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When India turns 100 in 2047, policymakers envision a nation that is prosperous, equitable and resilient – that is, a Viksit Bharat. Yet one threat could stall that dream–non-communicable diseases (NCDs), which already account for almost two-thirds of all deaths in the country. The NCD’s include heart diseases, stroke, cancer, chronic lung disease, liver and kidney disease among others. While total elimination is unrealistic, if we delay the onset of NCDs and reduce premature deaths, the gains for families and the economy will be transformational.
Unlike many high-income nations, where most NCD deaths occur after 70, over half of India’s NCD mortality strikes people before that age. In fact, over the last few years, there has been increasing alarm over people in their 30s or 40s passing away from sudden cardiac arrest. Apart from the obvious grief associated with untimely deaths, those lost years also coincide with prime earning and caregiving periods, eroding household income, shrinking the skilled workforce, and hiking health-care costs. This silent tax on productivity is manifested in absenteeism from work, and an even subtler problem of presenteeism – workers who show up but are too unwell to perform.
Five diseases, five levers: Global evidence, echoed in India’s studies, shows that five NCDs — cardiovascular disease, cancers, diabetes, chronic respiratory disease and mental-health disorders — are driven largely by five modifiable risks. These are tobacco use, unhealthy diet, physical inactivity, harmful alcohol use, and air pollution. This 5×5 framework gives India a clear battle plan. It’s important to note that many interventions sit outside the health ministry’s walls, demanding cooperation across taxation, urban planning, agriculture and energy. The government has already taken several commendable steps. Taxation on cigarettes, for instance, has been effective. Government-led initiatives like the POSHAN Abhiyan have laid the groundwork by promoting nutrition among children. At the same time, the Ayushman Bharat–PM-JAY safety net can help families curb catastrophic healthcare expenses but needs further expansion.
However, there is some way to go. Certain forms of tobacco, like beedis and chewable variants, remain under-regulated. Public awareness on salt intake and trans fats — often found in deep-fried street food — must be strengthened. Air pollution, especially in the Indo-Gangetic belt during the winter months, continues to pose a significant public health risk. Physical inactivity, especially in urban centres, presents another obstacle. Creating pedestrian-friendly infrastructure, with safe footpaths, regulated traffic, and public parks, is not just a matter of urban planning; it’s a preventive health strategy. After all, a patient may believe walking will prevent a heart attack in the long-run, but we have to address their first fear of getting hit by a vehicle today.
While prevention is pivotal, the 200 million Indians already living with hypertension or diabetes cannot wait. Only one in five urban patients and one in ten rural patients keep their blood pressure under control. Innovations are emerging Tamil Nadu’s Makkalai Thedi Maruthuvam home-care model, nurse-led hypertension clinics, and smartphone decision-support tools under the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS).
For decades, India has followed western clinical guidelines for NCD treatment, often without considering the unique needs of Indian populations. For example, beta blockers, a common treatment for hypertension in the West, may raise triglycerides and lower HDL cholesterol in Indian patients, potentially worsening their cardiovascular risk. Evidence generated in India, for India, must inform the next generation of public health decisions.
India has already shown what’s possible in health — from eradicating smallpox to rapidly scaling up Covid-19 vaccinations. While NCDs are fundamentally different from infectious diseases, we can borrow lessons: task-shifting, preventive focus, and health system integration. Accredited Social Health Activists (ASHAs) who once tracked immunisations can be retrained to screen blood pressure and provide holistic care by counselling on lifestyle risks and mental health. We don’t have to build a new workforce. We have to repurpose the one we already trust.
Viksit Bharat@2047 offers India a powerful vision. To make it real, we must ensure that every citizen – no matter their location or socio-economic standing – can live a long, healthy, and productive life, free from the burden of preventable diseases. An NCD-free India may not mean zero cases, but it can mean zero tolerance for preventable suffering. That’s a goal worth striving for.
This article is authored by Dr Dorairaj Prabhakaran, executive director, Centre for Chronic Disease Control (CCDC).
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