Dr Damodar Bachani, Deputy Commissioner (NCD), Ministry of Health & Family Welfare, Government of India elucidates on the emerging threat of non-communicable diseases (NCDs) in India and outlines the way forward to deal with them as a public health priority
Globally, 14.2 million people die prematurely every year from non-communicable diseases (NCDs) between 30 and 69 years of age. 86 per cent of these premature deaths from NCDs occur in developing countries. Deaths due to communicable diseases, maternal, perinatal conditions and nutritional deficiencies were 15.98 million which means 27.2 per cent of all deaths in 2008. It is projected that in the year 2030, this number would shrink to 9.37 million, and in proportionate terms, just 13.8 per cent. NCDs, on the other hand, would rise from 37.12 (63.2 per cent) million to 51.62 million (76.1 per cent) in the same year. While deaths due to cancer, heart diseases and stroke will increase, deaths due to communicable diseases, perinatal conditions and injuries will reduce during the next 15 years
India is also going through a time bomb of chronic NCDs epidemic at present, with over 60 per cent of the deaths in the country already attributable to non-communicable diseases, particularly the four biggest killers, namely cardiovascular diseases, diabetes, cancers and chronic obstructive lung diseases. While the nation’s priorities in terms of other longstanding health problems such as maternal and child health as well as various communicable diseases, have shown significant decline over the last two decades, there still seems to be a long way to go and the government has been consistently focusing on the challenges posing them. However, it also realises that India is running against time in combating large epidemics of various chronic illnesses in the coming years due to an increasing lifespan besides, rapid changes in lifestyle and the physical environment owing to economic progress and urbanisation.
A WHO report has suggested that India is projected to spend $ 237 billion (1.5 per cent of the GDP) as a result of heart disease, strokes and diabetes from 2005 to 2015. A World Economic Forum report (2014) reported that India is expected to lose $4.58 trillion before 2030 from expenses in care for NCDs and mental health conditions. Of this, $2.17 trillion is expected to be consumed by cardiovascular diseases alone.
Increase in life expectancy and unhealthy lifestyle behaviour are two main reasons for this epidemiological transition. Tobacco use, both smoking and smokeless forms, unhealthy diet rich in salt, sugar and saturated/ trans-fats, physical inactivity and alcohol use are key risk factors associated with this trend. Increasing levels of air pollution and mental stress have also been attributable to this trend.
National response to the NCD epidemic has been praiseworthy in recent times, though far from adequate, given the magnitude of the burden and the challenges in its control. A National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) was launched by MoH&FW in 100 select districts within 21 states in 2010-11 and has expanded to all the districts in a phased manner. Key strategies of the programme include health promotion for healthy life styles to reduce exposure to risk factors, early diagnosis through periodic/ opportunistic screening of population and better diagnostic facilities, infrastructure development for management of NCDs, capacity building of human resources in public health facilities, facilitating rapid referral in medical emergencies (e.g. in heart attack and stroke) to reduce mortality and providing treatment to persons with NCDs including rehabilitation and palliative care. The government is also planning to introduce population-based interventions wherever applicable through multi-sectoral approach (See table).
To achieve these targets, it would be necessary to introduce healthy public policies, involve the government, rope in NGOs and the private health sector and have massive campaign to make people realise to imbibe healthy lifestyle consisting of healthy and balanced diet, being physically active and abstain from use of alcohol and tobacco. Population-based intervention would require subsidies for healthy option, raising taxes on unhealthy food, tobacco and alcohol, controlling air pollution, providing clean energy in rural areas and upbringing children and adolescents in healthy lifestyles. The government should also realise that investment on health promotion, prevention and capacity building to manage NCDs will be cost-effective in long run by means of averting premature deaths and disability in productive age group and reducing out-of-pocket expenditure on these chronic diseases.
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