The Indian Economy Blog

June 26, 2007

Health And The Indian Economy

Filed under: Business,Health,Human Capital — Shefaly @ 1:42 pm

To many around the world, the Indian IT and BPO industry is the face of the current boom time, of India Rising or of whatever shorthand appeals to the reader or the writer. The industry is represented by NASSCOM, which has lost, through unfortunate coincidence, two of its leaders in their prime. First there was Dewang Mehta, who died at the relatively young age of 40. Dewang Mehta was at the helm of NASSCOM when I worked with a leading IT services provider first in India and then in Europe. He was energetic, enthusiastic and apparently in good health, a description which has also been applied by commentators to Sunil Mehta, a former head of research at NASSCOM whom I never met. Sunil Mehta also was by all accounts in his 40s, when he passed away in late 2006.

Much tut-tutting happened in the Indian press both times, but there was no commentary on the signalling effects of such untimely demises or whether the industry’s work practices need a closer scrutiny. I agree that Kiran Karnik, currently President of NASSCOM and an alumnus of one of the earliest batches of IIMA graduates, is in good health and apparently so are his executive colleagues at NASSCOM. But let’s face it – bad news does make more headlines than steady state does.

To an observer with experience in the nascent heady days of the Indian IT industry, but now with a health hat on, these two untimely demises appear to be more than coincidental. They are probably indicators of the general working practices of the industry, and their long-term health consequences. Such is my interest in the matter that recently a consulting prospect in the IT industry told me, jokingly I was assured, that if I were to get any consulting projects with Indian IT firms, I should keep a firm rein on my desire to make their employees aware of their rights as human beings and as employees, and the need to take stock of their health periodically. Not a good sign of management commitment, is it? But since one swallow does not make a summer, lets examine some trends.

In the 1990s, the industry was characterised by long work hours, even longer during industry jamborees, fuelled by a lot of testosterone and alcohol, never punctuated by exercise or recharge time. Those who left work at 6 or 7 pm were described as part-timers, albeit jokingly and most found it hard to take days off. Women in management roles in the IT industry – not including HR, accounting and software development – were few and far in between, some of whom are now at the helm of leading technology firms in India and elsewhere. Either we played the game by these rules, or we didn’t; but some of us struck hard bargains about working to different rules and were supported by our managers. Many of my colleagues from that time are still in the industry but experiencing, despite being relatively young, chronic problems such as overweight, neck and back pains, high blood pressure and cholesterol, and in some cases, the need for untimely bypasses.

Through the noughties however, with India being described as the world’s back office and increasingly the front office, the nature of work has changed slightly. And to already well-ensconced bad health habits – including lack of exercise, lack of regular health check ups, regular consumption of scrumptious but artery clogging foods – some new culprits have been added. To long work hours, we have added irregular work times, including night shifts, and an upward trend in eating out. The former does a lot more damage than just interfere with the normal circadian rhythm of the body. These ill effects are widely studied and well-documented. The latter, while almost always foods rich in sugar and fats, is made possible by good monies being made by young people too tired to cook or to relax otherwise after long work hours. There are some signs that more and more young people in urban areas are now taking to gyms, but with a greater focus on trendiness and appearance than on health and in the absence of solid data, it is moot whether actual exercise taking has increased.

Statistical data about India, that allow the examination of a correlation between working hours and chronic health problems, or even comparisons with data from other countries, are hard to come by. But the link itself is well understood.

In the interest of ensuring that the Indian economic boom does not become a one-time burst but remains sustainable in its growth, it is well-worth asking whether it is time we started investing in the health of the workforce today. Awareness, capacity and delivery mechanisms are all essential, but in a corporate context, what is required above all is management commitment. And to that end, I hope NASSCOM – and the Indian IT industry – bosses are listening.

26 Comments »

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  4. Interesting post Shefaly. I though you were going to talk about the general health of Bharatiya population. It’s nice to know it’s just about IT/BPO industry and people working AC and comfy chairs. I suppose they’re the main drivers of the new economy. But it’s hard to get worked up about these guys when vast majority of work force in non-IT/BPO industry slogs without AC and constant power cuts (ie not even a fan).

