India's Dialogue Around Mind Health Requires Change: Dr Sathya Sriram

Women's healthcare has long been significantly behind in the list of priorities whether at a family home or a national level. It may come as a surprise that women's participation in clinical research was a far-fetched idea globally. It was in 1986 that the National Institutes Of Health (NIH) established a policy enabling and pushing researchers to include women in clinical studies. Several statistics hovering over us, remind us that despite policies on paper, women have been overlooked when it comes to healthcare. Now that we're all talking about this, it's imperative to understand that progress cannot be made in a day and that Indian women's healthcare requires not just medical science and policymaking in tune with each other but also stigmas that prevail across the country. To understand more, we spoke with Dr Sathya Sriram, CEO-Preventive Health, Apollo, and learned about holistic patterns that can transform healthcare in India.

In an interview with SheThePeople, Dr Sathya Sriram, CEO-Preventive Health Apollo, tracks down the gaps in women's healthcare, how preventive health is key to fighting medical epidemics, why 'mind health' should top our priority checks, and more. 

Do you believe our country talks enough about women’s healthcare? 

Not enough. There needs to be more discussion, now than ever before, about women’s health, especially among the younger ages – from puberty through fertility. For example, the impact of obesity on our body’s physiology and hormones is not discussed enough. We have little awareness of the impact of excess sugars, carbohydrates, and milk in a girl’s diet along with the limited physical activity, which today has resulted in a generation of over-nourished adolescents and young women.  

What is hardly talked about is preventive health for middle-aged and senior women. From bone density to cardiac risk post-menopause, there is a lot for women to take cognizance of. Our bodies are built differently and therefore respond differently to changes in diets, medication, and stress. We have to raise the dialogue, in general, on preventive health and more so, for women. 

In your experience, how far have we come from treatment-based reactionary care to one focused on prevention and long-term well-being? 

I’d say, in India, we have made some very humble beginnings. In 1990, infectious diseases contributed to 62% of deaths in India, but by 2019, non-communicable diseases (NCDs) accounted for 65% of deaths in India. These NCDs include diabetes, cardiac diseases, cancers, and mental health concerns – almost all of which are preventable when identified early, ideally through appropriate holistic annual health checks. The challenge is that people either deprioritise their regular screenings because they are too busy as this isn’t an immediate problem that they can see or feel OR they are worried about finding one of these conditions. We have a very long way to go to help shift mindsets and behaviours to prioritise our health every single day. 

India has seen a positive rise when it comes to acceptance of mental health issues, however, there’s a long road ahead. What, in your experience, has people’s experience been in coming forward with this? 

There are two issues with 'mind health' – let's first try and change the language around this.

One is the stigma associated with coming forward and admitting that one has a problem that needs to be addressed. Since this is the most intangible of conditions (i.e., no blood test or imaging test to show the problem like blood glucose levels of plaque in arteries), it is harder for people to accept that they need to seek help.  

The second issue is that it is not easily diagnosed. Stress leading to anxiety and depression manifests in unusual behaviours – less focus, more mistakes, less confidence, not speaking up, poor physical posture etc. If you find yourself thinking, “Something is off with this person”, you are on to something. Find a way to reach out and identify what may be going on, in a way that is respectful to them and helps them realise they may need help.

A recent report mentioned how cancer tops the list of concerns for young people when they’re availing preventive checkups. Has the rise in early cancer detection increased in the youth today? What advice would you give young women about prioritizing such tests?  

The average lifespan is now 70 years, versus 40 years in 1950. We therefore must prepare for a much higher quality of healthspan, i.e., years spent in good health. Early screening and prioritising preventive health are the only ways to ensure this. We are seeing younger people being detected with NCDs, not just cancer. It is hard to attribute specific causes of the increased early detection. For example, medical technology has advanced significantly, so we are now able to pick up cancers much earlier. My advice to young women AND men - please prioritise your health. When you build this habit early, you take care of yourself, and you set the tone for your family. 

Studies suggest that one in two urban Indians claim quality healthcare, however, the numbers are harrowing as we move towards tier 2 and tier 3 cities. How important do you think it is for the government, society and medical fraternity to raise awareness and establish systems in those places to help raise healthcare? 

Today, the cost of quality healthcare – infrastructure, equipment, doctors, and paraclinical staff – is more concentrated in the metros and tier-1 cities because that is where the demand is. With more urban development and opportunities moving towards tier 2 and tier 3 cities, the demand for quality services will increase, and the supply will correct itself. In the meantime, we have to utilise telehealth and tele-ICU services to be able to serve this population somewhat reasonably. At Apollo, we are working with nursing homes in tier-2 and tier-3 cities through Apollo Connect, offering them real-time guidance for improved patient care.  

How can we raise more awareness about postpartum depression? 

Postpartum depression is a much bigger problem than we believe. Just as we dialogue with the birth parents about what to watch out for with the new baby, we must have health professionals bring up signs of postpartum depression as well.  

Almost all new mothers bring their newborns for routine checkups. We need to introduce a “well mother” checklist so we can identify any forms of depression and get the mother the necessary help.  

We also should set up support groups for new mothers. Birthing hospitals have a unique opportunity to set up this support group and help women find their comfortable space to lean on one another.

What are some of the myths about menopause?   

The three most common myths about menopause are:

• Only happens after 50 – not true! Some women can have menopause as early as their 30s, others in their 40s. This can be induced by some medical treatments or genetics. It is important to watch out for and get clinical guidance for irregular periods at any age.  

• Gain weight because of menopause – not really. You gain weight at that age because of your slowing metabolism, usually post 40 years of age. Eat only till you are 80% full and increase your physical activity – that's the best way to manage your weight. The cardiac risk goes up significantly for women post-menopause, so it is very important to have the right dietary and exercise habits! 

• Menopause makes you irritable – no. It is the symptoms associated with menopause – hot flashes, night sweats – that interrupt your sleep and mess up your energy levels. Therefore, one tends to be more irritable.

If you were to advise three things to women in their 30s when it came to preventive healthcare, what would they be? 

• Watch your weight – you start to deprioritise healthy diets and exercise about this time, with so many more demands on your time. 
• Fertility is a privilege – be thoughtful and deliberate about the decisions you take regarding this, so you are well aware of the potential consequences.
• Screen yourselves regularly – it is important to ensure you have a view of what is happening inside your body. Complement the routine blood tests with cancer screening tests such as ultrasound, x-ray, pap smear and mammograms (especially if you have a family history of cancers). 

If you were to advise three things to women over 60 when it came to preventive healthcare, what would they be? 

• Keep moving naturally – there is a tendency to slow down after 60, so it is very important to continue moving naturally with household chores (of course share the responsibility with your spouse!). But also ensure that you are aware of your balance and stability. 
• Keep your brain active – most of us have worked to keep our brains activated until retirement. Post 60, there is suddenly limited cognitive stimulation – if a brain cell is not used, it will lose its connection with the next brain cell and subsequently lose its function. Volunteer your skills, play brain games, and offer to plan trips (logistics are often complicated) so you can keep your brain active. 
• Screen yourselves regularly – you will need to think about different tests based on your age and genetics. Routine blood tests only tell part of the story. Post-menopause, the risk of cardiac disease increases rapidly, so heart function tests are a must. Cancer screening with ultrasound, x-ray, and mammograms as well as bone density and muscle function tests become important during this age.