Noncommunicable diseases surveillance in India – Lessons, challenges, and future roadmap

ABSTRACT The rising burden of noncommunicable diseases (NCDs) in India requires a holistic approach to disease control efforts. This review synthesizes evidence from articles, government reports, policy briefs, and guidelines to describe lessons learnt, challenges in surveillance, and propose a comprehensive framework for surveillance. Nationwide surveys have been periodic, expensive, time-consuming exercises generating evidence on four main risk factors (unhealthy diet, inadequate physical activity, and alcohol and tobacco use) and on major NCDs (cancer, cardiovascular diseases, diabetes, and chronic respiratory diseases). Although the country has demonstrated capacity in conducting surveys, registries, and risk factor assessments, there has been no cohesive linking of such information to action and evaluation to complete the surveillance cycle. Many of the surveys do not reflect state or district-level patterns that can enable better health planning. India lacks a systematic ongoing NCD surveillance system, even though there is a huge demand for it in the context of the rising NCD burden. The challenge is that no single model of surveillance can assess the interconnected risk factors, their social, commercial, and health system drivers, and NCD morbidity and mortality. A well-defined policy for institutionalizing NCD surveillance with well-defined objectives, standard methods, definitions, risk factors, health conditions, and health system response is the need of the hour. An exposome framework of endogenous and exogenous lifetime exposures and health effects monitoring can be instituted through a combination of active and passive models, digital data, a whole-of-society and whole-of-government approach. These shall support NCD surveillance and guide NCD prevention and control efforts.