Burden of NCDs in India
Policies and Programme for Prevention and Control
Dr Y. D. Badgaiyan
Prof. & Head
Deptt. of Community Medicine,
CIMS, Bilaspur (C.G.)
• Chronic non-communicable diseases (NCDs)
are most common causes of morbidity and
premature mortality worldwide.
• And its has been replaced communicable
• About 80% of the burden occurs in low and
middle-income countries and
• 25% of NCDs occur, in individuals younger
than 60 years.
• The global economic impact of NCDs is
• By 2015, just two diseases (cardiovascular
diseases and diabetes) are expected to reduce
global GDP by 5%.
• Approximately half of the total economic
burden is reported to account for by CVD
including stroke, ischemic heart disease and
peripheral vascular disease.
• Which together cause more deaths than
HIV/AIDs, malaria and tuberculosis combined.
• In recognition of the increasing burden
and importance of chronic diseases, in
2005, the World Health Organization
(WHO) released a plan for NCD
prevention and control.
• It offers the health community a new
global goal to reduce death rates from all
chronic diseases by 2% every year,
• over and above the existing trends during
the next 10 years.
Burden of non-communicable diseases in India
• As of 2004, NCDs contributed half of the total
mortality and were the major causes of death.
• Among the NCDs, cardiovascular diseases are
number one cause of mortality (52%).
• NCDs account for more than two-fifth (43%)
of the DALYs, and
• among this group, cardiovascular diseases,
diabetes, cancers together account for 40% of
the NCD-related DALYs in India.
• Regional studies have reported that even
in rural India the leading cause of death
(32%) is NCDs followed by injuries and
external cause of deaths (12%).
• Projection estimates from the WHO have
shown that by the year 2030, CVDs will
emerge as the main cause of death (36%) in
• Since the majority of deaths are
premature, there is a substantial loss of lives
during the productive years as compared to
The salient features of the Causes of Death in India.
(Survey (2001-03) conducted by the Registrar General of India)
• The overall non-communicable diseases are
the leading causes of death in the country.
• They constitute 42% of all deaths.
• Urban areas have a lower number of deaths from
communicable, maternal, peri-natal and nutritional
• But a higher proportion from non-communicable
Overall, leading causes of deaths in India
1. cardiovascular disease (19%), followed by
2. respiratory diseases ( 9%),
3. diarrheal diseases (8%),
4. perinatal conditions (6.3%),
5. respiratory infections such as acute pneumonia
(6.2%), tuberculosis (6%),
6. malignant and other neoplasms (5.7%),
7. senility (5.1%),
8. unintentional injuries: other (4.9%), and
9. symptoms, signs and ill-defined conditions (4.8%)
Table 1: Estimated burden and trends of Non-communicable diseases in India
National response to NCDs
• Government of India had supported the
States in prevention and control of NCDs
through several vertical programs.
• National Health Programs for Cancer and
Blindness were started as early as 1975
and 1976, respectively, followed by
program on Mental Health in 1982.
• However, during the 11th Plan, there was considerable
upsurge to prevention and control NCDs.
• New programs were started on a low scale in limited
number of districts.
• Convergence with public sector health system was a
feature of these programs.
• Some of the programs were within the framework of
National Rural Health Mission.
• New programs are focused on
CVDs, diabetes, stroke, tobacco
control, deafness, trauma, burns, fluorosis and
Future plan to prevent and control NCDs
• There is adequate evidence that NCDs are major
contributors to high morbidity and mortality in the
• Risk factors including tobacco and alcohol use, lack
of physical activity, unhealthy diet, obesity, stress
and environmental factors.
• The modifiable risk factors can be
controlled to reduce incidence of NCDs
and better outcomes for those having
• Most of the NCDs like
cancer, diabetes, cardiovascular diseases
(CVD), mental disorders and problems relating
to aging are not only chronic in nature,
• but also may have long pre-disease period
where effective lifestyle changes can turn
around health status of individuals.
• Costs borne by the affected individuals and
families may be catastrophic as treatment is long
term and expensive.
• The economic, physical and social implications of
NCDs are significant, justifying investment both
for prevention and management of NCDs and
well-established risk factors.
