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Sweet Truth: Non Communicable Diseases, firmly entrenched in Emerging Markets

1. Non Communicable Diseases Impacting Economic Growth
Non Communicable Diseases (NCD) is a leading cause of death and ill health in high income countries. It is no surprise that NCD prevalence is now rising in the rest of the world, where the burden of communicable diseases is largely on the growing middle aged population, rapidly aging population, and development and lifestyle changes due to social and economic globalization are increasing exposure to risk factors such as obesity, smoking, and pollution.

The long term drivers for Economic growth are also the risk factors for Non Communicable Diseases. Urbanization, globalization and the emergence of constrained resource environments within agglomerates, while on the one-hand drive economic growth, these are also risk factors for NCD’s. Demography is increasingly intensifying these risk factors.

It is important to emphasize that the developing economies will be faced with higher levels of NCD at earlier stages of economic development, with fewer resources, with broken delivery systems and markets and with less time to effectively respond.

2. Non Communicable Diseases - India Snapshot - Refer to Image

NCD’s account for close to 6 million of all mortality in India, with more than 20% of the population in India having at least one chronic disease and more than 10% of the people have more than one. It is estimated that 61.3 million people aged 20-79 years live with diabetes in India (2011 estimates) & this number is expected to increase to 101.2 million by 2030. In India, 118 million people were suffering from hypertension in 2000, and this number is likely to increase to 213 million by 2025. The rate of cardiovascular disease mortality in India in the 30-59-year age group is double that in the U.S. Indians get diabetes on average 10 years earlier than their Western counterparts.

3. Non Communicable Diseases and the Demographic Dividend

With India poised for rapid growth and its related outcomes, demography will increasingly add itself to the risk factors. The scenario of living longer with chronic conditions will steadily rise. An earlier onset and a longer living period with chronic NCD conditions is a reality. The prevalence of NCD among younger populations is on the rise. Over the next 2 decades the rise of NCD’s and its economic impact in lower income countries will exceed the impact in middle and high income countries.

The probability of dying between ages 30 and 70 years from four major NCDs (cardiovascular diseases, cancer, chronic respiratory diseases and diabetes) is 26%, which means that a 30-year old individual has a one-fourth chance of dying from these diseases before the age of 70 years.
From an India standpoint it is interesting to note that Lifestyle diseases are more common among poor than the rich. NCDs in India are as much a disease of poverty as it is of affluence, & traditional notions of classifying disease based on economic standard are no longer valid, Diabetes emerging epidemic in India – A latest study showed that diabetes rate has increased by around 45% globally and it has jumped 123% in India between 1990 and 2013

4. Non Communicable Diseases and the Changing Profile of the Risk Factors

Risk Factors 1990 2010
Childhood underweight Household Air Pollution
Household Air Pollution Smoking
Suboptimal Breast Feeding High Blood Pressure
Smoking Childhood Underweight
Iron deficiency Low Fruit
Ambient Air Pollution Ambient Air Pollution
High Blood Pressure High Fasting Glucose
Low Fruit Alcohol Use
Sanitation Iron Deficiency

There is a shifting pattern of disease burden in a country like India – An Indian today has over twice the odds of dying of a non-communicable disease than a communicable disease (WHO), about a decade ago, as compared to a 50-50 chance of succumbing to a non-communicable disease.

The risk factors have been evolving and dynamic over the years, factors like air pollution, occupation have increased the risk propensity of a person getting into a chronic disease like respiratory challenges placing a person at a high risk to concede to chronic diseases like CVD and Diabetes. The risk factors and the speed of growth in NCD burden in India reflect the absence of effective interventions both in rural and urban population. NCD’s are chronic life long illness and requires a closed loop continuum of care. As India transits from infectious disease to lifestyle disease, the current health systems that address infectious diseases and other communicable disease now have to rewire and address the silent epidemic of chronic illness and diabetes in the country.

A preventive based systems approach to screen, detect and transition the patient to a path to care is required especially in the rural and low income communities which can significantly reduce the burden on the public health system and improve the health outcomes in a country like India.
In addition the approach of ‘treating your way out of NCD conditions’ will neither be accessible nor sustainable for the low and medium income economies. There is a need to alleviating the NCD risk factors so as to reduce NCD prevalence and to push higher the age of onset of NCD’s. The role of policy, research, innovation and technology in enabling a comprehensive approach for NCD and its risk factors alleviation is essential.

Some examples of such interventions are:
1. Hospital / Clinic based care to Patient centric care dissemination through effective mass screening, engaging with informal health workers
2. Targeted Risk Profiles to prevent and enable to monitor, address specific disease burden
3. Standardizing care protocols from knowledge creation, to effective screening / detection and treatment protocols
4. Shifting screening and care from acute stage to Early identification there by creating a proactive prevention based system than a reactive health system
5. Empowering technologies and tools – utilize technologies and solutions for effective awareness in lifestyle modifications, suspect identification , screening and detection for disease condition and continuous care monitoring system to improve health outcomes out of clinical settings

Sources:
1. WHO – Non-communicable Diseases (NCDs) Country Profiles, 2014
2. Partnership to Fight Chronic Disease (PFCD) and Strategic Partners Group (SPAG Asia) January 2015
3. Call for Action: Expanding NCD / cancer care in India- E&Y
4. http://www.who.int/topics/noncommunicable_diseases/en/
5. Global Action Plan for the prevention of NCD’s 2013-2020, WHO
6. Innovations in non-communicable diseases management in ASEAN: a case series
7. Health information priorities for more effective implementation and monitoring of non-communicable disease programs in low- and middle-income countries: lessons from the Pacific
8. National Action Plan and Monitoring Framework For Prevention and Control of NCD’s – MoHW
9. Burden of NCDs and their risk factors in India(Excerpted from Global Status Report on NCDs -2014)
10. Institute of Health Metrics and Evaluation University of Washington

This blog has been made by Intellecap Innovation Labs.

Intellecap Innovation Labs is focused on bringing new, disruptive, technology-enabled solutions that can positively impact the lives of low-income and underserved communities across the developing world. We begin by sharply defining problems faced by low-income consumers, and identifying bottlenecks that must addressed for these problems to be solved. An effort is in place to bring best in class technology to real world and improve the care protocols towards NCD at the Microlab (watch video)

For more details please contact: chandana.kiran@intellecap.com, nakul.goswami@intellecap.com