For many years now, India has witnessed a shift in its causes of death. Noncommunicable diseases (NCDs) have outpaced infectious diseases as the country’s leading killers. Higher-income countries witnessed this trend. Now it is being seen in low- and middle-income countries (LMICs) as well.
NCDs now make up seven of the world’s top ten causes of death, according to WHO’s 2019 Global Health Estimates. Mirroring the gradual shift in India, this is an increase from four of the ten leading causes in 2000.
The most prominent NCD in India is heart disease. Heart disease accounted for 28.1 percent of all deaths in India in 2016, placing heart conditions at the forefront of causes of death. Death rates due to heart disease have eclipsed those of the many infectious diseases that previously stood as the country’s leading causes of death.
While some infectious diseases — namely diarrhoeal disease, lower respiratory infections and tuberculosis — remain in the top ten causes of death in the country, the list now consists of numerous NCDs. Besides the aforementioned heart disease, chronic obstructive pulmonary disease (COPD), stroke, diabetes, and cirrhosis all place within the top ten.
Heart disease, like in India, is the top cause of death across the globe. The condition now represents sixteen percent of total deaths. While a high rate, this indicates that India’s previous figure of 28.1 percent of all deaths is a massive step up from the global average, highlighting the need for more to be done in this area to address what could be considered India’s most prominent health concern.
“These new estimates are another reminder that we need to rapidly step up prevention, diagnosis and treatment of noncommunicable diseases,” said Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO). “They highlight the urgency of drastically improving primary health care equitably and holistically. Strong primary health care is clearly the foundation on which everything rests, from combatting [sic] noncommunicable diseases to managing a global pandemic.”
Alzheimer’s disease and other forms of dementia are now among the top ten causes of death worldwide, ranking third in both the Americas and Europe in 2019. As previously noted by Health Issues India, citing the Alzheimer’s Association, “in India, more than four million people have some form of dementia.” By 2030, the number is projected to rise to 7.6 million.
The vast shift in India, and in many other nations, from infectious diseases to NCDs dominating the top ten causes of death can be attributed to many factors. In part, this is due to these countries experiencing economic growth.
Life expectancies across the globe have risen as vast global efforts to combat diseases such as HIV, malaria, and tuberculosis have shown success over the years. Wider availability and increased efficacy of healthcare infrastructure and treatments across the developing world has seen many infectious diseases brought at least partially under control. However, with a higher life expectancy, other diseases have filled the void.
Many NCDs such as cancer and heart disease correlate with age. The higher the life expectancy, and the lower risk of dying from an infectious condition, the higher the chance an individual will at some stage succumb to diseases such as cancer.
Coinciding with this, greater levels of economic prosperity across developing nations has seen an ever-growing middle class. Many jobs previously involved in labour have been lost, and a growing number of individuals work in office settings, leading to sedentary lifestyles. Prominence of a so-called “western diet” rich in high-calorie, low-nutrient foods has also led to risk factors of many NCDs being increasingly prevalent across the globe.
It is necessary that in the coming years countries across the globe that have previously allocated more of the healthcare budget to infectious diseases than NCDs must coordinate a policy shift. However, as COVID-19 has demonstrated across much of Europe and the US, nations that have not faced a similar burden of infectious disease as developing nations have often found themselves unprepared for sudden outbreaks. This dual burden presents difficult times ahead, though as the death count is ever rising for NCDs, more must be done to address the root causes.