• There is urgent need for a comprehensive
scheme that should focus on health
promotion and prevention of NCDs and
• their risk factors and comprehensive
management of NCDs at various levels
across the country.
PREVENTION AND CONTROL
CANCER, DIABETES, CVD AND STROKES
• Considering the fact that NCDs are surpassing the
burden of communicable diseases in India and
existing health system is mainly focused on
• need for National Programme for control of
Diabetes, CVD and Stroke was envisaged.
• Later on this programme was integrated with
National Cancer Control Programme and
• National Programme for Prevention and
Control of Cancer, Diabetes, CVDs and Stroke
was came in to existence.
• During 11th Five Year Plan 100 districts in 25
states have been covered under the NPCDCS.
• The programme focused on health promotion,
capacity building and early diagnosis and
management of the diseases with integration
with the primary health care system.
Objectives of NPCDCS
1. Prevention and control of common NCDs through
behavior and life style changes.
2. Provide early diagnosis and management of
3. Build capacity at various levels of health care for
prevention, control and treatment of NCDs.
4. Train human resources for in Primary Health Care to
cope with burden of NCDs.
5. Establish and develop capacity for palliative and
ACTIVITIES AT VARIOUS LEVELS
PHC and Sub-Center Level
• Health promotion by life style change through health
education like banner, poster, personal communication and
• Opportunistic screening of population above 30 years by BP
and Blood Glucose measurements.
• Referral services for the suspected cases of CVD and Cancer.
• At CHC Level
• NCDs clinic at CHC shall do the diagnosis by
required investigation, management and stabilization
of common CVDs.
• One of the nurse appointed under programme shall
undertake home visit for bedridden cases, supervise
the work of health workers and monthly clinic for
NCDs random at villages.
• At District Hospital
• NCDs clinic at district hospital screen persons above the
age 30 years for DM, CVDs and HTN.
• Detailed investigation of high risk persons.
• Regular management and annual assessment for person
suffering from the Cancer, DM, HTN and CVDs.
Urban Health Check-up scheme
( for diabetes and high blood pressure)
• To screen urban slum population for DM and HTN.
• To create database for prevalence of diabetes and HTN in
• To sensitize urban slum population about healthy life-style.
The blood sugar and BP will be checked for all > 30 years and
all pregnant women.
Cancer component under NPCDCS
• With objective of early diagnosis and treatment the national
cancer control programme was launched in 1975-76.
• During 2010, the programme was integrated with NPCDCS.
• Objectives of the programme are -
1. Primary prevention of cancer by health education.
2. Secondary prevention by early diagnosis and treatment.
3. Tertiary prevention by stregthening of existing institutions of
comprehensive therapy including palliative care.
Policies and approach
• There have been some legal measures taken by
Government of India aiming at non-
communicable diseases e.g.
the Tobacco Control Act 2003
• which aimed at prohibition on advertisement
and regulation on production, supplies and
distribution of tobacco products.
• However, implementation of these acts is a
• It is expected that revision in National Health Policy
is due and should duly emphasize policies and
strategies to prevent and control NCDs including
population-based interventions that require multi-
1. Health promotion for healthy lifestyles that
preclude NCDs and their risk factors.
2. Specific prevention strategies which reduce
exposure to risk factors.
3. Early diagnosis through periodic/opportunistic
screening of population and better diagnostic
4. Infrastructure development and facilities required for
management of NCDs.
5. Establish emergency medical services with rapid
referral systems to reduce disability and mortality due
6. Treatment and care of persons with NCDs including
rehabilitation and palliative care.
7. Health legislation and population-based interventions
through multi-sectoral approach for prevention of
8. Building evidence for action through
surveillance, monitoring and research.
Status of national health programs on NCDs in India
• There is evidence to show that NCDs are
leading causes of death, disability and
• their burden is likely to increase if urgent
interventions are not initiated on a mass scale
throughout the country.
• Currently implemented programs that address
NCDs have not been able to reduce their
burden due to limited scale of implementation.
• An integrated and comprehensive approach is
• Emphasis should be given on health
interventions, prevention of exposure to risk
factors, specific measures at individual and family
level, early diagnosis through screening and better
diagnostic facilities, improved capacity for
management and universal access to health services.