NCDs

1. Meaning, burden and epidemiological transition

NCDs are conditions that are not ordinarily transmitted directly from person to person. They generally develop through interacting genetic, physiological, environmental and behavioural factors and often require long-term care. Cardiovascular diseases include heart attacks and strokes; other major groups are cancers, diabetes and chronic respiratory diseases such as chronic obstructive pulmonary disease. The wider NCD agenda also includes chronic kidney disease and other chronic conditions. NCD does not mean non-infectious origin: human papillomavirus can cause cervical cancer, while hepatitis B and C increase liver-cancer risk.

India’s epidemiological transition involves a growing burden of chronic diseases alongside persistent communicable diseases, maternal and child-health needs and undernutrition. Population ageing increases the number at risk, but many NCD deaths occur during working age. WHO monitors premature mortality from the four major NCD groups between ages 30 and 70. State-level variation is important: differences in age structure, deprivation, urbanisation and health-system capacity require locally adapted priorities rather than uniform assumptions about disease burden.

Prevalence, mortality and disease burden measure different things. Prevalence records people living with a condition; mortality records deaths; disability-adjusted life years combine years of life lost with years lived with disability. Rising prevalence may reflect greater incidence, better detection or improved survival. Therefore, screening totals alone cannot establish that an NCD programme has improved population health.

2. Risk factors and the social-justice dimension

Major modifiable risks are tobacco use, harmful alcohol use, unhealthy diets and physical inactivity. Air pollution is another major NCD risk factor. These exposures can produce intermediate metabolic risks, including raised blood pressure, overweight or obesity, raised blood glucose and abnormal blood lipids. Household solid-fuel smoke, occupational dust and outdoor pollution demonstrate why chronic respiratory disease cannot be addressed solely through individual counselling.

Risk is socially patterned. Low-income households may lack safe walking spaces, affordable nutritious food, clean cooking energy and reliable primary care. Long working hours, insecure employment and aggressive marketing of unhealthy products constrain apparently voluntary choices. India also faces a double burden of malnutrition, with undernutrition and micronutrient deficiencies coexisting with overweight and obesity, sometimes within the same household.

NCDs reinforce inequality through repeated spending on medicines, diagnostics, travel and lost wages. Poorer patients may interrupt treatment when symptoms are absent, allowing hypertension or diabetes to progress to costly complications. Women may face restricted mobility and delayed cancer diagnosis; rural, tribal and remote communities encounter specialist shortages. Older persons and people with disabilities often require coordinated care for several conditions. Equity therefore means measuring who remains undiagnosed, untreated or uncontrolled, not merely counting facilities or screenings.

3. India’s institutional and programme response

Article 47 directs the State to improve public health and nutrition. Public health and hospitals fall primarily within the State List, while the Union supports policy, financing, standards and national programmes. The National Health Policy, 2017 emphasises preventive and promotive care and sought a 25% reduction in premature mortality from cardiovascular diseases, cancer, diabetes and chronic respiratory diseases by 2025. This policy target should not be confused with evidence of achievement.

The National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke began in 2010. Its expanded framework is now called the National Programme for Prevention and Control of Non-Communicable Diseases, or NP-NCD. It supports health promotion, screening, diagnosis, management, referral and capacity building. The wider programme addresses additional conditions such as chronic respiratory and kidney diseases and non-alcoholic fatty liver disease.

Ayushman Arogya Mandirs, formerly Ayushman Bharat Health and Wellness Centres, provide the primary-care platform for population-based screening and continuing care. ASHAs mobilise communities and support risk assessment, while primary-care teams undertake screening, follow-up and referral. Community risk assessment helps prioritisation but does not replace eligibility for screening. PM-JAY complements this platform through eligible hospitalisation coverage; it is not a substitute for universal outpatient medicines, monitoring and counselling.

4. Prevention, regulation and continuity of care

Population prevention changes the environments in which risks arise. Tobacco control combines taxation, cessation services, pictorial warnings and enforcement of the Cigarettes and Other Tobacco Products Act, 2003. Food policy should improve diet quality through healthier public procurement, salt reduction, appropriate labelling and restrictions on industrial trans fats. FSSAI’s limit of 2% industrial trans fatty acids by mass of total oils and fats in food products took effect in January 2022. Clean-air action, active transport and accessible recreation make healthy choices more feasible.

Clinical prevention requires distinguishing screening from diagnosis. A raised blood-pressure or glucose reading generally needs confirmation according to clinical protocols. Screening must connect people to affordable treatment; otherwise, it can create anxiety and expenditure without improving outcomes. Cancer screening requires particular attention to test quality, eligibility, consent, diagnostic confirmation and timely treatment. HPV vaccination and hepatitis B vaccination can prevent infection-related cancers.

Effective chronic care depends on standard treatment protocols, dependable supplies of essential medicines, trained nurses and community health officers, functioning laboratories and referral feedback. Longer-duration refills for stable patients and decentralised medicine collection can reduce travel and wage losses. Digital records and teleconsultations can support continuity, but require privacy safeguards and non-digital alternatives. Rehabilitation, palliative care and mental-health support should accompany prevention and treatment.

5. Implementation gaps and reform priorities

India’s central challenge is the gap between detection and sustained disease control. Medicine stock-outs, staff vacancies, fragmented private-sector care and weak referral systems interrupt treatment. Hospital-centred spending can crowd out less visible but cost-effective primary prevention. Commercial interests may resist tobacco, alcohol and food regulation. Overreliance on awareness campaigns also risks blaming individuals for risks shaped by poverty, pollution and urban design.

District plans should integrate NCD services with tuberculosis care, maternal health, nutrition, mental health and elderly care. Financing should prioritise essential outpatient medicines and diagnostics alongside hospital protection. Urban planning, education, agriculture, food regulation and environmental agencies need shared responsibilities and measurable targets. Community organisations and patient groups can improve trust, treatment support and accountability.

Monitoring should follow a care cascade: eligible population, screened population, confirmed cases, treatment initiation, retention and disease control. Blood-pressure control, complication rates, premature mortality and financial hardship are more meaningful than screening volumes alone. Disaggregating outcomes by sex, income, geography and social group reveals exclusion. The guiding principle is proportionate universalism: universal services with greater support for populations facing greater barriers.

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