NCD Prevention in India: Setting an Example

Earlier this month, India Health Progress (IHP), an advocacy and research organisation, and PFCD co-hosted a roundtable discussion in New Delhi on the “Growing Social and Economic Burden of Non-Communicable Diseases in India”.

A variety of voices were heard at the discussion, which I was invited to participate in and moderate. These ranged from cardiac surgeons to primary health-care providers, from grassroots activists, working among India’s rural and urban poor, to educators seeking to integrate health, lifestyle and NCD prevention lessons into school curricula. There were also representatives from the pharmaceutical industry and from consumer organisations, research scientists and nominees to government bodies.

NCDs are an emerging health crisis in India. The country’s health minister recently admitted NCDs contributed to one of every two deaths in India in any given year. Between 2004-15, according to the World Health Organisation, NCDs – premature deaths, disabilities, time taken off work – could cost India US$ 237 billion.

So serious is the challenge that in April 2012 the Indian Ministry of Health plans to inaugurate a gigantic screening programme, covering 150 million people in its first phase. In 100 districts spread across 21 states, and incorporating urban slums in 33 cities, the programme will screen all males above 30 and all pregnant women for diabetes and hypertension. It will be the largest such identification and screening programme anywhere in the world. Yet, given India’s 1.2 billion population, it will only be a small start.

The government can’t do this alone. IHP has offered to start mapping underprivileged communities and schools in India’s capital city in the coming months, to ascertain the prevalence of and awareness about cancer and diabetes. It will then publish its findings, and take them to the Health Ministry and India’s Planning Commission.

The roundtable took place in this context, just as India is putting together its grand strategy to combat NCDs. It revealed a slew of ideas:

There were warnings as to the road India must not travel – the telling statistics from the United States, where one to three per cent of spending on NCDs goes into prevention and 97 per cent into medical research for new drugs and curative or NCD management technologies.
There were also innovations from the US that India would do well to adopt, such as getting fresh fruit and vegetables into lunch boxes in low-income schools, and integrating these institutions with farmers’ markets.
There was recognition that NCDs encapsulated a cross-cutting challenge and would need the help of urban planners and transport authorities, those who must incentivise walking and everyday physical exercise by building pavements – which India’s major cities famously lack – and creating bicycle tracks.
There was a suggestion that India’s pockets of scientific excellence be brought into the solution domain and see NCDs, rather than just infectious diseases, as their priority. For instance, the development of insulin that does not require refrigeration is a tantalising prospect. India and other developing countries have vast urban areas and even whole villages where electricity is erratic if not absent but where diabetes has already arrived.

None of this will happen in a hurry, but at least the thoughts have begun to flow. The Indian battle against NCDs will set the trend for low-cost interventions in a series of emerging and developing economies. That is why it should be worth watching.

Ashok Malik is a journalist writing primarily on public policy. Ashok is based in Delhi India and his columns and articles have appeared in several newspapers over the last 20 years.