    In any case, I think it’s a cultural attitude towards health and exercise because until recently, for most people in socialist India, it was about finding a decent job and making a living with little time for any exercise (if you weren’t already exhausted traveling home in packed buses and trains) . It may take a generation before health issues and exercise are considered part of living with more leisure time available.

    “Statistical data about India, that allow the examination of a correlation between working hours and chronic health problems, or even comparisons with data from other countries, are hard to come by.”

    I’d think it’s a false correlation; a non-working slob can also have chronic health problems. Correlation should be between life style choices and health problems. One can work long hours and still be fit. If we go this route we’ll end up like the Europeans, government mandated less work hours even if one has the capacity to work more and earn more. That would be a shame anywhere but especially in India where there is so much catching up to do as a nation.

    Comment by Chandra — June 27, 2007 @ 12:11 am

  5. Chandra: thanks for your thoughts. I would have posted about the general population but lack of good quality, reliable, internally valid data ties my hands. As for focusing on IT/ BPO, it is an industry I have observed closely first as a participant-observer, then just as an observer.

    ‘Availability of more leisure time will mean more exercise’ is a fallacious argument, I am afraid. This is not borne by the data and the experience of many countries whose health stats are better documented and temporally current and updated than India’s. Some Europeans, especially those with government mandated small number of weekly work hours and who consequently have plenty of time to exercise, also do not have a culture of exercise. The motivation of those, who eat properly and exercise in the face of the same challenges that others deem insurmountable (long work hours, long commute, living in a food desert, poor urban design and hence less opportunity to build exercise in day-to-day life etc), is less well-understood in literature.

    As for ‘false correlation’, I disagree. Correlation is not the same as causation, esp for complex phenomena, which is why causation is perpetually intriguing to intellectuals and academics and everyone else. But correlation can help focus a problem on the most significant contributory factors.

    But as false correlations and fallacies go, I am afraid I have to point some out to you from your argument. The Government mandated fixed work hours thing, that only works for certain jobs in certain industries. The vast majority works longer hours at will. And with Sarkozy at the helm in France, the diktat may yet be reversed.

    Further long hours do not mean more accomplishment by way of results. The UK works the longest hours in Europe, but our productivity numbers are lower than those of France with those mandated smaller number of hours.

    If India is to achieve a lot, we need to focus on outcomes and not efforts. And that needs great brain power. As they say: Mens sana in corpore sano, hence the need for a pre-emptive focus on health to ensure sustainable economic growth and productivity.

    Thanks again!

    Comment by Shefaly — June 27, 2007 @ 12:37 am

  6. shefaly,interesting post..

    the enthusiasm normally overflows when in a rising industry w/ lots of buzz about it and w/ relatively good compensation.(witness willingness of indians to work even out of beds letting some american taking heat off on him/her)
    however, within 5+ yrs burnout begins as nascent effervescence leads to stagnation/boredom and sheer unpleasantness of the work that has become a chore now..
    This moment, perhaps, has come for the indian tech industry that has equally grave implications as the financial meltdown that we will shortly see.

    Comment by andiron — June 27, 2007 @ 6:42 pm

  7. Andiron, thanks for your thoughts.

    Alas, the work patterns in the IT industry in India were never healthy. Now they are worse. It is not just the last 5 years. The period I described in my note was mid to late 1990s. It has been over a decade and half. The enthusiasm then was for opening up new markets (I set up Swiss offices for a leading IT services company and held key European and global roles) worldwide whereas now the enthusiasm is bringing work home. Humans will probably always find ways to generate excitement in their chosen lines of work. What is important is to know its futility in the event of failing health.

    Thanks again.

    Comment by Shefaly — June 27, 2007 @ 7:41 pm

  8. “Availability of more leisure time will mean more exercise’ is a fallacious argument”

    True. All I meant to say was there was at least a possibility for exercise. Doesn’t mean it’ll happen – just like less work hours will mean healther lifes.

