We have come a long way in the fight against the Covid-19 pandemic, and we have a lot to learn from it. The pandemic has put into focus areas that need to be strengthened in global health systems. Leaders worldwide are now aware that public health issues must be tackled through pre-emptive and comprehensive strategies. Health can no longer be viewed in isolation as a development issue as it can have devastating effects on overall well-being.

One of India's emerging health challenges is the rise in non-communicable diseases (NCDs) like cancer, diabetes, hypertension, stroke, heart diseases, mental health, chronic lung diseases etc. Together, NCDs contribute to nearly 62% of India's disease burden, which is even more than infectious diseases. An even more significant challenge is that most of the actions to avert NCDs lie outside the health sector, and thus a multi-pronged approach is needed.

National survey

To understand the root cause of the rise in the NCDs, ICMR-*NCDIR conducted a first of its kind National NCD Monitoring Survey (NNMS). The survey covered over 348 districts in 28 states and has revealed some interesting findings. It shows that two in five adults in the country had three or more risk factors for NCDs. There could be several reasons behind the high incidence of NCDs. The survey highlighted that one in every three adults had consumed tobacco in the past 12 months. More than two in five adults and one in four adolescents were doing insufficient physical activity. More than one in every four adults and approximately 6% of adolescents were overweight or obese. The health system preparedness needs to match up to meet the burden of NCDs and the services required.

The entire population across all age groups, genders and geographies need to be protected from risk, which causes NCDs. Tobacco, alcohol, inappropriate diet, physical inactivity, air pollution, water and soil, overweight, obesity are the major factors contributing to nearly 80% of NCD occurrences. Early life health promotion skills and empowerment will help in avoiding the acquisition of these risk factors. These risk factors work in groups or clusters, making it necessary to tackle them equally well and individual and population levels. Early detection and adequate treatment of any NCD are equally essential to reduce severe disease, complications, and adverse health outcomes. This may sound easy but needs a life course approach, considerable effort from the 'whole of government' and 'whole of society'.

Prevention and control

The Ministry of Health & Family Welfare, along with many other government departments, responded to the NCDs’ onslaught with a slew of measures over the past several years. The flagship National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) is spearheading the prevention and control of NCDs through its IEC (information education, communication), screening of common cancers, hypertension and diabetes, upgrading infrastructure and capacities at primary, secondary and tertiary levels to handle NCDs and management of diseases holistically. The Health & Wellness centres are the pillars of screening and early detection of NCDs and risk factors. The Foods Standards and Safety Authority of India's regulatory push on food labelling, salt, and trans fats will go a long way in improving dietary risks. The Indian Council of Medical Research (ICMR) has also set up several mechanisms over the years to monitor population-level health through registries (cancer, stroke, acute cardiac events and heart failure) and surveys.

While these programs have enabled a holistic approach towards tackling NCDs, the surveillance of risk factors remains a challenge. A robust surveillance system is essential to collect data on NCDs and their risk factors to guide actions and assess the impact of interventions. They help in forecasting the burden of disease and provide adequate directions to act upon. Interwoven monitoring of the social determinants of health (education, income, environment, crime, social support, etc.) will help address health inequalities. This requires a strong partnership amongst various stakeholders to amplify the watch and vigil over NCD risk factors and actions outside health department’s purview.

As the country moves towards achieving the health targets of the Sustainable Development Goals related to health by 2030, data-driven policies and actions will play a crucial role in improving population health. Prevention of NCDs needs to be built-in in the entire ecosystem as it is a vital investment for achieving universal health care. While we continue to fight Covid-19, we must not forget that a healthy India's fight needs to be a continuous one.

(Bhargava is Secretary Department of Health Research and Director General, ICMR, New Delhi; Mathur is Director, ICMR- National Center for Disease Informatics and Research *(NCDIR), Bengaluru.)

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