordingly to WHO 2021 (18) non-communicable disease kill 41 million people worldwide equals to 7% death all deaths worldwide and 77% deaths in low and middle income group(18).

Table 3

Key facts on Life Style Disease WHO 2021

Thus, India comes under high risk group countries due to High BP, DM, smoking and alcohol use. The obesity has increased worldwide. Most dangerous among NCD are (a) coronary artery disease, (b) stroke or CVA, (c) Cancer. These are also related to High BP and DM. Now we observe, Hypertension and Diabetes are the two major killers.

According to WHO (2021) Heart Attack (CAD), CVA is two major killers followed by Cancer, COPD and kidney failure. NCD affects low income group (18) almost 75% NCD deaths in low and middle income countries.

People all age groups are at risk of NCD

People of all age get affected by NCD. Maximum incidence of NCD is between 30-69 years, and leads to premature deaths (85%). Children, adult and elderly are all affected. In a study at Delhi 30-33% children are overweight, so also in most of the states in India, including Odisha. In Odisha, obesity and overweight together recorded in 32% people. Mostly, unhealthy diet, lack of exercise and change in life style, are the causes. Even 40% children in schools and colleges are having high BMI. High blood sugar and serum lipid is real concern in India, will be great problem in coming future.       

Table 4

Risk factor for Disease is Obesity

Over weight is the mother of all disease (NCD)

1. High BP
2. Diabetes mellitus
3. Obesity, and over weight
4. High Cholesterol
5. Smoking and tobacco chewing
6. Alcohol and drug abuse
7. Lack of physical activity and exercise
8. Aging population

My Personal Experience

1. Health Camp in my Village School in 2009, 2010 and 2011

• 15% are pre-diabetic, 10% children overweight and 20-25% were under weight.

1. Health Camp for Elder and Senior Citizens at various places of Bhubaneswar.

1. Age 60-70 years–High BP:20-25%,DM:20-25%,Obesity:30%
2. Age 70-80 years–High BP: 25%, DM: 26%, Obesity:60%
3. Above 80 years – No one was disease free. Only 12-15 had normal health above 65 years of age.

1. Medical and Nursing Students

2015-2016: Bhubaneswar (AIIMS Students)

• High BP                 15%
• Overweight           48%
• Depression(stress) 50%
• Sleep around 1AM getup 7.30 – 8.00 AM

These parameters have shown high incidence of High BP and Diabetes Mellitus. Anxiety, stress, depression are high and sleep problems in 40-50%, sleep and work cycle change in children. This has worsened during pandemic (2020-2021). Disease burden, mental status has deteriorated at further added by decrease income or unemployment.

Lifestyle changes are due to increase income. Change in food character, contents and timing has increase the risk of obesity (12,13,17). The pattern seen, in India was also observed in Bangladesh and Nepal, in an ICMR study (13). Women in reproductive age group have increased risk of obesity (13,17).

Real problem are life style change, food habbits, smoking and alcohol intake. These facts have increased all NCD, over last 25-30 years. Sleep problem is an important aspect, never discussed nor taken care of, by the patients or by the Doctors.

What is Good Health? (1946), WHO (Table 5)

A state of complete, physical, mental, social and spiritual welbing not mere absence of disease or infirmity (19) in 2005 (20). Houseman and Dorman described “the linear model, supported by previous finding, including (a) regular exercise, (b) limited alcohol, (c) absence of smoking, (d) 7-8 hours good sleep and (e) maintain healthy eating and weight. Play an important role in promoting longevity and preventing ill health and deaths.

WHO also recommend regular exercise, adequate sleep and avoiding bad habits like drug abuse or smoking (21). Stress reduction is an important aspect of good health to maintain balance and healthy mind.

Table 5

WHO, Good Health and Factors

1. Physical
2. Mental
3. Social
4. Economic status
5. Physical environment
6. Educational status

Large number of determinants for good health, which can improve health status and quality of life, for which we need appropriate and advanced health science and though an intelligent life style by the person or by the society.

In 1996, spiritual health was added by WHO, as the 4th Diemention of good health (1996). As defined by WHO, spiritual health is a state by which a person can deal with day to day life by full realization of potential, meaning and purpose of life and happiness within (22). In a detailed review, Dhar et at, published (23) details of spiritual health (Table 6). It is believed that 93.4% doctors believed in spiritual health is important for good health (22-27).

Table 6

Spiritual Health

1. Spiritual Wellbeing Scale Ellison
2. Spiritual assent scale – SAS
3. Spiritual Assent inventory, Sai Education
4. Independent Spiritual Assent Scale (ISAS)

All above methods described to assess the state and level of spiritualism. However, none of them are is adequate nor optimal.

Table 7

What is Spiritual Health?

• Self-realization
• Understanding purpose of life
• Happiness from others
• Self-evolution
• Transcendence

Structured berger (28) defined and correlated; link between religion, spirituality and health and commented that it is often forgotten topic. The aim is to identify and construct spiritual health, identity spiritual determinate of health, develop spiritual health scale, and to reliably validate the scale in various populations (Table 7).