    Yes, French productivity is high – that’s one reason why their economy doesn’t strink even with restrictive labour laws.

    “As for ‘false correlation’, I disagree. Correlation is not the same as causation”
    So without causation, what’s the point of a correlation? False correlation to me imply no causation.

    Motivation to live a healthy life may have to with upbringing (ie if parents have healthy life styles – one sees children of sportsmen play decent sports themselves) and surrounding environment at anytime. May be corporations can help get people off their behinds and move around.

    Comment by Chandra — June 27, 2007 @ 8:53 pm

  9. Chandra:

    In statistical terms, correlation may exist without causation. But I am not surprised you disagree. What you say is one of the most common fallacies in logic. Just because two variables are highly correlated does not mean that one causes the other. Several examples of correlation exist which are nonsensical if seen as causation. For example: hemline lengths and stock prices are highly correlated (as stock prices go up, skirt lengths get shorter). Would this imply causation?

    This fallacy can happen variously. Changes in variable X could be causing changes in Y. Or both X and Y may be responding to changes in some unobserved variable. Or the effect of X on Y may be mixed with the effects of other explanatory variables on Y. To establish causation, a designed and controlled experiment would be needed. Esp in social settings, such experiments are difficult to set up, run and analyse.

    As I mentioned, motivations behind individuals choosing healthy lifestyles are not well-understood, especially as these verisame individuals are also subject daily to the same environmental cues that some others see as triggers for bad lifestyle choices. (My several years of doctoral work in the area of public health meant seeing all sorts of data along with their gaps and if you are interested, I write about some emergent research on obesity on my other blog http://obesityheadlines.blogspot.com.)

    Socio-economic classification (encompassing indicators such as income, education, gender, race etc) is shown to have great bearing on health behaviours (by way of correlation, not causation, incidentally) but several other factors also shape health behaviours. Unhealthy behaviours are also known to exist in clusters, e.g. smokers may also be less active and probably prone to eating badly and therefore gaining weight, thereby making it difficult to separate negative health outcomes and ascribe them to specific bad health behaviours.

    Further, sportsmen’s and sportswomen’s progeny may also have inherent skill which is a different kettle of fish altogether from behavioural preferences and attitudes. :-) But there are many reasons why Milkha Singh’s son did not become an ace runner, or why Sunil Gavaskar’s son is not such hot property as his dad was!

    Thanks again.

    Comment by Shefaly — June 27, 2007 @ 11:32 pm

  10. Shefaly, may be you’re not reading what I wrote correctly but I think we do agree on the definition of correlation and causation and their differences. I just don’t agree with the way you used the word ‘correlation’ in your original post.

    Milkha Singh’s son may not be an ace runner, but Jeev is an ace golfer with two European wins in 2006 (not much money in sprints, I guess). Don’t know much about Gavi’s son.

    Comment by Chandra — June 28, 2007 @ 11:06 pm

  11. let me add something:

    I have heard that south-asians have pretty bad genes when it comes to cholesterol, in other words if india was to switch to american diet….its population may get reduced to half because of heart disease.

    If the above information is true, then combine that with high stress, high smoking, irregular sleep hours, no excercise (i am not sure, no excercise is same as western no excercise where people dont even walk 500 steps in the whole day) and it can definitely lead to pretty bad heart.

    Comment by TECHY2468 — July 3, 2007 @ 7:15 pm

  12. Techy2468: We, as a macro-ethnic group, are indeed predisposed to a range of cardio-vascular problems, which are exacerbated by our lifestyle choices. So you are right in recognising the many pathways to bad heart that we are quite able to map out.

    Comment by Shefaly — July 4, 2007 @ 1:10 pm

  13. Well the higher incidence of heart disease in Indians is not an exception.. any country or group that goes from a marginal lifestyle to affluence initially faces it.. Mexicans, Blacks and yes even Chinese

    read about the epidemic of heart disease and stroke in whites in between the 1930-1960s, it might be carefully concealed now.. to tout racial superiority.. but it did exist.. cholesterol levels (except in uncommon hereditary conditions such as familial hypercholestermia) have no significant correlation to heart disease..

