A Ticking Time Bomb: Non-Communicable Diseases ‘Behind Most Deaths In India’

Almost 61 per cent of all deaths in India have been attributed to non-communicable diseases, by a 2017 report of the World Health Organisation (WHO). About 23 per cent of the population is at risk of premature death due to such diseases, says the UN agency, which releases its “progress monitor” on non-communicable diseases annually. The document sheds some light on the changing trends of ‘burden of diseases’ in various countries, and points out to an increasing occurrence of non-communicable diseases (NCDs) in developing countries such as India - a discernable trend that is visible since past two decades.

The agency warned countries, including India, against premature deaths due to NCDs and asked governments to step up efforts to rein in this crisis without delay. "Limited national progress has been made in the fight against NCDs - primarily cardiovascular and chronic respiratory diseases, cancers and diabetes - which are the world's biggest killers, and claim the lives of 15 million people aged 30 to 70 years annually," WHO said.

Another study titled, ‘India: Health of the Nation’s States’ by three health organisations offers some remarkable insights into the changing landscape of India’s disease burden, both in terms of type of diseases as well as burden across the states. The 2017 report by Indian Council for Medical Research (ICMR), the Public Health Foundation of India (PHFI) and US-based Institute for Health Metrics and Evaluation (IHME) measures disease burden, in terms of disability-adjusted-life-years (DALYs) — the number of years lost due to ill-health, disability or early death.

Some highlights of the report:

• Out of the total disease burden in India measured as DALYs, the share of communicable and non-communicable diseases changed significantly from 1990 to 2016. In 1990, 61 per cent of total disease burden was due to communicable, maternal, neonatal, and nutritional diseases which dropped to 33 per cent in 2016. The contribution of non-communicable diseases, however, increased, from 30 per cent of the total disease burden in 1990 to 55 per cent in 2016.
• Among the leading non-communicable diseases, the largest disease burden or DALY rate increase from 1990 to 2016 was observed for diabetes, at 80 per cent, and is chaemic heart disease, at 34 per cent
• NCDs have also become the largest cause for deaths in the country (Figure 1).

Understanding Causes Of NCDs

Understanding the causes and risk factors can go a long way in preventing as well as treating medical aliments. The rise of NCDs in India is mainly due to significant lifestyle changes. As average lifespan has increased, owing to better healthcare facilities, the elderly have naturally become susceptible to NCDs such as cardiovascular and muscular disorders. In addition, with rapid urbanisation, people have been leading a sedentary lifestyle and opting forfast food. department of internal medicine director at Noida’s Fortis Hospital, Dr Ajay Agrawal, said: “Besides genetics, lifestyle and some environmental factors may cause non-communicable diseases like cancer, diabetes, cardiovascular disease and chronic obstructive pulmonary disease (COPD). Mostly male patients come in with the symptoms similar to non-communicable diseases. The risk factors of non-communicable diseases are often found in older people”.

As figure 2 shows, child and maternal malnutrition is India’s leading risk factor for health loss as of 2016. They caused 14.6 per cent of the country’s total DALY, mainly due to lack of nutrition and neo natal care. Air pollution is the second leading risk factor contributing significantly to India’s burden of cardiovascular diseases, chronic respiratory diseases, and lower respiratory infections. The behavioural and metabolic risk factors associated with the rising burden of NCDs have risen in India owing to changing lifestyles. Dietary risks, which include diets low in fruit, vegetables, and whole grains, but high in salt and fat, are India’s third leading risk factor, followed closely by high blood pressure and high blood sugar, which are indirectly linked to diet and lack of physical activities. Despite the increasing global awareness of the health risks it poses, tobacco use has increased in India leading to cardio-vascular disorders (CVDs), lung disorders as well as cancer.

Government Initiatives

Government announced its National Health Policy 2017 along with the budget last year after a gap of 15 years. The policy advocates an integrated approach, where screening for the most prevalent NCDs with secondary prevention will make a significant impact on reduction of morbidity and preventable mortality. It mentions as one of its aims, “To reduce premature mortality from cardiovascular diseases, cancer, diabetes, or chronic respiratory diseases by 25 per cent by 2025. The policy recognises the interplay of the three actions - policy and surveillance, strengthening of healthcare systems, and healthcare financing - presented in the national NCD blueprint SANKALP brought out by the Partnership to Fight Chronic Disease (PFCD) in 2015 .

Indian Council of Medical Research (ICMR), last year also launched the India Hypertension Management Initiative (IHMI). The IHMI aims to reduce disability and death related to CVDs by improving the control of high blood pressure (hypertension), reducing salt consumption and eliminating artificial trans-fats, which are leading risk factors for CVD. The initiative has been rolled out in 25 high-burden districts in India, aims to strengthen the cardiovascular disease component of the government’s national programme for control of cancer, diabetes, aardiovascular diseases and stroke (NPCDCS).

What You Should Be Doing?

Dr Ajay Agrawal believes that prevention is better than cure especially in cases of NCDs. “There are certain methods through which you can fight or keep these diseases at bay on your own and without any medical intervention.” And for this, he says, one should take regular check-ups, prevent exposure to ultraviolet rays, and follow a healthy lifestyle and a diet of green leafy vegetables and fruits. To keep a check on body vitals, he advises a regular monitoring of blood pressure,avoiding high salt intake as it may lead to stroke; and eliminating drinking and smoking.