Syllabus
GS Paper II – Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.
Context
A recently published study indicated a rise in the prevalence and morbidity of non-communicable diseases (NCDs) in India over the past decade.
Non-Communicable Diseases (NCDs)
Introduction
The burgeoning non-communicable disease (NCD) burden in India’s urban areas underscores the urgent need for comprehensive health reforms. Urbanisation has brought with it lifestyle changes that elevate the risk of NCDs, disproportionately affecting marginalized communities. To mitigate this crisis, it’s imperative to design and implement strategies that prioritize the creation of healthy cities. Ensuring access to primary healthcare for all, especially in underserved urban neighborhoods, is crucial for equitable health outcomes. This approach not only addresses the immediate healthcare needs but also fosters long-term societal well-being and resilience.
Non-Communicable Diseases (NCDs)
- Nature: Chronic illnesses that aren’t caused by infectious agents and do not spread from one person to another.
- Characteristics:
- Long-duration
- Slow progression
- Often need prolonged treatment
- Global Impact:
- Major contributors to death and disability worldwide
- Responsible for around 74% of all deaths globally
- Premature Deaths:
- 86% of early deaths (before age 70) occur in low- and middle-income countries
- Prevalence in Low- and Middle-Income Countries:
- These regions account for 77% of all NCD cases.
Types of Non-Communicable Diseases (NCDs)
- Cardiovascular Diseases (CVDs):
- Encompasses conditions like heart attacks, strokes, and hypertension.
- Cancer:
- Characterized by uncontrolled cell growth in specific tissues or organs, contributing to 9.3 million cases annually.
- Chronic Respiratory Diseases:
- Includes ailments such as asthma and chronic obstructive pulmonary disease (COPD).
- Type-2 Diabetes:
- A metabolic disorder leading to elevated blood sugar levels.
- Mental Health Disorders:
- Encompasses conditions like depression and anxiety, increasingly recognized as non-communicable diseases.
NCD Situation in India
- Tripled Prevalence:
- The prevalence of NCDs has tripled since 1995, with both urban and rural areas experiencing a rising burden.
- Mortality Rate:
- Non-communicable diseases are responsible for over 60% of deaths in India.
- Leading NCDs:
- Hypertension
- Diabetes
- Cancer
- Premature Mortality:
- Approximately 55% of deaths from NCDs occur before the age of 70, significantly impacting the working-age population.
- Geographical Disparities:
- Higher incidence rates in urban regions, with rural areas also showing an increasing trend.
- Kerala: Highest prevalence at 177 per thousand individuals.
- Following States: Pondicherry, Andhra Pradesh, Goa, Tamil Nadu, Punjab.
- North-Eastern States: Lowest prevalence of NCDs.
- WHO Report on NCD-Related Deaths in India:
- Cardiovascular Diseases: 22.66 lakhs.
- Chronic Respiratory Diseases: 11.46 lakhs.
- Cancer: 9.20 lakhs.
- Diabetes: 3.49 lakhs.
Risk Factors for Non-Communicable Diseases (NCDs)
- Definition:
- A risk factor is a condition that elevates the likelihood of developing a non-communicable disease. Multiple risk factors increase the probability of contracting a particular illness.
- Lifestyle Factors:
- Unhealthy diet
- Lack of physical exercise
- Use of tobacco and alcohol
- Physical Inactivity:
- According to The Lancet Global Health, nearly 50% of Indian adults are not physically active enough.
- Genetic Predisposition:
- Family history or genetic inclination towards certain diseases
- Environmental Factors:
- Exposure to pollutants
- Unsafe drinking water
- Occupational hazards
- Ageing:
- Higher risk due to the natural deterioration of body systems over time.
- Air Pollution:
- Major contributor to NCDs, accounting for 5.7 million deaths worldwide.
Impact of Non-Communicable Diseases (NCDs)
- Increased Health Burden:
- Urban communities confront a triple health burden during crises due to hazardous work environments, inadequate healthcare access, and financial instability.
- Financial Instability:
- Catastrophic healthcare costs threaten family livelihoods and financial security.
- Marginalized groups often lack health insurance, adding to financial stress.
- Impact on Vulnerable Populations:
- Informal workers, including sanitation staff, gig workers, and migrants, are disproportionately affected due to poor hygiene, nutrition, and lack of contract protections.
- Social and economic marginalization exacerbates health outcomes for these groups.
- Generational Health Impacts:
- Limited access to preventive care worsens health conditions in marginalized families, often persisting across generations and creating a cycle of vulnerability.
- Inaccessible Healthcare:
- Public health systems designed to support the lowest 40% of the population are often inaccessible to the urban marginalized.
- Increasing NCD cases overburden health systems, leading to inefficacy.
- Widening Inequality:
- Slum-dwelling populations and other marginalized groups face unequal access to healthcare, highlighting systemic issues in urban planning and governance.
- Economic Productivity Loss:
- Illnesses such as diabetes and cardiovascular diseases reduce workforce efficiency and productivity.
- Poorly managed NCDs contribute to absenteeism and long-term incapacity among urban workers.
