The Silent Epidemic: Non-Communicable Diseases (NCDs) and India’s Economic Future

Introduction 

• India’s ambition to become a $5 trillion economy by 2025 faces a serious threat from the rising burden of Non-Communicable Diseases (NCDs), which are responsible for 66% of all deaths in the country (WHO, 2023). 
• The “silent epidemic” of NCDs, including heart disease, diabetes, cancer, and chronic respiratory conditions, is undermining the nation’s economic and healthcare systems, placing tremendous strain on resources and workforce productivity.

What Are Non-Communicable Diseases (NCDs)?

• Non-Communicable Diseases (NCDs) are chronic diseases that are not caused by infectious agents but are instead linked to lifestyle factors, genetics, and environmental influences. These diseases progress over time and include:
  • Cardiovascular Diseases (CVDs): The leading cause of death in India, accounting for 28% of all deaths.
  • Diabetes: India has the highest number of diabetes cases in the world, with 101 million individuals affected (ICMR 2023).
  • Cancer: 1.4 million new cancer cases are reported each year (National Cancer Registry).
  • Chronic Respiratory Diseases (COPD): Caused largely by air pollution, affecting 55 million individuals.
  • Additionally, the early onset of heart disease in younger adults is rising, with Delhi NCR reporting a 25% increase in stroke cases among young adults (AIIMS, 2024).

The Impact of NCDs on India

• Lifestyle Crisis: 23% of adults in India are overweight, and 30% have hypertension (NFHS-5), highlighting the growing incidence of lifestyle-related risk factors.
• Mortality: NCDs account for nearly 66% of all deaths in India, with 5-6 million deaths annually. 22% of Indians aged 30+ are at risk of dying from an NCD before the age of 70.
• Diabetes and Cancer Capital: India is becoming the diabetes and cancer capital of the world, with a rising incidence of both in the 30–40 age group.
• Economic Cost: NCDs drain approximately 5-10% of India’s GDP annually. A WEF-Harvard study predicts a $3.5-$4 trillion loss by 2030 due to the rising prevalence of chronic diseases.
• Risk Factors: 80% of heart disease, stroke, and diabetes cases are preventable with proper intervention and lifestyle management (WHO).

Preventive Healthcare: A Vital Strategy for NCDs

• • Preventive healthcare is critical to combating NCDs and improving public health outcomes. Preventive measures aim to reduce the onset of diseases through three key levels:

• Primary Prevention: This stage focuses on preventing diseases from occurring in the first place. For instance, Vaccinations and anti-tobacco campaigns like the COTPA Act. Kerala’s Aardram Mission, which has successfully reduced cardiovascular disease risks through regular screening and community awareness programs.

• 2. Secondary Prevention: The focus here is on early detection and prompt treatment to manage diseases before they progress. This includes Mammograms for early breast cancer detection and  HbA1c tests to monitor and control diabetes, helping prevent complications.

• 3. Tertiary Prevention: In cases where diseases are already present, tertiary prevention aims to limit the impact and manage symptoms. This includes rehabilitation services for stroke and heart disease patients and use of wearables and mobile apps for continuous monitoring of heart rate and physical activity levels.

Why Preventive Healthcare Is Crucial for India?

• Demographic Dividend & Workforce Productivity: NCDs are increasingly affecting the working-age population, undermining India’s potential as a global workforce leader. With 65% of India’s population under 35, chronic diseases threaten the country’s labor productivity, which is vital for economic growth.
• Reducing Healthcare Burden: Preventive care can ease the strain on secondary and tertiary care systems. For instance, early diabetic management can help avoid costly interventions like dialysis or amputations, thus lowering healthcare expenditure in the long run.
• Digital and AI Integration: India’s 750+ million smartphone users present a tremendous opportunity for integrating AI and digital tools into healthcare. AI can create personalized health risk scores and send early alerts, allowing for better disease management. For instance, machine learning algorithms can be used to detect early signs of lung cancer or fatty liver, leading to earlier interventions.
• Aligning with SDGs: Preventive healthcare contributes to Sustainable Development Goal (SDG) 3.4, which aims to reduce NCD deaths by 30% by 2030. By investing in prevention, India can make significant strides in achieving this global goal.

What are Government Initiatives for Preventive Healthcare in India? 

