A System at the Brink

India’s epidemiological transition, once a slow-moving shift from infectious to lifestyle-related diseases, has now become a full-blown crisis. The latest Global Burden of Disease (GBD) study confirms what the 2017 National Health Policy had only anticipated: non-communicable diseases (NCDs) such as heart ailments, diabetes, and chronic respiratory illnesses now dominate India’s health landscape. For small Himalayan states like Sikkim, where fragile ecology intersects with limited health infrastructure, the warning could not be starker.

With WHO data showing that NCDs account for nearly 65% of deaths in India — and alarmingly, a quarter of these among people below 70 — the country is losing citizens in their most productive years. This early mortality rate is far higher than in countries like the US or China, exposing a systemic weakness in prevention, diagnosis, and long-term care. The tragedy is compounded by diseases like COPD, which forms over 75% of India’s respiratory disease burden yet remains chronically underdiagnosed. When doctors in primary health centres treat persistent coughs as seasonal nuisances rather than potential indicators of a lifelong disease, the system fails at its very first point of contact.

For states like Sikkim, the stakes are even higher. Mountain populations face elevated exposure to air pollution from vehicular emissions, construction, and crop burning, while steep terrains make access to specialised care difficult. Strengthening community health centres and primary health centres is necessary but not sufficient. What India urgently needs is a robust investment in diagnostic training, ensuring that frontline doctors can identify NCDs early rather than merely treat symptoms.

A meaningful response must go beyond medicine. Poor diets, sedentary lifestyles, and environmental degradation form the triad feeding the rise of NCDs. Integrating medical research with nutritional and ecological science — and linking health programmes with environmental initiatives like the National Clean Air Programme is imperative. Awareness on food habits, physical activity, and environmental health must begin in schools and permeate families and communities.

India’s health crisis is not a distant threat. It is here, shortening lives, straining families, and crippling economies. Unless we build an ecosystem where prevention, early diagnosis, and environmental health work together, states like Sikkim — and the country at large — will continue paying an unbearable price.