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Non-communicable diseases (NCDs) are medical conditions or diseases that are not caused by infectious agents. These are chronic diseases of long duration, and generally with slow progression and are the result of a combination of genetic, physiological, environmental and behavioural factors.
NCDs are one of the major challenges for public health in 21st century, not only in terms of human sufferings they cause but also the harm/burden they inflict on the socioeconomic development of the country. NCDs kill approximately 41 million people (71% of global deaths) worldwide each year, including 14 million people who die too young between the ages of 30 and 70. The majority of premature NCD deaths are preventable. According to World Health Organization (WHO) projections, the total annual number of deaths from NCDs will increase to 55 million by 2030, if timely interventions are not done for prevention and control of NCDs. NCDs are rapidly increasing globally and reached epidemic proportions in many countries, largely due to globalization, industrialization, and rapid urbanization with demographic and lifestyle changes.
India is experiencing a rapid health transition with a rising burden of Non-Communicable Diseases (NCD) surpassing the burden of communicable diseases like water-borne or vector-borne diseases, TB, HIV, etc. In India, nearly 5.8 million people (WHO report, 2015) die from NCDs (heart and lung diseases, stroke, cancer and diabetes) every year or in other words 1 in 4 Indians has a risk of dying from an NCD before they reach the age of 70. The NCDs like Cardiovascular diseases, Cancer, Chronic Respiratory Diseases, Diabetes and other NCDs are estimated to account for around 60% of all deaths, thus making them the leading causes of death. NCDs cause considerable loss in potentially productive years of life. Losses due to premature deaths related to heart diseases, stroke, hypertension and diabetes are also projected to increase over the years.
In a report “India: Health of the Nation’s States” by Ministry of Health and Family Welfare (MOHFW), Government of India (GOI), it is found that there is increase in the contribution of NCDs from 30% of the total disease burden- ‘disability-adjusted life years’ (DALYs) in 1990 to 55% in 2016 and also an increase in proportion of deaths due to NCDs (among all deaths) from 37% in 1990 to 61% in 2016. This shows a rapid epidemiological transition with a shift in disease burden to NCDs.
In response to the “WHO Global Action Plan for the Prevention and Control of NCDs 2013-2020”, India is the first country to adopt the National Action Plan with specific national targets and indicators aimed at reducing the number of global premature deaths from NCDs by 25% by 2025. The global action plan has suggested 9 targets for countries to set. But India has taken the unprecedented step of setting a tenth target to address household air pollution. India’s National Monitoring Framework for Prevention and Control of NCDs has committed for a 50% relative reduction in household use of solid fuel and a 30% relative reduction in prevalence of current tobacco use by 2025.
People should join together to reduce premature deaths from NCDs by one third by 2030, the commitment made in 2015, as a part of Sustainable Development Goals. The strategies must envisage the urgent need to halt and reverse the growing incidence of NCDs.
The major NCDs are cardiovascular diseases, cancers, chronic respiratory diseases and diabetes. Physical inactivity, unhealthy diets (diets low in fruit, vegetables, and whole grains, but high in salt and fat), tobacco use (smoking, second hand & third hand smoke, and smokeless tobacco), and the harmful use of alcohol are the main behavioural risk factors for NCDs. They contribute to raised blood pressure (hypertension); raised blood sugar (diabetes); raised and abnormal blood lipids (dyslipidaemia); and obesity. Air pollution is also a leading risk factor for NCDs in terms of both outdoor air pollution and household air pollution that mainly results from burning solid fuels in the home for cooking and heat. Although morbidity and mortality from NCDs mainly occur in adulthood, exposure to risk factors begins in early life. Therefore, NCDs and its risk factors have great importance to young people as well.
The epidemic of NCDs cannot be halted simply by treating the sick, healthy persons have to be protected by addressing the root causes. Reducing the major risk factors for NCDs must be the the key focus to prevent deaths/morbidities from NCDs. Tackling the risk factors will therefore not only save lives, it will also provide a huge boost for the economic development of the country.
