Once, India deadliest diseases came with fever, cough, and infection. Diarrhoea, tuberculosis, and pneumonia ruled hospital wards and rural clinics. Today, the danger is silent. It comes from the heart, the blood, and the arteries. Heart disease, diabetes, and stroke now top the list of causes of death in India, according to the Global Burden of Disease (GBD) Study 2023, launched at the World Health Summit in Berlin and published in The Lancet.
In 1990, diarrhoeal diseases topped the list of causes of death in India. The age-standardised mortality rate then stood at 300.53 per lakh population. By 2023, ischaemic heart disease had become the leading killer, with a mortality rate of 127.82 per lakh. Covid-19, once the top cause of death in 2021, has now dropped to 20th place.
India’s health profile has changed so fast that even experts are struggling to keep pace. The shift from infectious diseases to non-communicable diseases (NCDs) is reshaping every aspect of life, from how people eat and work to how the healthcare system must respond.
Longer Lives, New Burdens
There’s good news too. Indians are living longer than ever before. In 1990, the average life expectancy was 58.46 years. By 2023, it had risen to 71.56 years, an increase of 13 years.
For men, it grew from 58.12 to 70.24 years. For women, from 58.91 to 72.96 years. The overall mortality rate in India also dropped, from 1,513.05 deaths per lakh population in 1990 to 871.09 in 2023.
But living longer does not always mean living healthier. People are spending more years with illness. Chronic conditions such as heart disease, diabetes, cancer, and depression now dominate daily life.
Dr. Soumya Swaminathan, former chief scientist at the WHO, warned that this is the next frontier for public health. “The population is living longer but experiencing higher levels of morbidity. The focus must shift to healthy ageing. Preventing NCDs should be a priority,” she said.
This transformation was not unexpected. Nearly a decade ago, the Indian Council of Medical Research (ICMR), the Public Health Foundation of India (PHFI), and the Institute for Health Metrics and Evaluation (IHME) had already identified the same pattern through India’s state-level GBD study.
Dr. K. Srinath Reddy, Chancellor of PHFI University of Public Health Sciences, said that India has undergone a “rapid health transition.” Infectious diseases are now better controlled, but lifestyle-related illnesses have surged.
The culprits are familiar, high blood pressure, air pollution, smoking, high blood sugar, and obesity. These factors, often linked to urban life and diet changes, are now responsible for most early deaths.
The Numbers Tell the Story
Globally, NCDs cause nearly two-thirds of all deaths. Cardiovascular diseases remain the biggest killers worldwide. In poorer countries, people die from these diseases about 30 years earlier than in high-income regions, a stark reflection of inequality in healthcare access.
The GBD study estimates that if countries manage the top risk factors effectively, they could prevent up to half of all lost healthy years. That means millions of lives saved every year through simple, proven measures like controlling blood pressure, reducing air pollution, and promoting physical activity.
Beyond physical illness, another silent crisis is growing, mental health. The GBD report shows a steep global rise in anxiety and depression. Anxiety disorders have increased by 63%, and depressive disorders by 26%.
The study also identifies sexual abuse and partner violence as major causes of long-term depression and other mental health problems. Experts urge policymakers to expand healthcare priorities to include adolescents and young adults, who often suffer in silence.
Uneven Recovery After COVID-19
The pandemic changed the global health map. Between 2019 and 2023, Covid-19 killed 18 million people. Yet by 2023, it was no longer among the leading causes of death. Life expectancy has rebounded in most regions, but progress is uneven.
In parts of North America and Eastern Europe, deaths among children and young adults are rising. In sub-Saharan Africa, mortality among women aged 15 to 29 is now estimated to be 61% higher than earlier data suggested.
The report warns that reduced global health funding could reverse the gains made against infectious diseases and newborn deaths. Lower respiratory infections, diarrhoeal diseases, and neonatal disorders still remain among the top 10 causes of health loss worldwide.
India now stands at a crossroads. The country has successfully reduced infectious disease deaths and improved maternal and child health. But it must now prepare for a long battle against NCDs.
Heart disease, diabetes, stroke, and cancer are not only killing more people but also affecting them at younger ages. Urban lifestyles, pollution, and unhealthy diets are accelerating this trend.
Preventive care remains weak. Most people are diagnosed late, when treatment is expensive and outcomes are poor. Public health systems still focus heavily on infections rather than chronic disease management.
Experts say India must act fast to strengthen primary healthcare. Routine screening for blood pressure, sugar, and cholesterol should become as common as vaccination drives once were. Urban planning should promote walking and cycling. Food policies must encourage healthier choices.
What It Means for You
Every statistic in the report points to one truth, your daily habits determine your health destiny.
Check your blood pressure. Control your sugar levels. Stay active. Avoid tobacco. These small steps can prevent the diseases now claiming the most lives in India.
The shift from infections to NCDs is more than a medical story, it’s a social one. It reflects how India is changing, ageing, and urbanising. The next chapter in this story will depend not just on doctors or policymakers but on how each person chooses to live.
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