Why the 21st century's biggest health challenge is our shared responsibility

Non-communicable diseases (NCDs) are one of the 21st century's major health and development challenges, both in terms of human suffering and the damage they cause to a country's socioeconomic fabric. NCDs carry a huge cost that extends beyond health, creating enormous disparities in terms of opportunity, wealth and power.

NCDs are the leading cause of death globally, and have reached epidemic proportions. They were responsible for 41 million (71%) of the world’s 57 million deaths in 2016, according to the World Health Organization (WHO). The four major NCDs, accounting for 80% of all premature NCD-related deaths globally, comprise cardiovascular diseases (17.9 million deaths); cancers (9 million deaths); chronic respiratory diseases (3.9 million deaths); and diabetes (1.6 million deaths).

NCDs disproportionately affect populations in low and middle-income countries, where nearly 32 million deaths occur as a result - more than three-quarters of global NCD deaths. In countries such as India, NCDs account for more than 60% of mortality, while communicable diseases also continue to remain high, presenting a healthcare twin challenge.

Today, we have reached a decisive point in our fight against NCDs. We have a narrow window of opportunity to alter their course. Unless addressed, the world will lose $30 trillion by 2030 in the treatment of NCDs, representing 48% of global GDP. This will further push millions of people below the poverty line. The WHO estimates that in India alone, NCDs are estimated to cause a loss of $6.2 trillion between 2012-2030 - nearly three times India's current GDP.

While the global NCD burden is set on a high-growth trajectory, so too is our ability to combat NCDs. We have the capacities and skill set to reverse the advancement of these diseases and achieve quick gains, if appropriate and timely actions are taken to address the following key priority areas.

Good governance

NCD prevention should be included as a priority in national development agendas and associated investment decisions. While individual behaviour change through "information, education and communication" (IEC) efforts is important, combatting NCDs in a timebound manner requires conducive policy development and leadership at the highest levels, among all stakeholders for concerted action towards universal health coverage.

A shift to overall wellness

For every $1 invested in water and sanitation, there is a $4.30 return in the form of reduced healthcare costs for individuals and society around the world, according to the UN. Moreover, the WHO has recently cast off its previous “4-by-4” approach to preventing and controlling NCDs, and has moved towards a more holistic “5-by-5” approach, which includes mental health and air pollution as additional targets to combat.

It is critical to focus on total health and well-being, encouraging a holistic health approach that encompasses the community’s mental and physical well-being, along with emphasis on socio-economic determinants of health such as nutrition, sanitation, environment, education and financial empowerment. A comprehensive ecosystem to combat NCDs is needed that includes all elements of disease surveillance, prevention, management and treatment.

Strengthening health systems

Strengthening of national healthcare systems to address NCDs must be undertaken through reorienting existing organizational and financial arrangements. Innovative means of financing should be used to strengthen infrastructure, skills and technological prowess, with a focus on primary preventive healthcare.

Studies suggests that investment in primary care reduces unnecessary specialist referrals, hospitalizations and emergency room visits, with better health outcomes for patients. Research by Portland State University in Oregon shows that for every $1 invested in primary care, $13 is saved in downstream costs.

Scaling up sustainable healthcare models

Globally acceptable frameworks for adopting frugal, population-based, sustainable and replicable NCD pilot interventions need to be developed on a priority basis, and scaled up while customizing to local needs and requirements. Beyond pilot success, the bigger challenge is growing from "seed to scale". This will require collaborative efforts and pooling of resources to avoid replication and redundancy.

Innovative partnerships

Considering that most risk factors for ill health, and NCDs particularly, lie outside the realm of the health sector, policy-makers must identify successful approaches to engage non-health sectors based on international best practices. Adopting a multistakeholder, cross-sectoral approach and fostering innovative public-private partnerships (PPPs) will strengthen implementation of NCD management models on the ground, especially in countries such as India, where 70% of the population is catered to by private healthcare providers. For the success of PPPs, it is imperative to have policy frameworks defining public and private roles, along with standardized guidelines to support PPPs’ design, quality outcomes and monitoring, with course corrections along the way.

Leveraging opportunities emerging from the Fourth Industrial Revolution

Internet of Things (IoT) applications and emerging technologies such as artificial intelligence, analytics, machine learning, connected devices and telemedicine are opening new horizons for more effective patient-centric care, through monitoring disease trends and management; last mile continuum of care; and enhanced delivery of services while managing costs and streamlining supply chain processes.

To summarize, the multidimensional causes and implications of the NCD epidemic call for a robust response from both private and government health and allied sectors. This entails strengthening multistakeholder dialogues and joint action plans; developing a universally applicable, value-based, patient-centric, smart, sustainable and total health framework focusing on all strategic determinants of holistic health; and periodic reporting on national and international commitments.