    The factors that have the best known correlation to heart disease (morbidity and mortality) are hypertension, hyperinsulinaemia (found in type II diabetes) and levels of chronic inflammation. No cholesterol lowering therapy other than ‘statins’ has ever been shown to lower your risk of dying from heart disease, and statins have a significant effect on chronic inflammation. Large clinical trials have shown that statins work (prevent morbidity and mortality) in people who do not respond well to their cholesterol lowering actions.

    In my personal belief the excess mortality and morbidity caused by MI in Indians has a few reasons – Untreated Hypertension, Hyperinsulinaemia (have you ever considered that most Indians eat carbohydrate rich foods), Chronic inflammation (if you get more chronic infections in your life your immune response -good and bad get upregulated) and yes not enough alcohol. Alcohol (not just wine) reduce your risk of ischaemic heart disease, though if you exceed three drinks a day they also increase your risk of haemorrhagic stroke..

    Could say more on it but have to get back to work..

    Maybe more later

    btw the improvement in hypertension treatment and lower risk of exposure/ prompt treatment of chronic infections were the most likely factors that has started the reduction in heart attacks in the white population

    Comment by SR — July 5, 2007 @ 10:46 pm

  14. SR : Thanks for your note on the ‘incidence’ aspects of cardio-vascular diseases. It adds to the discussion where we had previously been talking of pre-disposition and contributory factors. You raise another key point re health monitoring.

    Most Indian families spring into action when an ‘incident’ occurs, which, in my view, is a rather rough way to get a diagnosis. Prevention requires much discipline at individual level (lifestyle changes, regular medical check-ups/ monitoring to assess the changes etc) and is therefore harder to enforce.

    However it would be misleading to suggest that the incidence of CV events in India is somehow a new phenomenon growing in step with the current economic boom. Pre-disposition has a considerable role and to that extent, without adequate data it is moot whether the disease incidence has increased or decreased through the push-pull effects of the current economic boom, more money hence greater affordability of preventative measures and access to better health monitoring. Likewise the Chinese are pre-disposed to metabolic syndrome as a large study published in the Lancet last year demonstrated. Their traditional lifestyles protected them to some extent but now there is an upward trend fuelled by the drastic change in their lifestyles. The examples from North and South America are similar as reflected in the famous study of Pima Indians, whose otherwise lean builds were challenged by ‘industrial’ food consumption. I have not suggested that it is purely a genetic thing, but that it is gene-environment-interaction that affects health outcomes. Since we cannot change our genes (yet), we need to focus on the environment and lifestyle.

    In the history of health and health services, one can read about the changes in the health of native or white populations. It is not concealed, as you suggest. Just like someone working in health may not know about the evolution of personal computing (e.g.), someone working in fields other than health may be unfamiliar with history of public health. To suggest that it is somehow a ploy to prove racial superiority of the whites is not really fair.

    If it interests you, you will probably know that in the UK, comparisons between Gujarati and Punjabi women (two major ethnic subgroups amongst Asians here) show that Gujarati women on the whole have smaller waists, and less incidence of hypercholesterolaemia, high BP and CV disease compares to Punjabi women. Amongst possible contributory factors identified were the presence of meat in the Punjabi diet.

    Further research has found that the risk of breast cancer among Asian women in the UK differs according to their specific ethnic subgroup and that Muslim women from India and Pakistan are almost twice as likely to develop the disease than Gujarati Hindu women. The researchers suggested that the trend may be caused by differences in lifestyle factors such as diet and body size between the two groups of women.

    Thanks again.

    Comment by Shefaly — July 6, 2007 @ 12:21 pm

  15. This is a great post. I hope that more would take note. IT/BPO industry aside, desk jobs involving use of computers are posing huge health risks. If you are reading this blog there is a good chance that you are at risk for Computer Vision Syndrome (CVS) among several other eye related complications. Walk into any eye clinic to gather data on this.

