Non-communicable diseases are India’s leading cause of death: Expert explains why heart disease, diabetes and cancer are rising

Non-communicable diseases are now India's leading cause of death: As per reports, NCDs account for nearly 60% of deaths in India around 5.87 million annually driven by poor risk control, limited screening, and delayed, costly treatment.

For decades, India built its public health system around clearly visible and urgent challenges. From cholera outbreaks, to managing pandemic situation, and maternal deaths in villages without trained midwives. This approach was appropriate for its time and proved highly effective, and the architects of this system deserve credit for what they achieved under severe constraints. However, India's health challenges have changed, and the system has not evolved at the same pace.

Today, cardiovascular disease, diabetes, cancer, chronic respiratory conditions, chronic kidney disease, and non-alcoholic fatty liver disease account for approximately 60 percent of all deaths in India; which is roughly 5.87 million lives lost annually to noncommunicable diseases. Most of these deaths have occurred because of lack of risk control, lack of screening, and lack of timely intervention because of high costs.

In this article, Dr. Sabine Kapasi, Global Health Strategist, Founder of ROPAN Healthcare, and UN advisor, tells us more about Non-Communicable Diseases (NCDs).

Non-Communicable Diseases Drain Household Finances

Non-Communicable Diseases (NCDs) strike hardest between the ages of 40 and 65. This is not incidental. These are the working years, the years when families depend on a breadwinner, when children are still in school, when savings are just beginning to accumulate. A cardiac event at 48 not only threatens one person's survival. It removes income, exhausts whatever financial reserves a household has built, and in many cases pulls children out of education permanently. The downstream consequences persist for a generation.

WHO placed the total economic cost of NCDs in India between 2012 and 2030 at $3.55 trillion. That estimate excludes mental health entirely. No health ministry budget can absorb that figure in isolation, yet finance ministries remain largely absent from this conversation. That absence is a policy failure in itself. Health outcomes at this scale are a macroeconomic problem, and they require macroeconomic engagement.

An Outdated System in an Age of Ageing Populations

In India, there are roughly 140 million people aged 60 and above. This demographic is growing three times faster than the general population. These are patients who have lived with unhealthy conditions for decades, who often have several illnesses interacting with each other, and whose medication needs are genuinely complex. They need consistent follow-up care. What they mostly get, outside major cities, is very little. Geriatric medicine is scarce in urban secondary towns and nearly absent in rural India.

By 2030, WHO projects that cardiovascular diseases, cancers, diabetes, and chronic respiratory disorders will cause close to 75% of all deaths in India. SDG target 3.4 aims to lower premature NCD deaths by a third over the same period.

Evidence-Based Drivers of NCD Risk

It is well known what the risk factors are for NCDs. Eating a lot of refined carbs, processed foods, red meat, and high-glycemic staples is linked to diabetes and heart disease. Urbanization has made people less active and made it easier for them to get high-calorie foods, which has led to higher rates of obesity, which raises the risk of almost all NCDs.

It works to stop things from happening. Interventions that focus on diet, exercise, and cutting back on tobacco use consistently lower the number of new cases of NCDs and the progression of existing ones. The problem is not a lack of evidence, but a lack of large-scale implementation.

India's Health System Favors Acute Care Over Chronic Care

The health system in India was made for short-term care. Chronic diseases need ongoing care, which includes taking medications every day, getting tests done again, seeing specialists, and following up for a long time. Most facilities in rural and semi-urban areas can't do this. Families have to pay for treatment until they have to choose between getting better and staying financially stable, which both have long-term effects on health and finances.

Ayushman Bharat made insurance coverage bigger, which was a good thing. The 2023 report from the Comptroller and Auditor General, on the other hand, said that there were gaps, false claims, and limited real-world effectiveness. Coverage without a working care infrastructure gives beneficiaries access to administrative services but not clinical care. Weak regulatory oversight makes the problem worse by making it hard for both public and private providers to be held accountable.

Foundations Are There, But Delivery Is Slow

The National Program for the Prevention and Control of Non-Communicable Diseases has done a lot of important work. It includes a life-course framework that follows the National Health Policy 2017, population-based screening, standard treatment protocols from the Indian Council of Medical Research, digital patient tracking through the NP-NCD Portal and ABHA, strengthening the supply of medicines, and the "75 by 25" initiative that focuses on diabetes and high blood pressure.

But there are clear gaps in delivery. Large hospitals in cities have seen capacity improve, but primary health centres at the block level often remain under-resourced and loosely connected to long-term NCD care. Turning policy into consistent delivery across India's diverse population and uneven geographies takes time, funding, and administrative follow-through. This is where implementation has lacked consistency, with outcomes varying widely across states and districts depending on local capacity and infrastructure.

Primary care needs to be strengthened in practical terms. This means a trained workforce on the ground, basic diagnostic tools, and systems that allow patients to be tracked and treated over time. Managing chronic diseases depends on continuity, not one-time interventions. Risk reduction also needs stronger enforcement. Food environments, tobacco use, and urban living conditions are shaped by regulation, and without clear enforcement, outcomes remain limited. Geriatric care requires focused investment as the population ages, both in terms of facilities and clinical capacity. Financial protection has to move beyond coverage on paper and ensure that care is actually accessible, affordable, and continuous for patients.

India's NCD burden is large, costly, and largely preventable. The data is clear, and policies exist. The gap is in sustained political and administrative focus across ministries and budget cycles to ensure that these policies translate into consistent outcomes on the ground.

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