India Shows Rise in Deaths From Non-communicable Diseases: Lancet Study

Higher NCD Mortality Risks: India’s Slow Progress Amid Rising Death Rates

Between 2010 and 2019, the percentage of female newborns likely to die from chronic diseases before reaching 80 rose from 46.6% to 48.7%. For males, this figure climbed to 57.9%, up from 57.8% in 2010. These numbers from the recent Lancet study on non-communicable diseases (NCDs) signal more than just incremental shifts—they reveal India’s struggle to mount an effective response to the chronic disease epidemic.

While the headline figure of rising mortality rates is concerning, the nuance demands attention. Despite heavy investments into schemes such as the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) and disease-specific initiatives like the National Programme for Prevention and Control of NCDs (NP-NCD), lifestyle diseases continue their expansionary march through India's population. The crux lies in implementation gaps, wide regional disparities, and a reactive—rather than preventive—public health approach.

The Institutional Landscape: Expanding Programmes, Shifting Priorities

India’s primary frameworks for tackling NCDs have grown considerably since the launch of NP-NCD in 2010. Initially targeted at diabetes and cardiovascular diseases, it now includes cancer, respiratory diseases, and kidney ailments. Expanded in 2023, the programme claimed sharper focus on early detection. Paired with the ambitious 75/25 initiative, aiming to deliver standardized hypertension and diabetes care to 75 million people by 2025, the efforts signal intent. But is intent enough?

The budgetary allocation for the 2023 expansion saw an increase of ₹4,500 crore over three years—commendable on paper. Yet, state-level implementation is patchy. States like Kerala, with strong primary healthcare systems, fare better, whereas poorer states such as Bihar struggle with infrastructural deficiencies and personnel shortages. The Ayushman Bharat programme added incentives for upgrading PHCs to Arogya Mandirs, yet rural regions see delays and underutilization.

Data, Outcomes, and Institutional Critique

India’s NCD burden is fueled substantially by lifestyle shifts. Urbanization has brought increasingly sedentary habits and diets high in fats, sugar, and processed foods. These are complemented by air pollution—both outdoor and indoor—exacerbating respiratory issues. Yet, critical data gaps persist. For example, while the Eat Right India Movement promotes nutritional awareness, recent surveys show that less than 40% of Indians are aware of trans-fat risks. Awareness campaigns remain limited to urban centers.

The Ministry of Health and Family Welfare (MoHFW) has emphasized early screening as a cornerstone of NCD policy, yet systemic bottlenecks undermine efficiency. Screening services under NP-NCD often fail in rural blocks due to lack of specialists and low follow-up rates. Notably, states where PHCs are poorly staffed—Jharkhand and Chhattisgarh—report screening rates below the national average. The irony here is that while tertiary care under PM-JAY receives media attention, the underfunding of preventive interventions remains the Achilles’ heel of India’s public health system.

What the Lancet study also obscures is the unequal gender impact. Female mortality risk saw an increment more than 20 times higher than males during the 2010–2019 period—a reflection not only of biological vulnerabilities but also access disparities. Women often delay seeking care due to social factors, financial constraints, or systemic biases in healthcare priorities.

Structural Tensions: Over-Centralization and Missed Opportunities

A deeper challenge lies in coordination between the Centre and states. Health remains largely a state subject under the Indian Constitution, yet many flagship programmes—from PM-JAY to NP-NCD—are spearheaded and monitored centrally. This creates friction where highly diverse health profiles and resource disparities are at play. Tamil Nadu, known for its robust public health infrastructure, contrasts sharply with UP, where PHC vacancy rates exceed 30%.

Furthermore, the political economy of healthcare innovation is troubled. While private players dominate tertiary care, public sector programs barely scratch the surface of chronic disease management at community levels. For instance, the Fit India Movement, designed to tackle sedentary lifestyles, lacks meaningful integration with school curriculums or urban planning frameworks like walkable cities.

International Comparison: Lessons from Thailand’s Preventive Revolution

Thailand offers a fascinating counterpoint. Its Universal Coverage Scheme (UCS) focuses heavily on preventive care, allocating more than 40% of its annual health budget to disease prevention and health promotion. Regular health screenings and community-level fitness campaigns reduce reliance on tertiary interventions, and mortality data shows outcomes vastly better than India’s for NCDs. For India, whose programs often veer toward secondary treatment rather than preventive mechanisms, this approach offers tangible lessons.

Future Metrics and Unresolved Gaps

What would success look like for India’s NCD agenda? First, meaningful reduction in mortality risks—a reversal of trends evident in the Lancet study—must become a measurable output. This requires bridging workforce gaps in rural health centers, improving data reliability on prevalence indicators, and shifting from reactive to proactive interventions. The true test is linked to primary healthcare utilization rates and dietary behavior changes across socio-economic classes.

Second, gendered health programs must come to the fore. An NCD-specific component under PM-JAY focusing on female education and early care is overdue. The evidence is mixed—policy frameworks exist, but much depends on state sincerity in actual enforcement.

UPSC-Style Questions

• Prelims Question 1: Which of the following initiatives primarily aims to provide standardized care for hypertension and diabetes?
  • (a) Fit India Movement
  • (b) Ayushman Bharat Scheme
  • (c) 75/25 Initiative
  • (d) Eat Right India Movement
• Prelims Question 2: 'Non-communicable diseases' include which of the following conditions?
  • (a) Tuberculosis
  • (b) Stroke
  • (c) Malaria
  • (d) Dengue

Mains Question: "To what extent have India’s national initiatives addressed the structural limitations of tackling non-communicable diseases? Critically evaluate with reference to state-level implementation disparities and international benchmarks."

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