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New Delhi: Noncommunicable diseases (NCDs) contribute to 66% of all deaths occurring in India, a World Health Organisation (WHO) report has found.
NCDs, as the name suggests, are diseases that are not passed from one person to another and are mostly lifestyle-related. The major NCDs are cardiovascular diseases (heart diseases), cancer, diabetes and chronic respiratory diseases. In absolute numbers, 60.1 lakh deaths – most of which were preventable – in India occurred due to NCDs.
Apart from being deadly on their own, NCDs can act as “comorbidities” which increase the chances of the person developing severe disease if infected by the novel coronavirus – or any other infectious diseases.
The WHO report, titled ‘Invisible numbers‘, takes stock of NCD prevalence in 194 countries. It was released on Wednesday, September 21, and also revealed that the probability of premature mortality due to NCDs in India is about 22%. In other words, 22% of all people in India who are 30 years or older would die due to NCDs before their 70th birthday. The global probability is 18%.
Cardiovascular diseases account for 28% of deaths in India – the highest among all NCDs. Hypertension (elevated blood pressure levels) is one of the leading risk factors for cardiovascular diseases. As many as 31% of all people between the ages of 30-79 are hypertensive. But what is more worrisome is that cardiovascular disease is undiagnosed in 63% of people and are therefore unaware of their condition.
Obesity, another contributing factor, is on the rise in India ever since 2000 among those aged 18+. The report has projected that the country would miss the global target of halting the rise of obesity by 2025.
More than one-third (34%) of Indians who are 18 years+ are physically inactive, against the world average of 28%. The WHO defines ‘physical inactivity’ as less than 150 minutes of moderately intense physical activity per week, or less than 75 minutes of vigorously intense physical activity per week.
Chronic respiratory diseases are the second highest contributors to NCD deaths, causing 12% of overall deaths. The most common chronic respiratory diseases are asthma and chronic obstructive pulmonary disease (COPD). Out of every 100,000 population of India, 113 die of CRDs in India – this is among the highest in the world.
Air pollution is one of the driving factors for CRDs in India. The WHO report states that the prevalence of particulate matter 2.5 (PM2.5) – a fine pollutant – is nearly 9 times higher than the permissible limits. Only a handful of countries in Africa, Asia and the Middle East perform worse than India. As far as reliance on polluting fuels and technologies is concerned, the urban-rural divide is clear for the country with nearly half (47%) of the people living in rural areas using them as against 9% living in the urban areas.
Tobacco consumption is consistently declining but the WHO report reckons that India has not done enough on fiscal measures to curb the usage by increasing taxes to the extent that they account for more than 75% of the retail price of the product. The country recently introduced the rule for large graphic health warnings on tobacco packets. India also needs to better implement the smoke-free premises rules which have been in place for a long time now.
Cancer accounts for 10% of all NCD deaths in India. In fact, out of all cancer deaths in the country, 68% happen in people who are less than 70 years old. Diabetes, asthma and cardiovascular diseases cause premature deaths in nearly half the people who have the diseases.
Among females, cervical cancer is the second most prevalent among all cancers, followed by breast cancer. Yet, according to the report, only 2% of females (30-49 years) ever had a preventive screening in their lifetime. This is when there exists a national programme for screening cervical cancer.
Among males, cancers of the mouth and oropharynx and those of the lung and trachea are the two biggest contributors to cancer deaths – primarily attributable to tobacco consumption, exposure to second-hand smoke and polluted air.
There is no significant gender divide as far as cancer deaths are concerned, according to the WHO report. The total number of deaths among males in 2019 attributed to cancer was 4.7 lakh – 20,000 more than females.
Among all the NCDs, if there is one where India is unambiguously off track to achieve the global target, it is diabetes. The specific global target for this NCD is to halt the rise in fasting blood glucose levels by 2025. The incidence and the deaths attributable to disease are consistently rising and the projected trends are they would continue to do so both among males and females in India. Obesity, tobacco use and physical inactivity are other risk factors associated with the disease other than the rise in glucose level.
As far as obesity is concerned, which is a risk factor for all the NCDs, there are by and large all requisite policies in place though their implementation is far from perfect. But India has failed to introduce a policy for checking the presence of trans-fats or industrially produced fats in food products which also increases the risk of obesity.
Globally, NCDs account for 74% of all deaths – causing about 70 million deaths every year. Lower-and Middle-Income Countries (LMICs) are the most affected ones, as against the perception that these diseases affect only the rich people or rich countries, the report reveals. Heart disease, cancer, diabetes and respiratory disease now outnumber infectious diseases as the top killers globally.
Lockdowns and other disruptions caused by the COVID-19 pandemic also caused hindrances in accessing NCD services. Referring to a survey conducted in this regard, the WHO reported that more than 40% of countries reported partial disruption of services for hypertension management, diabetes management, asthma services and cancer treatment. This survey was conducted in 163 countries, in which India did not take part.
NCDs cause not only morbidity and mortality but also significantly impact economies – thus affecting the countries indirectly also, especially, because these diseases limit the ability of people to work. “Between 2011 and 2030, the cost of this lost productivity from the four major NCDs is estimated to be a staggering US$ 30 trillion – and adding mental health increases it to US$ 47 trillion,” the WHO report says, calling for tangible investments in prevention and treatment of NCDs.
It adds that the “clock is ticking” towards the 2030 deadline for achieving the Sustainable Development Goal target to reduce premature mortality from NCDs by one-third. “Currently, we are far off track,” the report says.
Spending an additional US$18 billion per year across all low- and middle-income countries could result in benefits worth trillions of dollars, the WHO report said, “proving once again that health should be seen as an investment, not a cost”.