Rising Neurological & Non-Communicable Diseases in India

First comprehensive estimates of disease burden due to neurological disorders and their trends were published in The Lancet Global Health.

About the Report-

• The findings have been published under the title of ‘The burden of neurological disorders across states of India: the Global Burden of Disease Study 1990–2019’.
• The study aimed at increasing awareness about these disorders, early identification, cost-effective treatment, and rehabilitation.
• It provides policy-relevant insights into the trends of neurological disorders across the States.
• It presented a comprehensive perspective of the burden of neurological disorders over the last 30 years and systematically highlights the variations between the States.
• It has been released and published by the India State-Level Disease Burden Initiative.

Recommendations Suggested in the Report-

• Several government policies and initiatives are in place to address the burden of neurological disorders across India, however, more focused efforts are required for the planning of specific neurology services in each State.
• Prevention and early management which are key in reduction in neurological burden.
• There is a need to address the shortage of trained neurology workforce and strengthen early detection and cost-effective management of neurological disorders in the country to deal with their growing burden.

Non-communicable diseases (NCDs)

• 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 slow progression and are the result of a combination of genetic, physiological, environmental and behaviours factors.
• NCDs are one of the major challenges for public health in the 21^st century, not only in terms of human suffering but also the harm 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.
• 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.
• 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.

Major NCDs and their risk factors

• 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, secondhand 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 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.
• 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.

Actions to beat non-communicable diseases

• 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 is the key focus of MOHFW to prevent deaths 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.
• MOHFW, GOI is already implementing “National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular disease and Stroke” (NPCDCS) with the objective to increase awareness on risk factors, to set up infrastructure (like NCD clinics, cardiac care units) and to carry out opportunistic screening at primary health care levels.
• In response to the “WHO Global Action Plan for the Prevention and Control of NCDs 2013-2020”, India was 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 suggested 9 targets for countries to set but India also set 10th 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.
• Integration of NPCDCS with the National Health Mission (NHM) resulted into augmented infrastructure and human resources particularly in the form of frontline workers- the ANM and the ASHA.
• With the active participation of these frontline workers the population-based periodic screening of hypertension, diabetes, and common cancers (oral, breast, cervical cancers) is initiated to facilitate the early detection of common NCDs.
• Prevention and management of chronic obstructive pulmonary disease (COPD) and chronic Kidney disease (CKD); and better management of co-morbidities such as diabetes and tuberculosis are also considered under the programme.
• Integration of AYUSH with NPCDCS is a further step for promoting healthy life style changes among the population.
• Health promotion through social media is also being used to generate awareness about prevention and control of NCDs, such as use of mobile technology in applications called mDiabetes for diabetes control, mCessation to help for quit tobacco, and no more tension as a support for mental stress management.
• All 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.