The White Paper titled "Control of NCDs Through Primary and Preventive Healthcare"by Bain & Company presented at "The Future of Healthcare: A Collective Vision" Conference at Delhi (March 3-4, 2014) notes that the global burden from non-communicable diseases (NCDs) is significant and rising at a rapid pace. Low- and middle-income countries like India share a disproportionate 80% of the NCD mortality burden. India alone accounts for 17% of global deaths due to NCDs and 24% of disability-adjusted life years (DALYs).

Globally, NCDs are estimated to account for nearly 75% of all deaths in the world and will cost the world GDP an estimated US$47 trillion by 2030.[2]This high burden poses a substantial threat to India's socioeconomic development, with a potential loss of US$6.2 trillion by 2030-nearly 3.5 times our current GDP.

"India has a narrow-and closing-window of opportunity to shape its health and care eco-system to cope with a tsunami of non-communicable diseases (NCDs) and it must seize this opportunity to shift the focus from sickness to wellness and prevention and create a culture of healthier living" said Karan Singh, Bain & Company's Asia-Pacific Healthcare practice head and main author of the report.

India has a narrow window of opportunity to act quickly, through a joint effort of government and relevant stakeholders, to protect the health of current and future generations. Now is an opportune time as healthcare systems are still being defined (role of government, evolving regulations, citizens' right to health, use of technology in health, etc.), and new models of service delivery are being explored.

"The negative consequences of not doing so are significant and unaffordable as it will cost us over $6 trillion between now and 2030 - about 3.5 times current GDP", Singh said.

However, addressing NCDs will be a complex and difficult task. It will require multifaceted solutions involving a range of stakeholders across government, private sector, community and the individual. The solutions have to address underlying root causes but, more importantly, ensure a behaviour and mindset change among individuals and caregivers - one that inspires a shift from the current paradigm focusing on a care/sickness model to focusing on and creating a culture of health/wellness.

"Addressing the NCD challenge will require a disproportionate focus on prevention and change behavior of individuals, patients and caregivers. The NCD solution must be holistic - impacting several levers to create healthy living - and must involve multiple stakeholders including government, private hospital chains, educational institutes, consumer product/IT companies, medical device manufacturers and NGOs. All these stakeholders will have to collaborate and define new and innovative business models," said Bain's Singh.

Global experience with NCD control, especially in developed markets, has demonstrated that interventions aimed at prevention and early diagnosis are the most cost effective, giving the highest return on investment (ROI). There is clear evidence linking reductions in cardiovascular- and diabetes-related morbidity and mortality to a focus on high-ROI interventions such as large-scale awareness campaigns, lifestyle interventions, screening programmes, and medication for high-risk groups.

It is critical to recognize that many risk factors for NCDs (unhealthy diet, physical inactivity, tobacco use, harmful use of alcohol) are controllable with the right individual actions.The challenge for India is to create a mindset where healthy living is seen as an essential investment rather than a cost by individuals. This will also mean influencing individual daily decision-making so that people make healthy choices by understanding the consequences of short-term pleasure on the longer-term impact on health. Focusing on education/awareness, alignment of incentives and creating effective feedback loops will be critical in achieving this behaviour change.

To achieve this goal, multiple stakeholders need to collaborate in developing a holistic and sustainable healthcare system. The government, given its key position, will have a pivotal role in defining the vision and overall framework; rolling out public health initiatives that target behavioural and physiological risk factors; using its convening power to enable multi-sectoral, multi-stakeholder action; and ensuring that the needs of underserved areas/communities are addressed.

"Beyond the government, it is critical that other stakeholders including healthcare players (providers, payers, product suppliers), relevant non-healthcare companies (in consumer goods, technology, telecom, IT, education), and community organizations come together to drive collective action. Attempts must be made to test new approaches (by using/localizing global experiments and developing new ones), as well as to plan for scalability of successful efforts," mentions the white paper.