- Five conditions dominate: diabetes, high blood pressure and heart disease, TB, tobacco- and infection-linked cancers, and anaemia.
- India's age-adjusted diabetes rate (10.5%) is below the world average and the US[1]; the problem is risk at lower body weight[2] and late diagnosis[3].
- India has a quarter of the world's TB[4].
- Air pollution (21 lakh deaths in 2021[5]) and untreated mental illness (70–92% treatment gap[6]) add two more large burdens.
- Countries that do better find people early, treat simply and follow up.
The Five, Side by Side
| Condition | India's burden | Main reasons | Who does better, and how |
|---|---|---|---|
| Diabetes | 8.98 crore adults; 43% undiagnosed[3] | Risk at lower body weight, carbohydrate-heavy diet, late diagnosis | Netherlands, Sweden, France, UK: lower prevalence; lifestyle programmes cut new cases by 58% in trials[7] |
| High blood pressure and heart disease | 31.5 crore with high blood pressure[8]; heart disease causes 31% of deaths[9] | Undiagnosed, untreated, or treated but not controlled | South Korea, Canada, Iceland: more than half controlled[10] |
| Tuberculosis | 27.1 lakh cases and more than 3 lakh deaths in 2024; 25% of the world's cases[11] | Undernutrition, diabetes, smoking, alcohol, HIV, crowding | United States: 3.1 cases per lakh people[12] |
| Tobacco and infection-linked cancers | 26.68 crore tobacco users[13]; oral and cervical cancer among the most common | Smokeless tobacco; HPV without vaccination or screening | Australia: on track to eliminate cervical cancer by 2035[14] |
| Anaemia | 67.1% of young children, 57% of women[15] | Iron deficiency, diet, worms, and other causes | Rose between the last two national surveys, so India's own programme matters most |
Diabetes
The ICMR-INDIAB study, using its own survey and definitions, estimated 10.1 crore people with diabetes and another 13.6 crore with prediabetes[8]. The two estimates differ in method and age range; both say the same thing about scale.
Is India's Diabetes Rate Unusually High?
Not compared with other large countries. Once ages are adjusted so countries can be compared fairly, India's rate is below the world average and below the United States'. Several European countries are much lower.
Why Pakistan Is Highest
Pakistan has the world's highest adult diabetes rate. Its doctors and policy researchers point to sedentary lives (41.4% of people, and 53.7% of women, miss WHO activity guidelines), carbohydrate- and sugar-heavy diets, no control of free sugars or industrial trans fats, fast urbanisation, and genetic risk deepened by marriage between close relatives; more than a third of cases are undiagnosed[16]. Several of these apply to parts of India too.
Why India's Problem Is Still Serious
- BODYRisk at lower weightA South Asian at BMI 23.9 has the diabetes risk of a white person at BMI 30
- DIETCarbohydrate-heavy62% of calories from carbohydrates; refined cereals and added sugar raise the odds
- DETECTIONFound late43% do not know they have it
- RESULTDamage before diagnosisHeart, kidney, eye and nerve damage can start before treatment does
- Body type. Standard obesity cut-offs miss South Asians. In England, the diabetes risk a white adult has at a BMI of 30 is reached by South Asian adults at 23.9[2]. Many Indians who look slim are at risk.
- Diet. Indians get 62% of their calories from carbohydrates and about 12% from protein. Refined cereals were linked to 13% higher odds of diabetes, and added sugar to 14% higher odds; added sugar exceeded the national limit of 5% of calories in 21 states and union territories[17]. It is not only sugar: white rice and refined wheat matter as much.
- Late diagnosis. Nearly half of people with diabetes have not been diagnosed[3].
What Works, with Evidence
| Measure | Where | Result |
|---|---|---|
| Intensive lifestyle programme for people at high risk | Finland (2001) and the United States (2002) | 58% fewer new cases of diabetes in both trials[7] |
| Tax on sugary soft drinks | United Kingdom, from April 2018 | Manufacturers cut sugar: drinks liable for the levy fell from 52% to 15% of eligible drinks[18] |
| Screening everyone over 30 and standard treatment | India, NP-NCD and the 75 by 25 initiative | 2.53 crore people with diabetes on treatment under the initiative[19] |
High Blood Pressure and Heart Disease
Cardiovascular disease causes 31% of all deaths in India, more than any other cause[9]. High blood pressure is its biggest driver, and 31.5 crore Indians have it[8]. The problem is rarely the medicine; cheap, effective tablets exist. The problem is the chain from diagnosis to lasting control.
What the Best Countries and India's Best Districts Do
- Find people. Worldwide in 2019, 41% of women and 51% of men with high blood pressure had not been diagnosed[10].
- Treat by a simple protocol. India's Hypertension Control Initiative uses a fixed drug-and-dose protocol, free medicines and care close to home. In its districts, control rose from 37% to 48%, and the share of patients paying for medicines fell from 47% to 9%[20].
- Keep them on treatment. Under the 75 by 25 initiative, 4.20 crore people with high blood pressure were on standard treatment[19].
