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Year : 2011  |  Volume : 36  |  Issue : 5  |  Page : 2-3

Road Map and Challenges for Universal Coverage for Prevention and Control of Noncommunicable Diseases in India

WHO Representative to India, Nirman Bhawan, New Delhi, India

Date of Web Publication5-Apr-2012

Correspondence Address:
Nata Menabde
WHO Representative to India, Nirman Bhawan, New Delhi
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0970-0218.94701

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How to cite this article:
Menabde N. Road Map and Challenges for Universal Coverage for Prevention and Control of Noncommunicable Diseases in India. Indian J Community Med 2011;36, Suppl S1:2-3

How to cite this URL:
Menabde N. Road Map and Challenges for Universal Coverage for Prevention and Control of Noncommunicable Diseases in India. Indian J Community Med [serial online] 2011 [cited 2021 May 17];36, Suppl S1:2-3. Available from: https://www.ijcm.org.in/text.asp?2011/36/5/2/94701

Most Indian people do not get surprised anymore about the expression "emerging countries" being used in TV and other media so as to become part of the political and economic parlance. In many spheres, the promises of a better future are now increasingly within reach and in the life experience of many citizens - although much still remains to be done in order to raise millions out of poverty.

Plenty of citizens would probably be surprised, however, to hear that progress has come silently accompanied by major changes in the "reasons why Indians die and get sick." While communicable diseases (CDs) still impose a severe toll in terms of death and suffering in the form of air-, water-, food-, and vector-borne diseases, noncommunicable diseases (NCDs) such as cancer, cardio, and cerebro-vascular disease, chronic respiratory disease, diabetes, and other metabolic diseases, road traffic accidents, etc. have become the dominant cause of health problems (eight out of 10 adult deaths in urban areas and six out of 10 deaths in rural areas, for example are now due to them in India).

This unprecedented picture is rather similar to the one appearing in other middle- and even low-income countries of the world. As much as tall buildings and the ever-present public works, a so-called Double Burden of Disease is therefore the health face of the new India and it has to be confronted as such. Dealing with only either part of the picture - CDs or NCDs - will not be enough.

WHO has been alerting about this problem for years, e.g., by means of the 2008-2013 Global Strategy and Action Plan for Prevention and Control of NCDs. It is also promoting a special UN Summit on the topic in September 2011. The WHO Country Office in India itself has allotted one-third of its budget to NCDs in recent years.

It would also be unfair not to recognize the many initiatives developed in India to confront the emerging challenge as response for prevention and control of NCDs. The 27 cancer registries and 27 regional cancer centers initiated since 1975, the law on tobacco control enacted in 2003 and the integrated national program for prevention and control of cancer, diabetes, cardiovascular diseases and stroke currently being scaled up to 100 districts since 2010 attest to it.

The new period, however, calls for a more comprehensive response combining both work on the determinants of health ("the causes of the causes" such as nutrition, housing, education, employment, etc.) and effective preventive and nonpreventive personal and population health services (the preventive, curative and caring "solutions" for those already hit by such conditions). This can only be done by ensuring coverage in the sense that those affected by direct risk factors or indeed symptoms would be guaranteed access to and utilization of effective services. This is the only way to help them live with the diseases and overcome their most dramatic effects as much as possible.

Achieving broad health coverage has recently been formulated by the Indian authorities as one of the key challenges in the near future, and rightly so: the situation of poor healthcare coverage is forcing many to face the expenditures associated with acute and chronic care of NCDs only through out-of-pocket payments. But this can result in catastrophic health expenses leading families into poverty; almost 50% of households with a member suffering from cancer in India experience catastrophic expenses and 25% are just driven into poverty, according to a recent World Bank study.

Providing coverage for high-quality personal and population services to every citizen of India against the most important NCDs is therefore a vital initiative for the years ahead. The specific need of the health services for confronting different NCDs now is that rather than being separately managed as "vertical programs" with their own objectives, resources, funding, and health registers, etc. those services should be integrated into regular, affordable primary, secondary and tertiary health care provided by the public and the private sectors. The causes of NCDs are multiple and so are the solutions and services, often making single-topic, vertical service schemes rather inefficient.

Yet as the very explanations at the beginning of this text suggests, restricting national efforts to fighting only NCDs would make little sense in the long run. WHO herewith calls for building a robust health system, in line with the competences and creative power of modern India, one that will be able to provide care against both communicable and noncommunicable diseases. Reaching consensus on the roadmap to overcome such challenges will open the way for a better future.

Together with the above, the fight against NCDs also depends critically on multi-sectoral actions (for example, fostering the creation of no-smoking zones, increasing opportunities for safe physical activity by means of better urban design, including safe pedestrian paths, protected cycling lanes and other community recreational facilities, reducing environmental pollution and preventing the harmful use of alcohol, etc.). We should all promote these solutions.


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