We should not limit programs only to the major NCDs but cover all NCDs in an integrated manner. Diseases to be covered and other interventions recommended for inclusion under NCD may be for:
a.Programs for lifestyle chronic diseases and risk factors: 1. Cancer 2. Diabetes, cardiovascular diseases (CVD) and stroke 3. Chronic obstructive pulmonary diseases 4. Chronic kidney diseases 5. Organ and tissue transplant 6. Mental disorders 7. Iodine deficiency disorders 8. Fluorosis 9. Oro-dental disorders
b. Programs for disability prevention and rehabilitation : 1. Trauma (including road traffic accidents) 2. Burn injuries 3. Disaster response 4. Emergency medical services 5. Musculo-skeletal (Bone and Joint) disorders 6. Physical medicine and rehabilitation 7. Blindness 8. Deafness 9. Health care of the elderly (geriatric disorders) 10. Neurological disorders (epilepsy, autism) 11. Congenital diseases 12. Hereditary blood disorders (sickle cell anemia, thalassemia, hemophilia)
c. Health promotion and prevention of NCDs : 1. Tobacco control 2. Prevention and management of nutritional disorders and obesity 3. Patient safety program
MOHFW, GOI has already implementing several national Programme for Prevention and Control of these NCDs of public health importance. These are:
1. National Programme for prevention and control of Cardio vascular Diseases, Diabetes, Cancer & Stroke (NPCDCS). Under this broad head we have several initiatives which are added in phases are: Prevention and management of chronic obstructive pulmonary disease (COPD) and chronic Kidney disease (CKD), Population Based Survey (PBS), Integration of AYUSH, National Framework for Joint Tuberculosis-Diabetes Collaborative Activities, Integration with NationalUrban Health Mission, India Hypertension Management Initiative (IHMI), a collaborative project of ICMR, Implementation of STEMI Protocol.
2.National Programme for Control of Blindness & Visual Impairment (NPCB & VI). 3. National Programme for Health Care for Elderly (NPHCE). 4. National Programme for prevention and control of Deafness ( NPPCD). 5. National Programme for prevention and control of Oral Health (NOHP). 6. National Memntal Health Programme ( NMHP). 7. National Haemoglobinothathies Control Programme. 8. National Programme for Palliative Care ( NPPC). 9. National Iodine Deficiency Disease Control Programme (NIDDCP). 10. National Tobacco Control Programme (NTCP). 11. National Programme for prevention and control of Flurosis (NPPCF). 12. National Programme for Prevention and Management of Burn Injury (NPPMBI). 13. Pradhan Mantri National Dialysis Programme. 14. National Programme for Control Treatment of Occupational Diseases 15. National Organ and tissue transplant Programme.
There are few other NCD programmes running as state initiative which have public health importance:
1. Programme for prevention and control of Arsenicosis. 2. HALF YEARLY HEALTH CHECK UP OF ELDERLY. 3. Silicosis prevention and control programme.
We in our state are running the following public health programmes under the wing “STATE NCD CELL” of the Directorate. The other NCD programme/activities are run directly through the State Programme Officers/State Nodal Officers.
1. National Programme for prevention and control of Cardio vascular Diseases, Diabetes, Cancer & Stroke (NPCDCS). We have started “Care and management of COPD & Asthma” & India Hypertension Management Initiative (IHMI) in five districts in first phase. 2. National Programme for Control of Blindness & Visual Impairment (NPCB & VI). 3. National Programme for Health Care for Elderly (NPHCE). 4. National Programme for prevention and control of Deafness ( NPPCD). 5. National Programme for prevention and control of Oral Health (NOHP). 6. National Programme for Palliative Care ( NPPC). 7. National Haemoglobinothathies Control Programme (Thalassaemia & Haemophilia) . 8. National Iodine Deficiency Disease Control Programme (NIDDCP). 9. National Tobacco Control Programme (NTCP). 10. National Programme for prevention and control of Flurosis (NPPCF). 11. Programme for prevention and control of Arsenicosis (state initiative). 12. Half Yearly Health Check Up of Elderly(state initiative). 13. Silicosis prevention and control programme (state initiative).
