India’s disease burden has undergone a transition over the last decade, from communicable to non-communicable diseases (NCDs). Of the total deaths in India, 60% are caused by NCDs. Among the remaining deaths, 28% are attributable to communicable diseases, maternal mortality and other conditions, while 12% are caused by accidents and injuries. Liable for 53% of the disease burden, NCDs are depleting the country of its economic, social and human resources. The World Economic Forum estimated that India stands to lose $4.58 trillion before 2030 due to NCDs and mental health conditions.
Cardiovascular disease, diabetes, cancer and chronic respiratory ailments — the four leading NCDs — are the primary causes of mortality in India. The probability of death during the most productive years (ages 30-70) from the four main NCDs is a staggering 26%, adversely affecting not only health but also the productivity and work output of the working population of the country. Unhealthy lifestyles, rapid urbanisation, accelerated ageing, physical inactivity, obesity and growing consumption of alcohol and tobacco are crucial causes for the burgeoning NCD burden.
The ever-rising disease burden is translating into lost manpower and skill costs. It is also dragging millions of Indians into poverty due to rising out-of-pocket medical expenses. The public spend on health is a mere 1.1% of the GDP, as opposed to the ideal figure of 5-6%. Healthcare comprises a meagre 4% of the total government expenditure with less than 30% being spent on health-improvement. A miniscule part of this percentage is allocated towards NCDs, indicating that the government’s primary focus is still on addressing the communicable disease burden.
India lacks adequate resources to address NCD care. While the government is working on strengthening the health infrastructure of the country, it also needs to outline a comprehensive healthcare financing model that will help give individuals relief from the disease and financial burden they are facing. The need of the hour is the development of an evidence-based action plan for the government and the private sector towards achieving superior healthcare outcomes.
The need for a multi-dimensional, multi-sectoral, multi-agency programme to fight NCDs
The country is facing multifold challenges in its attempts to fight the NCD burden. India needs to develop novel, innovative methods and approaches that are cost-effective and easy to adopt. The country has a large and constantly expanding workforce which can be leveraged by providing the right skill sets and opportunities. India is facing a dearth of healthcare professionals, paramedical staff, nurses and caretakers. As a result, people are heavily reliant on expensive medical establishments in the private sector.
Second, the mounting disease burden is depleting the country of its economic capital gradually. With better allocation of funds, provision incentives, adequate manpower and infrastructure both at the central and state levels, the country can be uplifted from its existing NCD crisis.
The Draft National Health Policy 2015 is looking to shift focus to increased government spending on healthcare. Additionally, working out strategic public-private partnerships will help prioritise NCDs by infusing more funds, attracting active global involvement and creating necessary policies. The focus of addressing NCDs should be behavioural change at the family and community levels, promoting healthy dietary practices, physical activity, prevention of smoking, alcohol and pollution, starting early in life. This will require the engagement of sectors outside health. The recently adopted Sustainable Development Goals offers an excellent opportunity to bring focus on NCDs and multi-sectoral action. A tactical partnership between the public and private sectors can help the government ameliorate the debilitating conditions that communities are currently facing.
India needs to take urgent corrective action to check the growing burden. Focused action plans and initiatives can make a significant difference in tackling NCDs which are preventable if diagnosed in a timely way. If the future health strategy focuses on an all-inclusive approach, the government can accomplish much better outcomes.
Dr. Sanjiv Kumar
Executive Director at the National Health Systems Resource Centre (NHSRC),
Ministry of Health and Family Welfare, Government of India