By Jeff Sturchio There is a common misconception that chronic diseases – namely heart disease, cancer, diabetes and chronic respiratory disease – are largely problems of affluent nations. Collectively known as noncommunicable diseases (NCDs), 80% of deaths from these conditions occur in low- and middle-income countries. A 17% rise in the burden of NCDs is predicted within 10 years, and this bleak forecast is anticipated to have a significant impact on the poor. In India, where more than 50% of deaths are attributed to NCDs, one in five people has at least one chronic disease, and one in 10 suffers from two or more.The increase in heart disease and other NCDs in India mirrors the country’s recent economic gains, but points to a rapidly growing epidemic. Cardiovascular deaths in India are predicted to increase by 111% from 1990 to 2020. People in India, on average, experience coronary heart disease at least five to six years earlier than their peers in Western countries. With nearly 60 million diabetics, India has the greatest number of diabetes patients in the world. Moreover, estimates indicate that 77.2 million Indians are pre-diabetes and predict a near doubling of India’s diabetic population by 2030. Cancer is also a growing challenge in India, where mortality rates are exceptionally high and a 40% rise in cancer-related deaths is expected between 2012 and 2025. India also has one of the highest rates of chronic obstructive pulmonary disease (COPD) mortality in the world, and is home to an estimated 30 million COPD patients.Like many countries, India needs to address the growing prevalence of chronic illness as it continues to grapple with the challenges of child survival, maternal mortality and infectious diseases. The shifting burden of disease can be attributed to the increase in NCD risk factors. While socioeconomic development typically improves population health, migration and urbanization in India have brought about lower levels of physical activity, along with rising obesity and diabetes rates. Smoking remains a major problem, as 35% of the population uses tobacco – the cause of more than 40% of cancer cases in the country. For women and girls, a leading risk factor is exposure to pollution from indoor cook stoves, used by three-quarters of Indian households – approximately 700 million people.Difficulties in access to care and low disease awareness among patients and clinicians aggravate the region’s NCD problem and lead to diagnosis and treatment gaps. Socio-economic factors are also important considerations. Cancer mortality, for example, is twice as high among the least educated as it is among the most educated.NCDs pose a major challenge to economic growth, straining household finances and national health systems. Cardiovascular disease, cancer, chronic respiratory disease, diabetes and mental health conditions will cost India an estimated 126 trillion rupees from 2012 to 2030. This burden is felt across the country; for instance, families of nearly 50% of Indian cancer patients experience extreme financial hardship as a result of paying for health services. Households of diabetes patients are likewise compromised, spending as much as one-third of their income on care.These staggering statistics on NCDs should serve as a rousing call to action to the hundreds of organizations, practitioners and civil society advocates working to improve health in India. Both the World Health Organization and India’s National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke have adopted the goal of a 25% reduction in unnecessary deaths from NCDs by 2025. Such progress requires a multi-level response including prevention measures, affordable medicines, improved screening and treatment protocols, and consideration of the “dual burden†of NCDs and communicable diseases. Creative financing is also needs to be a key component of health reforms in India, where families bear the economic brunt of illness.India’s health and development hinge on the ability to align health priorities with the shifting disease burden. For effective and sustainable action, India must develop a “whole of society†approach to addressing NCDs. Government should work together with civil society, implementing agencies, the private sector and others in the health community at the global, national and community levels to create pragmatic policies and implement best practices to prevent, treat and control chronic disease.Jeff is a global health thought leader whose commitment to change is rivaled only by his encyclopedic knowledge of the issues. He is a trusted counselor for senior leaders in the private sector, multilateral organizations, governments, NGOs and foundations.