India’s challenge: stemming the rising tide of non-communicable diseases 

Non-communicable diseases (NCDs) — cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes — are among the most significant public health challenges of the 21st century. According to the World Health Organization (WHO), NCDs account for 62% of all deaths in the Southeast Asia region, with nine million people succumbing annually. A significant concern is the high number of premature deaths — those occurring before the age of 70 — linked to NCDs. The COVID-19 pandemic brought renewed focus to the need to fortify India’s healthcare system: following a devastating rise in mortality in May 2021, COVID-19 became the leading cause of death in the country, with research suggesting that the underlying NCD burden contributed to the mortality spike, particularly among individuals living with obesity and diabetes. 

Why are NCDs a cause for concern? 

NCDs are medical conditions that are not caused by infectious agents. They tend to be chronic, develop slowly, and are influenced by a combination of genetic, physiological, environmental, and behavioural factors. NCDs present a significant public health challenge, not only due to the human suffering they cause, but also because of the socioeconomic burden they place on countries. Each year, NCDs cause approximately 41 million deaths, accounting for 71% of global mortality, with 14 million of these deaths occurring prematurely — between the ages of 30 and 70. Most of these premature deaths are preventable. Without timely interventions, the WHO projects that NCD-related deaths could rise to 55 million annually by 2030. Globalisation, industrialisation, urbanisation, and lifestyle changes have all contributed to the rapid increase in NCDs worldwide. 

In India, the burden of NCDs has surpassed that of infectious diseases such as tuberculosis, malaria, and HIV. An estimated 5.8 million Indians die from NCDs each year, with conditions like heart disease, cancer, and diabetes accounting for a significant proportion of deaths. Approximately one in four Indians faces the risk of dying from an NCD before reaching the age of 70. These diseases not only claim lives but also result in significant losses in potentially productive years of life, with projections indicating an increase in losses related to heart disease, stroke, hypertension, and diabetes in the coming years. 

How can the increase in NCDs be halted?  

Curbing the rise in NCDs cannot rely solely on treating those already affected; preventive measures targeting the root causes must be prioritised. Reducing risk factors such as physical inactivity, unhealthy diets, tobacco use and harmful alcohol consumption is crucial to prevent the increase in NCDs. 

“People with sedentary lifestyles, unhealthy diets (low in fruits, vegetables, and whole grains but high in salt and fat), and those who use tobacco or consume alcohol fall into the high-risk category for NCDs,” says Mangala Gomare, former executive health officer of the Brihanmumbai Municipal Corporation. These behavioural risk factors contribute to elevated blood pressure (hypertension), high blood sugar (diabetes), abnormal blood lipids, and obesity. Air pollution — both outdoor and indoor — is also a significant risk factor. 

Addressing these risk factors would not only save lives but also boost socioeconomic development. Dr. Gomare, who worked on implementing the Centre’s National Programme for Prevention and Control of Non-Communicable Diseases in Mumbai, notes that while NCDs primarily affect adults, exposure to risk factors often begins in childhood, making it critical to address these factors early in life. 

“There is a need for greater investment in healthcare access, prevention, and treatment to combat NCDs, but individual actions also play a key role in stemming the tide. Public engagement is essential: education about NCD risk factors and early medical interventions can help prevent or delay disease progression,” she explains. 

Prevention, a crucial aspect  

Many NCDs develop due to unhealthy lifestyle choices, such as poor diets, lack of physical activity, smoking and excessive alcohol consumption. These are modifiable behaviours, meaning they can be changed with effort and awareness. “Rather than waiting for symptoms to appear, taking steps to adopt healthier habits can prevent the onset of these diseases,” says Rajiv Kovil, diabetes and obesity specialist and editor of Metabolic Health Digest. He emphasises that by focusing on prevention, individuals can avoid long-term health challenges and enjoy a better quality of life. Chronic diseases such as diabetes and heart disease can cause fatigue, chronic pain, and dependency on medications, leading to long-term health complications and reduced mobility. 

Prevention of NCDs can have financial benefits too. Treating NCDs is often expensive, involving frequent doctor visits, medications, and, in some cases, long-term hospital stays or surgeries. “Preventive actions, such as maintaining a healthy lifestyle, require relatively minimal investment in comparison. For example, regular exercise and a balanced diet may cost time and effort, but pale in comparison to the financial burden of managing heart disease or cancer,” says Dr. Kovil. 

NCDs among children a growing concern 

Over the past decade, the incidence of NCDs among children aged 5-17 has doubled. Paediatricians attribute this trend to rising rates of childhood obesity, sedentary lifestyles, and exposure to environmental risks. 

“The rising prevalence of obesity in children and its many adverse health effects are being recognised as a serious public health concern. Obesity is not a simple problem, as it can trigger at least 53 diseases,” says Prashant Patil, paediatric endocrinologist at NH SRCC Hospital, Mumbai. He adds that doctors are seeing a growing number of children being diagnosed with type 2 diabetes. Paediatric endocrinologists have observed adolescent girls diagnosed with polycystic ovary syndrome, the most common endocrine condition in adult women. 

