Until recently, communicable diseases contributed to over 60 per cent of all deaths globally. Today, they contribute to less than 40 per cent of all deaths. However, non-communicable diseases (NCDs) like diabetes, hypertension, heart disease, cancers, and mental health contribute to 55-60 per cent of deaths in most countries, including India. Diabetes is an excellent example of measuring the burden due to NCDs in a country. The reason is that it is extremely easy to measure the prevalence of diabetes even using a simple hand-held glucose meter and thereby get a good handle on the burden of NCDs in general. According to the 10th Diabetes Atlas published by the International Diabetes Federation in December 2021, there are 74 million people with diabetes in India. The rise in NCDs like type 2 diabetes is driven essentially by lifestyle changes, particularly, unhealthy diets and lack of physical activity. It would be tempting for someone to say, ‘why can’t people just eat healthy diets?’ One must appreciate that ‘healthy foods’ like fruits, vegetables, and nuts are expensive and often beyond the reach of the common man. This leads to consumption of fast foods and junk foods, which are mass produced, and therefore cheap. This has resulted in a massive increase in obesity rates, which is the forerunner of diabetes, hypertension, heart disease, and even some forms of cancer. Physical inactivity is another major driver of the epidemic of NCDs. Again, it is wrong to assume that it is because people are lazy, that they don’t do any physical activity. The truth is that we do not have safe environment for people to walk or exercise. Our cities are polluted. There are no safe footpaths for people to walk and the greenery, the so-called ‘lungs’ of every city are fast disappearing and being replaced by concrete jungles. It is no longer safe for children to play outside their homes, and playgrounds are being rapidly converted into commercial buildings. The increasing pressure on children and youngsters to perform academically leads to mental stress, which is the underlying cause for anxiety and depression, resulting in high suicide rates. Thus, it is clear that a completely new paradigm using a multi-sectoral approach needs to be urgently adopted by policy makers, healthcare administrators, governmental and non-governmental agencies, educational institutions, and various ministries including agriculture, health, education, and sports, if the epidemic of NCDs is to be slowed down. The introduction of Yoga, Pranayama, and meditation right from the school level will help to improve physical and mental health. Apart from academic excellence, importance must be given to sports and extracurricular activities for entry into professional and other courses. Due to advances in technology, healthcare costs are rising astronomically. As much as 70 per cent of healthcare in India is ‘private’ and therefore out of reach for many people. On the one hand, we promote medical tourism, on the other hand, our own countrymen are unable to afford high quality healthcare services. The introduction of universal healthcare with medical insurance coverage for the masses, can ensure that people do not fall into the ‘debt trap’ due to poverty. Schemes such as Ayushman Bharat taken up by the Government of India could be ideal solutions to offer optimal healthcare to people. Universal health coverage would include financial risk protection providing essential healthcare services and medicines, and also accessibility to safe, effective and affordable medicines for all as proposed by the World Health Organization. A look at the SDG India Index 2020-2021 and the performance of the states, as published by the NITI Aayog shows huge discrepancy in the achievement of SDGs between different states. We must ensure a more equitable distribution of healthcare indices in all states of India. The National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Disease and Stroke (NPCDCS) was launched in 2010 as part of the National Health Mission (NHM). The programme focuses on strengthening infrastructure, human resources development, health promotion and awareness generation for prevention, early diagnosis, management, and referral to an appropriate level of healthcare facility for treatment of NCDs. Under NPCDCS, 677 NCD clinics at district level, 187 district cardiac care units, 266 district day-care centres, and 5,392 NCD clinics at community health centre level have been set up to ensure the treatment of common NCDs. In addition, NPCDCS gives financial support under NHM for awareness generation activities.
