India has made phenomenal development progress in the past decade. Physical and human capital are accumulating rapidly, fertility rates are going down and income is increasing. But this progress is aiding the spread of non-communicable diseases (NCDs).
The five leading NCDs worldwide are
cardiovascular disease, cancer, chronic respiratory disease, diabetes and mental health conditions like depression, Alzheimer's/dementia and substance abuse disorders. These are the top NCDs in India as well. But, unlike the wealthy industrial countries, India's NCD burden is being piled atop a sizable health burden associated with infectious diseases and injuries.
Judging from trends in the risk factors for NCDs, India's exposure to these conditions is poised to worsen. Tobacco and alcohol use are on the rise. Income growth has promoted a sharp increase in diets rich in fat but deficient in fruits and vegetables. The resulting effect on obesity is magnified by the decline in physical activity that accompanies urbanisation.
The situation will be further aggravated by population ageing, another determinant of NCDs. Currently, 8% of India's population is over the age of 60, a figure that is projected to reach 19% (323 million people) by 2050.
The displacement of infectious disease mortality by NCD mortality is regarded as a welcome sign of greater longevity. But India cannot yet make that claim, as one-third of NCD deaths in India involve people under the age of 60, compared with one-fifth in China and one-tenth in Britain.
We are conducting a study with the World Economic Forum on this issue. Using a macroeconomic growth model, our calculations indicate that cardiovascular disease, cancer, chronic respiratory disease, diabetes and mental health conditions will cost India R126 trillion from now through 2030. This is a colossal sum by any reasonable measure: it is 1.5 times India's annual aggregate income and almost 35 times India's total annual health spending. Mental health conditions are the greatest contributors to this loss (49%), followed by cardiovascular and chronic respiratory diseases, respectively (28% and 18%). Much of the loss brought by NCDs can be contained through prevention and early detection of disease, and through improved approaches to treatment and care.
Through a judicious blend of technological innovation to generate new knowledge, institutional innovation to promote the efficiency and equity of health provision and public finance, and increased funding to close knowledge-action gaps, India will be able to ameliorate the human and economic fury of NCDs. Efforts taken under the 12th Five-Year Plan to increase public health expenditure to 1.85% of GDP by 2017 are a decisive first step in the right direction. One thing is clear: when it comes to NCDs, inaction is not an option.
David E Bloom and Elizabeth T Cafiero are with Harvard School of Public Health
The views expressed by the authors are personal
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