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SYMBIOSIS INTERNATIONAL UNIVERSITY (PUNE)
In Partial Fulfilment of Bachelor of Science in Economics Degree
(BSc. in Economics)
Under the guidance of:
Ms Ishita Ghosh
Assistant Professor, Symbiosis School of Economics
NCDs: Non-Communicable Diseases
WHO- World Health Organisation
CVD: Cardio Vascular Disease
CHD: Coronary Heart Disease
COPD: Chronic Obstructive Pulmonary Disease
Lifestyle Diseases: Issues and Challenges with a Specific Focus to India
The colossal advancements in science & technology in the 21st century have not only made us immensely dependent on mechanized gadgets but also ensured that our physical activity gets restricted to a minimal level. Moreover, our modern lifestyle is typically deskbound, tending towards untimely working hours, inadequate rest and unhealthy food habits.
This sedentary lifestyle ensures that we fall prey to lifestyle diseases.
Naturally, it is agreed that the human body system can develop internal failures making the person to feel unwell. However, these internal problems may take a longer duration. A chronic illness is when a body develops internal problems or failures
that may last for an extended period of time. That is to say that the patient lives with the illness for a very long time. As a result, it is generally accepted that chronic illness have
various effects on the life of the person diagnosed with the disease together with those close to them. This essay focuses on the impact of chronic diseases on the individual, the family and also the economic status of a country
Non-communicable diseases or lifestyle diseases as they are commonly termed characterize those diseases whose occurrence is primarily based on the daily habits of people and are a result of an incongruous relationship of people with their environment.
Bearing in mind the impact of chronic illness on the patient, it is necessary to point out that these impact also extend to the patient's family. To be more precise, when one member of a family is chronically ill, the family members are also directly affected
. We can see this through a number of examples
. Financial burden is one of the devastating impact of chronic illness on the family. since seeking of medical attention of a chronic d disease is costly, the family is forced to take care of the hospital bills. Financial matters together with normal family activities and relationship with a person's family
members are directly impacted because of the medical costs and the resources spent on the ill person. More also, the family member with chronic illness is
given a lot of attention than the other family members. As a result, the other family members feel jealous and consequently the relationship between the family members is altered.
The key factors responsible for lifestyle diseases include wrong food habits coupled with increased smoking and alcohol consumption, physical inactivity, obesity, raised blood sugar, raised cholesterol level, wrong body posture and disturbed biological clock.
To summarize, a chronic illness is a disease that can last for an extended time and has no cure. chronic diseases have various impacts on the individual, the family and also the economic status of a country. Evidently, a person with a chronic illness
experiences stress due to isolation by peers. Again, the family members are also impacted by the chronic illness. This can be illustrated by the financial burdens caused by the hospital bills. Lastly, the economic status of a
nation may be affected too. The resources put in place to curb chronic diseases bear
no fruits making the economy.
According to the World Health Organisation (WHO), non-communicable ailments are gradually replacing communicable diseases like diarrhoea, tuberculosis.
Lifestyle diseases have been recognized as a clear threat not only to human health, but also to the development and economic growth in many countries.
Non-infectious, or non-communicable diseases are caused b malfunctions of the body. These include organ or tissue degeneration, erratic cell growth, and faulty blood formation and flow. Also included are disturbances of the stomach and intestine, the endocrine system, and the urinary and reproductive systems. Some diseases are be caused by diet deficiencies, lapses in the body’s defense system, or a poorly operating nervous system.
People’s disposable income has increased due to improvement and expansion in employment opportunities. However, this enhancement in the standard of living has increased expenditure on health due to adoption of faulty habits and schedules; so the contribution to the national income on the whole stands meagre.
A disease is a condition that impairs the proper function of the body or of one of its parts. Every living thing, both plants and animals, can succumb to disease. Hundreds of different diseases exist.
The number of individuals suffering from these diseases has been on a steady rise. These diseases which have been responsible for 63% of all deaths worldwide are now attributed to be the leading cause of mortality in the world.
