Non communicable diseases pose a formidable challenge to developing countries

Still, at the dawn of the third millennium, non-communicable diseases are sweeping the entire globe. There is an increasing trend in developing countries, where the demographic and socio-economic transition imposes more constraints on dealing with the burden of non-communicable diseases in a squalid environment, characterized by ill-health systems. It is predicted that, by 2020, non-communicable diseases will cause seven out of every ten deaths in developing countries.

Among non-communicable diseases, special attention is devoted to cardiovascular disease, diabetes, cancer and chronic pulmonary disease. The burden of these conditions affects countries worldwide but with a growing trend in developing countries. And India constitutes the major contributory of the whole.
NCDs are the leading cause of death in the South-East Asia (SEA) Region, killing 7.9 million annually. NCDs listed by WHO account for over 60% of global deaths annually. NCDs have been silent killers and for too long not been highlighted in health and development agendas of countries.

There is a gathering of momentum between organizations and national as well as regional alliances in the field of NCDs who are now joining forces around the world to lobby governments, provide education, treatment and patient support, and raise awareness of the growing NCD burden. And Indian health ministry has come forward and doing fairly well in collaboration with WHO as part of the greater expedition to combat NCDs.

Reducing the burden of NCDs is no longer just a technical issue, but a political problem. Health ministers and policy-makers in developing countries such as in India are aware of the burden and the existence of cost-effective interventions. Yet, thus far, donors and the international development community have been slow to respond, in part because NCDs are not among the Millennium Development Goals (MGD 3).

Supposedly, in the upcoming High-level Meeting of the UN General Assembly going to be held in September 2011, non-communicable diseases are supposed to be included in Millennium Development Goals (MGD 3). The outcome of this meeting is expected to create the political momentum to galvanize funds and commitments for prevention and treatment interventions in resource poor settings in developing countries, where morbidity and mortality due to NCDs is increasing rapidly.

Considering the above in mind, regional consultative workshops are being held in different parts of India to feed into the national workshop to be held later in Delhi, to eventually facilitate a dialogue with the Indian Health Ministry, which is going to play a key role in the negotiations at the Summit. In this context, WHO recently organized a one day workshop to deliberate upon key issues of the NCDs Agenda.

“It is already known that NCDs account for a major disease burden in India and cause nearly 53% of deaths. The global community is now beginning to recognize them as developmental challenge. NCDs are expensive, usually require long drawn treatment and are a leading cause of poverty. A World Bank study in 2004 for instance, showed that the cost of treating cancer was 160 % more than treating any communicable disease. This is particularly a concern for India since out-of-pocket expenditure is very high-nearly 3.3 % of GDP. Unless we tackle NCDs, we won’t be able to achieve our Millennium Development Goals”, asserted Dr. J.S. Thakur, the World Health Organization’s professional officer for NCDs about the biggest challenge NCDs pose to India.

During 16th to 19th September 2011, the High-level Meeting of the UN General Assembly, attended by the heads of states and governments of 192 Member countries, will be held in New York to generate global commitment and accelerate responses to NCDs. This High-level Meeting is a turning point in advocating for a high-level commitment and mobilizing a broad ‘whole of the society’ approach to the prevention and control of NCDs.

In continuation with the advocacy efforts, and as a run up to the UN High-level Meeting, the Member countries of the Region are organizing national multi-sectoral meetings on NCDs from July 2011 through August 2011. The national meetings are expected to sensitize stakeholders about the problem of NCDs in each country, build consensus about the need for a multi-sectoral response to the problem of NCDs, and set in motion a process of developing action plans for prevention and control of NCDs.

India stands today where developed countries were in seventies with regard to NCDs. Their graph is on the wane. We need to have a look what is working globally, and adopt interventions accordingly which might have worked and are cost effective. Now onwards, our medical model should be replaced by a public health approach. We need to change attitudes through awareness and education.

Now the question is that how NCDs are pulling down India's economy and the increasing disease burden is hampering India's growth because if we look at the previous year’s data such as in 2004, 4.8 million (59.4 percent) of the estimated 8.1 million Indian deaths were due to NCDs. In the same year, Indians spent nearly INR 846 billion out of pocket on health care expenses, amounting to 3.3 percent of India’s GDP for that year.

The share of NCDs in out of pocket health expenses incurred by households increased over time, from 31.6 percent in 1995-96 to 47.3 percent in 2004. More than one-half of the out-of-pocket expenses on health care were incurred on purchases of medicines, diagnostic tests and medical appliances.
The odds of incurring catastrophic hospitalization expenditures are nearly 160 percent higher with cancer than the odds of incurring catastrophic spending when hospitalization is due to a communicable condition. By comparison, the odds of incurring catastrophic hospital spending due to communicable and viral diseases (CVD) or injuries are about 30 percent greater compared to communicable conditions that result in hospital stays.

In 2004, assuming that all care-givers and sick individuals above the age of 15 years were productive yielded an annual income loss from NCDs of one trillion rupees. If NCDs were completely eliminated, the estimated GDP in a year such as 2004, using two different assumptions, would have been 4-10 percent higher. Per capita GDP would also be higher. The primary driver of these results on GDP is the change in life expectancy at birth. In view of the above fact, we can substantiate that NCDs constitute a significant economic burden on India. Still, we have to be optimistic in the wake of the UN meet scheduled for next month, once NCDs are included in MDG-3, it might bring drastic changes so as to lessen the economic burden on India. Let see, how the post summit story unfolds.