Multi-Sectoral Action for Addressing Social Determinants of Noncommunicable Diseases and Mainstreaming Health Promotion in National Health Programmes in India

Abstract

Major noncommunicable diseases (NCDs) share common behavioral risk factors and deep-rooted social determinants. India needs to address its growing NCD burden through health promoting partnerships, policies, and programs. High-level political commitment, inter-sectoral coordination, and community mobilization are important in developing a successful, national, multi-sectoral program for the prevention and control of NCDs. The World Health Organization's “Action Plan for a Global Strategy for Prevention and Control of NCDs” calls for a comprehensive plan involving a whole-of-Government approach. Inter-sectoral coordination will need to start at the planning stage and continue to the implementation, evaluation of interventions, and enactment of public policies. An efficient multi-sectoral mechanism is also crucial at the stage of monitoring, evaluating enforcement of policies, and analyzing impact of multi-sectoral initiatives on reducing NCD burden in the country. This paper presents a critical appraisal of social determinants influencing NCDs, in the Indian context, and how multi-sectoral action can effectively address such challenges through mainstreaming health promotion into national health and development programs. India, with its wide socio-cultural, economic, and geographical diversities, poses several unique challenges in addressing NCDs. On the other hand, the jurisdiction States have over health, presents multiple opportunities to address health from the local perspective, while working on the national framework around multi-sectoral aspects of NCDs.

Prevalence of hypertension and diabetes morbidity among adults in a few urban slums of Bangalore city, determinants of its risk factors and opportunities for control – A cross-sectional study

“…Mondal S et al [ 19 ] discuss the MoHFW's focus areas on NCDs during the SDG (Sustainable development goal) era, which include a shift in approach from treatment to locally led prevention initiatives, increasing civic accountability, and multisectoral cooperation. WHO's action plan for global strategies on NCD prevention and control activities during 2008–13,[ 20 ] provides guidelines for India's multi-sectoral framework for NCD related activities. Such actions include collaborative initiatives by the Government with non-governmental organizations (NGO), private sector, civil society, media and social service organizations.…”

“…Such actions include collaborative initiatives by the Government with non-governmental organizations (NGO), private sector, civil society, media and social service organizations. A good example of horizontal integration in the Indian public sector includes the MoHFW's “Inter-ministerial task force for Tobacco control.”[ 20 ] This has representation from other Ministries such as: Information and broadcasting, Industrial policy and promotion, Agriculture, Commerce, Labor, Revenue, Rural development, Food standards and safety authority of India, Drug controller General of India and some civil society members.…”

Developing a national set of health equity indicators using a consensus building process

“…Effective intervention to increase health equity should be multi-sectoral, given the nature of health determinants. 42 Involvement of stakeholders in the process, such as those charged with reducing health equities in the four HMOs, might increase the chances of implementing this set of indicators to guide interventions aimed at reducing disparities. 35 Moreover, the active involvement of the regulating body -the MOH -in the research, facilitated collaborations during the preparation phase and also increased the likelihood of translation of the study outputs into measurable disparity reduction targets for the national healthcare system.…”

Whole‐of‐society monitoring framework for sugar, salt, and fat consumption and noncommunicable diseases in India

“…Government departments under different ministries, directly or indirectly linked to salt, sugar, and fat markets in India, have formulated and implemented policies and plans to facilitate a pro‐investment environment without realizing the potential impact on public health in the form of NCDs. In this background, if the country desires to formulate multisectoral action plans to monitor various market forces and social determinants discussed in previous sections that influence cardiometabolic risk factors and outcomes, there could be many challenges: lack of linkages with different stakeholders within and outside health sectors, fragmented data sets from cross‐sectional studies that are inadequately representative, wide use of nonstandardized indicators in routine health or economic information systems, and others. Wide variation in the sugar, salt, and fat consumption data from different sources emerging repeatedly in previous sections points to the need for urgent integrated action across sectors with standardized measurement approaches.…”