Infectious disease are caued by various agents such as virus, bacteria, fungi and protozoa. (a) Disease caused by Bacteria : Cholera, Diphtheria, Tuberculosis, Leprosy, Tetanus, Typhoid, Plague, Whooping Cough, Sore Throat, Pneumonia, Bacillar Dysentery, Gonorrhea, Syphilis and Botulism. (b) Diseases caused by Viruses : Chickenpox, Measles, Poliomyelitis, Rabies, Mumphs, Influenza
, Hepatitis, Herpes, Viral Encephalitis and AIDS. (c) Diseases caused by Fungi : Ringworm, Athelet’s fott, Dhobie itch. (D) Diseases caused by protozoans: Amoebiasis, Malaria, Sleeping sickness, Kalaazar, Diarrhoea, (e) Diseases caused by Helminthes or Worms: Filaria, Tapeworm and Hookworm transmission.
The fact that around 80% of these deaths occurred in low and middle-income countries like India which are also crippled by an ever increasing burden of infectious diseases, poor maternal and prenatal conditions and nutritional
deficiencies, is definitely a
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Almost 50 % of those who die of chronic non-communicable diseases are in the prime of their productive years, and thus, consequently industry competitiveness is being imperilled.
In case of India the statistics are even more alarming.
Moderate static work might produce localized fatigue in the muscle involved and could lead to intolerable pain. As for excessive effort or work (could be static or dynamic) repeated over a period of time could lead to light pain initially and then to intense aches and pains. It is not only involving muscle but could affect joints
, tendon, ligament and other tissues. Thus, long lasting and often repeated efforts can lead to damage of joints, ligaments and tendons. These impairments are usually categorized under the term musculoskeletal disorders (MSDs). MSDs develop over time; the process evolves
gradually with the repeated overuse and lack of recovery. Sudden appearances of injury such as torn ligament or a sprain is not musculoskeletal disorders associated with
repetitive work and clearly work related accident
In India, 23.10 per cent men and 22.60 per cent women over 25 years old suffer from hypertension, says the World Health Organisation’s ‘global health statistics 2012’. The country as a whole is home to 25-30 million diabetic patients.
Infectious, or communicable, diseases are those that can be passed between persons such as by means of airborne droplets from a cough or sneeze. Tiny organisms such as viruses, bacteria, fungi and worms can produce infectious
diseases. Whatever the causative agent, it services in the person it infects and is passed on to another. Sometimes, a disease-producing organism gets into a person who shows no symptoms of the disease. The asymptomatic career can then pass the disease on to someone else without even knowing he has it.
Moreover, increased blood pressure which is a high-risk condition causes approximately 51 per cent deaths from stroke and 45 per cent from coronary artery disease in India.
According to the World Health Organisation Department of Health Statistics and Informatics, by 2030, non-communicable conditions are expected to cause more than three-fourths of all deaths; almost one-third of all deaths will result from cancer, heart disease and traffic accidents.
Deficiency diseases are due to deficiency in the diet of a nutrient. They can generally be cured by providing the missing nutrients. (a) Protein deficiently causes two major diseases kwashiorkor and Marasmus. (b) Mineral deficiency causes specific diseases. (i) Anaemia : Iron deficiency causes hemoglobin deficiency in blood. (ii) Goitre : iodine deficiency causing no synthesis of thyrozine hormone of thyroid gland). (iii) Hypokalemia : (potassium deficiency). (iv) Hyponatremia : (sodium causes this state of low blood pressure and loss of body weight. (c) Vitamin deficiency causes a variety of disease. (i) Night Blindness: (Vitamin A). (iv) Beri-beri: (Vitamin B0thiamine). (v) Ariboflavinosis : (Vitamin B0riboflavin) (vi) Pellagra: (nicotinic acid / niacin-part of B complex group
). (vii) Pemicious Anaemia: (Vitamin C - ascorbic acid). (ix) Rickets : (a disease causing disorder of calcium and phosphorus metabolism due to Vitamin D deficiency, often found in the early childhood: 60 months and 2 years. (x) Ostemalacia: (Vitamin D)
Keeping in mind the above data, one can gauge the impact of such ailments on the health sector by and large. The growing threat of non-communicable diseases can however be combated with existing knowledge and comprehensive and cohesive actions at country level
, led by national governments
Besides that, other consequences of MSDs on the victims must be considered also. Such as physical and mental suffering, loss of quality of life, temporary and permanent limitation in work and daily routine activities, financial problem
, relationship problems, difficulties in social life and many more. These consequences have been overlooked.