Government Initiatives in India
- National Programme for Prevention and Control of NCDs (NP-NCD):
- Emphasizes awareness, prevention, and affordable treatment.
- Ayushman Bharat:
- Provides financial backing through the Pradhan Mantri Jan Arogya Yojana (PMJAY).
- State Cancer Institutes (SCI) and Tertiary Care Centers (TCCC):
- Established nationwide to enhance cancer treatment facilities.
- PM Swasthya Suraksha Yojana:
- Aims to set up oncology departments in new AIIMS and upgrade existing ones.
- Health and Wellness Centers (HWCs):
- Facilitate the screening and management of common NCDs.
- Tobacco Control Initiatives:
- Includes campaigns such as the National Tobacco Control Programme (NTCP) and higher taxes on tobacco products to reduce usage.
- Fit India Movement:
- Encourages physical activity and promotes healthy lifestyles.
- POSHAN Abhiyaan:
- Targets malnutrition and promotes healthy dietary practices.
- Integrated Disease Surveillance Programme:
- Offers regular health check-ups and digital data collection.
- Mobile Medical Units (MMUs) & Telemedicine:
- Supported by the National Health Mission to enhance healthcare access, particularly in rural areas.
Challenges in Controlling Non-Communicable Diseases (NCDs) in India
- Healthcare Infrastructure Gaps: Inadequate facilities and a shortage of skilled healthcare personnel, especially in rural areas.
- High Out-of-Pocket Expenditures: NCD treatment often incurs significant costs, leading to financial strain and reduced access to healthcare.
- Corruption and Inefficiency: Issues such as unregulated private hospitals and exploitative pharmaceutical practices hinder effective implementation of health schemes.
- Low Health Literacy: Limited awareness and understanding of NCDs among the population, affecting early detection and management.
- Environmental Factors: Exposure to pollution and unsafe living conditions contribute to the rising prevalence of NCDs.
- Lack of Preventive Measures: Insufficient emphasis on preventive healthcare and lifestyle modifications to reduce NCD risk factors.
Measures to Address NCDs in India
- Strengthening Primary Healthcare:
- Enhance access to publicly funded primary healthcare, especially for urban marginalized groups.
- Leveraging Technology:
- Implement real-time health monitoring using digital tools for conditions like hypertension and diabetes.
- Conduct population-level screenings for evidence gathering and individual awareness.
- Community-Based Solutions:
- Promote health education and awareness among the public, working collaboratively with ASHA workers.
- Develop community-led surveillance systems for NCDs in marginalized urban areas.
- Train ASHAs to bridge the gap between the community and public health systems.
- Engaging Stakeholders:
- Involve employers, municipalities, traffic systems, schools, and health systems in discussions to address interconnected health determinants.
- Collaborate with urban local bodies and experts to create healthy city solutions.
- Improving Primary Health Centers:
- Enhance participation and accountability in rural areas to provide better facilities in public health centers.
- Addressing Social Determinants of Health:
- Tackle issues related to workplace safety, housing, family connections, and community health infrastructure.
- Recognize the impact of social identities, employment, and migration status on health outcomes.
- Policy-Level Interventions:
- Expand state-level action plans to improve access to primary healthcare.
- Focus on preventive measures to avoid catastrophic out-of-pocket (OOP) healthcare expenses.
Conclusion
In conclusion, the escalating burden of non-communicable diseases in India necessitates a multifaceted approach that integrates robust healthcare infrastructure, technological advancements, community engagement, and comprehensive policy interventions. Strengthening primary healthcare, leveraging digital tools, promoting preventive measures, and addressing social determinants of health are crucial for effective NCD management. A concerted effort involving all stakeholders, including government, private sector, and civil society, is essential to create equitable, sustainable health outcomes. By prioritizing holistic health solutions, India can mitigate the impact of NCDs and enhance the well-being of its population.
Related PYQ
Appropriate local community level healthcare intervention is a prerequisite to achieve ‘Health for All’ in India. Explain. [UPSC CSE – 2018 Mains]
Practice Question
Discuss the increasing prevalence and morbidity of non-communicable diseases (NCDs) in India over the past decade. Highlight the factors contributing to this trend and suggest measures that can be implemented to address this growing health challenge. (15 marks, 250 words)
Guidelines to Answer
- Introduction:
- Briefly introduce the topic of NCDs and their rising prevalence in India.
- Body:
- Prevalence and Morbidity Trends:
- Provide statistics and data on the increase in NCD cases and mortality rates over the past decade.
- Contributing Factors:
- Discuss lifestyle changes, urbanization, genetic predisposition, environmental factors, and ageing population as key contributors.
- Challenges:
- Highlight issues such as inadequate healthcare infrastructure, high out-of-pocket expenses, and low health literacy.
- Measures:
- Suggest strategies to combat NCDs, such as strengthening primary healthcare, leveraging technology, community-based solutions, policy interventions, and addressing social determinants of health.
- Prevalence and Morbidity Trends:
- Conclusion:
- Summarize the critical points and emphasize the need for a comprehensive and multifaceted approach to mitigate the impact of NCDs in India.