New Delhi: India is passing through a critical and complex phase of epidemiological transition, grappling simultaneously with persistent communicable diseases and a rapidly rising tide of non-communicable diseases (NCDs), the Economic Survey 2026 has cautioned.
While the classical public health model suggests a linear shift from infectious diseases to NCDs, India’s experience has been far more layered and overlapping, the Survey noted. Over the past five decades, life expectancy at birth has risen sharply—from 49.7 years in 1973 to 70.3 years in 2023—reflecting major gains in public health and medical care. At the same time, mortality from infectious diseases has declined substantially.
Yet, the country continues to face a “double burden” of disease. Communicable diseases such as tuberculosis and vector-borne infections remain a concern even as cardiovascular diseases, diabetes and cancers surge. According to the Survey, NCDs now account for over 57 per cent of all deaths in India.
Cardiovascular diseases have emerged as the leading cause of death among both men and women, with consistently higher mortality rates among males since 2004–06. Other major causes of death include perinatal conditions, diabetes and genitourinary diseases. While men have higher all-cause and cardiovascular mortality, women often face poorer outcomes following acute cardiac events, possibly due to delayed diagnosis and under-treatment.
The Survey also flagged a higher proportion of ill-defined causes of death among women, pointing to gaps in diagnostic accuracy and healthcare utilisation. It stressed that consolidating gains in maternal and child health while scaling up care for the elderly and those with chronic diseases will be crucial as India’s population ages.
Obesity: a growing public health emergency
Among the most pressing concerns highlighted is the rapid rise in obesity, now described as a major public health challenge cutting across age groups and geographies. Driven by unhealthy diets, sedentary lifestyles, growing consumption of ultra-processed foods (UPFs) and environmental factors, obesity is fuelling a surge in NCDs such as diabetes, heart disease and hypertension in both urban and rural India.Data from the National Family Health Survey (2019–21) show that 24 per cent of Indian women and 23 per cent of men are overweight or obese. Obesity affects 6.4 per cent of women and 4 per cent of men aged 15–49 years. Particularly worrying is the rise in childhood obesity, with excess weight among children under five increasing from 2.1 per cent in 2015–16 to 3.4 per cent in 2019–21. Estimates suggest that over 3.3 crore children were obese in 2020, a number projected to rise to 8.3 crore by 2035.
Ultra-processed foods under scrutiny
The Survey drew a direct link between rising obesity and the explosive growth of ultra-processed foods in Indian diets. India is now one of the fastest-growing markets for UPFs, with sales rising by over 150 per cent between 2009 and 2023. Retail sales jumped from USD 0.9 billion in 2006 to nearly USD 38 billion in 2019—a 40-fold increase—mirroring a period during which obesity rates nearly doubled among men and women.UPFs are increasingly displacing traditional diets, worsening overall diet quality and raising the risk of multiple chronic diseases. Citing the Lancet Series on Ultra-Processed Foods and Human Health, the Survey noted strong global evidence linking high UPF consumption to obesity, cardiovascular disease, diabetes, respiratory illnesses and mental health disorders. Beyond health impacts, the economic costs are substantial, including higher healthcare spending, productivity losses and long-term fiscal strain.
Policy response and enforcement gaps
India’s policy response dates back to the 2017 National Multi-sectoral Action Plan (NMAP) for Control of Common NCDs, which called for reducing unhealthy diets and high-fat, sugar and salt (HFSS) food consumption through coordinated action across 39 departments. Measures proposed included front-of-pack labelling, restrictions on HFSS food advertising, and a comprehensive law to curb the marketing of unhealthy foods and alcohol. The NMAP had set a target to halt the rise in obesity by 2025.
More recently, the ICMR–NIN Dietary Guidelines (2024) explicitly warned against UPFs, while the Central Consumer Protection Authority’s 2022 guidelines prohibit misleading food advertisements. However, the Survey acknowledged that enforcement remains weak.
A growing body of evidence, including a multi-sector consensus involving 29 organisations, supports the use of warning labels over rating-based systems such as Health Star Ratings. Studies show warning labels are more effective in discouraging UPF consumption, especially among children. The Survey recommended extending such labels to foods targeted at infants and toddlers and banning nutrient and health claims on UPFs to prevent “health halo” effects.
Call for a multi-pronged strategy
Reiterating recommendations from earlier Surveys, the document stressed the need for a multi-pronged approach. It suggested bringing UPFs under clearer regulation through the Food Safety and Standards Authority of India, adopting strict definitions and labelling standards, enhancing monitoring of branded products, and running targeted awareness campaigns in schools and colleges.
The Survey stated that the government has rolled out multiple initiatives—including POSHAN Abhiyaan, Poshan 2.0, Fit India, Khelo India, Eat Right India and the ‘Aaj Se Thoda Kam’ campaign—to promote healthier diets and physical activity. Under the National Programme for Prevention and Control of NCDs, over 31.5 crore adults have been screened, with 8.47 crore identified as overweight or obese.
The Survey emphaisised that tackling India’s evolving disease burden will require sustained policy coordination, stronger regulation of food systems and a renewed focus on balanced nutrition to secure long-term health and economic gains.