BACKGROUND ON NON-COMMUNICABLE DISEASES
Our knowledge had always been restricted to the conventional infectious diseases only till we realized recently that much of the health disorders are linked to the choices that people make in their day to day life. NCDs are defined as diseases of long duration, generally slow progression and major cause of adult mortality and morbidity worldwide in the current scenario (WHO, 2005a  ). The four dominant diseases in this respect are considered to be cardiovascular diseases (including heart disease and stroke), diabetes, cancer and chronic respiratory diseases (including chronic obstructive pulmonary disease and asthma). Common, avertable risk factors underlie most of these diseases.
It is important to note that a combination of modifiable and non-modifiable risk factors have been responsible for the rampant spread of non-communicable diseases. The non-modifiable risk factors basically comprise of those characteristics that are inherent (age, sex, genes) and cannot be altered due to individual (or environment) efforts. Although they might not be the prime determinants in the spread of lifestyle diseases yet they define the effectiveness of many prevention and treatment approaches.
On the other front we have the modifiable risk factors which can be transformed by the societies or individuals thereby ensuring amended health outcomes.
Every disease has a cause, although the accuses of some remain to be discovered. Every disease also displays a cycle of onset, or beginning, course, or time span of affection, and end, when it disappears or it partially disables or kills its victim. An epidemic diseases one that strikes many persons in a community
. When it strikes the same region year after year it is an endemic disease. An acute disease has a quick onset and runs a short course. A chronic disease has a
slow onset and runs a sometimes years-long course. The gradual onset and long course of rheumatic fever makes it a chronic ailment.
Poor diets, physical inactivity, tobacco use, have been typically highlighted as the prime causes of lifestyle diseases by World Health Organisation.
Poor diet and physical inactivity
Fixed lifestyles, long working hours, demanding jobs have transformed the eating habits of people to a great extent. The composition of human diets has changed considerably over time, with high demand for readily available pre-cooked food. These foods are found to be ominously high in sugar, salt, unhealthy fats and lack adequate nutrition.
This spread of the fast food culture has resulted in the increased spread of obesity worldwide and has led some people to coin this as an emerging threat.
The factors that contribute to the risk of MSDs are called risk factors. A risk factor is something that may cause or contribute to an injury. Two or more risk factors can be present at one time, increasing the risk of injury.
As a result of the above factors obesity and overweight are spreading as "globesity"  epidemic.
Tobacco and Alcohol
Tobacco accounts for 30% of cancers globally, and the annual economic burden of tobacco-related illnesses surpasses total annual health expenditures in low- and middle-income countries  .
High rates of tobacco use are likely to double the number of tobacco-related deaths between 2010 and 2030 in low- and middle-income countries unless adequate measures are taken now.
As for Malaysia scenario of MSDs, there has been increase of reported cases of MSDs. Figure below shows the distribution of total number of cases of MSDs reported to Social Security Organization (SOCSO) of Malaysia from year 1995 to 2012.
There are likely to be 6.8 million deaths in 2030 due to tobacco usage  .
Alcohol on the other hand has been accounted for many cancers and cardiovascular related diseases in the recent past  .
Table 1: Risk Factors (2008)
Raised Blood Pressure 13%
Increased Cholesterol 4.50%
Physical Inactivity 6%
Tobacco Use 9%
Source: WHO- World Health Statistics
The effect of non-communicable diseases (NCDs) has been proliferating worldwide imposing an impediment on human health. 63% of all deaths worldwide (2008) occurred from NCDs. Furthermore, the effect of these diseases has been across all ages and in fact has been primarily affecting people in their productive ages that is, below 60 years.
Evidently, chronic diseases are one of the major issues that given a lot of attention in most countries. Most countries have put various measures to curb the number of deaths caused by chronic illness. However, it is noticeable that most of these measures end up to be in effective
. As a result, a lot of resources are wasted in the process of dealing with chronic diseases
. What this means is that the economic status of the country is negatively affected. To be more precise, the money that is spent on chronic diseases can be put into more profitable use.
One-quarter of all NCD related deaths are among the people belonging to this age bracket.
Interestingly, what were once considered "diseases of the riches" have now impinged on developing countries also. In 2008, approximately four out of every five NCD deaths happened in low- and middle-income countries  .
NCDs also account for 48% of the healthy life years lost as opposed to the 40% which are lost due to maternal and perinatal conditions, nutritional deficiencies, and communicable diseases and1% due to injuries  .
