India has made phenomenal development progress in the past decade. Physical and human capital are accumulating rapidly, fertility has continued to drop steadily and income is increasing at a blistering pace. It is cruel irony that this progress is aiding and abetting a lurking and insidious threat to the health and well-being of India’s population: non-communicable diseases (NCDs).
The five leading NCDs worldwide are cardiovascular disease, cancer, chronic respiratory disease, diabetes and mental health conditions (e.g. depression, Alzheimer’s/dementia and substance abuse disorders). These are the top NCDs in India as well. But, unlike the wealthy industrial countries, India’s NCD burden is being piled atop a sizable and consuming health burden associated with infectious disease and injuries.
Judging from trends in the risk factors for NCDs, India’s exposure to these conditions is poised to worsen. Tobacco and alcohol use are on the rise. Income growth has promoted a sharp increase in diets rich in fat but deficient in fruits and vegetables. The resulting effect on obesity is magnified by the decline in physical activity that accompanies urbanization.
The situation will be further aggravated by population ageing, another determinant of NCDs. Currently, 8% of India’s population is over the age of 60, a figure that is projected to reach 19% (323 million people) by 2050.
The displacement of infectious disease mortality by NCD mortality is generally regarded as a welcome sign of greater longevity. But India cannot yet make that claim, as one-third of NCD deaths in India involve people under the age of 60, compared with one-fifth in China and one-tenth in the United Kingdom. Moreover, many NCDs are accompanied by costly medical care and a great deal of disability and suffering. Dementia requires daily care, chronic obstructive pulmonary disease makes taking a simple breath a struggle and uncontrolled diabetes can lead to heart attack, blindness or amputation.
NCDs are costly not just in terms of human suffering, but in economic terms as well. The high cost is due to spending on treatment, including payments to private providers and care provided by the state. NCDs are also costly because NCD-related disability and death undermine labour’s contribution to output.
A study we are conducting with the World Economic Forum is looking precisely at this issue. Using a macroeconomic growth model, our calculations indicate that cardiovascular disease, cancer, chronic respiratory disease, diabetes and mental health conditions will cost India 126 trillion rupees from now through 2030. This is a colossal sum by any reasonable measure: it is 1.5 times India’s annual aggregate income and almost 35 times India’s total annual health spending. Mental health conditions are the greatest contributors to this loss (49%), followed by cardiovascular and chronic respiratory diseases, respectively (28% and 18%).
Much of the loss brought by NCDs can be contained through programmes and policies aimed at the prevention and early detection of disease, and through improved approaches to treatment and care.
The reality today is that many Indians have NCDs but are unaware of them. For example, India is home to an estimated 61 million people living with diabetes, although the International Diabetes Federation estimates that one-half of these cases are undiagnosed. Similarly, a recent four-state study of Indians aged 45 and over showed that only 17% of the approximately 1,700 individuals interviewed self-reported high blood pressure. However, when measured, nearly 50% of the sample was found to have high blood pressure.
Early detection is crucial, as many of these conditions can lead to grave complications, including heart attack, stroke, blindness or kidney failure. Many Indians do not know they have NCDs until they experience one of these emergencies. Health systems can save the high costs of treating such complications by addressing NCD risk factors and identifying NCDs while they are still relatively easy and cheap to manage. With India making progress towards universal health coverage, prevention and early detection are key cost-saving features to have in such a system.
Comprehensive care by a multidisciplinary team is necessary for people living with NCDs. Dr Mohan’s Diabetes Specialties Centre in Chennai, with its motto “Total diabetes care under one roof”, is a clear example that care needs to be reoriented from a cure-focused system to one that promotes health and prevents disease by offering a comprehensive approach. The Government of India has recently launched pilots through its National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Disease and Stroke to train health professionals to recognize and treat NCDs and integrate these services within the existing framework of the National Rural Health Mission.
Through a judicious blend of technological innovation to generate new knowledge, institutional innovation to promote the efficiency and equity of health provision and public finance, and increased funding to close knowledge-action gaps, India will be able to ameliorate the human and economic fury of NCDs. Efforts taken under the 12th Five-Year Plan to increase public health expenditure to 1.85% of GDP by 2017 are a decisive first step in the right direction. One thing is clear: when it comes to NCDs, inaction is not an option.
Authors: David E. Bloom is Professor of Economics and Demography at Harvard School of Public Health. Elizabeth T. Cafiero is Research Analyst at Harvard School of Public Health.
Image: A patient is pushed in a wheelchair along a corridor by a ward boy at RGGGH in Chennai REUTERS/Babu Babu