What you eat, how you move, and whether you sleep: The science that could bend India's NCD curve

India debates hospital beds, insurance premiums, and drug procurement with great urgency, but it also needs to address non-communicable diseases with the same urgency. They account for 5.87 million deaths each year, or 60 percent of all mortality in the country, as per WHO. Cardiovascular disease, chronic respiratory disease, cancers, and diabetes drive 82 percent of that toll. India also bears more than two-thirds of all NCD deaths across the WHO South-East Asia Region. The scale of the problem and the thinness of the prevention response have never been in proportion.

These deaths are concentrated in the working years. As reported by WHO, NCDs kill hardest between 40 and 65, when people are raising children, running households, and holding livelihoods together. A country where 60 percent of deaths come from chronic conditions that were years in the making has a prevention problem at its core, alongside the treatment capacity problem. People who are physically inactive face a 20 to 30 percent higher risk of dying than those who are sufficiently active, according to WHO. This is where a serious national health strategy should be organised.

The diet problem is specific

India’s diet has changed sharply over the past three decades, and disease patterns have followed. Refined carbohydrates, processed foods, and high glycaemic diets are now common. Over 135 million Indians are living with obesity. NFHS-5 puts overweight and obesity at 24 percent among women and 23 percent among men, nearly three times what they were a decade ago. Projections suggest 27 million children could be on an obesity path by 2030. This will drive a steep rise in heart disease, diabetes, and cancer as this group ages.
There is clear evidence on what protects against these risks. A meta-analysis by Schwingshackl et al. shows Mediterranean-style diets are linked to lower HbA1c levels, thus benefitting long-term glucose control. Many of the same benefits exist in Indian diets built around millets, dal, pulses, seasonal vegetables, and everyday spices like turmeric, cumin, fenugreek, and coriander.

Taxing ultra-processed foods, enforcing clear front-of-pack labelling, restricting junk food advertising aimed at children, and making fresh food affordable and accessible in low-income urban areas are the measures that shift population eating patterns. Two-thirds of premature deaths from chronic diseases trace back to four modifiable risks, tobacco, poor diet, physical inactivity, and alcohol. Three of those four are within reach of fiscal and regulatory policy. That window deserves to be used.

Physical activity and diet work together

Inactivity produces several problems simultaneously, elevated blood pressure, reduced insulin sensitivity, systemic inflammation, and increased cancer risk, all running in parallel. It also compounds the effects of poor diet. A calorie-restricted eating plan without exercise regularly produces muscle mass loss, which undermines metabolic outcomes over the medium term. Diet and physical activity function as one clinical system. Treating them as two separate awareness campaigns, which is largely how Indian public health communication handles them, misses that reality entirely.

Urban India has removed movement from ordinary daily life. Office work is sedentary. Commutes are long and sitting-based. Working-class neighbourhoods were built without walking or cycling in mind. The built environment determines behaviour at scale. Public health and urban planning in India need to work from the same set of priorities. Moderate, consistent physical activity sustained over time is what the evidence supports. The challenge is making the structural conditions for it possible across the population.

Sleep and NCD risk

Short-term sleep restriction in otherwise healthy people produces measurable rises in blood pressure, disrupted blood sugar regulation, and elevated inflammation. Sustained poor sleep raises cortisol, increases hunger hormones, suppresses satiety, and progressively degrades the body's capacity to manage inflammatory response. The connections between chronic sleep deprivation and hypertension, heart disease, heart failure, and metabolic dysfunction run through established physiological pathways. Sleep deprivation impairs both innate and adaptive immune function, producing chronic low-grade inflammation that builds cardiovascular and cancer risk over years.

India has a sleep problem that is going uncounted. Shift work, the noise of dense urban settlements, financial stress, and a working culture that normalises exhaustion all cut into sleep across large sections of the population. This belongs in NCD surveillance systems and in programme design. A prevention framework that accounts for diet and exercise and brings sleep into that picture is working with the full evidence.

Where policy falls short

Spending over the years has mostly gone into medical services. The NCD trend has not changed. India has had a National Programme for Prevention and Control of NCDs since 2010, but fifteen years later, implementation is uneven. State health departments still treat NCDs as a secondary issue, and a programme running at partial capacity delivers limited results.

Prevention takes time and its gains are less visible. Treatment is immediate and easier to show. This has pushed health spending toward treating disease rather than preventing it. What people eat, how much they move, and how well they sleep will decide whether SDG 3.4 is met, or whether India keeps expanding hospitals to deal with preventable illness. India already has the basics for prevention, traditional diets backed by science, long-used grains and spices, and community networks that can support change. Policy needs to take prevention seriously and build on what already exists.

Authored by: Dr. Sabine Kapasi, Global Health Strategist, Founder of ROPAN Healthcare, and UN advisor