Foreword: The economic impact of NCDs must not be underestimated

Tackling the growing economic and social burden of non-communicable diseases (NCDs) has become a global priority for government, NGOs, industry and patients – and is the focus of this inaugural edition of India Health Quarterly.

According to the World Health Organization, chronic diseases are now the major cause of death and disability worldwide, accounting for 59% of the 57 millions deaths annually and 46% of the global disease burden. NCDs increasingly affect people from developing as well as developed countries, reflecting a significant change in diet habits, physical activity levels, and tobacco use worldwide as a result of industrialization, urbanization, economic development and increasing food market globalization.

With one of the world’s largest populations, the impact of NCDs in India is enormous. According to a recent report (The Burden of Non-Communicable Diseases in India) published by The Cameron Institute – an independent think-tank – the most preventable illnesses: heart diseases, strokes, and diabetes alone are projected to cost USD 237 billion in lost national income between 2006 and 2015.

In 2009, the World Economic Forum emphasized that NCDs were among the most severe threats to global economic development.

To drive home the impact of NCDs in India, The Cameron Institute report has intentionally highlighted some key facts:

  • In 2004, deaths due to non-communicable diseases in India were twice those from communicable diseases.
  • The projected cumulative loss of national income for India due to non-communicable disease mortality for 2006-2015 will be US$237 billion.
  • According to the World Heart Federation, 35% of all cardiovascular disease deaths in India occur in those aged 35-64 years.
  • Coronary heart disease is the predominant cardiovascular disease accounting for 90-95% of all cases and deaths.
  • India currently has the highest prevalence of oral cancer cases in the world due to the popular practice of chewing tobacco in rural regions.

Rather than focusing on all NCDs (the WHO lists a dozen) this study focused on four major chronic killers in India: cardiovascular diseases (CVDs), diabetes mellitus (diabetes), chronic obstructive pulmonary disease (COPD) and cancer.

Besides CVDs and cancer, equal prominence in the report has been given to diabetes – the silent killer. This is especially relevant since many Indians are prone to developing diabetes and India is already considered the diabetes capital of the world. The report also notes that although an estimated 1.1 million people died from diabetes in 2005, the actual number should be much higher because many people live with diabetes for years and their cause of death is often recorded as heart disease or kidney failure – life-threatening illnesses brought on by diabetes.

When it comes to cancer, the importance of prevention and regular screenings can’t be stressed enough since one-third of the cancer burden can be decreased via timely detection and early treatment. The key is to detect cancer when it is localized and before metastasis (a process whereby cancer spreads from its place of origin as a primary tumour to distant locations in the body). But early detection is only possible through:

(a) Awareness and education of people to recognise the early signs of cancer and thereafter seek prompt medical help, and

(b) Screening programmes to identify early cancer or pre-cancer before the appearance of recognizable signs.

Chronic Obstructive Pulmonary Disease (COPD) – the last of the conditions addressed in the report – consists of a group of disorders characterized by chronic, persistent and largely irreversible airflow obstruction. COPD victims are afflicted by two different ailments – chronic bronchitis and emphysema. As the rate of urbanization increases and traffic volume expands, COPD will add significantly to the morbidity and mortality figures in India.

Nearly 60% of all deaths in India are caused by non-communicable disease.  The economic and human toll of these non-communicable diseases is enormous, yet these conditions are preventable and manageable.

The WHO – and many health professionals – note that a few, largely preventable, risk factors account for most of the world’s disease burden. The six main risks factors associated with NCDs are: tobacco use, physical inactivity, overweight/obesity, high blood pressure, high cholesterol levels and high blood glucose levels.

There is a growing realization that the impact of disease, and of NCDs in particular, cannot be measured through mortality alone. This has led to the development of the concept of “presenteeism” – the loss of productivity that occurs when employees come to work but under-perform due to illness.

In 2009, the World Economic Forum emphasized that NCDs were among the most severe threats to global economic development alongside the fiscal crises, natural disasters and pandemic influenza. If India is to continue to reduce poverty and ensure inclusive economic growth, the burden of NCDs must not be underestimated.

References:

World Health Organization - http://www.who.int/dietphysicalactivity/publications/facts/chronic/en/

The Cameron Institute, “The Burden of Non-Communicable Diseases in India.” - http://bit.ly/fPenTg