India’s non-communicable disease burden growing at an alarming rate: Report

New Delhi: The Associated Chambers of Commerce and Industry of India (ASSOCHAM), as part of its ‘Illness to Wellness’ campaign, has unveiled India’s largest primary healthcare survey report on the rising burden of non-communicable diseases in the country. The report titled “Non-Communicable Diseases in India” covered 2,33,672 people and 673 public health offices in 21 states, to analyse the rising cases of NCDs in the country and the social profile of suffering households.

Calling diabetes an overpowering non-communicable disease, Dr. Ambrish Mittal, Chairman and Head, Endocrinology and Diabetes Department, Max Healthcare (Pan Max), said, “Diabetes has risen exponentially in India from 2% in the 1970s in urban areas to between 10-20% in 2020. The cases of diabetes are even higher in metros at 35-40%. This spike is linked to urbanization led by economic development and has been more prevalent in urban areas as compared to rural areas.”

He further added, “Amid Covid pandemic, people suffering from uncontrolled diabetes and comorbidities had poorer outcomes when exposed to the virus. These people had to stay in ICU, depend on steroids, and suffered higher mortality. This pandemic is not just about viruses but also about reducing the number of vulnerable people as the amount of medical service required will be much more if we have a large diabetic population with comorbidities. If India wants to successfully navigate more such pandemics in the future, it must address NCDs.”

· Prevalence of NCDs in India is 116 per 1000 population; shows a quantum jump among individuals above 35 years of age.

· Hypertension, Digestive Diseases, and Diabetes are among the top three most prevalent NCDs; Cancer is the least prevalent.

· Environment factors are the biggest cause of NCDs followed by inactive lifestyle and imbalanced diet; intoxication (alcohol & tobacco consumption) and leisure lifestyle fall at no 6 to 8 rank.

The Covid-19 pandemic has brought a sharper focus on health care. Patterns emerging from Covid management across the country indicate that people with co-morbidities of non-communicable diseases (NCDs) have a higher mortality rate than those who do not. This has grave implications for the country not only because of mortality and years of healthy lives lost but also because of India’s health infrastructure.

Report prepared by Thought Arbitrage Research Institute (TARI), the survey report observed that India’s non-communicable disease burden is growing at an alarming rate with the average age for onset falling sharply. It reported that NCDs increase after 18 years and show a quantum leap when an individual crosses the age of 35 years. It found that more than 2/3 of the individuals suffering from NCDs are in the most productive-life age groups i.e., between 26-59 years. This is an alarming trend and points to the grim reality that the burden of NCDs on India is long-lasting given that 65% of the country’s population is below 35 years of age.

Other Key Findings

The survey suggested that the prevalence of having any NCDs among the population is 116 per 1000 population in India. It identified hypertension, digestive disease, and diabetes as the top three NCDs followed by respiratory diseases, brain/neurological disorders, heart diseases/CVD, kidney disorders, and cancer in the order of prevalence.

Sharing his opinion on NCDs and talking about their neurological aspects, Prof. (Dr.) Rajinder K. Dhamija, Head of Neurology Department, Lady Hardinge Medical College New Delhi said, “The cases of stroke have grown 4 times in the last 30 years. This can be attributed to changes in the lifestyle and the demography of our country. It is worth noting that the life expectancy of our population has increased from 47 years in the 1970s to 70 years today. This means that we have a large aging population that is vulnerable to neurological diseases, dementia, stroke, etc. There is also an interesting trend of lower-income countries witnessing a rise in cases of vascular diseases like stroke and mortality, unlike developed countries that are more resourceful and yet registering a decline in such cases. This is due to an epidemic of diseases like diabetes and hypertension coupled with changes in lifestyle, an aging population, lack of physical activity, and air pollution.”

Highlighting the treatment gap in the treatment of stroke, he added, “All the NCDs are preventable and treatable but in case of stroke, only 10% of the eligible population get the requisite treatment in the golden window of 4.5 hours. We need to work on this and in this direction strengthening the district health system which has not kept pace with changing times can be a good starting point. District hospitals must be equipped with the latest equipment like CT Scanners to address cases of stroke.”

On a collective basis, the report identified air pollution as the most prevalent risk factor among the surveyed population. It was trailed by low physical activity – a key metabolic and physical activity and an imbalanced diet, a behavioural risk factor that occupied 3rd spot. An imbalanced diet includes a diet low in legumes, milk, omega-3 fatty acids, vegetables, fruits, calcium etc. High consumption of sugar and trans-fats due to growing urbanisation often leads to sedentary and stressed lifestyle also contribute to factors that lead to an imbalanced diet. Interestingly, chewing tobacco and tobacco consumption were found not to play any significant role in the occurrence of NCD, and alcohol consumption was found to have an even smaller impact on the prevalence of NCD. Together these intoxications, deeply connected to modern-day lifestyle, were found to have a much lesser impact on the occurrence of NCDs.

Genetic and hereditary factors have a significant impact on the prevalence of NCDs, but the factors of causality cannot directly be determined with certainty with individual or group of diseases. Nevertheless, genetic factors have an overwhelming impact on the incidence of NCDs’.

