Circulatory system diseases remain leading cause of deaths in 2023: Report

The recent annual report on medical certification of causes of death for 2023, highlighting circulatory system diseases as the leading cause of death in medically certified cases for individuals aged 15 and above, underscores a critical public health challenge facing India. This finding is not an anomaly but rather a reinforcement of a long-standing trend, signaling a significant epidemiological transition in the country's disease burden.

Historically, India grappled predominantly with communicable diseases like tuberculosis, malaria, and diarrheal diseases. However, over the past few decades, a marked shift has occurred towards non-communicable diseases (NCDs), with cardiovascular diseases (CVDs) leading the charge. This transition is largely attributed to rapid urbanization, changing lifestyles, dietary habits moving towards processed foods high in sugar, salt, and unhealthy fats, reduced physical activity, increased stress levels, and environmental factors like air pollution. These factors contribute significantly to risk factors such as hypertension, diabetes, dyslipidemia, and obesity, which are direct precursors to CVDs like heart attacks, strokes, and congestive heart failure. The report's focus on 'medically certified deaths' is crucial as it implies a certain level of diagnosis and record-keeping, providing more reliable data compared to uncertified deaths, though it might still underrepresent the true burden in areas with limited medical access.

Several key stakeholders are involved in addressing this pervasive health issue. The **Government of India**, primarily through the Ministry of Health & Family Welfare (MoHFW) and NITI Aayog, is responsible for policy formulation, resource allocation, and program implementation. Organizations like the **Indian Council of Medical Research (ICMR)** play a vital role in research, data collection, and evidence-based policy recommendations. **Healthcare providers** – doctors, nurses, hospitals, and primary health centers – are at the forefront of diagnosis, treatment, and patient education. Individual citizens themselves are crucial stakeholders, as lifestyle modifications are paramount to prevention. Furthermore, **NGOs and civil society organizations** contribute significantly through awareness campaigns, advocacy, and community-level interventions.

This trend holds immense significance for India. From a public health perspective, it represents a substantial burden of disease, leading to high mortality and morbidity, often impacting individuals in their most productive years. Economically, the rising incidence of CVDs translates into escalating healthcare costs, both for the government and individuals (often through out-of-pocket expenditure), and a significant loss of productivity due to premature deaths and disability. This can severely impede India's economic growth trajectory and threaten its demographic dividend, as a large, young workforce succumbs to preventable diseases. Socially, the impact is profound, leading to immense strain on families, reduced quality of life, and increased dependency.

India's constitutional framework provides a basis for public health interventions. **Article 47** of the Directive Principles of State Policy mandates that the State shall regard the raising of the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties. This forms the bedrock for various health policies and programs. The **Right to Life (Article 21)**, interpreted broadly by the judiciary, implicitly includes the right to health. In response to the NCD challenge, the government launched the **National Health Policy (2017)**, which aims to achieve universal health coverage and reduce the NCD burden through preventive and promotive health approaches. Key initiatives like **Ayushman Bharat**, comprising the Pradhan Mantri Jan Arogya Yojana (PMJAY) for health insurance and Health and Wellness Centres (HWCs) for comprehensive primary healthcare, including NCD screening and management, are critical steps. The **National Programme for Prevention and Control of Non-communicable Diseases (NP-NCD)** (formerly NPCDCS) specifically targets the prevention and control of common NCDs, including cardiovascular diseases, diabetes, cancer, and stroke, through awareness, early diagnosis, and management.

Looking ahead, the future implications are clear: there is an urgent need for a multi-pronged, comprehensive strategy. This includes strengthening primary healthcare infrastructure, particularly HWCs, to ensure early detection, screening, and management of NCD risk factors. Robust public health campaigns promoting healthy lifestyles – balanced nutrition, regular physical activity, cessation of tobacco and alcohol use – are essential. Policy interventions targeting food industries to reduce sugar, salt, and unhealthy fats in processed foods, along with stricter regulations on tobacco and alcohol, are crucial. Investment in medical research, robust data collection systems, and leveraging technology (like telemedicine and AI) for better outreach and personalized care will also be vital. Ultimately, addressing the circulatory disease burden requires a societal shift towards health consciousness, supported by strong governmental commitment and active community participation to safeguard India's present and future well-being.