Combined Morbidity

Addressing the increased combinations of communicable diseases (CDs) and noncommunicable diseases (NCDs) in India linked to the unprecedented epidemiological transition, a gender related approach and the subsequent need for a three-pronged approach that WHO will support:

First, there will be continued commitment to the fight against CDs under the new circumstances, for example, vector-borne diseases are acquiring an increasingly urban rather than rural-related profile due to specific rapid urbanization patterns and water-borne diseases require more robust inter-sectoral work in collaboration with municipal governments and urban developers, among others.

Second, there will be a massive scaling up of upstream (that is, addressing broad determinants of health) and downstream approaches (addressing the symptoms of diseases and immediate needs of patients) to fight cardiovascular, cerebrovascular and metabolic diseases, cancer, mental illnesses and other NCDs in India. Inter-sectoral actions aimed at reducing the risks of contracting NCDs will be combined with effective health services to reduce death and disability once the diseases have started and the risk of acquiring the disease – for example, by diminishing exposure to tobacco and other addictive substances, decreasing consumption of salt, sugar and fat, increasing physical activity and increasing access to effective services, all socially influenced factors.

Third, it is foreseeable that new service modalities of primary health care and hospital care will emerge. WHO will support the government in designing approaches to minimize the catastrophic impact of repeated costly visits to health-care facilities and repeated tests, especially under OOP payment conditions, for those who suffer co-morbidities. At the moment, for example, almost half of Indian families with a member affected by cancer already experience catastrophic spending and a quarter of all families are pushed into poverty as a consequence of the disease. This will be a highly demanding change from the viewpoint of health service facilities and human resources.

The National Commission on Macroeconomics and Health has already identified the delay in introducing changes as being responsible for an unduly high toll in terms of mortality, morbidity and disability in India. If the majority of the population is to be served, enormous innovative efforts in terms of networking delivery arrangements, technologies, health workforce skills and training modalities, among others, will be needed in the coming years to overcome the challenges identified.