NCDs: A major public health challenge in India

Shobha Shukla, Citizen News Service - CNS
Non-communicable diseases (NCDs) have emerged as a major public health threat worldwide. They accounted for 38 million deaths in 2012, and this number is expected to rise to 52 million by 2030. NCDs are a major threat to economic growth too. NCDs and mental health conditions could cost the world $47 trillion in lost economic output from 2010 to 2030 if urgent action is not taken to prevent and treat them.

A review article, based on the study of 123 reference papers and published in Current Diabetes Review, gives interesting insights on the escalating and interrelated problems of obesity, diabetes and cardiovascular diseases (CVDs) in India, which are fuelling the epidemic of NCDs. Here are some of its findings:

The burden of NCDs (including CVDs and type 2 diabetes) is rapidly increasing in India. Estimates from the Global Burden of Disease Study 2013 have shown that number of deaths for most of the leading NCDs increased by 42% between 1990 and 2013 (from 27.0 million in 1990, to 38.3 million) in India. The common NCDs are interlinked— for instance, it is estimated that about 44% of the diabetes burden and 23% of the CVD burden can be attributed to overweight and obesity in India.


Obesity affects more than 135 million individuals in India. According to the, first of its kind, Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study, the prevalence of obesity (BMI ≥ 25 kg/m2 ), varied from 11.8% in Jharkhand (east India) to 31.3% in Chandigarh (north India). It is more in the urban population as compared to rural population, and is higher in women than men. A recent study conducted on rural, urban-poor and urban-middle class women reported the prevalence of overweight/obesity as 22.5%, 45.6% and 57.4%, respectively.


India has more than 69 million people with type 2 diabetes, which is expected to rise to 140 million by 2040. Latest studies show an almost tenfold increase in the last 40 years in prevalence of diabetes. The CARRS  Study shows that overall diabetes prevalence in 3 major cities of South Asia was 25.2% in Delhi (North India); 22.8% in Chennai (South India); and 16.3% in Karachi (Pakistan). There is marked heterogeneity in prevalence of diabetes, it being less in rural areas, and less in low socio-economic strata. The ICMR-INDIAB study shows that it varied from 3% in rural Jharkhand, to 13.7% in urban Tamil Nadu (South India). The rate of increase in diabetes prevalence has been higher in men (3.33 per 1000 per year) as compared with women (0.88 per 1000 per year).


The prevalence of CVD is constantly rising in India. CVD prevalence has been documented to be 2.5%-12.6% in urban and 1.4%-4.6% in rural India. Mortality rates in India due to acute myocardial infarction (AMI) were 141 per 100,000 in males and 136 per 100,000 in females, which were much higher than those recorded in other countries. CVD mortality rates varied from 75-100 per 100,000 in the states of Nagaland, Meghalaya, Himachal Pradesh and Sikkim to a high of 360-430 per 100,000 in Andhra Pradesh, Tamil Nadu, Punjab and Goa.

Diet and physical inactivity

The intake of saturated fatty acids, n-6 polyunsaturated fatty acids and trans-fatty acids is higher, and that of n-3 polyunsaturated fatty acids lower in Asian Indians as compared to other populations. The use of ghee (clarified butter), vegetable ghee (partially hydrogenated vegetable oil) and coconut oil, with high content of saturated fatty acids and trans-fatty acids, in cooking also contributes to dysmetabolic state in South Asians. Increase in sugar consumption (from traditional sources and from sugar sweetened beverages) has been recorded in India. The INTERHEART study done in 52 countries shows that Asian Indians had a low daily intake of fruits and vegetables. High intake of refined cereals such as polished white rice has also been shown to increase the risk of type 2 diabetes and metabolic syndrome in this population. CVD mortality rates in India have positive correlation with dietary consumption of fats, milk and its products and sugars and negative correlation with intake of green leafy vegetables. Physical activity levels are lower in Asian Indians in comparison with other ethnic groups.

Economic consequences of NCDs

The economic consequences of NCDs pose a significant drain on the economy of individuals, families and the nation. As individuals tend to develop type 2 diabetes and CVD at a younger age, it increases their risk of morbidity and mortality during the peak years of their productive life. In Asian Indians, inadequate resources and medical reimbursement, insufficient healthcare budget, and socioeconomic barriers contribute to the rising cost of diabetes and CVD management. The mean cost of hospitalization for CVD has been shown to be approximately INR 13143 (USD 219) per patient. Cost of diabetes care was estimated to be 1541.4 billion INR (USD 31.9 billion) in 2010. Studies have shown that nearly 25–35% of the annual income of low-income group is spent on diabetes care. The NCD cost burden is likely to double from 2010 to 2030 in India and the country stands to lose $4.58 trillion during 2012-2030 due to NCDs ($3.55 trillion) and mental health conditions ($1.03 trillion)—this is more than 6 times India’s total health expenditure over the previous 19 years. CVDs will contribute to $2.17 trillion, and diabetes to $ 0.15 trillion of this increase in the economic burden.

The way forward

Developing countries with scarce healthcare resources, like India, face the double burden of infectious diseases, and the emergence of NCDs. Only concerted sincere efforts from multiple stakeholders, and political will can help counter this increasingly difficult challenge. There is a need for planning strategies with an integrated approach to tackle the burden of obesity, diabetes and CVD in India. The only cost-effective solutions lie in investing in prevention and early detection strategies, which will yield long lasting benefits. The major risk factors for NCDs in India are tobacco use, harmful use of alcohol, lack of physical activity, and a poor diet; while those contributing to the onset of type 2 diabetes include obesity, a sedentary lifestyle, and also poor maternal nutrition that can also lead to insulin resistance and, later, to type 2 diabetes. Almost all of these are preventable through life style changes.

“Going by the current progress, India will not be able to achieve the goal of reduction by one third of premature mortality due to NCDs by 2030 and other sustainable development goals as set by WHO. It is clear that all prevention and management approaches should be cost-effective and focussed on underserved populations, middle/low middle class, women, and children to accelerate progress towards meeting the SDGs”, said Dr Anoop Misra, lead author of the review study, and Chairman, National Diabetes, Obesity and Cholesterol Foundation.

Shobha Shukla, Citizen News Service - CNS
August 30, 2016