By Sanjiv Kumar & Preetha GS
Changing lifestyles due to urbanisation, globalisation of trade and marketing, and increasing life expectancy because of medical and technological advances have, in recent years, contributed to a shift in disease burden from communicable to non-communicable diseases (NCDs), the world over. NCDs are a categorised group of diseases or medical conditions that are not always transmitted by infectious agents, but acquired through unhealthy lifestyle or metabolic/physiological changes or environmental factors. NCDs are usually chronic in nature, affecting individuals for an extended period of time, sometimes lifelong, and are generally slow in progression.
The commonly identified NCDs include cardiovascular diseases, stroke, chronic lung disease, cancer, diabetes, high blood pressure and mental disorders. NCDS are often erroneously assumed to be a priority area only for high-income, developed countries, and seen as diseases of old age. Data, however, shows that 80% of NCD deaths occur in low- and middle-income countries, and a quarter of them occur in people below 60 years of age. India, like any other developing country, is also afflicted with a heavy burden of NCDs, while still grappling with the ‘unfinished agenda’ of communicable diseases, and maternal and child health issues. Of late, NCDs have become a major cause of mounting disease and death count in the country.
Today, NCDs account for 63% deaths worldwide and 53% deaths in India. According to a 2012 study, 35% of all outpatient visits and 40% of all hospital stays in India are attributed to NCDs. Statistics for 2013 reveal that while cardiovascular diseases account for 24% of total deaths in India, chronic respiratory diseases account for 11%, cancer for 6% and diabetes for 2% deaths occurring in India every year. The latest figures would understandably be much higher. In such a scenario, the incidence of NCDs and the resultant mortality rates are something that can no longer be ignored. With changing lifestyles and environmental factors, one can expect further increase in incidence. In fact, unless massive efforts are taken to prevent and control them, the burden of NCD mortality is only going to rise.
According to the World Health Organisation (WHO), most NCDs are the result of four major behavioural risk factors, namely tobacco use, physical inactivity, unhealthy diet and excessive consumption of alcohol. High blood sugar, obesity, high blood pressure and raised cholesterol levels are also metabolic risk factors that lead to NCDs. Air pollution is an additional risk factor in India.
Tobacco use: It is one of the prime risk factors, which could lead to serious health hazards and death. Tobacco, smoked or in other forms, can cause chronic lung problems, cancers and cardiovascular diseases. Long-term excessive consumption of alcohol, too, increases the risk of high blood pressure, cardiovascular disorders, stroke, heartbeat irregularities and cancer.
Sedentary lifestyle: High intake of sugar, salt and saturated fats, and lack of physical activity are associated with increased risk of Type 2 diabetes, hypertension, obesity, hyperlipidemia, cardiovascular diseases, some cancers and metabolic syndrome. High fat and high-calorie foods that people, especially the younger generation, are increasingly consuming today have been associated with obesity. Many studies have established a link between NCDs and obesity or weight gain in general. According to WHO estimates, more than 2 million deaths, every year, are caused by sedentary lifestyle (physical inactivity) and unhealthy eating habits.
Other health problems: NCDs, maternal and child health problems, and communicable diseases are not mutually exclusive. Pregnant mothers have one in a six chance of having pregnancy-induced hypertension and a similar proportion runs the risk of gestational diabetes. Adverse pregnancy and newborn health problems are more likely in mothers with these conditions. Even those who scrape through this period somehow could suffer from hypertension and diabetes later in life. Those with NCDs are more likely to get infections. For example, diabetes and cancers reduce immunity and make one more susceptible to infections and these are likely to be more severe in those with NCDs.
India’s healthcare delivery system has been traditionally focused on communicable diseases, and maternal and child health problems. Efforts need to be directed towards strengthening governance and orienting the service providers in the country’s health systems, both in public and private sector, towards prevention, early screening interventions and new treatment modalities to reduce the burden of NCDs. The major risk factors present need to be identified and addressed. Provisions for cost-effective, quality healthcare services across the country need to be made to control the growing incidence of NCDs. In 2010, the government had launched the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke.
It lays stress on health promotion, early diagnosis, management and referral of cases, and strengthening infrastructure and capacity building of health providers. India is also the first country to develop specific national targets and indicators aimed at reducing the number of global premature deaths from NCDs by 25% by 2025. However, challenges abound in attempting to tackle the diverse population-based NCD needs.
A whole-of-population approach has to be adopted, covering different population groups with appropriate interventions—healthy population, population with risk factors, population with NCDs but not yet aware, and population with established NCDs. The interventions include promoting a healthy lifestyle, risk factor screening, NCD screening, early treatment and care, disability limitation and rehabilitation. Such a holistic approach can tackle the challenges posed by the growing burden of NCDs.
Sanjiv Kumar is director, Preetha GS is associate professor, International Institute of Health Management Research (IIHMR) Delhi