Guest Post: Non-Communicable Disease in India – A Great Burden, But Also A Great Opportunity

Posted on: March 15th, 2011 by Arogya World

Arogya World’s first guest blogger, Jeffrey Meer, is the Special Advisor of Global Health Policy and Development at The Public Health Institute. He conducts PHI’s Washington-based advocacy on global health, and provides strategic direction for the organization’s participation in global health procurements by the United States Government and private donors.

This year is an important one for those interested in non-communicable diseases (NCDs). A number of events are taking place around the globe on this topic, in recognition of the massive and growing burden that cardiovascular disease, cancers, diabetes and lung disease place on people from all locations and walks of life. The United Nations will convene a high-level session on this subject in New York during September 19-20, 2011, at which many heads of state are expected to speak.

Around the globe researchers continue to document the growing concerns about non communicable diseases and the relatively little money being spent on the problem. For example, on January 31, Dr. Christopher Murray, director of the Institute for Health Metrics and Evaluation at the University of Washington, launched the 2010 version of his thoughtful and comprehensive annual report on development assistance and country spending for global health.

The report offers careful readers many different ways to slice the rich data the team has assembled, including by country. One interesting chart lists side-by-side the top 30 recipient countries during 2003-2008 for development assistance for health, together with the “Disability-Adjusted Life Year” (or DALY) during 2004, a broad measure of disease burden in particular countries. In both categories, India comes out on top.  In fact, India is the only nation in the top 30 which has a ranking of development assistance for health that matches its overall disease burden. Some countries (e.g. Zambia and Argentina), which Dr. Murray sometimes refers to as “development darlings,” have relatively high total receipts for development assistance for health, but rank much lower on the DALY scale. Others (e.g. Mexico and Sudan) have relatively low development assistance for health receipts, but high ranking by DALY.

Why does India rank so high on both?  Dr. Murray points out that allocation of development assistance for health is driven by many considerations of which burden of disease appears to be just one factor. India enjoys a strong historical and economic relationship with several major donor nations, including the United Kingdom, one of the five largest donors of development assistance for health. The World Bank has also emerged as a key funder of health programming in India, particularly for HIV/AIDS and the construction of medical facilities. The Danish and U.K. Governments have provided major funding for blindness, TB, HIV/AIDS, and leprosy. Over time, India’s development assistance for health has grown from roughly $100 million in 1990 to more than $679 million in 2008, the latest year for which audited data are available.  At the same time, India’s per capita receipts for development assistance for health increased from $0.12 to $0.57, even though the nation’s population was expanding rapidly. This appears to be good news, for global health and for Indians generally.

Unfortunately India also suffers significantly from the epidemic of NCDs. According to the World Health Organization, four diseases cause an abundance of illness and death in the country: asthma, tuberculosis, jaundice, and malaria. A survey conducted in 1999 indicated that the leading cause of mortality in India was NCDs – representing almost half (48 percent) of all deaths. The dominant NCDs include malignant neoplasm, diabetes mellitus, neuropsychiatric disorders, sense organ disorders, cardiovascular diseases, respiratory diseases, digestive diseases, musculo-skeletal diseases, congenital anomalies, oral diseases and others. About six percent of India’s adult female population is obese.  That is even more the case today.  More than one in ten men is a smoker. Almost 70 percent of Indian teenagers spend an inadequate amount of leisure time being active. India’s DALY total in 2004 related to NCDs was second in the world, and just a hair behind the country most negatively affected by NCDs — China.

What are India and the foreign donors doing about India’s considerable NCD burden?  While I don’t know the answer to this question, I do know that India will join other nations at the upcoming UN High Level Session on NCDs, as the first time the UN body will officially address the world’s largest source of mortality. Its delegation will speak about NCDs, what can be done to prevent them, and how best to treat and care for those who live with them. India, along with every other nation on earth, has a stake in this discussion, not only because it bears an enormous burden from this set of diseases, but because its large and diverse population, and global leadership in technological innovation, may well contain the seeds of future success to benefit its own citizens as well as those from every country.

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