South Asia, in the midst of a demographic transition, is at risk of suffering from a crippling pandemic of noncommunicable chronic diseases (NCDs). However, a recent World Bank report has highlighted that the region is at a critical juncture where urgent action at the local, domestic and regional levels can turn the tide.
India, the subcontinent’s economic and political hub, is the only country that can lead such regional efforts.
Indian leadership would not only enhance the country’s domestic public health response, but boost its often mercurial regional image and demonstrate its unique ability to lead.
South Asians face a huge challenge in NCDs (cancer, diabetes, cardiovascular diseases and chronic respiratory diseases). The demographic transition is supposed to be a blessing for countries as death and birthrates decrease, life expectancy expands and the prevalence of communicable diseases declines. Naturally, longer life expectancy results in an increase in noncommunicable disease.
However, South Asia presents a special case. The region is faced with what is termed “a dual disease burden”. The rate of noncommunicable disease is rapidly expanding amidst a persistent (though declining) rate of communicable disease.
Already beleaguered health systems will be even further stretched by diseases that require long-term, often life-time treatment. The World Bank also found that South Asians have their first heart attack six years earlier than the global average. This means that in South Asia, cardiovascular disease is taking an even larger chunk out of what would otherwise be healthy and economically productive years of living. This problem is particularly salient for India. The country’s demographics have been hailed as an economic “trump card”, particularly against China, a strategic rival with a rapidly ageing population.
From 2006 to 2015, the estimated loss of national income caused by NCD mortality will be in the realm of $237 billion, according to the World Health Organisation. NCDs are already racking up daunting direct costs. One study by the Cameron Institute estimates that in 2004, Indians spent $9.1 billion (or 3.3 per cent of the gross domestic product) on out-of-pocket expenses related to managing NCDs. These ever-increasing costs could drive many Indian families back, or further into poverty, reversing the advances in poverty reduction of the last 20 years. South Asian countries share a number of risk factors for NCDs, including poor childhood nutrition, weak health infrastructure, high tobacco use and inconsistent food labelling.
While many of these issues will need to be addressed at the national level, several challenges require regional collaboration. Harmonising standards on tobacco advertising and taxation, improving regional food labelling and bargaining collectively on essential drugs are a few areas that could be tackled by a regional coalition.
As the pre-eminent South Asian economy, tobacco and food products for the entire region are designed around Indian preferences and regulations.
Additionally, India, one of the largest producers of generic drugs, is the only country in the subcontinent that can work with industry to ensure access to essential medicines. With its growing network of non-governmental organisation and research organisations, India would also be ideal to lead a South Asian effort to collect, analyse and disseminate epidemiological surveillance data. Many though will suggest that India itself has too many challenges to help its neighbours.
Despite recent successes in improving relations with Bangladesh, India’s influence has been waning in South Asia as the US and China become more engaged in the region.
By demonstrating leadership on chronic diseases, India would be willing to partner with its neighbours on an issue where the smaller countries obviously have the most to gain.
As a member of the UN Security Council, India could be the first major country to truly champion NCDs and begin to take a greater role in global health diplomacy, where it has been largely absent.
South Asian countries need to take the threat of noncommunicable diseases seriously and now is the time to act. When it comes to regional challenges and potential solutions, only India has the political and economic influence to take the initiative. The world’s largest democracy will benefit from an improved public health response and begin to demonstrate that it is truly a “regional power”.
* Daniel J. Barker, research associate, Council on Foreign Relations, New York , and
fellow, Institute for International Public Policy (US)