The number of deaths due to NCDs will rise substantially in the coming decades.
It is worthy to acknowledge the fact that the number of patients suffering from chronic diseases aggrandize rapidly from day to day. For instance, Boice reported that 10% of children in US have chronic illness. Chronically ill
individuals experience various devastating problems caused by the disease they are suffering from. This can either be emotional, physical or psychological. However, the main impact experienced is isolation. Once a person is diagnosed
with a chronic illness, they feel isolated by the society. Indeed, this feeling of isolation and rejection may result to stress. Hollidge research has shown
that over 40% of patients diagnosed with a chronic disease lose their self- esteem mainly because of isolation. Chronic diseases require a lot of medical attention. As a result, the process of seeking medical attention and cure is expensive. This means that a person with a chronic illness may
experience financial burdens due to the accumulation of hospital bills and other medical requirements.
There are two prime causes behind this, firstly, the world population is rising at an alarming rate and there will be approximately 2 billion more people by 2050. In addition, the occurrences of these diseases are expected to accelerate in the future due to increasing pervasiveness of the key risk factors
Source: WHO- World Health Statistics
Cardiovascular disease (CVD)
CVD basically refers to a group of diseases involving the heart, blood vessels, poor blood supply due to a diseased vascular supply.
Each has its own particular set of symptoms and signs, clues that enable a physician to diagnose the problem. A symptom is something a patient can detect, such as fever, bleeding, or pain. A sign is something a doctor can detect, such as a swollen blood vessel or an enlarged internal body organ
CVD has been the largest cause of death worldwide causing nearly 30% of all deaths and about 50% of NCD deaths  . The behavioural risk factors comprising of physical inactivity, tobacco use and unhealthy diet have been identified as the prime causes of nearly 80% of the CVD related NCD deaths
Cancer is the rapid division of abnormal cells in the body. These cells outlast the normal cells and have the ability to metastasize, or attack parts of the body and quickly spread to other organs.
Degenerative disease occur due to malfunctioning of some organ or organ system in the body. They are Hear Attack, Diabetes mellitus, Arthritis.
Different risk factors are attributable for spread of different types of cancers in different sites.
Recent literature projected the number of new cancer cases in 2009 to be at 12.9 million, and this number is likely to rise to nearly 17 million by 2020  . 13% of the deaths (76 million deaths) worldwide are caused due to cancer which is the second largest cause of death globally.
Chronic respiratory diseases
Chronic respiratory diseases are associated primarily to the airways and other structures of the lung. Some of the most commonly known CRDs are asthma, chronic obstructive pulmonary disease (COPD), respiratory allergies, occupational lung diseases and pulmonary hypertension, which collectively account for 7% of all deaths worldwide (42 million deaths).
Diabetes which is one of the major risk factor for other causes of deaths is a metabolic malady in which the body fails to regulate the level of sugar appropriately, mainly due to insufficient production of insulin by the pancreas.
Diabetes is not directly a cause of mortality but is definitely a major contributor to other life threatening diseases such as cardiovascular disease, kidney disease and blindness.
Mental illness basically refers to a set of medical disorders that affect a person’s thinking ability, feelings, mood, ability to relate to others and daily functioning.
Example of work related musculoskeletal disorders are epicondylitis, tendinitis, tenosynovitis, carpal tunnel syndrome, bursitis thoracic outlet syndrome, prolapsed intervebra disc (PID) and etc.
Mental health conditions/ or neuropsychiatric disorders, commonly christened as depression, affected 154 million people in 2002. Approximately, 25 million people suffered from schizophrenia and over 100 million people suffered from alcohol or drug abuse disorders  .
India is native to 1.2 billion people and is the second most populous nation in the world. The impact of growing non-communicable diseases on this highly populated nation has had profound effects on the mortality rates.
Along with the effects on morbidity and mortality, the burden of these diseases has significantly affected productivity as well. There has been a rise in unemployment levels, absenteeism, and health care expenditures.
Source: World Health Organization, Global InfoBase, https://apps.who.int/infobase
As evident from the above figure in 2004, non-communicable diseases constituted the bulk of India’s disease burden. 50% of the deaths in the country were due to non-Communicable/ Lifestyle Diseases.
