Affecting people irrespective of age, gender and socioeconomic background, the menace of non-communicable diseases (NCDs) is a major health problem globally. More worrying is that India’s burden of NCDs is escalating.
 
That 41 million people die worldwide each year due to NCDs, which is equivalent to 74 percent of all deaths globally, depicts the severity of the problem. Notably, 17 million people die from a NCD before the age 70 with 86 percent of such premature deaths reported in low-and middle-income countries. Cardiovascular diseases account for most NCD deaths (17.9 million people annually) followed by cancers (9.3 million), chronic respiratory diseases (4.1 million) and diabetes (2.0 million including kidney disease deaths caused by diabetes).  
 
Simply put, NCDs are chronic conditions that develop slowly over time and often progress over many years, affecting any part of the human body. Known as “silent killers”, most common NCDs like cardiovascular disease (CVD) heart attacks/strokes, cancer, chronic respiratory diseases (pulmonary disease/asthma) and diabetes often seem to develop without any obvious symptoms. In many cases and for a plethora of reasons they are often not diagnosed until they have reached an advanced stage.
 
The study report, “India: Health of the Nation's States” - The India State-Level Disease Burden Initiative in 2017 by the Indian Council of Medical Research (ICMR), had estimated that the proportion of deaths due to NCDs in India had increased from 37.9 percent in 1990 to 61.8 percent in 2016. The challenge India is presently facing with regard to NCDs has been documented in the Metabolic non-communicable disease health report of India: the ICMR-INDIAB national cross-sectional study (ICMR-INDIAB-17) published in the recent issue (7 June 2023) of the Lancet Diabetes & Endocrinology journal.
 
Briefly, the main takeaways, of this report (which is said to be based on a survey of 1.13 lakh people aged 20 years and older across the urban and rural areas of the country undertaken between 2008 and 2020) is that presently over 101 million Indians (compared with 70 million people in 2019) are living with diabetes. So, for 11.4 percent of our population suffering from this condition, the pancreas is unable to produce enough insulin, a hormone required for regulating the movement of sugar into the cells. 136 million Indians (15.3 percent) are pre-diabetic, meaning that such individuals may have a higher than the normal blood sugar level but it’s not high enough to be considered type 2 diabetes yet. However, without lifestyle changes, adults and children with prediabetes are at high risk to develop type 2 diabetes. Notably, the ratio of diabetic to prediabetic people is 1:1 in Delhi, 1:1.2 in Maharashtra, 1:1.5 in Haryana and 1:3.8 in Uttar Pradesh. The 10 worst affected States/UTs are Goa (26.4 percent of population affected with diabetes and 20.3 percent with prediabetes), followed by Puducherry (26.3 percent & 25.8 percent), Kerala (25.5 percent & 18.3 percent), Chandigarh (20.4 percent & 15.6 percent), Delhi (17.8 percent & 18 percent), Tamil Nadu (14.4 percent & 10.2 percent), West Bengal (13.7 percent & 23.5 percent), Sikkim (12.8 percent & 31.3 percent), Punjab (12.7 percent & 8.7 percent) and Haryana (12.4 percent & 18.2 percent). While, 213 million of our people live with high cholesterol, 185 million (suffer from high lipoprotein LDL cholesterol or bad cholesterol and 254 million live with generalised obesity.  36 percent of the Indian population have hypertension.
 
According to the World Health Organisation, NCDs share four major risk factors: tobacco use, physical inactivity, the harmful use of alcohol and unhealthy diets. The risk factors for heart disease and stroke are high blood pressure, LDL cholesterol, diabetes, smoking including second-hand smoke exposure, obesity, unhealthy diet and physical inactivity. Individuals are more likely to develop CVD if they have risk factors such as High blood pressure (hypertension), high cholesterol (hyperlipidemia), regular use of tobacco, type 2 diabetes, family history of heart disease, lack of physical activity, obesity, diet high in sodium, sugar and fat and overuse of alcohol etc. Nearly 40 per cent of cancer cases are said to be caused by tobacco, alcohol and pan masala, 4 per cent cases are genetic and 10 per cent are related to cleanliness, while there is no clue about 20 per cent cancer cases, including blood and bone cancers. Alcohol consumption is estimated to be responsible for about three million deaths worldwide each year, which is said to be increasing in many low and middle-income countries. That liver-related deaths in India have touched a whopping 2.6 lakhs which is over 3.17 percent of all deaths per year contributing to 18.3 percent of global 2 million liver-related deaths is shocking. A report released on the occasion of World Liver Day this April 19 states that liver diseases can slowly turn deadly with one out of every five adults in the country suffering from some kind of liver disorder, mainly fatty liver.
 