Currently Health Pyramid is reversed. We do attach too much importance to physical health, little for mental and almost no significance to social and spiritual health (Fig.1-2). In India, due to western influence, divorce increased and family structure changed. Life has become more self-oriented Nuclear family and joint family structure has collapsed leading to gross reduction in family support. There is no social security. Elder persons have few people to look after them in old age, which has added to problems and going to worsen, in future. There is increasing intolerance and increased indiscipline in society, destroying social fabrics and secular concept of Indian society. This has led to with increased violence poor social health (30). The happiness index has decreased and service of belonging and concern for other has also shown marked deterioration. The Social Determinant Of Health (SDOH) are as follows. The sound social health of an individual and society is bad (Table 8) (31, 34).

Table 8

Social Determinations Of Health (SDOH)

1. Health Promoting Factors
2. Economic Stability
3. Health Care Quality
4. Social and Community Concerns
5. Neighborhood and environment
6. Education Access and quality

How to Improve Social Health?

Large number of factors can improve social health of an individual, which helps in improving health status of Society, such as, ask for help, keep your hobbies and interest, join caregiving group to support people, and mixing with good people etc. (Table 9).

Table 9

Tips for Good Social Health and Wellness (34)

1. Surround yourself with good people
2. Find health coping methods
3. Treat your body as a temple
4. Have some hobbies and extracurricular work
5. Develop communication skill
6. Follow your works
7. Set up boundaries
8. Check in with our people
9. Stick to health route

How have achieve good health?

It is easier said than done. Despite of education, money and knowledge we suffer from poor health and disease. It has to be well balanced with a good routine and healthy life-style. The following parameters are necessary to be regulated to maintain a healthy, happy and peaceful life (Table 10).

Table 10

1. Food – Quality, Quantity and Timing
2. Rest – Timing and Relation to food
3. Exercise – Regularity, Duration, Type  according to need.
4. Relation – Physical, Mental, Social
5. Meditation – Prayer, Timing and duration

Food is important for good health. As per Bhagabat Gita, (Chapter 17) Satwik food give energy, vitality, longevity, creativity, peace of mind and provide mental and social wellbeing (35). It must be balanced, small quantity and more frequent (4-6 times) with a gap of 3-4 hours. Ideally food should contain less sugar, less lipid (fat) and low salt, and should have fresh fruit, green vegetable and fibers. Many people do avoid breakfast, and have heavy dinner at late night, both are very bad eating habits and must be avoided. In India, over weight and malnutrition both are problem. BMI must be kept below 25, ideally below 22 to avoid accumulation of visceral fat. This can be achieved by avoiding junk food, and performing adequate and regular exercise. Over eating is bad, hence must be avoided at all cost (Table 11).

Table 11

What is good food habit?

1. Eat balanced food
2. Eat small amount 4-5 times a day
3. Take regular breakfast
4. Avoid junk food, too much of fat and sugar
5. Try to keep BMI<25 and <23 ideal
6. Do not drink water 30 minute before food and within 1 hour of food

Other ingredients for good health

For good health, regular, and adequate exercise is necessary. It depend on age and disease status such and cardio-repiraty system. A person with cardiac problem cannot expect too much, so also patient with. COPD or Bronchitis. Exercise helps in food metabolism, burns down extra calories, activate mind, and helps in good sleep (Table 12).

Table 12

How Exercise helps?

1. Helps in good circulation
2. Increase lungs (vital) capacity
3. Metabolize food and reduce body fat
4. Activate mind
5. Help in sound sleep
6. Reduce depression and negative thinking
7. Keeps mind positive and healthy

Sound sleep and meditation helps in stability and peace of mind, stimulate immune system and energies you for next day activities. Daily 6-8 hours of sound sleep is necessary for good health, so also meditation for 10-15 minutes morning and evening (Table 13).   

Table 13

Sleep and Meditation

Thus, food is for body, meditation is for stable, strong, positive mind and prayer for peaceful soul. One can have good harmony between body, mind and soul that helps in wellbeing and good health.

Table 14

Body, Mind and Soul

1. Harvard medical school every year September – October, International Conference
2. Brahma Kumari’s Iswariya Viswa Vidyalay, Mount Abu – Body, Mind and Medicine
3. AIIMS, New Delhi, Every Year February – Body, Mind and Medicine

Above are few example of conference for healthy body and sound mind that helps in achieving on peaceful state.

Conclusions

To be healthy physically, mentally and socially one has to change his current life style. He has to reduce the needs, have timing balanced food. Sleep is integral part of good health and 6-8 hours of good quality sleep necessary for positive health. It is also important to realized exercise, meditation and prayer can boost positive health by burning down extra fat, improving blood circulation and make someone mentally sound and positive. Pranayama and meditation can also improve immune system and prevent disease. Thus, one can have a good time table for work, sleep and relaxation for healthy life.