The major risk factors for non-communicable diseases in the Indian scenario are smoking, alcohol abuse, sedentary lifestyles, and unhealthy diet structure. As clearly evident, these factors are modifiable and hence can be prevented to a large extent. Hence, 40-50% of non-communicable disease-related, untimely deaths in India are preventable  .
Major NCDs in India
Table 2: The prevalence of CVD, diabetes, COPD and cancer in India
NO. OF CASES 2005*
PROJECTED CASES 2015**
PROJECTED DEATHS 2015*
Cardiovascular Diseases 
31,039,932 n/a 45,809,149 n/a
17,020,000 n/a 22,210,000 n/a
2,016,700 538,858 2,496,133 666,563
*CVD/diabetes data from 2005; COPD from 2006; cancer from 2004.
** Projected data for CVD/diabetes is for 2015; COPD is 2016; cancer is 2014.
The above table is clearly indicative of the fact that cardiovascular diseases and diabetes related cases have been the maximum and will continue to rise in the coming years given the demographic trends and lifestyle vicissitudes ensuing in India. The four prominent chronic non-communicable diseases prevalent in India, in descending order are: cardiovascular diseases (CVDs), diabetes mellitus (diabetes), chronic obstructive pulmonary disease (COPD) and cancer.
Table 3: Four common non-communicable disease types in India share four modifiable risk factors
Harmful Use of Alcohol
Cardio- Vascular Diseases
Source: World Health Organization Non‐Communicable Disease Network, www.who.int/ncdney/about/en, 2009"
All four of the above mentioned non-communicable diseases have common risk factors. All these similar modifiable risk factors aid in early detection, prevention, timely treatment and ensure that combating of these diseases becomes very much plausible.
A 2008 article in The Lancet claimed that:
"India will bear 60% of the world's heart disease burden in the next two years [2008- 2010]. In addition, researchers have determined that compared to people in other developed countries, the average age of patients with heart disease is lower among Indian people and Indians are more likely to have types of heart disease that lead to worse outcomes." 
"According to the World Heart Federation, 35% of all CVD deaths in India occur in those aged 35-64 years."  This figure is clearly disturbing given the fact that the productive population of the country also belongs to this age bracket.
In addition, coronary heart disease (CHD) is the principal CVD which accounts for 90-95% of all deaths. CHD includes conditions such as congestive heart failure and inflammatory heart disease  . The key risk factors for coronary heart disease (CHD) comprise of: overweight/obesity, a sedentary lifestyle, smoking, hypertension, diabetes, and stroke.
The repercussions of such a disease are not only restricted to ones well-being but also destabilize the socio-economic development of families, communities, regions and nations.
This is primarily because the income and consecutively the savings of inflicted families get affected in the long run, due to the huge monetary burden which is innate in the treatment of such diseases.
As observed earlier the factors causing CVDs are preventable to a large extent and hence simple measures can be undertaken to ensure timely preclusion. These simple yet effective measures include regular physical activity, healthy balanced diet, and avoiding tobacco smoke. Moreover, diabetic patients need to monitor their blood sugar levels regularly. Also, effective and inexpensive medicines are accessible to help prevent and treat nearly all cardiovascular diseases, such as statins to lower cholesterol, drugs to lower blood pressure, and simple aspirin for strokes.
Source: World Health Organization, Global InfoBase, https://apps.who.int/infobase
Rising obesity levels contribute majorly to CVD related non-communicable diseases today. In last 3 decades, occurrence of obesity in people has almost doubled. America was in the highest position with 62% overweight population. India too saw a rise in the percentage of obese population from 2002-10. Deskbound jobs, lack of activity, inadequate exercises are the chief causes for the emergence of obesity at such a scale. Initiatives, specifically by business units need to be taken in this regard. Companies can ensure that out of the total working hours, some hours are necessarily dedicated towards some form of physical exercise. This can be done by installation of equipment within the offices itself. This will not only boost the energy levels of the employees but will successively bring down the rising obesity levels.
The International Journal of Diabetes in developing countries, christened India as the diabetes capital of the world. With the highest number of diabetic patients in the world, the sugar disease is posing an enormous health problem in the country and is expected to become a pandemic in the near future.
The International Diabetes Federation projected that in 2007, 40.9 million people in India suffered from diabetes which is almost double the number in 1995 (19 million).