    Chandra, you are missing the point. Yes, well paid IT/BPO kids seemingly deserve little sympathy but keep in mind these are kids. Most are under thirty! Sitting loads your spinal column 1.5 times more than when you stand. Again check the number of instances of sciatica or other back related conditions. Compound that with sitting for long hours glued to a computer screen.

    Eating out and eating out often is going to bite back in terms of all kinds of gastro problems. This is a time bomb waiting to explode.

    Comment by Nikhil — July 7, 2007 @ 12:39 am

  16. Nikhil: You once again raise some very important points about the age of the workforce and the occupational hazards of the IT/ BPO industries. Many of my colleagues from my early years in the IT industry are already suffering a lot from a range of problems regarding their backs, their necks,their wrists and their vision. Awareness is the first step before any reasonable action towards sustainable change can be taken. Thanks for reading.

    Comment by Shefaly — July 7, 2007 @ 2:02 am

  17. Hi..
    Some Clarifications..

    The reason why I mentioned the point of whites feeling racial superiority regarding their risk of CVD and MI because of a few rather obvious factors..

    1] Most scientific articles always point out that whites have lower risk of CVD than any other racial group except some east-asian countries.. so indian,hispanic, black etc are supposed to be high risk groups..

    The most common explanation given is natural selection of individuals who were more good at accumulating fat.. and in times of plenty that works against you..

    This is curious as there is no logical reason why it would work out that way.. as for most of human history (save the last 150 odd years), the degree of hunger, poverty and deprivation of the average white was not that different from countries. Evolution and selection of that order takes longer… like thousands of years.. inbred natives in south-west US (historically arid) such as ‘pima indians’ are an example of that adaptation.. however almost all other nonwhites are not!

    2] There is a serious lack of understanding about the nature of the arterial plaque that causes a heart attack.. Plaques start out as an inflammation in the arterial wall attracting immune cells that then take up cholesterol (LDL) from the surrounding blood and create more inflammation.. the result of this inflammation is a form of scar tissue on the arterial walls. These are known as unstable plaques.. When for some reason the ‘cap’ of one of these unstable plaque comes off, a localized clot forming event occurs.. and it is this clot that blocks your coronary arteries giving you a heart attack..

    In time.. if the unstable plaques does not come off ,and give you a heart attack, they become stable hardened plaques.. these are the ones you can see on arteriograms..they however mainly cause exertion angina.. and can increase your risk of getting MI by allowing a smaller clot to cut of blood supply.. SO when people see these in arteriograms, they should be seen as what they are.. proxy measurements for he dangerous little buggers (small unstable plaques).

    3] I think Indians should drink more alcohol regularly as alcohol does reduce the risk of CVD, MI and ischaemic stroke (majority of stokes).. Of course if you drink over 4-5 drinks a day it does increase your risk of haemorrhagic stroke (minority of strokes). Aim for 2-4 drinks/day (depends on your weight and CVD risk) The interesting link between alcohol consumption and CVD/MI was first discovered in the early years of the 20th century, when autopsies were first done on a large scale. They realized that drunks usually has perfect plaqueless arteries compared to others of their age.. This link has been shown time and again in large studies (thousands of people for years). Maybe that is why gujratis have a higher risk of CVD?MI than punjabis.. which is higher than white britons, which is higher than french.. You get the point.

    And alcohol also lowers reactive protein C levels (maybe that is how it works- by lowering chronic inflammation).. a proxy indicator of chronic inflammation and considered to be very good predictor of CVD/MI risk.. and indians do have significantly higher average levels of this than the white population..

    Curiously on the flip side indians have significantly lower levels of mortality/ morbidity from cancer than whites (coincidence or correlation?)

    More next time… off to get some wine.. you should too *S*

    Comment by SR — July 7, 2007 @ 3:05 am

  18. SR LOL … lay off the juice!

    Comment by Nikhil — July 7, 2007 @ 11:43 pm

  19. SR: Thanks for your thoughts. I am interested in finding out what it is that you are reading that I am not… Can you give some references in support of 1. above? Thanks.

    As for 2. I cannot disagree but for the rest of the readership, again how about some references? Thanks.