Countries That Cut Heart Disease Deaths, and How
| Where | What they changed | Result |
|---|---|---|
| North Karelia, Finland (from 1972) | Less butter and fatty dairy, more vegetables; community blood-pressure screening and a hypertension register with nurse clinics; salt reduction with food companies; tobacco law and quit programmes | Coronary deaths in the middle-aged fell 84% by 2014; about two-thirds of the fall came from risk-factor change[21] |
| England (2003–2011) | Salt targets for processed food | Salt intake down 15% (9.5 to 8.1 g a day); blood pressure down 3/1.4 mm Hg; stroke deaths down 42% and heart disease deaths down 40% over the period, not all due to salt[22] |
India's Own Levers
| Risk | Where India is | What is being done |
|---|---|---|
| Salt | About 11 g a day, 2.2 times the WHO limit of 5 g[23] | ICMR's Project Namak is testing low-sodium salt in Punjab and Telangana[23] |
| Tobacco | Adult use fell from 34.6% (2009–10) to 28.6% (2016–17); smoking from 14.4% to 10.7%[24] | Tobacco control laws and warnings; smokeless tobacco remains the larger problem |
| Trans fat | Industrial trans fat was allowed up to 5% of oils and fats | Capped at 2% from 1 January 2022[25] |
| Diet | 62% of calories from carbohydrates; added sugar above guideline in 21 states[17] | Guidance only so far |
Control depends on follow-up: the next doctor must know the dose that was working. That is a record problem.
Tuberculosis
Why TB Stays High in India
WHO names five drivers of TB: undernutrition, HIV, diabetes, smoking and alcohol use disorders[4]. India has all five at scale, along with crowded housing that spreads infection. In the United States, 77% of cases are in people born abroad, and the rate among US-born people is 0.8 per lakh[12]: where nutrition and housing are good and cases are found fast, TB nearly disappears.
What Works
| Measure | Evidence or status |
|---|---|
| Food for patients and their families | The RATIONS trial in Jharkhand gave households monthly rice and pulses: TB among family contacts fell by about 40%, and by nearly 50% for infectious TB[26] |
| Cash support during treatment | Ni-kshay Poshan Yojana raised support to ₹1,000 a month for all TB patients in 2024, with extra nutrition for about 12 lakh underweight patients[27] |
| Finding and treating every case | Treatment coverage rose from 53% to 92% between 2015 and 2024[11] |
Cancers Driven by Tobacco and Infection
India has far fewer new cancers per person than Denmark or Australia (about 98 against 350 per lakh, age-adjusted)[28], yet about 3 in 5 Indians diagnosed with cancer die of it[29], and India's cancer death rate rose about 21% between 1990 and 2023 while the world's fell[30]. The difference is late diagnosis: only 1.9% of Indian women have ever been screened for cervical cancer[31]. How other countries changed this.
Tobacco and Oral Cancer
Cervical Cancer: A Cancer That Can Be Eliminated
Cervical cancer is caused by HPV infection, so it can be prevented by vaccination and caught early by screening. Australia began HPV vaccination in 2007, moved to HPV-based screening, recorded no cervical cancer in women under 25 in 2021, and is on track to eliminate the disease as a public health problem by 2035. Even there, vaccination coverage has slipped to just under 80% and screening participation is falling[14].
India began a nationwide single-dose HPV vaccination drive for 14-year-old girls in 2026, aiming to reach the 1.15 crore girls who turn 14 each year. Ministry officials cite nearly 80,000 new cases and more than 42,000 deaths a year[33].
Anaemia
| Group | NFHS-4 (2015–16) | NFHS-5 (2019–21) |
|---|---|---|
| Children, 6 to 59 months | 58.6% | 67.1% |
| Women, 15 to 49 | 53.1% | 57.0% |
| Pregnant women | 50.4% | 52.2% |
| Men, 15 to 49 | 22.7% | 25.0% |
Source: National Family Health Survey[15]. Anaemia rose in every group between the two surveys.
India's Anaemia Mukt Bharat programme, launched in 2018, combines six interventions for six age groups: iron and folic acid supplements, deworming, year-round behaviour change, digital testing and treatment, fortified foods in government programmes, and treatment of non-nutritional causes where they are common[34]. Anaemia in pregnancy raises the risk of bleeding and of low birth weight, which is why a mother's haemoglobin belongs in her record.
Two More Large Burdens: Air Pollution and Mental Health
Air Pollution
Air pollution is not a disease but a risk factor behind heart disease, stroke, lung disease and childhood pneumonia. Fine particles from burning fossil fuels and biomass cause most of the harm[5]. For a doctor, the useful record is the patient's exposure (cooking fuel, occupation) alongside the diagnosis.
Mental Health
Mental illness can first appear in a general clinic as headache, sleeplessness or body pain. A record that shows the pattern across visits helps the doctor recognise it.
