In the last few decades, the epidemiological transition from communicable to non-communicable diseases (NCDs) has left India’s health system in a tussle for resources and policy. But is it possible to address one at the expense of the other? And if so, which way do we go?

According to the ‘Lancet Global Burden of Disease Study in 2016’, NCDs contributed to 61.8% of all deaths, while the communicable diseases contributed to 27.5% of all the deaths. Three of the top five causes of death were NCDs (ischemic heart disease, chronic obstructive pulmonary diseases, cerebrovascular disease), and the remaining two were communicable diseases (diarrhea and lower respiratory infections). It is important to note that in India, epidemiology cannot be generalized; one cannot draw conclusions without taking cognizance of regional differences in causes of death and disease burden. Not only do NCDs cause a lower proportion of deaths in less developed states, the pattern of cause of deaths is also different. In more developed states, cardiovascular causes and diabetes contribute to most deaths attributable to noncommunicable groups, while in less developed states, chronic pulmonary conditions cause a larger burden.

Addressing common risk factors is an efficient way to reduce the burden of both categories of disease. In India, a few key risk factors account for over a quarter of mortality and disability: maternal and child undernutrition, dietary risks, and high BMI. Since these risk factors are linked to communicable and NCDs, ensuring adequate and nutritious diet can therefore lead to a significant decrease in prevalence and deaths.

Strengthening health systems with a transition towards decentralized, integrated care will reduce the burden of both NCDs and communicable diseases. Rather than viewing these conditions as competing for resources, we should remember that strong primary care can address them both.

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