    You say: “Maybe that is why gujratis have a higher risk of CVD?MI than punjabis.. which is higher than white britons, which is higher than french.. You get the point.”

    Actually that UK study found that Gujaratis have a LOWER risk than Punjabis and that Hindus have a lower risk than Muslims. So I am afraid much as your reasoning may sound lyrical it is not accurate.

    A few counter-points to ponder:

    Japanese alcohol consumption is lower than their western counterparts and so is their risk of heart disease. Recent studies in Japan however indicate a strong relationship between hypercholesterolaemia and heart disease.

    On the other hand, black and Indian/ Asian (in UK speak) populations drink less alcohol than the white population in the UK but has a higher risk of heart disease.

    The incidence of heart disease in France is not much lower than say in the UK, but their mortality from heart disease is lower. Even within France there are differences in mortality across regions and some US states have mortality rates from heart disease similar to France’s. Wine – the main French tipple – is being consumed less and less in France and many adults do not drink any alcohol at all.

    Unless your point about alcohol was made in jest, I am not sure I would support the alcohol suggestion.

    I do not drink and I would much rather prefer to keep the great chance at amusement I have when people around me get progressively drunker and drunker. You may think they have healthier hearts than I do, but the positive effect of unbounded laughter on heart health is probably even bigger than the alcohol effect :-)

    Comment by Shefaly — July 9, 2007 @ 11:53 pm

  20. Hi,

    I will soon (a day or two) give you a basic list of pubmed searchable references for point 1]. It will be a longish list.. you will have to see the general slant of these articles.. somewhat like a meta-analysis.

    About point 2]- again a a longish list soon (couple days). I should say that C-reactive protein levels (and other markers of chronic inflammation)are higher in every ethnic group that has higher CVD risks and they are well correlated to your risk of getting CVD. People with serious autoimmune diseases like lupus and rheumatoid arthritis have a significantly increased risk of CVD. Moreover high C-reactive protein levels are linked to your risk of getting IGT and Type-2 diabetes. Why? I don’t know.. no one really understands it… Is reduced insulin sensitivity the cause of elevated C-reactive protein levels or vice-versa.. who knows?

    I will also devote one post to the reasons why the cholesterol hypothesis (later refined to high LDL and low HDL) for CVD came to be dominant and why it may be wrong.. in that it is correlation (or maybe amplification), not causation..

    Maybe I will also devote one post to why CVD was a problem when the west first industrialized (lots of men did die around 50-60 at the turn of the last century and into the early decades of the last century and not from infections).. and why it was not well noticed at that time (technology and low value of human life) and possible reasons for it’s decline including epigenetic influences on tissue insulin sensitivity and exposure to some infectious diseases.

    About point 3] – once again you will get a long list. You should however keep in mind that research about alcohol consumption and CVD risk from japan (and other asian countries) could be affected by their sensitivity to alcohol (dehyrogenase deficiency), ‘cultural leanings’ and the fact that unlike in western countries moderate regular alcohol consumption is associated with lower socioeconomic classes, a group that always has had higher CVD mortality in developed countries.

    The reason that the alcohol – CVD connection strikes me as important is because many alcoholics have rather bad food habits, weight problems, hypertension, liver damage but their arteries are amazingly clean and plaque free- Yes you will get references for that too.. What I am saying here is that even if moderate regular alcohol caused a modest 30-50% reduction in CVD (extrapolated from results in white populations), it would still be worthwhile for indians, especially since we do not have the dehydrogenase deficiency that east-asians have. Moreover indians are somewhat less prone to severe hypertension and intracerebral bleeds, the major vascular effect of excessive chronic alcohol use.

    Comment by SR — July 10, 2007 @ 5:49 am

  21. SR: Thanks. I am sure it is not just I, who shall await the promised posts and the references eagerly.

    In the last para, you bring up an important point – the clustering of unhealthy behaviours. I would however also like to know if you have any data on the change in alcohol consumption trends in India. On a minor scale, I have noticed a marked change between the early 1990s and now, with women being the key contributors to the trend. On the relationship between alcohol consumption and women’s health, the jury is still out. It is possible to argue a point by choosing selective studies but I am keeping an open mind.

