About six months ago, Renuka Sachdev, 56, was diagnosed with hypertension and diabetes. A sales professional with a leading corporate firm in Mumbai, she had never had a smoke or a drink. What she did have, however, were long workdays, erratic meal timings and a near-permanent relationship with stress. “The anxiety to thrive at work had seeped into me so much that it became normal for me to remain tensed about deadlines and sales all the time,” she says. Her doctor told her that stress had caused her psoriasis and diabetes. “I have been asked to either take a break, find another job or simply shift the industry I work in. So I am now trying to take it slow by making some time for myself, especially in the first four hours of the morning.”
Sachdev is not alone. Across India, doctors are reporting a troubling trend—non-communicable diseases (NCDs) like diabetes, cardiovascular diseases, chronic respiratory disorders and cancers are striking younger people and growing at an alarming pace.
The World Health Organization estimates that 73 per cent of all NCD deaths are in low- and middle-income countries. It says that cardiovascular diseases account for most NCD deaths, at least 19 million in 2021, followed by cancers (10 million), chronic respiratory diseases (4 million) and diabetes (over 2 million including kidney disease deaths caused by diabetes). These four groups of diseases account for 80 per cent of all premature NCD deaths. It further states that tobacco use, physical inactivity, excessive use of alcohol, unhealthy diets and air pollution all increase the risk of NCD deaths.
As per a 2023 report by Shifa Habeeb and colleagues from the department of community medicine, Amrita Institute of Medical Sciences, Kochi, published in The Lancet Diabetes & Endocrinology, India has an estimated 101 million people living with diabetes, which is higher than the 74.2 million previously reported by the International Diabetes Federation. Similarly, the prevalence of hypertension stands at 35.5 per cent, significantly higher than the 28.5 per cent recorded in the National NCD Monitoring Survey. The authors note that awareness, treatment and control rates remain dismally low—46 per cent, 36 per cent and 16 per cent for diabetes, and 28 per cent, 15 per cent and 13 per cent for hypertension, respectively. Even in Kerala, one of India’s most advanced state in terms of literacy and health care access, diabetes prevalence is 25.5 per cent, with control rates of just 15 per cent for diabetes and 12 per cent for hypertension.
The Union government’s target under the National Multisectoral Action Plan is to reduce premature mortality from NCDs by one-third by 2030, in line with the UN Sustainable Development Goals. But experts warn that without urgent, systemic lifestyle changes, that goal may remain out of reach. “Over the past decade, the age of diagnosis has dropped by at least a decade,” says Dr Rajiv Kovil, diabetologist and founder of United Diabetes Forum. “In the US, diabetes is typically diagnosed in the late 50s. In India, we are seeing it at 40, sometimes even in the early 30s. Post pandemic, the curve for NCDs has become frighteningly linear.” Blame it on our lifestyle. “We have normalised unhealthy living,” he says. “People eat dinner at 10:30pm, skip breakfast, sit all day and consider that normal.”
Cardiologists say they are seeing similar trends in hypertension and cardiac ailments. “The number of young hypertensives is worrying,” says Dr Rahul Gupta, director-cardiology, Gleneagles Hospital, Mumbai. “Earlier, we would see hypertension in the 50s or 60s. Today, we are seeing 30-year-olds with dangerously high blood pressure. Add obesity and stress to the mix, and you have a generation heading towards early heart disease.”
The overlap between NCDs is significant: diabetes predisposes people to cardiovascular disease; obesity heightens the risk of certain cancers; and air pollution worsens chronic respiratory conditions. “The body doesn’t compartmentalise illness the way we do,” says Gupta. “If your lifestyle is unhealthy, everything begins to collapse—your sugar levels, your cholesterol, your heart, your sleep.”
One of the starkest drivers of India’s NCD epidemic is diet. From ultra-processed convenience food to sugar-laden beverages, poor nutrition cuts across income groups. “We talk about millets on paper but eat nothing close to a balanced meal,” says Kovil. “Even middle-class families in cities like Mumbai rely on sandwiches, dosas or street food, which are convenient but nutritionally poor.”
The problem, he argues, is as cultural as it is economic. “Healthy food is expensive, and we celebrate everything with sugar,” says Kovil. “Our average sugar consumption per person is 23.5kg a year, higher than some developed nations.”
Health activists agree that prevention must begin with changing public behaviour. India cannot medicate its way out of the NCD crisis, they insist. “We need a population-level approach that makes early screening, active living and healthy eating a part of everyday life. That’s where partnerships between government, industry and civil society are essential,” says Dr Sridevi Paladugu, consultant endocrinologist, Apollo Clinic.
Novo Nordisk, for instance, runs several awareness and screening programmes across India under its ‘Changing Diabetes’ initiative. “As a nation, we have to overcome this with collective enthusiasm and dedicated efforts,” says Gupta. “For many patients, the common complaint is long working hours or commute to work is cumbersome. If there is a legislation that can regulate the work hours of employees, it might help. Better infrastructure can reduce the travel time and give individuals more time to themselves.”
For 44-year-old homemaker Ankita Sharma (name changed) from Delhi, diabetes was never a concern until a sudden blackout led to an ER visit last year. “My blood sugar was 300,” she recalls. “I was shocked. I thought only overweight people get diabetes, I am not even 60kg.”
Her case, doctors say, underscores the changing face of NCDs. “We are now seeing thin diabetics, young hypertensives, non-smokers with heart attacks,” says cardiologist Dr Pravin Kahale, Kokilaben Dhirubhai Ambani hospital in Mumbai. “This is no longer about wealth or weight. It is about what we eat, how we live and how much we move.”
Meanwhile, for daily wage workers and the urban poor, the problem is different. “They cannot afford healthy food,” says Kovil. “Street food is cheap, accessible and satisfying, but full of oil, salt and sugar. Unless healthy options become cheaper, we cannot expect real change.”
The Union government has, in recent years, introduced measures to curb the NCD wave—from health taxes on sugary beverages to mandatory front-of-pack labelling on packaged foods. But implementation remains uneven.
“Food labelling is the biggest untapped weapon we have,” says Kovil. “People buy products labelled ‘no added sugar’ or ‘high protein’ without realising how misleading those claims can be. The Food Safety and Standards Authority of India needs to come down hard on mislabelling.”
Experts also emphasise the need for built environments that support healthy living. “If you tell a 78-year-old to walk, where will he walk?” asks Kovil. “There are no safe pavements, no parks, no clean air. Even exercise is a privilege.”
Experts agree that the most effective interventions must begin in childhood. “We teach history and geography, but not nutrition,” says Kovil. “If we can make food literacy part of school curriculums and gamify nutrition for kids, we can change lifelong habits.”
He cites the example of the US, where soda manufacturers were barred from using cartoon characters like Disney princesses on sugary drinks. “Rewarding healthy behaviour works,” he says. “We should reward wellness—for children, teachers and corporate employees alike.”
Ultimately, experts agree that India’s NCD crisis is as much a social problem as a medical one. “We must stop normalising poor lifestyle,” says Kahale. “That means reducing sugar in religious offerings, creating walkable cities, regulating food marketing and making preventive health aspirational.”
For Sachdev, that change has already begun, one step at a time. She now takes brisk walks each morning and monitors her blood pressure weekly. “My doctor said this isn’t about curing something,” she says. “It is about preventing what’s coming next.”
If India is to meet its 2030 target of reducing NCD-related deaths, millions like her will need to make the same shift from reactive treatment to proactive living. As Kovil puts it, “Health must become a cultural choice, not just a medical one.”