The Dual Burden of Disease in India

Rajasthani older people from Jaisalmer
India’s older people are especially at risk of developing non-communicable diseases (NCDs)

This year’s World Health Day publicized the increasing prevalence of hypertension by choosing high blood pressure as the theme for 2013’s celebration. Focusing on high blood pressure, the leading risk factor for cardiovascular disease, brings much needed attention to a broader public health problem facing India, the rise of non-communicable diseases (NCDs) and the increasing dual disease burden.

According to a 2012 WHO report, NCDs are responsible for two-thirds of the total morbidity burden and about 53% of total deaths in India. This figure is up from 40.4% in 1990 and is expected to rise to 59% by 2015. These statistics are staggering considering India accounts for 21% of the world’s global burden of disease. This shift in epidemiological profile presents a unique challenge to India’s health system: as rates of cardiovascular and metabolic disease, obesity and cancer rise, tuberculosis, diarrheal disease and water borne illnesses remain widespread.

It’s difficult to comprehend the toll that a dual disease burden can take on a population. In the US, my native country, “lifestyle” diseases are the leading causes of mortality. Many people assume that diseases caused by inactivity, poor diet, tobacco use and alcohol consumption mainly affect populations of industrialized countries. The tendency to associate communicable disease with developing countries is so engrained that as I was preparing to leave for India, my health became a constant topic of conversation. Questions about my flight and departure date were immediately followed by concerns over whether I’d gotten shots and was taking malaria medication.

These concerns are somewhat legitimate as infectious diseases continue to be a major cause of mortality in India—you will find more cases of typhoid here than in the US.  But they also demonstrate a tendency for those living in the developed world to assume lower life expectancies and preventable deaths in India are a result of diseases that could never affect them. It seems that the information we receive has created a sort of global health binary, with communicable diseases like malaria, tuberculosis and HIV/AIDS effecting the developing world, and NCDs like heart disease, diabetes and cancer being largely confined to the developed world.

This idea is far from reality, and exclusively using a country’s GDP as an indicator of health threats is highly ineffective. Due to climate change, increased urbanization and the spread of globalization, more countries than ever will face the dual disease burden. The factors that enable the spread of infectious disease—poverty, unclean water, poor sanitation and weak health systems—exacerbate chronic conditions and contribute to “premature” deaths. Of the 36 million people NCDs kill each year, 9 million die before age 60. Ninety percent of these deaths occur in low and middle-income countries. Hypertension, heart disease and diabetes are increasing in prevalence, but many Indians don’t have the means to live with them for decades, especially in rural areas.

The Indian government is taking on the challenge by developing initiatives to curb the rise of NCDs. The Ministry of Health and Family Welfare is leading a large-scale effort aimed at early detection of diabetes. The government is working with the WHO to draft global and regional action plans for 2013-2020 addressing NCDs. GRAVIS is doing its part by teaming up with Help Age International to lead a research study on the double burden of disease in South Asia. Reducing the dual disease burden is a difficult task but one that can be accomplished through research, effective policy and collaboration.

*Lia Garman, Volunteer


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