Doctors note that while type 2 diabetes in children is a worrying trend, lifestyle changes and weight loss can reverse the condition. “Parents should increase their child’s physical activity based on the child’s interests. It can be jogging, cycling, swimming, playing football, etc. The key is that any physical activity they take up should be sustainable,” says Phulrenu Chauhan, consultant endocrinologist at PD Hinduja Hospital. She recommends home-cooked meals, portion control, reduced screen time and sufficient sleep as essential factors to managing children’s health. 

Respiratory diseases such as asthma are among the most common NCDs in children. Asthma can lead to chronic lung problems if not managed properly, affecting the child’s quality of life and even contributing to school absenteeism and reduced physical activity. 

Increased exposure to tobacco smoke (both direct and second-hand) and air pollution has also led to a rise in respiratory issues such as asthma and chronic obstructive pulmonary disease (COPD) among children. Furthermore, many children today face a lot of stress due to academic pressures and societal expectations, which can have long-term effects on their mental and physical health. 

Fortunately, many NCDs are preventable, especially when measures are taken early in life. “By inculcating healthy lifestyle habits in our children, we can prevent the onset of NCDs and ensure a healthier future for the next generation. The responsibility lies not just with parents but also with schools, healthcare providers, policymakers, and communities to work together to safeguard children’s health and well-being,” says Dr. Patil. 

Technology and NCD prevention 

Technological advancements offer promising avenues in the prevention and management of NCDs. Mobile health applications, wearable devices, and telemedicine platforms are revolutionising how individuals monitor and manage their health. 

“We now have many apps that promote healthy behaviours, track physical activity or monitor chronic conditions like diabetes, empowering individuals to take control of their health. For instance, apps that remind users to take their medication or monitor blood sugar levels are proving useful in managing diabetes,” says Gaurish Kenkre, a physiotherapist in Mumbai. 

Fitness trackers and wearable health monitors provide real-time data on physical activity, heart rate, and sleep patterns, helping individuals make informed decisions about their health. These devices can be used to track progress, set health goals and alert users to potential health risks. 

“AI-powered tools are being developed to analyse vast amounts of health data, enabling early detection of disease patterns and personalised treatment plans. AI is also being used to predict patient outcomes and optimise treatment strategies for chronic diseases, including cancer,” adds Mr. Kenkre. 

The power of the individual 

Prevention starts at the individual level. The easiest way to prevent NCDs is to adopt a balanced and nutritious diet. “It is proven that a healthy diet plays a crucial role in preventing many NCDs, particularly diabetes, cardiovascular diseases, and some cancers. One should invest in eating more fruits and vegetables and choose whole grains like brown rice, oats, and whole wheat, which contain more nutrients than refined grains,” says Nazneen Hussain, former president of the Indian Dietetic Association. She adds that one should limit processed and sugary foods as they can contribute to weight gain, high blood pressure, and insulin resistance. 

“Simple dietary changes like staying hydrated, reducing your intake of sugary drinks and alcohol, eating more meals at home, reducing portion sizes and reading food labels can help you make healthier food choices that reduce the risk of developing chronic diseases,” says Dr. Hussain. 

Sudhir Pillai, a cardiologist at PD Hinduja Hospital in Mumbai, emphasises incorporating physical activity into the daily routine, such as taking the stairs instead of the lift, walking, or cycling, as these can significantly reduce major risk factors for NCDs, particularly obesity, heart disease and type 2 diabetes. 

“Regular physical activity helps improve blood circulation, regulates blood sugar, and helps individuals maintain a healthy weight. One should aim for at least 150 minutes of moderate-intensity aerobic exercise, such as brisk walking, swimming, or cycling each week,” he says. 

Dr. Pillai also underscores that smoking and excessive alcohol consumption are other lifestyle behaviours that contribute to NCDs. “Smoking is one of the leading preventable causes of NCDs, especially lung cancer, cardiovascular diseases and chronic respiratory diseases. The chemicals in cigarettes damage nearly every organ in the body, and quitting smoking can drastically reduce the risk of developing these conditions. Similarly, excessive alcohol consumption increases the risk of liver disease, certain cancers, and hypertension. Avoiding tobacco and alcohol consumption can significantly reduce the risk of alcohol-related NCDs,” he adds. 

Managing stress, along with regular health check-ups and screenings, are other ways to help prevent NCDs. For those who smoke or drink regularly, seeking support through smoking cessation programmes, counselling, or support groups can make quitting more feasible. Early detection of conditions such as hypertension, diabetes and cancer is key to effective treatment and can prevent disease progression. “Chronic stress contributes to health problems like high blood pressure and heart disease. Stress management techniques such as mindfulness and exercise can help,” says Dr. Pillai. 

Work on root causes, now 

Non-communicable diseases represent one of the most pressing health challenges of our times. The rising tide of NCDs threatens not only individual health but also the stability of healthcare systems and economies worldwide. By addressing the root causes of NCDs, promoting healthy behaviours and ensuring equitable access to healthcare services, it is possible to stem the tide of these diseases and improve the health and well-being of populations globally. The time to act is now, and it requires a united, global effort to combat the growing NCD epidemic. Preventing non-communicable diseases is not only essential to improve individual health but also to reduce the burden on families, communities and healthcare systems. 

(Somita Pal is a journalist with nearly two decades of experience covering healthcare in Mumbai. She covers a range of topics, focusing on health, social issues and civic news.)