The disease burden in India is changing. While communicable diseases remain a significant threat, noncommunicable diseases (NCDs) are fast becoming the country’s pre-eminent threat to public health and wellbeing. The reasons for this are manifold. These include a genetic predisposition towards conditions such as diabetes and the increasing adoption of unhealthy diets and sedentary lifestyles placing Indians at elevated risk of conditions such as hypertension and heart disease.
India transits rapidly from non infectious to lifestyle diseases
NCDs dominate the list of the top causes of death in India. Heart disease is at the top. In 2016 a staggering 28.1 percent of all deaths in India were caused by heart conditions. Overall, 61.8 percent of all deaths in the country were caused by NCDs in 2016.
India is seemingly unable to cope with the newfound burden of NCDs. Despite heart conditions being the most common cause of death, medical specialists in this area are lacking. India needs 88,000 cardiologists. It has just 4,000. By comparison, there are 31,890 cardiologists in the United States, catering to a far smaller population.
NCDs are the biggest cause of premature deaths in India. One in four Indians are at risk of dying before the age of seventy due to an NCD.
Diabetes emerging as an epidemic in India
India has the highest number of diabetes cases in the world, with 72 million reported in 2017. Prevalence of the disease is rapidly increasing in India, at a much higher rate than the global average. Between 1990 and 2013, the rate of diabetes increased by 123 percent in India. This is compared to a global increase of 45 percent.
Indians possess a genetic predisposition to diabetes. Compounding the issue is the increase in sedentary lifestyles and unhealthy diets, leading to rising rates of risk factors for diabetes such as obesity. The combination of these factors means the number of diabetics in the country is expected to double by 2023.
Further factors link diabetes with India’s growing economic success. Demographics are constantly shifting towards living in India’s wealthier, urban centres. With this comes significant lifestyle changes. The wealthy are far more likely to be overweight, as are those living within the cities.
This is related to both wealth and occupation status. Higher income jobs in India’s cities are far more likely to be sedentary, office based jobs where physical exertion is all but unheard of. The result of this is a lifestyle with very little time for exercise. This is a risk factor for both diabetes as well as a host of other NCDs such as heart disease.
Dietary shifts also play a major role. Those in rural areas typically have a diet rich in fresh fruits and vegetables. Those in urban areas find it far easier — and cheaper — to access fast food, fried and processed food. These high-calorie, low-nutrient diets are a risk factor for the development of diabetes.
12 million dementia patients in India by 2050
India’s ageing population means rates of diseases such as dementia are liable to increase exponentially in the coming years. Currently, 4.1 million Indians are believed to live with dementia. This figure is expected to double by 2035.
By 2050, India could have as many as 12 million dementia sufferers. India is entirely unprepared for a future in which the prevalence of Alzheimer’s disease rises sharply., This is according to the Alzheimer’s and Related Disorders Society of India (ARDSI), which cites the lack of government policy in place to address the condition.
India has already gained 2.9 million cases of dementia in the last 26 years. This is according to recent research published in The Lancet, which revealed that the number of people suffering from Alzheimer’s disease and other forms of dementia increased from 20.2 million in 1990 to 43.8 million globally in 2016.
Tobacco use still a significant threat
Tobacco use is a significant lifestyle factor leading to the development of various NCDs, including several forms of cancer, respiratory disease, cardiovascular ailments and strokes. Tobacco use in India is on the decline, its prevalence falling by six percentage points between 2009-10 and 2016-17. However, according to the Tobacco Atlas, tobacco-caused illnesses continue to kill 932,600 deaths every year. The cost to the Indian economy is projected to be more than 27 billion USD as a consequence of lost productivity due to disability and illness and healthcare expenditure.
Findings of NFHS-4
The fourth National Family Health Survey (NFHS-4), covering the 2015-16 period, includes key data on a number of NCD indicators. Among the most revealing findings
- 20.7 percent of Indian women and 18.9 percent of Indian men are obese
- Rates of alcohol and tobacco consumption are much higher among men than women. 44.5 percent of men use tobacco and 29.2 percent of men consume alcohol, compared to 6.8 and 1.2 percent of women respectively
- 8.0 percent of men and 5.8 percent of women have high blood sugar levels; 3.9 and 2.8 percent of the same have very high blood sugar levels
- 13.6 percent of men and 8.8 percent of women are hypertensive
- Anaemia is a significant health crisis across the country. It affects 58.5 percent of children aged 6-59 months; 50.3 percent of pregnant women; 53.1 percent of non-pregnant women; and 22.7 percent of men.
