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COMMENTARY
Year : 2018  |  Volume : 62  |  Issue : 4  |  Page : 302-304  

A review on Noncommunicable Diseases (NCDs) burden, its socio-economic impact and the strategies for prevention and control of NCDs in India


1 Public Health Specialist, Airport Health Organisation, Kolkata and Research Scholar, Techno India University, Kolkata, West Bengal, India
2 Demonstrator, Department of Epidemiology, All India Institute of Hygiene and Public Health, Kolkata, West Bengal, India
3 Director-Professor, Department of Epidemiology, All India Institute of Hygiene and Public Health, Kolkata, West Bengal, India
4 Assistant Professor, Department of Bio-Technology, Techno India University, West Bengal, India

Date of Web Publication11-Dec-2018

Correspondence Address:
Dr. Manas Kumar Kundu
Greenwood Premium, Flat No. F-301, Kaikhali Main Road, Kaikhali, Kolkata - 700 136, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijph.IJPH_324_16

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   Abstract 


Noncommunicable diseases (NCDs) have become a major public health problem in India accounting for 62% of the total burden of foregone DALYs and 53% of total deaths. Out-of-pocket expenditure associated with the acute and long-term effects of NCDs is high resulting in catastrophic health expenditure for the households. A large national survey in India found that spending on NCDs accounted for 5.17% of household expenditure. According to a macroeconomic analysis, it is estimated that each 10% increase in NCDs is associated with a 0.5% lower rate of annual economic growth. The income loss due to hypertension is the highest, followed by diabetes and cardiovascular diseases. The macroeconomic impact of NCDs is profound as they cause loss of productivity and decrease in gross domestic product. Since the health sector alone cannot deal with the “chronic emergency” of NCDs, a multisectoral action addressing the social determinants and strengthening of health systems for universal coverage to population and individual services is required.

Keywords: Macroeconomic impact, noncommunicable diseases, out-of-pocket expenditure


How to cite this article:
Kundu MK, Hazra S, Pal D, Bhattacharya M. A review on Noncommunicable Diseases (NCDs) burden, its socio-economic impact and the strategies for prevention and control of NCDs in India. Indian J Public Health 2018;62:302-4

How to cite this URL:
Kundu MK, Hazra S, Pal D, Bhattacharya M. A review on Noncommunicable Diseases (NCDs) burden, its socio-economic impact and the strategies for prevention and control of NCDs in India. Indian J Public Health [serial online] 2018 [cited 2019 Mar 19];62:302-4. Available from: http://www.ijph.in/text.asp?2018/62/4/302/247228




   Brief Introduction about the Novelty of Noncommunicable Diseases: Studies Relating to its Recurrent Economic Burdens in India Top


Noncommunicable diseases (NCDs) already pose a substantial economic burden, and this will evolve into a staggering one over the next two decades. For example, with respect to cardiovascular disease (CVD), chronic respiratory disease, cancer, diabetes, and mental health, the macroeconomic simulations suggest a cumulative output loss of US$ 47 trillion over the next two decades. This loss represents 75% of global gross domestic product (GDP) in 2010 (US$ 63 trillion). NCDs have become a major public health problem in India accounting for 62% of the total burden of foregone DALYs and 53% of total deaths. The effects of NCDs are inequitable with evidence of a reversal in social gradient of risk factors and greater financial implications for the poorer households in India. Out-of-pocket expenditure associated with the acute and long-term effects of NCDs is high resulting in catastrophic health expenditure for the households. A study in India showed that about 25% of families with a member with CVD and 50% of families with cancer experience catastrophic expenditure and 10% and 25%, respectively, are driven to poverty. The odds of incurring catastrophic hospitalization expenditure were nearly 160% higher with cancer than the odds of incurring catastrophic spending when hospitalization was due to a communicable disease. In macroeconomic term, most of the estimates suggest that the NCDs in India account for an economic burden in the range of 5%–10% of GDP, which is significant and slowing down GDP thus hampering development.

