India has a staggering burden of chronic disease arising from a variety of causes, but there is encouraging evidence to show that it can reduce both death and disability through effective low-cost measures. The key to successful intervention lies in learning from good pilot programmes and making them integral to health-care protocols in both public and private sector institutions. A new series of articles published by The Lancet on universalising health coverage in India highlights the challenge that lies ahead. In the next two decades, chronic diseases resulting from cardiovascular and metabolic disorders, respiratory conditions, mental illness, and cancer are expected to cast a long shadow over national ambitions for economic growth in terms of healthy life-years lost. The section of the population that is likely to suffer the most will be those over 45. They may find the threat of infectious and parasitic diseases reducing with better standards of living but the threat of chronic diseases will increase. This is because the incidence of hypertension, poor control of blood glucose, tobacco use, and abuse of alcohol is expected to rise. The imperative therefore is to scale up the pilot programmes that have shown good results at prevention.

Last year the central government approved two key measures — the testing of adults for chronic diseases, and an awareness campaign on healthy behaviour — as part of an integrated national programme for prevention and control of cancer, cardiovascular diseases, and diabetes. A lot more needs to be done structurally to align policies with disease reduction goals. Regulation of unhealthy foods to reduce high calorie and salt content can mitigate the risk of diabetes and hypertension but this agenda is not making speed. Also, the unhealthy effects of energy-dense foods are compounded by negative changes in the urban environment. This experience shows that an assessment of the health effects of macroeconomic policies must be made mandatory. Achieving a drastic reduction in tobacco use must be made a national priority in the fight against cancer. The State health ministers, who met recently in Hyderabad, have done well to recognise the need to curb both smoking and smokeless forms of tobacco. But even with modified lifestyles, a medicalised approach to prevention will be needed. There are examples in this area to show that population-level testing for impaired blood glucose and hypertension, followed by a protocol of lifestyle modification and low-cost drug therapy, can stop disease progression. Given such clear evidence, the campaign against chronic disease must move into high gear.

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