The Invisible Epidemic: Rising Burden Of Childhood NCDs In India

When we hear the words non-communicable diseases (NCDs), most of us think of adults living with diabetes, heart disease, cancer, or respiratory illnesses. But a more unsettling reality is emerging – children are increasingly affected by NCDs. This silent crisis, an “invisible epidemic”, is unfolding in our homes, schools, and communities, yet it remains largely invisible in policy discussions.

NCDs account for 71% deaths globally, and nearly two out of three deaths in India. Unlike infectious diseases, they do not spread from one child to another. Instead, they emerge from a mix of genetics, environment, and lifestyle. For children, this means more than just a diagnosis; it becomes part of daily life. Insulin injections before school, breathlessness while playing, fatigue that hampers learning, or stigma in classrooms are lived experiences that quietly erode childhood. The numbers speak for themselves.

India ranks third globally for sickle cell disease burden, with nearly 1.2 million people affected. In Maharashtra alone, more than 16,000 patients have been identified, with the Vidarbha region accounting for nearly 70% of all reported cases in the state. In Mumbai and Pune, childhood asthma and obesity are rising, driven by air pollution, sedentary routines, and diets high in processed food. Urban slums present another paradox, where children face the combined threats of under-nutrition, polluted air, and lack of quality healthcare access.

The World Health Organization estimates that one in five children worldwide aged 5-19 is overweight, with 8% classified as obese. The national prevalence of T1D (Type 1 diabetes) and congenital heart disease (CHD) applied to Maharashtra equates to ~2000 and ~20,000 new cases of T1D and CHD, respectively, among children annually. In India, a metaanalysis reported 6.5% children and adolescents in the general population, 23.3% of those in schools suffer from mental health issues. In Maharashtra, this means ~8.8 million children and adolescents suffer from some mental health disorder.

Two reasons make urgent action essential. First, many NCDs have their onset in childhood like T1D, CHD, asthma, and sickle cell disease, if diagnosed early and appropriately managed, can significantly improve survival and long-term quality of life. Second, childhood is when risk factors for adult NCDs take root. Poor diets, lack of physical activity, and even early initiation into tobacco and alcohol all begin in adolescence. The adult NCD epidemic of tomorrow is being seeded in childhood today. There are some promising steps.

AIIMS Nagpur, with support from UNICEF, has established a dedicated Paediatric NCD Clinic offering weekly outpatient services for children with conditions such as T1D, asthma, CHD, and obesity. Maharashtra is also working to integrate childhood NCDs into the National Programme for Prevention and Control of NCDs (NP-NCD).

The WHO PEN-Plus strategy, supported by UNICEF, offers a way forward by decentralising care for severe chronic NCDs, ensuring that district hospitals (not just tertiary centres) are equipped to provide quality, long-term treatment. Maharashtra has already shown leadership in policy directions and implementation on many social issues. It now has the opportunity to do so again by showing commitment to early life interventions for NCD control.

Sanjay Singh is chief UNICEF, Maharashtra; Dr Mangesh Gadhari is health specialist, UNICEF, Maharashtra