OPINION | Prioritizing children and adolescents to turn the tide on Non-Communicable Diseases

Described as the ‘invisible pandemic,’ non-communicable diseases (NCDs) are the world’s leading cause of death, responsible for 74 per cent or 41 million global annual deaths currently. The majority (85 per cent) of premature NCD deaths are among people between 30-70 years are occurring in low and middle-income countries. NCDs place a major burden on the global economy, and are linked to poverty, poor social and economic development, and inequities. They most negatively impact poor countries, poor communities, and the poorest individuals within all nations, including children and adolescents. 

Health systems have traditionally focused on NCDs among adults. However, many NCDs also impact children and adolescents. NCD prevalence is rapidly rising among children and young people globally, requiring comprehensive policy action to combat exposure to harmful NCD risk factors and health system strengthening to manage these chronic conditions. Despite the escalating prevalence, NCD prevention and management focused on children and adolescents is neglected in global public health policy, expenditure, and discourse. The cost of inaction is staggering. Economic losses to NCDs average US$25 per capita per year in low-income countries, and US$139 per capita per year in upper-middle-income countries. This economic toll will only increase in the absence of firm and coordinated action to protect and promote the health of today’s youth. 

The Sustainable Development Goal (SDG) target 3.4 is to reduce premature mortality from NCDs by one-third by 2030 relative to 2015 levels. Only a handful of countries are on track to meet this target. The target will be impossible to achieve unless we close the loop by investing in early life course interventions for NCDs prevention and health promotion. Most NCDs can be prevented by addressing modifiable and environmental risk factors. Behaviours are etched during the early years of life around the consumption of unhealthy commodities and other harmful habits, which continue through adulthood, causing early onset of NCDs as young adults. A life-course approach to primary prevention of NCDs is more acceptable now with a greater understanding that many NCDs have their origins in early life, through epigenetic mechanisms before conception. A multi-sectoral approach to deliver interventions before, during and after pregnancy, and through childhood and adolescence, can significantly reduce their prevalence. 

This two-pronged approach is the need of the hour: 

(1) Prevention of risk factors by adopting a comprehensive health promotion approach in all settings frequented by children and adolescents

(2) Health system strengthening to integrate NCD prevention in Maternal and Child Health (MCH) programmes and to manage childhood onset of NCDs e.g., Type 1 Diabetes Mellitus (T1DM), Sickle Cell Anemia, Chronic Obstructive Pulmonary Disease (COPD) and Asthma, and congenital and acquired heart diseases in children. 

India is facing a massive burden of NCDs and related risk factors:

India aspires to be a developed nation by 2047, leveraging its demographic dividend. To do so it will need investments in health promotion and NCD prevention across the life course, especially the early life course interventions. With an improving survival rate in children, India needs to invest in opportunities for their holistic development. This will require special attention in safeguarding children’s health from NCD risk factors and managing any childhood onset of NCDs to enable them to reach their full potential. 

NCDs undermine children's and adolescents’ right to health, nutrition, education, and play. As the world prepares for the fourth UN High-Level Meeting (UNHLM) on NCDs in 2025 to review progress towards global NCD targets, we need to remember to prioritize the health of children and young people as a human right as codified in the UN Declaration of Human Rights, UN Convention on the Rights of the Child (CRC) and other international treaties and conventions. Article 24 (c) from the CRC emphasizes combatting disease and malnutrition, including within the framework of primary health care, through the application of readily available technology, the provision of adequate nutritious foods and clean drinking water, taking into consideration the dangers and risks of environmental pollution.

Let us not forget to bring children and youth to the forefront of the NCD agenda globally and in India. As with the Political Declaration of 2011, and 2018 and the Global Action Plan for NCD Prevention and Control, the world must include specific targets focusing on children and adolescents as they renew their commitment to NCDs in 2025. 

It is also crucial to support and build capacities of adolescents and youth to engage meaningfully to ensure their voices are included in NCD action planning and policies so their present and future health is protected. 

Many evidence-based, youth engagement models for NCD prevention and control have been pioneered in India, for example, the tobacco use prevention model of Mobilizing Youth for Tobacco Related Initiatives in India (MYTRI) by HRIDAY, Youth4Health (y4H) and have been shared globally through Global Youth Meets on Health (GYM). Engaging people with lived experience, especially children with T1DM and their families in effective management of their condition has been demonstrated in Indian schools by PHFI.

India’s Advocacy Agenda exhibits the clear intent of people with lived experience to contribute to supporting others struggling with NCDs through their meaningful involvement in strengthening health systems. 

India is the only country that has included meaningful engagement of people living with NCDs in revised operational guidelines for the National Programme on NCD Prevention and Control (NP-NCD). However, this programme is focused only on adults. Given the Government of India’s current focus on providing an enabling environment to children and youth in the country, India could lead the global agenda at this UNHLM by including NCD prevention and management among children and adolescents for the Political Declaration of 2025. 

NCD Alliance, a global civil society network and partner to Governments and UN agencies, is urging all governments to fulfil their commitments to tackle the NCD burden, by accelerating implementation and delivering proven, cost-effective policies to reduce NCD risk factor exposure, integrating quality NCD interventions into person-centered care and universal health coverage benefit packages, and expanding access to essential NCD medicines, technologies, and resources. NCD Alliance’s key asks to Member States at UNHLM in September 2025 are to mobilize investment, accelerate implementation, integrate NCDs into other global development agendas, meaningfully engage people living with NCDs and civil society, and deliver accountability.

India's goal of acquiring global leadership will require a healthy workforce, which means that today’s children and youth must be free from preventable and premature NCDs and related long-term disabilities. These measures will not only reduce the financial strain on health systems, families, and communities but these healthy youth will be able to contribute as a demographic dividend to accelerate India's progress to becoming 'Viksit Bharat’ by 2047. 

(Dr. Vivek Virendra Singh Chief of Health a.i., UNICEF India and Prof. Monika Arora, Vice-President (Research) Public Health Foundation of India (PHFI) and President, NCD Alliance)