Throwing light on the co-morbidity of NCDs with each other, the study underlined that hypertension has the highest comorbidity with almost all NCDs. This is followed by diabetes, kidney, and digestive disorders in their relative simultaneous occurrence in morbidity. This coexistence, according to the survey, is followed by diabetes and respiratory diseases. On the other hand, cancer and kidney disease were found to have lower comorbidity.

Prevalence Across Different Geographies

Significant variation exists in India when it comes to the prevalence of NCDs in different geographies and states. The survey found that the population of northern, central, and western regions of the country has prevalence lower than the national average while prevalence is quite high in lesser developed regions of India including eastern and north-east regions. The state of Odisha was found to have the highest prevalence of NCDs (272 per 1000 population) while Gujarat registered the lowest prevalence (60 per 1000). Andhra Pradesh, Telangana, and West Bengal were other states where NCD prevalence was higher than the national average. This calls for state-specific strategies to tackle NCDs.

NCDs affect both rural and urban populations. There is however higher prevalence of hypertension and diabetes in urban areas due to migration and differences in living conditions. Family structure also has bearing on the prevalence of NCDs as individuals from nuclear families are more prone to NCDs in comparison to joint families due to more workload and perhaps higher stress. Furthermore, males are found to be more prone to contracting NCDs than females except for hypertension and neurological disorders which are more prevalent in women. The prevalence of NCD among males is 119 per 1000 male population while for females it is 113 per 1000 female population.

Preventive Strategy

A person’s knowledge and awareness about NCDs is an important part of any population-based preventive strategy. The survey found a marked lack of awareness and knowledge about NCDs among the population. It observed that across almost all diseases, except skin disease, digestive disorders, and cancer, more than 40% of the respondents were not aware of the suffering from their respective diseases for more than three years. This directly affected the diagnosis which was confirmed by 60% of the respondents who stated that they were diagnosed with their NCD after 1 year of suffering.

For India to check the alarming rise in the number of NCDs, it is essential to significantly increase public expenditure on healthcare, which includes the creation of healthcare infrastructure including health centers, hospitals, medical colleges, research institutes, and laboratories, as a percentage of GDP. The country must launch national programs to extend financial protection for / to enable coverage of the predictable and long-term cost of treatment to be financed through taxation.

The battle against NCDs is half won if symptoms are detected early. Towards this, empowerment of the community through effective health education and preventive health checks can help to completely manage the situation and cure it. This can be further complemented by creating awareness about the benefits of health insurance in times of health emergency and coverage of low-income and vulnerable households under the universal health insurance scheme of the government of India.

NCDs have significant homogeneity and variation across different states and one size fits all principle will not work in mitigating the brewing NCD crisis. The focus therefore should be on specific measures that work in each state.

It is imperative to prevent and control risk factors in an integrated manner by developing strategies and policies to inhibit the NCD burden on the country. Moreover, a conscious effort needs to be made to reduce sedentary lifestyle, break unhealthy habits like low physical activity, and unhealthy food habits that have become integral aspects of modern-day lifestyle and have been found to have the most significant role in causing NCDs.

The Indian economy is in a transition phase where the fast pace of change is leading to the breakdown of conventional wisdom in matters of nutrition and health. Increasing urbanization, growth of the food processing sector leading to consumption of convenience food, the influence of global lifestyles, the unplanned explosion of growth of towns and cities are further exacerbating the rapid rise in NCDs.

As a nation, we must strike the right balance among competing claims and constituencies to arrive at a point where economic growth and a healthy population need not be at cross purposes or a contradiction.

Congratulating Assocham India for the initiative and exhorting health practitioners and common people to come together in the fight against non-communicable diseases, Padma Bhushan Prof. (Dr.) Shiv Kumar Sarin, Head, Department of Hepatology and Director, Institute of Liver and Biliary Sciences, New Delhi added, “Health practitioners must work together as a cohesive group to mitigate the NCDs. Also, there is a need for all of us to change our attitude towards NCDs to positive health and prevention of the disease. It is possible to live 100 years of a healthy life if we invest in ourselves and embrace good lifestyle habits like 15 minutes of vigorous exercise daily to ensure utilisation of glucose by the muscles besides switching to a healthy and balanced diet.”

Expressing her thoughts on NCDs from an Oncology perspective and highlighting rising cases of breast cancer, Dr. Shikha Halder, Director and Senior Consultant, Department of Radiation Oncology, BLK-Max Super Speciality Hospitals stated, “Cancer cases has been increasing steadily in India contributing to 9% of total deaths related to NCDs which is the second-highest. Cases of breast cancer are on the rise in our country and have overtaken uterine cancer with an increase in the number of working women, women having fewer children, hereditary factors, and an increase of fatty diet in food. The only way to address the rising cases of cancer is to embrace treatment-seeking behavior, seek preventive screening, avoid pollution and improve dietary habits like consuming colourful vegetables rich in antioxidants.”

Dr. K.K. Talwar, Chairman, PSRI Heart Institute, Former (HoD), Cardiology AIIMS, New Delhi and Director, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh stated, “Indoor air pollution is an important risk factor when it comes to NCDs and Assocham India’s report clearly shows this. It contributes to lung diseases, cardiac diseases, cancer, etc. just like outdoor air pollution, and must be taken seriously. We should work towards ensuring a clean environment for our people both outside and in the closed premises like home, office, etc. to check high instances of air pollution related NCDs in the country.”