While India is simultaneously experiencing several disease burdens due to old and new infections, nutritional deficiencies, chronic diseases, and injuries, individual interventions for clinical care are unlikely to be affordable on a large scale. While it is clear that “treating our way out” of the NCDs may not be the efficient way; it has to be strongly supplemented with population-based services aimed at health promotion and action on social determinants of health along with individual services. Since the health sector alone cannot deal with the “chronic emergency” of NCDs, a multisectoral action addressing the social determinants and strengthening of health systems for universal coverage to population and individual services is required.[1]


   Researches and their Findings about Out-of-Pocket, Public and Private Expenditures (Direct and Indirect Costs) of Different Types of Noncommunicable Diseases in India Top


As per the WHO review on researches on the impact of out-of-pocket payments for the treatment of NCDs in the developing countries, 2011, the following studies in regards to India are elaborated below:

The study focused on households with illness episodes in five resource-poor locations in rural India. A total of 2204 households within the catchment area of a few micro-insurance schemes were included in the analysis. Using multivariate regression, the study found that the cost of chronic illness was higher than the cost of nonchronic illnesses but neither details of what impact these costs had on families nor how much was reimbursed by the insurance schemes was provided.[2]

A large national survey in India in 2004 study found that spending on NCDs accounted for 5.17% of household expenditure. This accounted for just under 50% of all household health expenditures. Using multivariate regression analysis, the study also found that the odds of incurring catastrophic hospitalization expenditures were nearly 160% higher for a patient with cancer than the odds of incurring catastrophic spending when hospitalization was due to a communicable condition. By comparison, the odds of incurring catastrophic hospital spending due to CVD were about 30% greater compared to communicable conditions that resulted in hospital stays. Catastrophic expenditure was defined in this study as out of pocket spending exceeding 30% of nonsubsistence spending, where nonsubsistence was based on the poverty line data from the Indian Planning Commission.[3] These results should be interpreted with care because they focused only on people who were hospitalized.

A study of 3150 households from West Bengal found that among households who accessed health services, expenditure on chronic illness was 5.16% of total household expenditure. In comparison, spending on inpatient, outpatient, and institutional deliveries were 11.55%, 4.03% and 3.96% of total household expenditure, respectively. The study defined catastrophic expenditure based on thresholds of nonfood expenditure. Using regression analysis, it found that households with members who had chronic illnesses had a higher risk of incurring catastrophic health expenditures as compared to members who had sought outpatient care or inpatient care for undisclosed conditions or given birth by a formal provider. No details were provided of the proportions actually suffering financial catastrophe.[4]

A number of studies documented the household financial burden from specific illness and conditions, like household burden due to specific noncommunicable and chronic illnesses. Five hundred and ninety-six diabetic patients presenting at a private and a public hospital in Chennai were included in one study. The costs reported by the patients were validated against hospital records. In the private hospital, the poorest quartile of patients spent 24.5% of their income on diabetes care, compared to 3.5% in the richest quartile. In the public hospital, where median family income was much lower than in the private hospital, the poorest quartile spent 3.3% of their income on diabetes care while the richest quartiles spend almost 0% of their incomes on care.[5]

A total of 557 diabetic patients at hospitals, clinics, and GPs from seven states were included in the study. Patients were asked to report costs of diabetic care and their income. The study found that poorest households in urban areas spent 34% of their income on diabetes care, compared to 4.8% for the richest households. The poorest households in rural areas spent 27% of their income on diabetes care compared to 5% for the richest households.[6]

Combinations of specific illnesses India: A study used a subsample of a national survey. Information from 2129 individuals hospitalized for CVD and 438 individuals hospitalized for diabetes was analyzed. The study found that hospital costs represented 30% of annual total household expenditure for CVD and 17% for diabetes patients. Poorer households had a significantly higher burden (Rao et al. 2011). Again, this is not particularly useful as it does not identify what proportion of total household expenses is consumed by the medical costs of CVD.

