A Non-Communicable Disease (NCD) is a non-infectious disease condition that can last for a long term but cannot spread from person to person. These illnesses take a long time to develop and do not present symptoms in the early stages. They require treatment for several years, and some require life-long treatment.

There are several diseases which fall into this group of conditions. Cardiovascular diseases, stroke, diabetes, cancer, mental health, dementia, infertility, obesity and overweight, and other chronic respiratory diseases are categorized as Non-Communicable Diseases. In the last few years, these diseases have become an epidemic in India, due to changes in lifestyles, increase in aging populations, unplanned urbanization, and globalization. They are diseases of long duration targeting men, women and children and people in all income groups. Some of these diseases progress slowly or cause chronic symptoms requiring long-term care and control while others progress rapidly. People may look apparently healthy, but they may still have these diseases.

Physical inactivity, unhealthy diets (diets low in fruit, vegetables, and whole grains, but high in salt and fat), tobacco use (smoking, secondhand smoke, and smokeless tobacco), and the harmful use of alcohol are the main behavioural risk factors for NCDs.

To overcome these epidemic situations in Non-Communicable Diseases, it requires a huge determination to continuously counsel all patients to adopt healthy lifestyle to prevent it. Gynaecologists in India are seeing wide spectrum of this epidemic from polycystic ovarian disease to post-menopausal metabolic syndromes. To control this epidemic, productive lives should be continuously screened/ monitored with healthy public guidelines and lifestyles. These unique challenges should be addressed more efficiently with more cost-effective techniques and also with the assistance of widely acceptable technology like mobile phones and computers.

An assessment by WHO early in the Covid pandemic found that 94% of countries reported that all or some of the staff working on NCDs in health ministries had been reassigned to COVID-19. As intermittent lockdowns and high infection rates compounded the pressure on all health-care systems, there were huge declines in the screening and treatment of NCDs. Cancer registration and screening fell rapidly where cancer registrations decreased by around 40%. The result has been a screening deficit of millions of people [1].

One of the most serious concerns about Non-Communicable Diseases is that they affect people in the productive years of their life. Non-Communicable Diseases are a leading cause of premature mortality. Although till date, too much of the narrative around NCDs has focused on mortality, morbidity—the lived burden on billions of people—can be a powerful lever for action.

Another cause of premature mortality is the increasing occurrence of injuries. They include both unintentional and intentional injuries—due to road traffic accidents, burns, workplace related injuries, and violence [2].

In July 2020, the UN Economic and Social Council (ECOSOC) adopted a resolution on prevention and control of NCDs, titled ‘Coordination, programme and other questions: prevention and control of non-communicable diseases’ (E/RES/2020/22) which highlighted five main areas of concerns;

Recognizes that “many countries still face significant challenges” in implementing commitments related to NCDs and that the human and economic cost of NCDs “contribute to poverty and inequities”.

Calls on the UN Inter-Agency Task Force on the Prevention and Control of NCDs to continue to work to support Member States in line with its strategy for 2019–2021, paying particular attention to Member States’ needs during COVID-19 response and recovery.

Requests the Task Force to further support Member States in their efforts to address the burden of NCDs, including through: maintaining essential health-care services and their timely delivery; promoting access to safe, effective, quality and affordable diagnostics, therapeutics, essential medicines, vaccines, and other health technologies; and strengthening health systems and supply chain management;

Requests the Task Force to strengthen its capacity to provide technical and policy advice to governments; and

Requests the UN Secretary-General to report on progress achieved at ECOSOC’s 2021 session [3].

In addition to this, World Health Organization (WHO) has instructed governments to take action to tackle NCD’s as people affected by with NCD’s are prone to be the most affected population post-COVID-19 era. Moreover, the Global Action Plan for the Prevention and Control of NCDs 2013–2020 aims to make the world free of Non-Communicable Diseases. Although this is a difficult target to achieve in low- and middle-income countries like India, studies indicate that government institutions are making efforts to reach the desired goal as it exerts enormous financial burdens. The two major action plans developed by the WHO and European Union focus on improving health-care services in the country by educating people over the importance of healthy lifestyle behaviour and patterns and increasing budget allocated for improving health-care services. However, external factors such as changes in social, economic, environmental, and cultural contexts need to be taken into consideration before implementation [1].

The government in India has been implementing the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular diseases and Stroke (NPCDCS). This is now implemented through the National Health Mission. In this programme, an important component is the examination of all individuals who came to the health-care facilities for hypertension, diabetes, and selected cancers. This is called Opportunistic Screening. Now the government is planning to expand the scope of the NPCDCS to undertake screening of all healthy women and men 30 years of age and above in the community or in a health facility nearby. This is also called Population-based Screening [4].

Preventive aspect of NCDs is strengthened under Comprehensive Primary Health Care through Ayushman Bharat Health Wellness Centre scheme, by promotion of wellness activities and targeted communication at the community level. Other initiatives for increasing public awareness about NCDs and for promotion of healthy lifestyle include observation of National & International Health Days and use of print, electronic, and social media for continued community awareness. Furthermore, healthy eating is also promoted through FSSAI. Fit India movement is implemented by Ministry of Youth Affairs and Sports, and various yoga-related activities are carried out by Ministry of AYUSH. In addition, NPCDCS gives financial support under NHM for awareness generation (IEC) activities for NCDs to be undertaken by the States/UTs as per their Programme Implementation Plans (PIPs).

India has more than 35,000 gynaecologists practicing in rural and urban areas. They are one point contact for women’s health. They can definitely help to reduce the burden on NCDs provided each and every gynaecologist screens all patients for Non-Communicable Diseases. The problem is that all over the world, gynaecologists are not always screening for Non-Communicable Diseases in their patients.

Important clinical pointers are.

1.

Update knowledge on the risk factors, prevention and control of common Non-Communicable Diseases.

2.

Understand the program for Non-Communicable Diseases in your surrounding area and your own role in undertaking screening, detection, referral, and follow-up.

3.

Counsel individuals and families on modifying life style behaviours and reducing salt intake.

4.

Measure blood pressure and assessing random blood glucose in all patients above 30 years of age.

5.

Screen all elderly patients for Non-Communicable Diseases through available modalities like blood tests, ECG, X ray, etc. twice a year.

6.

Screen all women, young and old for all gynaecological cancers.

7.

Estimate Body Mass Index and undertake clinical examination of breast and oral visual examination of the oral cavity.

8.

Enable referral of those suspected with the common Non-Communicable Diseases.

9.

Be able to identify complications among patients with Non-Communicable Diseases and refer them.

10.

Undertake follow-up of patients with Non-Communicable Diseases and support them to adhere to treatment and to make changes in their lifestyles.

In response to the “WHO Global Action Plan for the Prevention and Control of NCDs 2013–2020”, India is the first country to adopt the National Action Plan with specific national targets and indicators aimed at reducing the number of global premature deaths from NCDs by 25% by 2025. The global action plan has suggested 9 targets for countries to set. But India has taken the unprecedented step of setting a tenth target to address household air pollution. India’s National Monitoring Framework for Prevention and Control of NCDs has committed for a 50% relative reduction in household use of solid fuel and a 30% relative reduction in prevalence of current tobacco use by 2025.

Medical community should join together to reduce premature deaths from NCDs by one third by 2030, the commitment made in 2015, as a part of Sustainable Development Goals. The strategies must envisage the urgent need to halt and reverse the growing incidence of NCDs.