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Prof. (Dr.) Ashok Kumar Mahapatra was born at PURI on 29.12.1952. His father was Mr. Naba kishore Mahapatra and Mother, Dinamani Devi, stayed at a Brahmin Village (Sasan) near PURI. In child – hood they had a simple life. However, they had landed and the family belongs to the advisor to PURI King (Gajapati Maharaja)shifted to MKCG Medical College in 1970, where he completed MBBS in 1975. MS and MCh Neuro Surgery from AIIMS Delhi. From 1983 – 2017 he worked as a faculty of Neuro Surgery at AIIMs Delhi. In 1996 March he joined as Professor and 2004 as a Senior Professor. He was appointed Director, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow in 2006 and Director AIIMS Bhubneshwar in 2012. He retired as Dean Research, AIIMS New Delhi, after spending nearly 42 years at AIIMS. Currently he is working as Vice-Chancellor at SOA University, (Deemed to be University), at Bhubneswar.
During his tenure at AIIMs, he published 870 papers, wrote 16 Books and more than 140 chaptered. In last 30 years he conducted over 20 research projects and received over 10 crores as research grant. He guided 12 PhD students during his tenure at AIIMs. During1998 - 2008 he had 3rd highest Medical Publication in India and highest no of publications at AIIMS. He has 870 publications with more than 13,500 citations and H index 50 and I 10 index 355 (enclosed)
During his illustrious carrier he had worked as Director of SGPGI for 3yr (2006-2009). During 3years he had successfully completed more than 10-12 projects and started and completed 2nd phase of SGPGI (2006-2009) during which he received Budget worth of 1000crores. Completed. (1) School of Telemedicine 2) Liver Transplant Centre 3) BMT centre 4) Advanced Pediatric
centre 5) PMSSY Building 6) Nursing College 7) College of Medical Technology 8) During his tenure library block, convention centre complex, Trauma Centre construction started and completed. PMSSY building started and completed, 1st to get completed project of PMSSY in India (2007-2008). During his tenure 6no depts started in SGPGI. A) Hospital Administration 2) Pediatric Surgery 3) Pulmonary Medicine 4) Maternity and reproductive health 5) Neonatology and 6) Molecular Medicine. The work and progress made at SGPGI during 2006-2009was un-parallel.
He was the founder Director of AIIMS Bhubaneswar, started 2012. Starting from Scratch, MBBS, BSC (Nursing Hons), PG and DM, MCh was started in a 4yrs period between 2012-2016. He also started BSc. (Hons) Medical Technology at AIIMS Bhubaneswar – 2015.
In last 40 years Dr. Mahapatra received many awards, (award 65) delivered 15 Orations and received many life time achievement awards. A fellow of National Academy of Science, and member and Academy fo Medical Science. He started Neurological Surgeon Society of India (NSSI) in 2010 became the founder President. He also started Indian Society of Peripheral Nerve surgery 2011 and was the founder President. He contributed heavily to the development of Pediatric Neuro surgery (1989-2012) Neuro trauma (1991-2014) and skull base surgeon society in India (1988-2008) and Peripheral Nerve Surgery (2010-2018). Thus he has been architect of developing super specialization in India staying as a faculty at AIIMS Delhi over 37 years.
In 2016, Dr. A.K.Mahapatra after completing 4 years and 3 months as Director at AIIMS Bhubaneswar, went back to AIIMS, New Delhi, and took over Chief Neuro Science Centre. In January 2017 he was appointed as Dean Research at AIIMS by MoH. Govt. of India, which he continued till December 2017 till his superannuation.
In 2017, he along with his team operated Jaga and Kalia (Balia) conjoint twin (Craniopagus), successfully and both baby survived. Overall 12 such operations done in the world from 1987 to till 2017. It was the first reported successful operation in India. He came back to Odisha and took over Director of Hospital
serves in March 2018. Since joining at IMS & SUM Hospital, Bone marrow Transplant, liver transplant and kidney transplant started.
It was also instrumented in starting B.Sc. (Hons.) Medical Technology, in many places in India, SGPGI 2006-2009, AIIMS Bhubaneswar, 2015- 2016, and IMS & SUM Hospital 2018-2019.
Established the Bone Marrow Transplant Centre, Liver Transplant Centre, Advanced Nursing College, Pediatric Centre, Trauma Centre and Hematology Centre at SGPGI (2006-2009). In last 3 years many DM, MCh started at IMS & SUM Hospital took over as Vice Chancellor of Siksha ‘O’ Anusandhan Deemed to be University in March 2020. During last 1 year and 3 months lot of work done for Covid19. In 1st wave (2020) 2320 beds for Covid19 and 2nd wave (2021) 2661 beds for Covid19 patients in six different towns of Odisha. Largest being at IMS & SUM Hospital, Bhubaneswar, 750 beds with 150 ICU beds.
Started doing PCR for Covid19 in May 2020 and Covaxin trial at IMS & SUM Hospital in 2020 July – March 2021. Free Vaccine Centre for Covid19 (Covaxin) vaccine since January 2021, Now paid vaccine Covishield since May 2021.