It is anticipated that it will further increase to 69.9 million by 2025. The World Health Organisation further estimated that mortality from diabetes and heart disease cost India about $210 billion every year and is expected to increase to $335 billion in the next ten years. These estimates have stemmed from data on lost productivity, which is principally a consequence of premature deaths.
The most ubiquitous is the Type 2 diabetes, which is exists in 95% of the diabetic population of the country. About 80% of Type 2 diabetes can be eradicated by eating a measured diet which includes whole grain carbohydrates, taking regular exercise and oral medication.
Type 1 diabetes on the other hand is not avertable. In fact, the Chennai-based Diabetes Research Centre in India says that over 50 per cent cases of diabetes in rural India and about 30 per cent in urban areas remain undiagnosed for many years.
Innumerable studies have continued to highlight that the high incidence of diabetes in India is essentially because of sedentary lifestyle, lack of physical activity, obesity, stress and consumption of diets rich in fat, sugar and calories.
Other terms generally used apart from MSDs; cumulative trauma disorders, repetitive stress disorders, repetitive stress injury (RSI), overuse injuries and repetitive motion disorder (RMD).
Given the economic encumbrance on individuals, families, regions and health systems that diabetes foists in India, alteration in lifestyle and appropriate timely medication is called for.
Prompt diagnosis can be achieved by regular blood testing. These simple behavioural measures can defer and prevent diabetes in high-risk groups to a large extent.
It is expected that in the near future health care expenditure will increase due to increased life expectancy, high cost of pharmaceuticals and increasing lifestyle diseases, expensive treatment for the same. In India only a small fraction of the population close to 5.51 %of the population have insured themselves under some health insurance schemes, the rest spend from their pockets.
The developed countries spend a higher proportion of their GDP on health as compared to the developing countries like India where only 2.5%  of the GDP is kept aside for health related activities. With limited resources being allocated for the heath sector on one hand and rising demand for health services on the other hand the country is bound to have developmental pressures. This might prove to be a hurdle in its growth path.
In order to improve the situation, the Indian government like in the developed countries will have to shift some of the resources or increase spending on prevention, screening and early detection of such ailments. Lifestyle ailments can be avoided if taken care at the right time. As it is seen the major reasons for such diseases are smoking, alcohol consumption, fixed lifestyle and an unhealthy diet; reducing the fat composition of diet, engaging in regular physical exercises and restraining from indulgence in excessive alcohol consumption can help improve the situation.
Cost of treatment for an oral cancer patient is estimated to be about Rs 4, 00,000. Most oral cancers are preventable by avoiding the use of tobacco and tobacco products. Cost effective preventive interventions are the need of the hour in an environment of resource scarcity. Such an approach will be a relief to most Indian families that meet 70 per cent of their health expenses out of their own pockets. 
The growing burden of NCDs is likely to grow even further in the coming years. The health community and the business community are both equally likely to be effected by the same.
First, in economic terms, NCDs matter ominously. At the global level, world’s economic leaders - top government officials, including finance ministers and their economic advisors - who control large amounts of spending at the national level and who have the power to react to the tremendous economic threat posed by NCDs, should now earnestly map the consequences of this growing chronic disease and take requisite steps.
Second, at the national level, the human and economic burdens of NCDs can both be confined by dedicating resources directly or indirectly towards prevention, screening, treatment and care. Health spending needs to be seen from the point of view of an investment that yields a handsome rate of return in terms of increased productivity.
There are many factors which puts a heavy pressure on the demand of health care services in India. The population growth has slowed down but it still remains very high. It is also observed that the growth of population in the bracket of 60 years and above is increasing. This change in the population pyramid coupled with a better standard of living and health awareness is expected to fuel the demand for healthcare in general, particularly lifestyle diseases. It is the need of the hour that India’s health industry is better equipped with improved facilities, an effective delivery mechanism and awareness programs on Lifestyle diseases.
Non-communicable diseases can be tackled to a large extent by simple modifications in our lifestyle. Dietary changes (for example, reduced intake of salt and increased consumption of fruit and vegetables); improved physical activity; cessation of smoking and detrimental use of alcohol (perhaps by increased tobacco and alcohol taxes, and through information, education and communication crusades); and transforming medical training to address the altering nature of disease burdens are all options to prevent and manage NCDs.