As people age – and as countries progress on the scale of epidemiological and economic transitions – the causes of morbidity and mortality become predominantly chronic in nature. The problem of chronic diseases is much more severe in low and middle countries (LMICs) vis-à-vis high income countries – not only are 74 percent of chronic disease-related deaths concentrated in LMICs, most of these deaths are happening at premature levels (under 70 years), which is the most problematic feature. And, given that their at-risk populations are also substantial vis-à-vis developed countries, the enormous burden of chronic disease-related morbidity, productivity and economic losses too in LMICs is anybody’s guess. In India, in 2012, 59 percent of premature deaths happened due to chronic diseases, while 27 and 15 percent were due to acute diseases and injuries respectively. The burden of chronic diseases is only going to increase in the future, with more fatal consequences for India’s poor and middle class. This research program aims to draw the attention of both national and state policymakers to this critical area, and provide them with evidence and analysis based on our research in developed as well as developing contexts. Given the promise and potential of prevention based on surveillance in developing countries like India, we started out our research under this program with the following themes and shall be picking up others as we go ahead.
ONGOING RESEARCH (2015-16)
- Prevention of chronic diseases – Reorienting primary health systems in India– In India, 66 percent of all deaths are premature (under the age of 70 years). While the burden of premature mortality has shifted from child (0-5 years) to adult (30-69 years) level over the years – there are three times more deaths happening at the latter vis-à-vis the former level – primary health systems continue to focus almost exclusively on child mortality. They need to make a health system transition and get engaged in the prevention of risk factors, morbidity and mortality related to chronic diseases – the biggest determinant of adult mortality – together with their original focus on child mortality. This paper analyzes some of the major challenges in terms of governance, manpower and financing that such a transition will be faced with, and offers a number of actionable policy recommendations to tackle such challenges.
- Surveillance of chronic diseases – Risk factors, morbidities and mortality (RMM)– Robust surveillance mechanisms for chronic disease RMM can go a long way in their prevention. Nevertheless, this has not received adequate attention among policymakers in India, and the country’s draft National Health Policy 2015 does not even mention it. This paper presents the status, scope and challenges for strengthening surveillance of chronic disease RMM in India, drawing upon the surveillance experience of selected states and countries to develop policy recomendations.