India's war on ncds: the 75/25 initiative and the path to a healthier future

Non-communicable diseases (NCDs) represent a silent epidemic sweeping across India, posing a formidable threat to public health and the nation’s economic aspirations. These chronic conditions, which include cardiovascular diseases, cancers, diabetes, and chronic respiratory diseases, are non-infectious and largely driven by a combination of genetic, physiological, environmental, and behavioral factors. Once considered ailments of the affluent, NCDs now disproportionately affect all sections of society, creating a dual burden of disease alongside persistent communicable illnesses.

The scale of the crisis was starkly illuminated by a comprehensive 2023 ICMR-INDIAB study, which revealed alarming statistics for 2021: an estimated 101 million people with diabetes, 136 million with prediabetes, and a staggering 315 million with hypertension. This data underscores the urgent need for robust, multi-pronged public health strategies.

Fun Fact: India carries the grim distinction of being the “diabetes capital of the world,” with the number of affected individuals projected to swell to over 134 million by 2045 if current trends continue.

In a major policy response, the Government of India launched the ambitious “75/25 Initiative” in May 2023. This flagship program, the largest of its kind globally, aims to screen and provide standard care to 75 million individuals with hypertension and diabetes by the end of 2025. This initiative operates under the umbrella of the broader National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD), leveraging the nationwide network of Ayushman Bharat - Health and Wellness Centres (AB-HWCs) for mass screening and primary care delivery.

The Four Horsemen: Major NCDs and Their Risk Factors

The NCD burden is primarily driven by four major disease categories, which share a set of common, modifiable risk factors. Understanding these is key to effective prevention.

These risk factors are often interconnected and amplified by broader social determinants like rapid urbanization, changing lifestyles, and widespread air pollution.

Analogy: Tackling NCDs is like trying to turn a massive ship. It requires slow, sustained, and coordinated effort in changing national habits and environments—from promoting healthier diets to building more walkable cities—not just quick medical fixes.

A simple way to remember the four most significant behavioral risk factors is through a mnemonic.

Mnemonic for Key NCD Risk Factors: TUPA

• T - Tobacco Use
• U - Unhealthy Diet
• P - Physical Inactivity
• A - Alcohol (Harmful Use)

Critical Policy Appraisal

India’s fight against NCDs is marked by ambitious programs and significant challenges. A balanced view is essential for understanding the path forward.

Fun Fact: The promotion of millets (Shree Anna) in the 2023 Union Budget is a strategic agricultural and nutritional intervention. Millets are low-glycemic, high-fiber grains that can play a crucial role in managing diabetes and improving overall metabolic health.

Analytical Lens: UPSC Focus (Mains & Prelims)

Conceptual Basis

The constitutional mandate for public health intervention stems from Article 47 of the Constitution of India (Directive Principles of State Policy), which directs the State to raise the level of nutrition, the standard of living, and to improve public health. The primary operational framework is the National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD).

UPSC Integration: Connecting the Dots

• GS Paper 2 (Polity & Governance, Social Justice): Health as a state subject, federal cooperation, policy implementation, issues relating to the development and management of the social sector, and health services.
• GS Paper 3 (Economy): The impact of disease burden on human capital, labor productivity, and economic growth. The threat posed by NCDs to India’s demographic dividend.
• GS Paper 1 (Society): Impact of urbanization, globalization, and changing lifestyles on public health; poverty and its relation to health outcomes.

Expert Analysis: Future Impact

The escalating NCD crisis poses a direct threat to India’s demographic dividend. A nation’s greatest asset—its people—is at risk of being less healthy and less productive. The long-term economic and social costs of inaction are immense, potentially leading to overwhelmed healthcare systems and strained household finances. The future policy direction must pivot aggressively from a curative to a preventive model, focusing on primordial prevention (preventing the development of risk factors) and health promotion at a mass scale. Integrating health considerations into all policies—from urban planning and transport to agriculture and education—is the only sustainable path forward.

Prelims Practice Question (MCQ)

Question: With reference to India’s strategy against Non-Communicable Diseases, which of the following is the primary objective of the “75/25 Initiative”? (a) To reduce the national infant mortality rate by 25% by the year 2025. (b) To provide standard care for 75 million individuals with hypertension and diabetes by 2025. (c) To ensure 75% of the rural population has access to tertiary healthcare facilities by 2025. (d) To eliminate 25 vector-borne diseases from 75 high-burden districts.

Answer: (b) Explanation: The “75/25 Initiative” was launched by the Union Health Ministry in May 2023. Its specific, time-bound goal is to put 75 million people with hypertension and diabetes on Standard Care by 2025. This makes it a highly targeted program within the broader NP-NCD framework.

Mains Sample Question

Question: Non-communicable diseases (NCDs) pose a significant threat to India’s demographic dividend and economic growth. Critically analyze the government’s multi-sectoral approach to combat this challenge, highlighting recent policy shifts like the ‘75/25 Initiative’ and suggesting measures for more effective implementation. (15 Marks, 250 Words)

Mind Map Outline (Revision Structure)

• Non-Communicable Diseases (NCDs) in India
  • Core Concept & Definition
    • Chronic, non-infectious health conditions.
    • Leading cause of mortality in India (>66% of deaths).
    • Socio-economic drivers: Urbanization, lifestyle changes.
  • Major Types of NCDs
    • Cardiovascular Diseases (CVDs)
    • Cancers
    • Chronic Respiratory Diseases
    • Diabetes
  • Key Risk Factors (Mnemonic: TUPA)
    • Tobacco Use
    • Unhealthy Diet (high salt, sugar, trans-fats)
    • Physical Inactivity
    • Alcohol (Harmful use)
    • Environmental Factors (e.g., Air Pollution)
  • Government of India’s Policy Framework
    • Constitutional Basis: Article 47 (DPSP)
    • Primary Program: National Programme for Prevention and Control of NCDs (NP-NCD)
      • Objectives: Health promotion, early diagnosis, management, capacity building.
      • Integration with Ayushman Bharat - Health and Wellness Centres (AB-HWCs).
    • Recent Developments (2023-2025)
      • ICMR’s 2023 Study: Highlighted the massive prevalence of metabolic NCDs (101M diabetic, 136M pre-diabetic).
      • “75/25 Initiative”: A time-bound mission to provide standard care to 75 million people with hypertension and diabetes by 2025.
      • Promotion of Millets (Shree Anna): A nutritional strategy to combat lifestyle diseases.
  • Critical Policy Appraisal
    • Challenges & Criticisms
      • High Out-of-Pocket Expenditure (OOPE).
      • Implementation gaps and inter-state disparities.
      • Urban-centric healthcare infrastructure.
      • Predominantly curative rather than preventive focus.
    • Opportunities & Way Forward
      • Leveraging Digital Health (Ayushman Bharat Digital Mission).
      • Strengthening primary healthcare via AB-HWCs.
      • Adopting a ‘Whole-of-Government’ and ‘Whole-of-Society’ approach.
  • UPSC Analytical Lens
    • Inter-Topic Linkages
      • Economy (Human Capital, Demographic Dividend)
      • Polity (Federalism, Health Policy, Governance)
      • Society (Lifestyle, Urbanization, Social Justice)
    • Future Impact: Risk to economic growth, need for a paradigm shift to preventive and primordial healthcare.