By Ashok Malik
Just how much of a threat are non-communicable diseases (NCDs) to emerging economies? Take India, a country where economic change is both endangered by chronic diseases and is also, paradoxically, spurring these.
One of the consequences of India’s robust GDP growth in recent years is rapid urbanisation. In 2001, 28 per cent of India’s people lived in urban areas. Government estimates suggest 35 per cent or more of India’s 1.2 billion people live in cities now. This number is estimated to reach 50 per cent by 2025.
In 2010, the McKinsey Global Institute released a report on India’s urbanisation challenge. As of 2008, urban areas contributed 58 per cent of India’s GDP. By 2030, an incredible 68 Indian cities would have a population of one million or more. Together these cities would account for 70 per cent of GDP. They would also be packed with residents living westernised, or ‘developed country’ lifestyles, with all the health implications.
So what’s the downside? India’s top four chronic diseases are cardiovascular diseases (CVDs), diabetes, chronic obstructive pulmonary disease and cancer. As a 2010 paper published by the Cameron Institute (“The Burden of Non-Communicable Diseases in India”) pointed out, NCDs now kill about twice as many people in India as communicable diseases.
As per a World Bank study based on mortality figures for 2004, of the 8.1 million Indians who died that year (of all causes), 4.8 million died from non-communicable conditions ( including accidents and injuries). The projected loss to national income due to NCD mortality for 2006-15 is US$ 237 billion.
Among the six leading causes of NCDs are physical inactivity, obesity, high cholesterol and blood glucose levels, and rising blood pressure. All of these are linked to sedentary lifestyles and changing food habits promoted by urbanisation and white collar jobs. In New Delhi, paediatricians talk about a virtual asthma and respiratory diseases epidemic among young children, growing up in a city that sometimes resembles a dustbowl amid frenzied construction.
The economic burden this poses on the country and also on individual families is remarkable. Globally, government/public spending on health care is 60 per cent of all spending on health care. In India it is 26 per cent (2007 figures). Of private spending, out-of-pocket spending – resorted to by families that dip into savings, without recourse to welfare programmes or insurance – is 44 per cent worldwide. In India, it is 90 per cent.
Rising costs of treatment of NCDs could potentially have many newly-emerged middle class families in India slipping back into poverty. At the other end of the scale, it could have cutting-edge business corporations losing a key executive out of the blue, felled by a sudden heart attack or an undetected tumour.
Indian business once knew the abbreviation NCD only as non-convertible debentures – a benign manner of raising money. Today, it is beginning to resemble something more sinister.
Ashok Malik is a journalist writing primarily on public policy. Ashok is based in Delhi India and his columns and articles have appeared in several newspapers over the last 20 years.