The macroeconomic impact of NCDs is profound as they cause loss of productivity and decrease in GDP.[7] A recent study by the Harvard School of Public Health and World Economic Forum estimates that over the next 20 years, at the global level, NCDs will cost more than US$ 30 trillion, representing 48% of global GDP in 2010, and will push millions of people below the poverty line.[8] According to a macroeconomic analysis, it is estimated that each 10% increase in NCDs is associated with a 0.5% lower rate of annual economic growth.[9] Economic implications of chronic obstructive pulmonary disease (COPD) in India reveals that the cost of COPD treatment is increasing in both urban and rural areas. As per the estimates, the economic burden of COPD for India is likely reach Rs. 48,000 crore in the next 5 years.[10] Families in Delhi (India) with at least one member consuming three or more drinks per week spent almost 14 times more on alcohol each month compared with families where no member consumed more than one drink.[11] Further, in India, the share of out-of-pocket expenditure due to NCDs among the economically better off households increased from 32% in 1995 to 47% in 2004, indicating the growing financial impact of NCDs at the household level. The total income loss due to chronic diseases in India was between the Indian Rupee (INR) 1094–1113 billion. Of this, income loss due to hypertension was the highest (INR 199 billion), followed by diabetes (INR 163 billion) and CVDs (INR 144–158 billion).[12] WHO projected cumulative GDP loss in India by 2015 would be 17 billion US$ [Table 1]. World Economic Forum estimated that economic loss between 2012 and 2030 due to Cardiovascular diseases and Diabetes would be 2.17 and 0.15 trillions of 2010 dollars respectively [Table 2].
Table 1: WHO Projected cost of cardiovascular disease in terms of lost GDP in selected countries of South-East Asia Region, 2006 and 2015

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Table 2: Economic Burden of NCDs in India, 2012-2030

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NCDs have become a major public health problem in India accounting for 62% of the total burden of foregone DALYs and 53% of total deaths. Out-of-pocket expenditure associated with the acute and long-term effects of NCDs is high resulting in catastrophic health expenditure for the households. In India, the share of out-of-pocket expenditure due to NCDs among the economically better off households increased from 32% in 1995 to 47% in 2004, indicating the growing financial impact of NCDs at the household level. A national multisectoral action plan with national targets is a necessary framework for addressing NCDs and their risk factors through a public health approach. Instead of one plan per disease, a comprehensive NCD plan, with a clear budget and an integrated monitoring framework, makes possible the coherent national policy response required to attain national targets.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Thakur J, Prinja S, Garg CC, Mendis S, Menabde N. Social and economic implications of noncommunicable diseases in India. Indian J Community Med 2011;36:S13-22.  Back to cited text no. 1
    
2.
Dror DM, van Putten-Rademaker O, Koren R. Cost of illness: Evidence from a study in five resource-poor locations in India. Indian J Med Res 2008;127:347-61.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Mahal A, Karan A, Engelgau M. The Economic Implications of Non-Communicable Diseases for India. Health, Nutrition and Population (HNP) Discussion Paper. The World Bank, Washington, DC; 2010.  Back to cited text no. 3
    
4.
Mondal S, Kanjilal B, Peters DH, Lucas H. Catastrophic Out-of-Pocket Payment for Health Care and its Impacts on Households: Experience from West Bengal, India. Future Health Systems: Innovations for Equity. Available from: http://www.chronicpoverty.org. [Last accessed on 2018 Aug 20].  Back to cited text no. 4
    
5.
Shobhana R, Rao PR, Lavanya A, Vijay V, Ramachandran A. Cost burden to diabetic patients with foot complications – A study from Southern India. J Assoc Physicians India 2000;48:1147-50.  Back to cited text no. 5
    
6.
Ramachandran A, Ramachandran S, Snehalatha C, Augustine C, Murugesan N, Viswanathan V, et al. Increasing expenditure on health care incurred by diabetic subjects in a developing country: A study from India. Diabetes Care 2007;30:252-6.  Back to cited text no. 6
    
7.
Abegunde DO, Mathers CD, Adam T, Ortegon M, Strong K. The burden and costs of chronic diseases in low-income and middle-income countries. Lancet 2007;370:1929-38.  Back to cited text no. 7
    
8.
World Economic Forum. The Global Economic Burden of Non-Communicable Diseases. Harvard School of Pubic Health. Geneva: World Economic Forum; 2011.  Back to cited text no. 8
    
9.
World Health Organization. The WHO Global Status Report on Noncommunicable Diseases 2010. NCDs and its Development. Geneva: WHO; 2010.  Back to cited text no. 9
    
10.
Bhome AB. COPD in India: Iceberg or volcano? J Thorac Dis 2012;4:298-309.  Back to cited text no. 10
    
11.
Institute of Medicine of National Academies. Promoting Cardiovascular Health in the Developing World: A Critical Challenge to Achieve Global Health. Washington, DC: The National Academies Press; 2010.  Back to cited text no. 11
    
12.
World Health Organization. Noncommunicable Diseases in the South-East Region 2011-Situation and Response. New Delhi: WHO; 2011.  Back to cited text no. 12
    



 
 
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  [Table 1], [Table 2]



 

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