• National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke (NPCDCS): This program, under the National Health Mission (NHM), focuses on community-based screening, diagnosis, and health promotion. As of 2023, 677 NCD clinics and 187 District Cardiac Care Units have been set up across the country.
• Ayushman Bharat – Health and Wellness Centres (HWCs): Over 1.6 lakh HWCs are operational, providing preventive, promotive, and curative services, including screenings for hypertension, diabetes, and cancers.
• Fit India Movement & Eat Right India: These initiatives aim to promote active lifestyles and healthy eating through campaigns such as the #22KStepsChallenge.
• School Health Programme: This joint initiative between the Ministry of Education and Health focuses on health education and screening for school children.
• National Tele Mental Health Programme (Tele-MANAS): This program addresses the growing burden of mental health issues, which are becoming a significant component of NCDs.
• National Clean Air Programme (NCAP): This program focuses on air pollution, a major contributor to chronic respiratory diseases and cardiac issues.
• Pradhan Mantri Jan Arogya Yojana (PMJAY): Covers treatment for NCDs for over 500 million people across India.
• Disease Surveillance: Platforms like the Integrated Health Information Platform (IHIP) and the Integrated Disease Surveillance Programme (IDSP) enable real-time disease tracking, helping in early detection and response.

Hurdles in Preventive Healthcare in India

• Low Public Awareness: Health-seeking behavior remains largely reactive, with many individuals seeking healthcare only when symptoms arise. According to the NITI Aayog (2023), only 12% of Indians access preventive screenings, such as mammograms or diabetes tests, despite the growing need for early intervention to combat non-communicable diseases (NCDs). For example, India’s rural areas often face challenges in promoting awareness about early detection for diseases such as cancer or diabetes, leading to late-stage diagnoses and higher mortality rates. 
• Fragmented Healthcare System: Preventive services are often underfunded and poorly integrated with curative services, limiting access to early detection and intervention. For instance, the National Health Mission (NHM) covers preventive measures, but its funding remains insufficient, especially in remote areas. For the fiscal year 2024-25, the budget estimate for NHM has been raised to ₹31,967 crore, indicating a year-on-year increase of approximately 10% but there have been recommendations to augment NHM funding, with suggestions to allocate at least 2.5% of GDP to public health, aligning with the targets set in the National Health Policy, 2017.
• Inadequate Infrastructure: There is a shortage of trained personnel and diagnostic equipment, particularly in rural areas, where access to mammography and HPV testing is often limited. A 2019 study by the World Health Organization (WHO) revealed that mammography services are unavailable in over 60% of rural areas. Similarly, HPV testing (important for early detection of cervical cancer) is scarce in many villages. The Indian Council of Medical Research (ICMR) also reports that there is a need to increase infrastructure at the primary healthcare level to combat diseases like cervical cancer, which sees over 70,000 new cases annually in India. 
• Urban-Rural Divide: Rural areas have limited access to digital health tools and screening services, preventing effective implementation of preventive programs. According to TRAI’s 2023 report, only 29% of rural households have access to smartphones, limiting their ability to benefit from digital health services like telemedicine or health apps. For example, Kerala has been a leader in implementing digital health solutions like the “Aardram Mission”, but states like Uttar Pradesh have struggled with implementing similar programs due to infrastructure deficits. 
• Air Pollution:  Air pollution continues to be a major contributor to diseases like chronic respiratory diseases, cardiac issues, and strokes. According to IQAir (2024), seven out of the ten most polluted cities in the world are located in India, with Delhi, Kolkata, and Mumbai being the worst affected. The Lancet (2023) reports that air pollution causes over 1.6 million deaths annually in India, primarily due to diseases like COPD (Chronic Obstructive Pulmonary Disease) and heart disease. This escalating pollution leads to an increase in healthcare costs for treating preventable conditions.
• Behavioral Barriers: Health literacy remains a significant barrier, with many individuals adopting a “Chalta Hai” attitude towards health checks. This attitude is particularly prevalent in rural areas where health education programs are often inadequate. For instance, NFHS-5 (National Family Health Survey) found that only 38% of women in India receive blood sugar tests regularly. This low rate of preventive healthcare engagement leads to higher rates of undiagnosed diabetes and other chronic diseases, ultimately burdening the healthcare system.

Way Forward

• Corporate and Community Engagement: Mandate employee wellness programs and engage schools and local communities in health awareness campaigns. Google India’s Fit Weeks and Health Olympics in schools are examples of effective community engagement.
• Health in All Policies (HiAP): Embed health literacy in school curricula and promote health impact assessments for infrastructure projects.
• Increase Health Spending: Raise health spending to 2.5% of GDP (currently 1.28%), and implement sin taxes on unhealthy foods like Mexico’s soda tax. Offer insurance discounts for adopting healthier lifestyles (e.g., Singapore’s “Healthier SG”).
• Behavioral Nudges: Use nudge theory to influence healthier choices, such as providing rewards for making healthy choices or gamification of fitness challenges.
• Strengthen Primary Health Infrastructure: Expand Health and Wellness Centres (HWCs), integrate telemedicine, and invest in rural digital infrastructure to support tech-driven preventive care.
• Leverage AI and Big Data: Use AI algorithms for predictive modeling and risk mapping. Partner with private tech companies to create scalable health solutions. For example, Telangana’s “eHealth” app tracks NCD risks in the population.
• Regulatory Action: Implement food labeling norms, junk food taxes, and urban planning reforms to promote healthy living.