A disturbing trend has emerged in recent years: a sharp increase in the number of young people experiencing heart attacks. From the rising incidence of cancer to the increasing prevalence of obesity, diabetes and heart disease across generations, these alarming occurrences mirror the broader crisis of rising non-communicable diseases (NCDs). In 2019, NCDs accounted for 74 per cent of deaths globally and 66 per cent of deaths in India.
Many NCDs cannot be cured, and the management of these chronic conditions (e.g. diabetes) often requires lifelong care, drain resources and hinder development. The majority of NCDs can be attributed to tobacco use, unhealthy diets, physical inactivity, and harmful alcohol consumption, making NCDs largely preventable.
In addition to lifestyle factors, climate change has also been increasingly impacting NCD through many pathways, and we all need to play a role in addressing this. Reducing the burden of NCD requires major lifestyle changes prioritising healthy and environmentally sustainable choices. Many lifestyle choices and behaviours are deeply intertwined with misconceptions and information gaps. Even with adequate information and resources, societal norms and organisational practices and policies are major barriers to improving lifestyle and achieving healthier and sustainable choices.
Marginalised populations, including those in rural areas and lower socioeconomic strata, bear a greater burden of NCD. Addressing these vulnerabilities requires a multi-faceted approach that tackles the root causes of NCD and health inequities, by providing access not only to screening and treatment, but to preventive measures. The potential for prevention is immense, offering a promising path towards a healthier future for all, especially for poor and vulnerable communities.
Transforming socio-cultural norms through bold actions and a Whole Village Approach
Peer pressure and group dynamics are very important determinants of individual behaviour and choices. People often smoke or drink due to peer pressure. Although less obvious, similar patterns are true for many other risk factors, such as unhealthy food choices or sedentary behaviour. Most efforts in prevention, target individual behaviour within the existing social norms that contributed to such behaviour in the first place. For example, research suggests that we should move more throughout the day, whereas social norms limit when, where and how we can move.
Importantly, it is often necessary to change social norms to get communities to adopt healthy changes and lifestyles. This is not easy as somebody needs to take the first bold step to do something different from peers, and inspire others to join. Sugar is a major risk factor for diabetes, yet India’s favourite beverage, chai, is often only available with sugar already added. In India, people often meet over a chai break, and we get drawn to join our friends and colleagues, even though we may want to limit sugar, as we don’t want to miss out on socialising. There is a better option to joining or sitting out of choices that may adversely impact health. In this case, one could be to educate others that high sugar intake is a risk factor for diabetes, and to request tea without sugar or bring your own sugarless tea and draw your friends along. Such norms and bold approaches to changing norms apply to many other NCD risk factors.
As public health professionals, we need to find innovative ways to not only inform and inspire individuals, but to develop large-scale initiatives that would help communities and the nation attain a tipping point, where people will instead start feeling peer pressure to engage in healthy behaviour. Such initiatives, interventions and programmes could target families, schools, workplaces, neighbourhoods and different communities, and would be even more effective, if supported by government efforts and a national campaign (as has been initiated for Yoga). Globally and nationally, there has been the most progress in reducing tobacco use, through a multi pronged comprehensive approach. Similar approaches are needed for other healthy changes to be effective at a population level.
Way forward
The NCD crisis demands urgent attention. By focusing on prevention and early detection, investing in public health, and fostering supportive communities and healthy environments, we can significantly reduce the burden of these diseases and create a healthier future for all. A concerted effort involving governments, civil society, the private sector, communities, schools, families and individuals is essential to achieve this ambitious goal.