India’s Double Disease Burden

The discovery of Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD)  in 84% of Hyderabad’s IT workforce has spotlighted India's growing health crisis, where rising non-communicable diseases now coexist with persistent undernutrition. This dual burden highlights the urgent need for a comprehensive, preventive public health strategy.

Urbanization and the Emerging Nutritional Shift

• Reflects the Coexistence of Dual Malnutrition: India’s cities present a paradox where urban affluence and economic growth have failed to eliminate undernutrition, while simultaneously giving rise to obesity and metabolic syndromes. In many states, districts with high stunting rates now report increasing incidences of adult-onset diabetes and fatty liver disease.
• Links Work Culture to Nutritional Disorders: The rise of urban-centric, tech-driven professions—especially in the IT sector—has led to prolonged screen time, high stress, and poor dietary habits. These factors reinforce the earlier dual burden by pushing individuals from undernutrition to overnutrition, often without an intervening phase of balanced dietary transition.
• Shows Higher NCD Risk in Productive Age Groups: As sedentary work styles take hold, national data confirm that middle-aged men in higher income brackets (40–49 years) are among the most affected by obesity and NCDs. This linkage between work culture and lifestyle disease challenges the idea that economic advancement alone can ensure public health improvements.

Public Health Deficits and Inadequate Preventive Measures

• Reveals Gaps in Disease Management Outcomes: Despite efforts like mass screenings under Ayushman Bharat, states such as Tamil Nadu report low rates of disease control—only 16% of hypertensive patients and under 10% of young diabetics are effectively managed—suggesting that the health system is reactive rather than preventive.
• Highlights Inadequate Dietary and Physical Habits: The lack of disease control is directly connected to poor lifestyle choices—94% of surveyed individuals consume insufficient fruits and vegetables, and nearly one-fourth are physically inactive. These habits are often rooted in urban work-life imbalances highlighted in Part I.
• Attributes Health Risks to Food Environment Failures: These poor lifestyle habits are reinforced by an unhealthy urban food environment, saturated with ultra-processed foods and limited regulation. The weak enforcement of FSSAI's Eat Right India campaign allows junk food to proliferate, exacerbating both undernutrition (via micronutrient deficiency) and NCDs (via caloric excess).

Global Models and India’s Path Forward

• Use of Fiscal Measures for Food Reform: To correct the food environment failures discussed earlier, taxation on high-sugar, high-salt, and high-fat foods can disincentivize consumption. Like tobacco taxes, such fiscal tools can help finance public health initiatives and steer consumers toward better choices.
• Need for Front-of-Pack Labelling: Fiscal measures must be complemented by mandatory and comprehensible food labelling, especially for urban populations inundated with fast food choices. Clear warnings on sugar or salt content enable consumers to act on the awareness raised by the taxes.
• Cross-Sectoral Structural Reforms: For sustained change, India needs a Vision 2030-style inter-ministerial approach, combining urban planning, nutrition regulation, and public education. Just as the food environment shapes personal health behaviour, cross-sectoral policy must shape the environment to enable healthier choices.

Practice Question:

Q. India faces the dual challenge of undernutrition and rising non-communicable diseases, particularly in urban areas. Discuss the socio-economic and systemic drivers behind this paradox, and suggest a multi-pronged public health approach to address it.