Rural women-led community action key to tackling India’s metabolic diseases: Experts

India is currently grappling with a significant public health challenge: the escalating burden of metabolic diseases. Conditions like diabetes, hypertension, obesity, and dyslipidemia are becoming increasingly prevalent, not just in urban centers but alarmingly in rural areas. This epidemiological shift from communicable to non-communicable diseases (NCDs) presents a complex socio-economic and public health crisis. Against this backdrop, the recent panel discussion, moderated by Dr. Rakesh Kalapala of AIG Hospitals, highlighted a crucial, yet often underestimated, solution: empowering rural women through community-led action.

**Background Context:** Historically, India's public health efforts largely focused on infectious diseases. However, lifestyle changes, dietary shifts, reduced physical activity, and increased stress have contributed to a rapid rise in NCDs. According to the Indian Council of Medical Research (ICMR), NCDs account for over 60% of deaths in India, with metabolic diseases being a major contributor. Rural populations, despite often being perceived as healthier, are increasingly vulnerable due to changing food habits, lack of access to affordable nutritious food, limited awareness about preventive health, and inadequate healthcare infrastructure. The existing healthcare system often struggles with outreach and sustained engagement in remote areas, making community-based solutions indispensable.

**Key Stakeholders:** The success of this approach hinges on the active involvement of several key stakeholders. At the forefront are **rural women themselves**, who, through Self-Help Groups (SHGs) or other community forums, can become powerful agents of change. They are often the primary caregivers, food providers, and health managers within families, giving them a unique vantage point and influence. **Healthcare professionals and institutions**, like Dr. Rakesh Kalapala and AIG Hospitals, play a vital role in providing expertise, training, and resources. They can design evidence-based interventions and equip women with the necessary knowledge and tools. The **Government**, particularly the Ministry of Health & Family Welfare at the Centre and State Health Departments, is crucial for policy formulation, funding, and integrating these initiatives into broader health programs like the National Health Mission (NHM) and Ayushman Bharat. Finally, **Local Self-Government (Panchayati Raj Institutions)** and **Non-Governmental Organizations (NGOs)** are essential for facilitating grassroots implementation, ensuring accountability, and mobilizing community resources.

**Significance for India:** The emphasis on rural women-led community action holds profound significance for India. Firstly, from a **public health** perspective, it offers a sustainable and culturally sensitive way to tackle the NCD crisis by focusing on prevention, early detection, and lifestyle modification at the household level. This can significantly reduce the burden on tertiary care facilities. Secondly, it has a massive **economic impact**. NCDs lead to substantial healthcare expenditures, productivity loss, and impoverishment due to catastrophic health spending. By improving community health, India can enhance its human capital and economic output. Thirdly, it is a powerful tool for **social equity and women's empowerment**. By giving women leadership roles in health initiatives, it enhances their agency, decision-making power, and social standing, aligning with national goals of gender equality. It also addresses the health disparities prevalent between rural and urban populations.

**Historical Context and Broader Themes:** India has a rich history of leveraging community health workers, predominantly women, such as ASHA (Accredited Social Health Activist) workers under the NHM and Anganwadi workers under the Integrated Child Development Services (ICDS) scheme. These programs have demonstrated the effectiveness of women as frontline health facilitators. The concept also aligns with the Alma-Ata Declaration (1978) on primary healthcare, emphasizing community participation. Furthermore, the success of women's SHGs, promoted under schemes like the National Rural Livelihoods Mission (NRLM), in various development sectors provides a strong precedent for their role in health. This initiative connects to broader themes of decentralized governance (enabled by the 73rd and 74th Constitutional Amendments empowering Panchayati Raj Institutions), participatory development, and sustainable public health models.

**Constitutional Provisions and Policies:** The Indian Constitution, through its **Directive Principles of State Policy (DPSP)**, lays the foundation for such initiatives. **Article 47** mandates the State to raise the level of nutrition and the standard of living and to improve public health. **Article 38** calls for securing a social order for the promotion of the welfare of the people, minimizing inequalities. The **73rd Constitutional Amendment Act, 1992**, which institutionalized Panchayati Raj, empowers local bodies to plan and implement schemes for economic development and social justice, including health. Policy frameworks like the **National Health Policy 2017** explicitly advocate for community participation and a shift towards preventive and promotive healthcare. The **National Health Mission (NHM)**, particularly its rural component, extensively uses female community health workers. The **Ayushman Bharat** program, with its focus on Health and Wellness Centres (HWCs), aims to provide comprehensive primary healthcare services, including NCD screening and management, at the grassroots level, often relying on the active involvement of women health workers.

**Future Implications:** The future implications of this approach are vast. It could lead to the development of robust, resilient community-based health networks that are self-sustaining. It has the potential to integrate traditional knowledge with modern medical science and promote indigenous health practices. However, challenges such as ensuring adequate training, continuous funding, overcoming patriarchal mindsets, and providing proper infrastructure must be addressed. Successful models can be scaled up across the nation, potentially making India a leader in community-led NCD management. This strategy represents a paradigm shift, moving healthcare from a purely clinical model to one that is deeply embedded within communities, with women at its heart.