diseases, and cancers, have emerged as the foremost global health challenge. Unlike infectious diseases, NCDs

are not transmitted from person to person but arise through complex interactions among genetic,

environmental, behavioral, and physiological determinants. Modifiable lifestyle-related factorssuch as

unhealthy diets, physical inactivity, tobacco use, and harmful alcohol consumptionplay a pivotal role in their

increasing prevalence. The global burden is particularly alarming in low- and middle-income countries, where

demographic shifts, urbanization, and health inequities exacerbate the problem. India, undergoing a significant

epidemiological transition, vividly reflects this trend. States such as Andhra Pradesh report high diabetes

prevalence, rising cardiovascular mortality, and tobacco-related cancers. This paper critically reviews the

epidemiology, risk factors, health system challenges, and policy responses to NCDs at global and national

levels, with a case study from Andhra Pradesh, and underscores the need for integrated prevention and control

diseases (CVDs), diabetes mellitus, cancers, and chronic respiratory diseases (CRDs) are not contagious but

result from a complex interaction of biological predispositions, lifestyle factors, and environmental influences

long-term management, creating unique challenges for healthcare systems.

NCDs account for nearly three out of every four global deaths, equating to approximately 41 million lives lost

annually. Cardiovascular conditions remain the most significant contributor, followed by cancers, respiratory

Once considered problems of affluent societies, NCDs now disproportionately affect low- and middle-income

countries (LMICs), where they cause more than 75% of premature deaths. This shift is closely tied to rapid

urbanization, sedentary behaviors, and nutritional transitions. Economic impacts are equally substantial, with

National surveys, such as NFHS-5 (2021), report concerning increases in obesity, diabetes, and hypertension,

NCDs are now the foremost contributors to both death and disability worldwide. Each year, cardiovascular

diseases claim an estimated 17.9 million lives, cancers nearly 10 million, chronic respiratory conditions about

these diseases account for a large share of years lived with disability, creating a dual health and economic

Although once concentrated in wealthier nations, LMICs now bear the greatest share, accounting for more than

three-quarters of global NCD related mortality. This trend reflects broader demographic and lifestyle shifts:

urbanization, greater reliance on processed diets, declining physical activity, and increased tobacco and alcohol

insulin secretion, resistance to insulin action, or both. Current estimates suggest that around 537 million adults

carries the second-largest number of diabetic individuals, largely due to dietary transitions, increasing obesity,

and genetic predisposition. The disease significantly heightens the risk of cardiovascular complications and is

also a major cause of kidney failure, blindness, and lower-limb amputations.

CVDs including ischemic heart disease, stroke, and hypertension remain the world’s top cause of mortality,

tobacco consumption, obesity, and diets rich in salt and fats. In addition to high mortality, CVDs impose

severe economic burdens through premature deaths and long-term disability.

Cancer encompasses a broad set of diseases involving abnormal and uncontrolled cell division and growth,

substantially to oral, lung, and oesophageal cancers, while breast and cervical cancers are significant among

women. Early screening programs are critical for improving survival outcomes but remain underutilized in

many regions.

The onset and spread of NCDs are largely shaped by behavioral and social determinants. The four most

prominent modifiable risks include tobacco use, harmful alcohol intake, poor diet, and physical inactivity

hand smoke. Excessive alcohol consumption has been associated with more than 200 health conditions ranging

Health systems face considerable hurdles in responding to NCDs. Early detection remains insufficient, with

trained professionals especially in rural and underserved areas further weakens the capacity to manage chronic

Financial costs are another critical barrier. Because NCDs require ongoing treatment, households frequently

as the WHO’s Global Action Plan for the Prevention and Control of NCDs (2013–2030). This plan outlines

nine voluntary global targets, including at 25% reduction in premature NCD deaths by 2025, curbing tobacco

multisectoral action, engaging areas such as agriculture, transport, and education alongside health systems.

In India, policy responses are anchored in the National Programme for Prevention and Control of Cancer,

Diabetes, Cardiovascular Diseases and Stroke (NPCDCS). This initiative strengthens NCD prevention through

population-based screening, public education, and integration of chronic disease management into primary

financial protection and upgrade health and wellness centers. Despite these efforts, challenges in funding, rural

outreach, and evaluation mechanisms persist. Sustained political commitment and intersectoral collaboration

immunization, and screening for non-communicable diseases (NCDs); and the Pradhan Mantri Jan Arogya

Yojana (PM-JAY), which provides secondary and tertiary healthcare coverage of up to ₹5 lakh per family per

Comprehensive Health Insurance Agency of Kerala (CHIAK), both aligned with Ayushman Bharat, ensuring

secondary and tertiary care and operates in convergence with the national PM-JAY framework to enable

cashless treatment in government and empanelled private hospitals. In recent years, the state has also

emphasized the establishment of Health and Wellness Centres to strengthen preventive healthcare, maternal

and child welfare, and the management of chronic diseases such as diabetes, hypertension, and cardiovascular

carethroughEmployment Health Scheme (EHS). Citizens are encouraged to undergo regular health check-ups

Figure 1.Box plot of diabetes prevalence (%) across Andhra Pradesh, Maharashtra, Kerala, and Tamil Nadu

(2018–2022) . Andhra Pradesh shows an intermediate range, with values above Maharashtra but consistently

below Kerala. The narrow spread highlights a steady upward trend.

2022. Mortality increased from 210 to 230 per 100,000, a 9.5% rise, showing a strong correlation with diabetes

prevalence.

Figure 7.Trend in chronic respiratory disease (CRD) prevalence (%) in Andhra Pradesh from 2018 to 2022.

CRD prevalence rose gradually from 4.5% to 4.9%, highlighting a slow but persistent increase.

Figure 8.Trend in cancer incidence (per 100,000) in Andhra Pradesh from 2018 to 2022. - Cancer incidence

increased from 120 to 131 per 100,000, reflecting a 9.2% growth.

constitutes the largest burden, followed by cancer incidence, with diabetes and CRD prevalence forming

smaller proportions. Units differ across indicators; this figure serves as a communication tool for prioritization

rather than direct comparison.