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For decades, public health in India has been dominated by infectious diseases like tuberculosis, diarrhoea, pneumonia, which were also the scourges of underdevelopment. But a new Global Burden of Disease (GBD) report launched at the World Health Summit, Berlin, by reveals a deep transformation: By 2023, deaths from chronic non-communicable diseases (NCDs) now form the majority in India. As the country witnesses rising rates of heart disease, chronic lung disease and stroke, the profile of disease burden is shifting, with implications for policy, healthcare investment and individual risk prevention. According to the report, while in 1990 diarrhoeal diseases held the top spot in mortality with an age-standardised mortality rate (ASMR) of 300.53 per lakh, in 2023 ischaemic heart disease leads with an ASMR of 127.82 per lakh. COPD is the second leading cause, with ASMR of 99.25 per lakh, followed by stroke (92.88 per lakh). Meanwhile, causes such as COVID-19, which dominated in 2021, have dropped to the 20th position in the ranking of causes of death. This shift matters deeply. When disease burden moves from acute infections to chronic, lifestyle-related illnesses, the nature of prevention, healthcare delivery and long-term care changes. What The Study Shows: Numbers, Rankings And Trends Here are some key takeaways from the new Lancet Global Burden of Diseases study:

• The GBD report, built by a large international collaboration of over 16,500 researchers, finds that non-communicable diseases now account for nearly two-thirds of deaths globally, and the same holds true for India.
• By 2023, ischaemic heart disease has become the top cause of death, ASMR of roughly 127.82 per lakh.
• COPD (Chronic Obstructive Pulmonary Disease) is now second (ASMR 99.25 per lakh).
• Stroke rounds out the top three (ASMR of around 92.88 per lakh)
• Infectious diseases like lower respiratory infections, diarrhoeal diseases, neonatal disorders occupy much lower ranks now
• The all-cause mortality rate (ASMR) has declined from 1,513 per lakh in 1990 to 871 per lakh in 2023, meaning overall fewer people are dying per population, but the cause profile has changed.
• Life expectancy in India has increased by about 13 years in the same period (from around 58.5 years to 71.6 years) for both sexes combined.

Also notable is the fact that, between 2010 and 2019, while many countries saw declines in chronic disease mortality, India bucked the trend and deaths from NCDs rose. The risk of dying from chronic disease before age 80 actually increased for both men and women in India during that time. Women, in particular, saw a sharper rise in NCD death risk than men. Implications For India's Health Agenda This epidemiological pivot demands a reorientation in India's health policy in the following ways: 1. Strengthening primary health systems for early detection of hypertension, diabetes, cancers, and chronic lung diseases. 2. Scaling preventive interventions like tobacco cessation, diet, physical activity, air pollution control. 3. Integrating chronic care models and long-term management, including patient follow-up and care continuity. 4. Equity focus ensuring that rural, poor, and marginalized groups have access to NCD prevention and care. 5. Data systems and monitoring refining cause-of-death reporting, subnational surveillance, risk factor tracking. 6. Policy realignment with shifting funding, resources and training from infectious disease dominance to a more balanced portfolio As India marks its healthcare milestones and moves toward its goals for 2047, achieving progress on NCDs will be central to reducing avoidable mortality and enhancing healthy lifespan. India's health landscape has undergone a silent but sweeping transformation. The era of infectious diseases dominating mortality is giving way to chronic, lifestyle-linked illnesses as the chief killers. While overall death rates have come down and life expectancy has risen, the nature of threats has shifted, and with it, the strategies required to combat them. If India is to win the next stage of the health challenge, it will need to pivot from reactive disease control to proactive prevention, from episodic care to lifelong disease management, and from fragmented programmes to integrative health systems. The clock is ticking, not just for India's future health, but for current generations facing mounting risks from conditions once considered diseases of affluence.

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