Junk foods, that is any food with zero or negligible nutritional value, high in fat and transfat content can serve as a treat to the taste buds. But consuming them regularly can adversely impact one’s health and also cause irreparable damage to the body and lead to type 2 diabetes, obesity and heart diseases. A study published in the American Journal of Clinical Nutrition has noted that people who ate junk food performed poorly on cognitive tests. Further, junk foods can deteriorate one’s memory and leave them with a weaker brain.
 
At the macro level several initiatives have been undertaken at the Government level. This includes taxing all tobacco products, food high in fats, salt and sugar including sugar sweetened beverages in the highest slab of 28 percent. Measures have been put in place to prohibit sale of unhealthy food in educational institutions and to promote healthy food options in canteen/school kitchen. Providing low salt and low saturated fat diet in Mid-Day Meal programme. Promoting healthy food that is low in saturated fats, sugar and salt in trains and at railway stations.
 
Presently according to reports, over 8.8 million people 6.2 million receive hypertension treatment and 2.6 million for diabetes) in India received NCD treatment from government. More recently, the Union Government has announced that standard treatment is to be provided to 75 million people with diabetes and hypertension by 2025.
 
Under the Corporate Social Responsibility initiative, a number of public and private organisations have been going the extra mile in undertaking health checkups for the neighbourhood communities. Mumbai’s Brihanmumbai Municipal Corporation (BMC) has been in news for organising health camps and surveys in the city. For instance, when around 5200 Mumbaikars (2,601 men and 2,598 women) participated in a survey undertaken by BMC during August to December 2021, four out of 10 people in the 18-69 age group were declared to be at a high risk of contracting CVD. 37 percent of the participants reported three or more CVD risk factors, including regular smoking, insufficient intake of fruits and vegetables, obesity, inadequate physical activity, high BP and glucose levels. Seven out of 10 citizens did not include fitness/sports-related activity in their daily routine.  Similarly, when BMC screened over 12 lakh children, two out of five children in Mumbai had various health issues and some 4.4 lakh children were suffering from minor and major illnesses. They have since been reportedly referred for treatment.
 
A model worthy of replication across the country is the healthcare at the doorstep or the “Makkalai Thedi Maruthuvam” (MTM) initiative launched by the Tamil Nadu Government in 2021 with a Rs 250 crore plus budget. It envisaged community- based intervention in tackling and treating NCDs by screening for an 18-plus population for common conditions including diabetes, hypertension, TB, leprosy, chronic kidney disease, mental health, oral, cervical and breast cancers. Hypertension and diabetes drugs were door delivered to patients aged over 45 years and those with restricted or poor mobility. Having covered one crore people as of December 2022, MTM has since been extended to cover 8.35 lakh workers in 711 factories and unorganised sector including migrant workers across the state in the first phase. Health check-up camps is being held in identified factories with emphasis on non-communicable diseases such as high blood pressure and diabetes.
 
With people in India, living longer than ever before, it needs to be realised at an individual level that our health is in our hands. As the rising prevalence of NCDs are largely driven by a combination of factors like sedentary lifestyles, unhealthy food habits and tobacco/alcohol use, it is time to strike at its roots. According to health experts, obesity and being overweight are the most important risk factors responsible for diabetes. Around 30 to 50 per cent of those with prediabetes can develop type 2 diabetes, although some may remain as prediabetics. The disease burden can be prevented or delayed by lifestyle changes. Above all, it is possible to even reverse their condition. So, it pays to get involved in regular physical activity regularly besides health check-ups for the sake of one’s own health as prevention of NCDs is better than cure. Some of the actions that merit consideration at an individual level includes good sleep, staying physically active, eating a healthy diet, maintaining face-to-face social connectedness, desist from smoking, drinking, avoiding self-medication etc.