The Common Thread
- 1PreventDiet, tobacco control, vaccination, nutrition
- 2Find earlyScreening; nearly half of diabetes is undiagnosed
- 3Treat simplyStandard protocols and free medicines
- 4Follow upThe next doctor knows what was tried and what worked
India already runs serious programmes for every one of these conditions. Where they work, it is because each patient is found, treated and followed up. Follow-up is where a missing record does the most damage, and it is the step 1Heath is built for: a record written at every visit, from the conversation, that the next doctor can see.
Sources
- International Diabetes Federation. Diabetes Atlas, age-adjusted comparative prevalence of diabetes (20 to 79 years), 2024. diabetesatlas.org
- Caleyachetty R, et al. Ethnicity-specific BMI cutoffs for obesity based on type 2 diabetes risk in England. Lancet Diabetes and Endocrinology, 2021 (University of Warwick release). warwick.ac.uk
- IDF Diabetes Atlas, 11th edition (2025): key takeaways for India, as reported by Medical Dialogues. medicaldialogues.in
- WHO Global Tuberculosis Report 2025: country shares and risk factors, as reported by Business Standard, November 2025. business-standard.com
- State of Global Air 2024 report, as reported by The Tribune, June 2024. tribuneindia.com
- National Mental Health Survey 2015-16, as cited in the Economic Survey 2023-24 (Asianet Newsable). newsable.asianetnews.com
- Finnish Diabetes Prevention Study (NEJM 2001) and US Diabetes Prevention Program (NEJM 2002), summary by Wiki Journal Club. wikijournalclub.org
- ICMR-INDIAB study group. Metabolic non-communicable disease health report of India: the ICMR-INDIAB national cross-sectional study. Lancet Diabetes and Endocrinology, 2023. Figures as reported by M3 India. m3india.in
- Office of the Registrar General of India. Sample Registration System, Causes of Death 2021 to 2023, as reported by Business Standard, 5 September 2025. business-standard.com
- NCD Risk Factor Collaboration. Worldwide trends in hypertension prevalence and progress in treatment and control, The Lancet, 2021 (Luxembourg Institute of Health summary). lih.lu
- WHO Global Tuberculosis Report 2025: India figures, as reported by Medical Dialogues. health.medicaldialogues.in
- US Centers for Disease Control and Prevention. Tuberculosis surveillance report 2024: executive commentary. cdc.gov
- Global Adult Tobacco Survey 2 (GATS-2), India 2016-17: fact sheet. nhm.uk.gov.in
- University of Sydney. Australia on track to eliminating cervical cancer, 20 November 2025. sydney.edu.au
- National Family Health Survey 5 (2019-21) anaemia results, as reported by Down To Earth. downtoearth.org.in
- Health Policy Watch. Pakistan has the world's highest diabetes prevalence and lacks focus on prevention. healthpolicy-watch.news
- ICMR-INDIAB diet study, Nature Medicine, 30 September 2025, as reported by Down To Earth. downtoearth.org.in
- Scarborough P, et al. Impact of the UK Soft Drinks Industry Levy on soft drink sugar content. PLoS Medicine, 2020 (University of Warwick release). warwick.ac.uk
- Rajya Sabha reply on the 75 by 25 initiative, as reported by Medical Dialogues, 2025. health.medicaldialogues.in
- Resolve to Save Lives. Evidence from India demonstrates progress in hypertension control (India Hypertension Control Initiative). resolvetosavelives.org
- The North Karelia Project: cardiovascular disease prevention in Finland (review, PMC). pmc.ncbi.nlm.nih.gov
- He FJ, Pombo-Rodrigues S, MacGregor GA. Salt reduction in England from 2003 to 2011. BMJ Open, 2014 (MedicalResearch.com summary). medicalresearch.com
- ICMR-National Institute of Epidemiology on salt intake and Project Namak, Medical Dialogues, July 2025. health.medicaldialogues.in
- GATS-1 (2009-10) and GATS-2 (2016-17) comparison, Governance Now. governancenow.com
- FSSAI caps trans fatty acids in food to 2 per cent by 2022, Outlook Business. outlookbusiness.com
- RATIONS trial (The Lancet, 2023), as reported by Telangana Today. telanganatoday.com
- The Tribune. Health Ministry enhances monthly support for TB patients, October 2024. tribuneindia.com
- World Cancer Research Fund. Global cancer data by country (GLOBOCAN 2022 age-standardised rates). wcrf.org
- ICMR study in Lancet Regional Health Southeast Asia, February 2025, as reported by Medical Dialogues. medicaldialogues.in
- GBD Cancer Collaborators, The Lancet, 25 September 2025, as reported by ThePrint. theprint.in
- National Family Health Survey 5 (2019-21) cancer screening, as reported by ThePrint. theprint.in
- The Wire. Over 14 lakh new cancer cases and 9 lakh deaths in India in 2022: WHO (GLOBOCAN 2022). thewire.in
- ThePrint. Centre's HPV vaccine drive for 14-year-old girls, 25 February 2026. theprint.in
- The Week. Anaemia Mukt Bharat: how India fights anaemia, 24 April 2025. theweek.in