Published in The Hindu on October 16, 2010

No longer can it be said that non-communicable diseases like diabetes and cardiovascular disease, and risk factors like hypertension, high cholesterol, and obesity are seen only among the urban rich in India. In the past, several localised studies undertaken in rural areas found evidence of an epidemiological transition from communicable to non-communicable diseases. A large-scale study published online recently in the British Medical Journal (BMJ) has confirmed this trend. The study involved nearly 2,000 people drawn from 1,600 villages across 18 States. The key finding is that India faces a double whammy. While those belonging to the lower socioeconomic group are underweight, those from the higher strata are obese, diabetic, and have high levels of total cholesterol, bad cholesterol (LDL) or triglycerides, as well as low levels of good cholesterol (HDL). South Indians tend to be obese more than north Indians. One reason for this may be that people in the four southern States show a marked preference for polished rice. Cardiovascular disease and diabetes are currently the most prevalent lifestyle diseases. Considering that the number of people chewing tobacco or smoking bidis is increasing, the incidence of certain cancers linked to these habits is likely to rise in the conceivable future.

The effects of globalisation and urbanisation may be some of the reasons for the increasing numbers of rural folk with non-infectious diseases. Sedentary lifestyles combined with increased intake of calorie-rich food are at the root of many lifestyle diseases. The challenges posed by non-communicable diseases are very different from those by communicable and infectious diseases. Diabetes, cardiovascular diseases, and risk factors like hypertension and high cholesterol require prolonged care, unlike the transmittable diseases. The requirements of diagnosis and treatment are also very different. The healthcare system obtaining in rural areas is not equipped to handle these challenges. Making people more aware of lifestyle changes and running educative campaigns against junk food and in favour of healthy food, especially among children and youth, should go some way in stemming the tide. A recent report in The New England Journal of Medicine spotlights the magnitude of the challenge India faces: going by the present trends, it will lose $237 billion over the next decade owing to non-communicable diseases.