Fifty years of statehood: Why does Meghalaya top the list?

World Cancer Day, February 4, 2022

By Dr Caleb Harris

As Meghalaya celebrates fifty years of statehood, we have been treated to several articles extolling the achievements of the state in the past five decades. Looking back into our past is necessary to ensure that we do not repeat our mistakes and also encourage us to build up on our successes. While a lot has been written about achievements in education, law and order, connectivity; being a doctor, I pondered over the state of healthcare in Meghalaya. As a surgical oncologist (cancer surgeon), I would confine to my area of expertise, cancer care.
When a society invests in good roads, the results may be visible immediately, but investments in health and education would show major returns only after several years. So our current state is the result of efforts put in several years earlier.
World Cancer Day, observed on February 4th annually, is an initiative of the Union for International Cancer Control (UICC). The theme for this year is ‘Closing the gap in cancer care’. The UICC says that, ‘Half the world’s population lacks access to the full range of essential health services. When it comes to cancer, many are denied basic care, despite the fact that we live in a time of awe-inspiring advancements in cancer prevention, diagnosis and treatment. People who seek cancer care hit barriers at every turn. Income, education, geographical location and discrimination based on ethnicity, race, gender, sexual orientation, age, disability and lifestyle are just a few of the factors that can negatively affect care’.
Several patients rue the fact that the cancer care facilities in Meghalaya are inadequate. We have only one radiotherapy machine and many patients end up traveling outside the state. But we would soon see two more machines being installed, one in NEIGRIHMS and the other in Civil Hospital, Shillong, both being technologically advanced machines. We also have the necessary technical expertise to operate these machines. Once the 252-bed Regional Cancer Centre at NEIGRIHMS is functional, we would have a comprehensive cancer treatment facility and would sure augment the cancer care being provided.
But is increasing cancer treatment facilities the only answer to cancer? For long we have focused a lot on treating the ‘effect’ without adequate focus on treating the ‘cause.’ The National Health Policy has seen a shift in focus towards health promotion, which is the need of the hour.
The National Cancer Registry Program Report released in 2020 is an important document which enables us to understand the burden of cancer in India. The data pertaining to all patients diagnosed with cancer in India are recorded into ‘Cancer Registries’ and this is analysed at regular intervals to provide us with valuable information which helps shape health policy. One of the important information provided in this report is the number of persons affected by cancer in each district/state. East Khasi Hills is second on this list with 228 males per one lakh population being affected with cancer. It is sad to note that only the states from Northeast India have crossed the 200 mark in this list, with the other states in the country well below the 150 mark. All these are Age Adjusted Rates (AAR), meaning that the differences in demographics are accounted for. To give another perspective, one in four men below the age of 74 in East Khasi Hills is likely to develop cancer.
When I share this information with people, they often quip that probably there is some ‘genetic problem’ in Northeast India, due to which people get more cancer than the rest of India. While that needs more research (which is being carried out), one cannot ignore the fact that we know the reason for high cancer rates in Northeast India. This report also gives data pertaining to cancers which are known to be caused by tobacco-Meghalaya tops the list! It is sad to note that 70.4% of cancers in men and 46.5% of cancers in women of East Khasi Hills District are preventable. These are all tobacco-related cancers and by shunning tobacco, we would be left with fewer cancers to treat. As per the Global Adult Tobacco Survey(GATS 2016-17), 47% of people in Meghalaya use tobacco, as compared to the national average of 28.4%.
Tobacco, in any form, is the most important cause of cancer. The use of kwai (betel nut) can also independently (without the use of tobacco) cause cancers. Meghalaya has among the highest rates of esophageal (food pipe) cancer in the world. Tobacco, betel nut and alcohol are group 1 carcinogens, yet are abused by a majority of the population, including minors.
The UICC adds, ‘The most disadvantaged groups are also more likely to have increased exposures to a host of other risk factors, like tobacco, unhealthy diet or environmental hazards’. We were all shocked to hear that a 17 year old is the prime accused in the recent bombing to disturb the peace of Shillong and it is good that the society is awakened by such signs of depravity. I wish the same society wakes up to the fact that 34% of our youngsters (13-15 year old) consume tobacco according to the Global Youth Tobacco Survey(GYTS 2019). This is another form of a bomb which these youngsters are handling, and if we do not intervene now, there would be long term ramifications, not only on the health of the individuals, but also on other aspects of the society.
While India has excellent laws to curb the use of tobacco, unfortunately, the implementation is rather poor. The Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003 or COTPA, 2003 provides the legal basis for curbing the use of tobacco. As per this Act, there should not be any smoking activity or sale of tobacco within 100 yards of all educational institutions. The Health and Education Ministries of Meghalaya have implemented the ‘Tobacco Free Educational Institution’(ToFEI) program to curb use of Tobacco by school students. But this needs the cooperation from the parents and other members of the society. The civil society and religious organisations can also do their part in curbing tobacco, as this would transform the state over the next decade. The society should share the burden of changing this dubious distinction of Meghalaya topping the list for tobacco-related cancers in India.
Meghalaya has come up with a State Health Policy, which aspires to improve the life expectancy in the state from the current 62.3 years(national average 68.8) to 70 years by the year 2025. This will never be possible by improving healthcare facilities in the state, but can sure be done by curbing tobacco, which is a much cheaper intervention.
(Dr. Caleb Harris M.Ch.(Surgical Oncology) is Associate Professor, Surgical Oncology, NEIGRIHMS. Views expressed are personal. Email: [email protected]

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