    I am sure you will separate the studies about incidence and those about mortality when you share the references. Many here are not regular readers of Health related journals so they will probably also appreciate the granularity of the data.

    Thanks again.

    Comment by Shefaly — July 10, 2007 @ 3:33 pm

  22. Returning more to the point of the importance of health in employee productivity and hence at a macro-level in the sustainability of the economic boom, here is an article that may be of interest to the readers.

    http://money.cnn.com/news/newsfeeds/articles/prnewswire/DCTU04210072007-1.htm

    Summary excerpt:
    A new study suggests that U.S. employers may be significantly underestimating the overall costs of poor employee health, while failing to fully assess the diseases and health conditions that drive these costs.

    The study, which appears in the July issue of the Journal of Occupational and Environmental Medicine quantifies the link between employee health and productivity more dramatically than any other study to date and shows that the relationship between the two is much more significant than previously thought.

    Thanks.

    Comment by Shefaly — July 11, 2007 @ 9:31 pm

  23. Hi,

    I am bit busy today… so you will have to wait a day for me to post referenced stuff about ‘alcohol consumption’ and the link to increased ‘adiponectin levels’ and decreased ‘C-reactive protein levels’… but you know what I will be writing about in the next post.. If you are curious – google the stuff I have put in ”. So you can combine ‘alcohol consumption’ +’adiponectin levels’ and ‘alcohol consumption’ + ‘c-reactive protein’ levels.. you can also try a search in pubmed.. In any case do google and find more about ‘adiponectin’ and ‘c-reactive protein’ and their association with the risk of myocardial infarction (heart attack) rates.

    On the other side I will put a link (at the end of this post) to a recent and very good (free to access)paper by an indian author on the role of epigenetic factors and the interaction of environment on the current increase in the rate of Type II diabetes (and insulin resistance) seen in the urbanized and NRI population. He has done a very good of summarizing what I would have said on this subject and the paper is well written.

    In a nutshell, he is saying that bad maternal nutrition causes low birth weight and insulin resistance (through epigenetic mechanisms), in babies. The babies then get lots of carbohydrate rich food that helps them gain weight quickly and creates a muscle thin/ fat rich phenotype.. and that the very quick rise in living standards in urban india and NRIs.. provides fuel to the fire.. and makes them more centrally obese and insulin resistant.

    My take – This insulin resistance leads to type II diabetes and increased C-reactive protein and decreased adiponectin levels. Thus you get an increase in the rate and aggressiveness of heart attacks in the affluent indian population. Now given that this seems to epigenetic (temporary changes in gene transcription that die off after 3-4 generations).. it will very probably not be big issue for 3rd and 4th generations NRIs or even urban india in say 40 years. You see the west also went through a similar stage (chronic undernourishment to plenty) .. however it is likely that because this change occurred more gradually in the west (about 60-80 years – 1840-1920) and they used to drink alcohol (reduce chronic inflammation) and eat meat (lower risk of maternal under-nutrition and more fat in diet)they were spared the worst effects of that change (remember they had high CVD rates in fairly young affluent people at the begining of last century all the way in the 1940s)..

    Indians because of their twin obsessions with vegetarianism and abstinence from alcohol will likely be the worst hit in this change.. and the fact that the change occurred in less than 2 generations..

    Again

    vegetarianism is very often = low maternal body weight, low birthweight
    and neonatal insulin resistance (probably a combination of intrauterine conditions and epigenetic imprinting) and once you born high carbohydrate foods do not help either..

    moderate alchohol = increased adiponectin, decreased c-reactive protein levels and a consistent association with lower CVD risk..

    And here is the link

    http://jn.nutrition.org/cgi/content/full/134/1/205

    Early Life Origins of Insulin Resistance and Type 2 Diabetes in India and Other Asian Countries

    C. S. Yajnik

    J. Nutr. 134:205-210, January 2004

    Comment by SR — July 12, 2007 @ 1:45 am

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