- Just 9.8 percent of women aged 15-49 have undergone breast cancer examinations. This is despite it being the most common form of cancer among Indian women
Lifestyle diseases more common among poor than rich in India
Studies have found high prevalences of various NCDs among India’s poor. Many go undiagnosed due to a lack of access to healthcare infrastructure. For example, a 2017 study published in The Lancet found that the urban poor are the most at risk group of developing diabetes. Approximately half of participants in the research were unaware of their diabetic status until participating in the study.
NCDs are commonly thought of as an urban issue. However, rates are also high in rural areas, where deaths from NCDs almost match those from communicable diseases. A 2017 study of rural farming populations in Maharashtra found around forty percent of those surveyed suffered from hypertension. More than fifty percent suffered from diabetes or prediabetes and between a third and a half of participants were at risk of cardiovascular ailments.
One in five Indians below the age of eighteen suffer hypertension, according to research presented at the 70th Annual Conference of the Cardiological Society of India. This is a disturbing trend, showing that one of the primary risk factors for heart disease — India’s biggest killer — is prevalent from a young age.
As many NCDs are chronic conditions necessitating management and treatment over a lifetime, this puts many rural sufferers at a disadvantage. Inadequacies in rural public health infrastructure force many patients to seek treatment at private hospitals. As such, the cost of treatment is often borne out-of-pocket. Especially with recurring costs, treatment of NCDs rapidly becomes unaffordable and unmanageable for many of the households affected.
Compounding this is the fact that NCDs are major causes of disability in India. As this has the potential to leave many sufferers unable to work, the economic burden becomes even more pronounced – on individuals, on families, and on society as a whole.
Wealthy states lead in non-communicable diseases
The effect of NCDs on India’s poor cannot be understated. However, it is worth noting that Punjab, Tamil Nadu and Kerala, all wealthy states, were found to have some of the highest rates of heart disease in the country.
These trends are consistent with the known risk factors associated with heart disease and other NCDs. Sedentary lifestyles, often associated with higher paid occupations involving less physical exertion such as office work, presents considerable negative effects on heart health. With more and more jobs moving away from manual labour in India, this may be a driving force of the rising prevalence.
World NCD Congress, 2017: A Sustainable Development Perspective
Chandigarh hosted the World NCD Congress in November 2017, spotlighting the impact of NCDs both in India and on the global stage. The theme of the conference was “Preventing Noncommunicable Diseases: Realising Sustainable Development Goals (SDGs)”. The 2030 Agenda for Sustainable Development highlighted the significance of the threat to sustainable development from NCDs, outlining targets to be met by 2030 including
- Reducing premature mortality caused by NCDs by a third
- Strengthening measures aimed towards curbing consumption of alcohol and tobacco
- Supporting research and development for vaccines and medicines targeting NCDs which principally affect the developing world
- Ensuring access to affordable medicines and treatment
- Achieving universal health coverage (UHC)
India has shown commitment towards realising the above goals. In 2015, it became the first country to adopt the WHO’s Global Monitoring Framework on Noncommunicable Diseases; has weathered intense opposition from the tobacco industry to implement tobacco control legislation, including the third largest pictorial health warnings on tobacco product packaging in the world; and announced in 2018 the rollout of a National Health Protection Scheme (NHPS), positioning it a step closer to achieving UHC.
Despite these admirable steps, there is significant work to be done. There are significant inequalities between India’s states and union territories in term of healthcare delivery and indicators. This translates to the preparedness of district health systems to address the NCD crisis, with there often being wide disparities between states at higher and lower levels of economic development. As such, programmes to screen for NCDs and provide affordable medicines can often fail to reach those who need them most.
NCDs cause 61 percent of deaths
An article published in September 2011 said that over 52 lakh people died in India of non-communicable diseases (NCDs) like cardiovascular diseases, stroke, diabetes and cancer in 2008. NCDs accounted for 53 percent of all deaths in 2008.
This would indicate that the burden of NCDs is rapidly rising. Over an eight-year period this figure increased. NCDs accounted for 61 percent of all deaths in the country in 2016.
Seven lakh Indians die of cancer every year
India has a lower prevalence of cancer compared to western nations. However, in a country with a population exceeding 1.3 billion, this can still entail a large – and, in many cases, avoidable – loss of life. Cancer kills 700,000 (seven lakh) Indians every year. Seventy percent of India’s cancer patients do not survive five years after their diagnosis. Many patients do not consult a doctor until their cancer has progressed to the terminal stage.
The total productivity loss due to cancer in 2012 equated to 0.36 percent of India’s gross domestic product (GDP), according to the study published in the Journal of Cancer Epidemiology. This equals just over a quarter of India’s current spending on public health provision, which is currently estimated to be around 1.4 percent of GDP.
Deaths due to cancer pale in comparison to the numbers associated with heart disease. Cancer accounts for 8.3 percent of deaths, implying the economic impact of heart disease is far larger.