Non-communicable diseases (NCDs) are the leading cause of death in the world, accounting for 63% of all annual deaths across the world, per estimates from the World Health Organization (WHO). Furthermore, 80% of these deaths occur in low and middle-income countries, a category India also falls under. Yet, on average, only about half of the 18 policies to reduce NCDs recommended by the WHO were implemented by countries between 2015 and 2017, a first-of-its-kind study to analyze the rate of execution of WHO’s plans, has revealed.

Given how figures from the report indicate that just over half of these policies didn’t move beyond the stage of being endorsed, the slow progress is not alarming. Non-implementation of policies to curb NCDs, states an article in the Economic and Political Weekly (EPW), does not only lead to the impoverishment of families but also has consequences for the country as a whole as it leads to, “excess mortality, lowering of investment, and consequent deceleration of economic growth.”

NCDs, which often lead to premature deaths, include cardiovascular and respiratory diseases, cancers, and diabetes. Currently, per this report, NCDs are the most common cause of deaths in India, and also one of the leading factors causing premature deaths in the country with one in four dying before the age of 70. An October 2019 report, even shows a rise in the prevalence of NCDs — from 30% to 55% between 1990 and 2016, especially of diabetes and hypertension.

“The government has to deal simultaneously with the rising fiscal burden of NCDs and substantial burden of infectious diseases,” adds EPW. Failure to contain these NCDs or implementing policies mandated by various health organizations such as the WHO could result in at least “jeopardizing the target of reducing premature deaths by one-third by 2030.” It will also “reduce the supply of labor and redirect resources from productive investments to healthcare, and thus drain the public and private budgets, raise business costs, and undermine competitiveness.”

Despite policies and the effects of not following those policies being clear, the burden of NCDs is only rising worldwide, according to the current report published in Lancet Global Health with data from 151 countries.

In 2015, 193 countries had committed to reduce premature NCD deaths by one-third by 2030, as part of the Sustainable Development Goals, especially by reducing the major risk factors for NCDs — tobacco use, physical inactivity, unhealthy diet and the harmful use of alcohol.

Overall, the rate of implementation of policies improved from an average of 42% to 49% by 2017 — that is, the percentage of the policies implemented remain just under half. While 109 of the 151 participating countries increased the number of policies implemented, other countries showed a decline in the rate of implementation. South Sudan and Haiti showed to have implemented only 5% of the policies while Iran and Costa Rica performed the best by having implemented 87% of the policies. Countries proactively implemented policies that were aimed at the introduction of clinical guidelines and graphic warnings on tobacco packaging. However, they were least likely to implement those that demanded taxation on tobacco, tobacco mass-media campaigns, and bans on alcohol advertising. Countries also regressed when it came to implementing policies related to physical activities — from 61% in 2015 to 54% in 2017 — and on imposing restrictions on the sale and advertising of alcohol.

India wasn’t a part of this report, but in the same year, it was one of the first countries to adopt the WHO’s Global Monitoring Framework on NCDs, which sets specific national targets and indicators to reduce the number of global premature deaths from NCDs by 25% by 2025. In addition to it, the country also made an effort to reduce the demand for tobacco products by prohibiting sales of tobacco products around educational institutions, restricting tobacco imagery in films and TV programs, banning some smokeless tobacco products, and developing tobacco-free guidelines for educational institutions.

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While the implementation of policies is as important to reduce the burden, a lack of knowledge of potential symptoms and risk factors also plays a role in worsening India’s NCD crisis. “Many individuals are unaware of the warning signs of, for example, heart disease, and therefore will not avail treatment even where it is available,” states Health Issues India. “Community-led efforts to raise awareness and perform screening programs could be an effective means of reaching out to a population that may be able to receive healthcare but are unaware of potential warning signs. Early screening and diagnosis could be a major stepping stone to alleviating the high mortality rate of NCDs,” it added.