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Noncommunicable diseases (NCDs)—cardiovascular illnesses, malignancies, chronic respiratory diseases, and diabetes—are becoming a source of worry among the country’s many socioeconomic classes and areas. Fast food, hectic work schedules, inactivity due to sedentary lifestyles, and a lack of time for meal preparation have all contributed to an increase in NCDs such as hypertension and diabetes in urban India. A lack of access to adequate foods is causing a variety of NCDs in rural India. Furthermore, traditional beliefs and cultural traditions may prohibit the eating of specific foods, resulting in a diet that is less diverse and less balanced.
Recognizing the country’s growing burden of NCDs, the Indian government launched the National Health Policy in 2017 to prioritize illness prevention and control. The program includes initiatives such as encouraging healthy lifestyles, expanding access to inexpensive and high-quality health care, and enhancing NCD surveillance and monitoring. Despite the government’s efforts, efforts to manage NCDs focus on screening, monitoring, treatment, and referral rather than prevention. The primary health care system in India is designed to screen a large number of people for diabetes and hypertension and send them for clinical care and treatment.
While screening and testing for NCDs is necessary, it is a time-consuming and expensive process. Given the numbers—roughly 136 million individuals in India are pre-diabetic, and more than half are unaware of their diabetes status—it is practically difficult to focus solely on therapy as a means of resolving the situation. As a result, it is critical to address the condition with prevention-focused therapies based on behavioral change that support lifestyle changes and the adoption of healthy habits.
This article is based on our learnings from our work on NCD prevention in India, and highlights how programmes can reach the required scale with tech-based interventions and through collaborations among various stakeholders.
1. Take prevention to the doorstep
Early detection and prevention of NCDs is key to controlling them. However, many people still view them as diseases that only affect the elderly and may not even get tested for NCDs such as hypertension and diabetes. It is crucial, therefore, to spread awareness about NCDs and why they need to be taken seriously, as well as educate individuals on healthy behaviors that they can adopt to prevent them. This makes it necessary to take NCD prevention interventions to where the people are—schools, homes, and workplaces.
Keeping this in mind, we launched the MyThali programme to promote healthy dietary choices among urban women, who are more prone to diabetes. Based on the success of MyPlate by the US Department of Agriculture, we translated India’s National Institute of Nutrition guidelines into an easy-to-follow image that we then disseminated through social media. We engaged with micro-influencers in the health and nutrition, lifestyle, food and travel space in order to reach urban women looking for nutrition advice from credible sources. Another reason for collaborating with influencers was to make healthy eating aspirational and accessible while simultaneously increasing awareness about it to prevent lifestyle diseases.
2. Intervene early
Many NCDs have their origin in childhood, and are shaped by lifestyle and environmental factors. According to a study by the Indian Council of Medical Research, the prevalence of diabetes and pre-diabetes among adolescents in India ranges from 12.5 percent to 14.5 percent. The study also found obesity to be a major risk factor for diabetes among adolescents. Research shows that urban adolescents are more likely to suffer from NCDs than rural adolescents, mainly due to lifestyle factors such as physical inactivity, unhealthy diets, and excessive screen time. Adolescents from lower socio-economic groups are also at a higher risk of NCDs, as they have limited access to healthcare services, education, and information on healthy lifestyles.
Teachers can use peer-led group discussions, age-appropriate, compelling games, and activities to teach adolescents good lifestyle habits. Therefore, intervening in the early adolescent years becomes crucial to encouraging healthy habit formation and lifestyles for the future. In 2011, based on the school education model for tobacco control, we developed a two-year school-based program for diabetes awareness and prevention. Through a network of teachers and student peer leaders, the program aimed to educate 11–14-year-olds about the benefits of increasing physical activity and improving dietary intake.
We used peer-led group discussions as well as age-appropriate, compelling games and activities to teach adolescents good lifestyle habits. For example, in classrooms, we used the game of snakes and ladders to explain the difference between healthy and unhealthy dietary choices, representing a bag of chips by a ‘snake’ and eating fruits and vegetables with a ‘ladder’.
We realized though that it was first important to build awareness among teachers in schools. For this, we worked with various partners such as CINI and SRU Innovations to conduct workshops and learning sessions about NCDs with teachers. We encouraged the teachers to carry out these games with children in classrooms and integrate the messaging of healthy eating habits and physical activity through their teaching.
3. Collaborate with multiple stakeholders
To enable the prevention of NCDs in a country as large as India, one must design programs keeping scale in mind. A gamut of knowledge, research, and learnings already exists in the form of public and private organizations that work on NCD screening, prevention, and management. These include the Public Health Foundation of India, Madras Diabetes Research Foundation, Indian Council of Medical Research, All India Institute of Medical Sciences, PATH, and The George Institute. Collaboration and coordination among these organizations is essential to maximize resources and impact.
Nonprofits can leverage the networks of NCD organizations to share knowledge, expertise, and resources, and to develop and implement joint program and initiatives. This also helps in bridging the trust deficit communities may have when approached by a new organization.
For example, for the MyThali program, which PATH—a nonprofit focused on improving health equity in the country—originally developed for urban women, we partnered with them to adapt it for rural adolescent girls. PATH brought in stakeholders—from policymakers to nutrition experts—to deliberate on core elements of the existing programs content and tweak it for adolescent girls. Using this information, we developed an eight-page comic book and activity booklet, and then disseminated them across schools we were working with.
4. Leverage technology effectively
Technology not only allows for programs to reach otherwise isolated locations, but also permits the continuous circulation of knowledge. Using technology such as text messages can be an important means of enabling behavior change. As part of our mDiabetes program (a text/voice-message-based diabetes prevention program), the team sent 56 messages twice a week for 6 months to more than one million people.
The organization focused on informing about diabetes and its prevention, sending these messages in 12 different languages, including English, Hindi, Kannada, and Tamil. The content of the messages was developed with the objective of highlighting the benefits of adopting healthy lifestyles and nudging for behavior change, such as eating two to three fruits and vegetables a day, avoiding fried food, and increasing physical activity.
When it comes to imagining a future without NCDs, interventions that focus on prevention are key. And in order to address the problem at scale, coordinated and collective efforts are essential, wherein all stakeholders work together to build an environment conducive to healthy living for the population at large.
