Why non-communicable diseases are rising in rural India

Om Singh, a 65-year-old resident of Gangnauli, a village in Baraut community development block of Baghpat district in Western Uttar Pradesh, first noticed a wound in his gums in August 2009.

Located around 34 km north from district headquarters, his village has limited access to quality healthcare. Initially, Om Singh consulted a local doctor who prescribed antibiotics and some general medications, but his condition didn’t improve. A dentist later advised surgical removal of the wound which provided temporary relief but later a tumor eventually developed.

Given inadequate health services in the district, he went to Safdarjung Hospital in New Delhi in July 2010 where he was diagnosed with cancer and admitted for two months for treatment. Later a surgery was recommended. 

Om Singh is not the only cancer patient in Gangnauli. More than 10 individuals from the village are currently undergoing treatment.

A list shared by the lekhpal (village accountant) with the research team documented six active cancer cases and eight hepatitis patients. This list was prepared in May 2024, following a directive from the sub-district officer and prompted by media coverage on rising cancer cases.

However, interviews with local residents indicated that the official report may have understated the actual numbers. Community members recalled that the spike in cancer cases began attracting attention nearly a decade ago. Since then, the number of cases and deaths has remained consistently high. 

According to people’s testimonials, around 350-400 residents of the village have suffered from various forms of cancer, including oral, gall bladder, uterine and lung, with an estimated 150-200 fatalities. However, the document submitted to sub-district office recorded only 100 cancer cases in 10 years.

Three decades ago, non-communicable diseases (NCD) like cancer, diabetes and cardiovascular ailments were rare in the villages. Today, however, low- and middle-income countries confront an NCD burden that has spread from cities to villages.

In Gangnauli, almost every household now reports at least one member with cancer, heart disease or debilitating joint pain, a trend confirmed by local physicians, Accredited Social Health Activists (ASHA) and community elders.

Villagers attributed these health issues to multiple interlinked factors. Historical shifts in agricultural practices, political regimes, environmental degradation and industrial pollution are among the commonly cited causes.

According to Dr Sushil, a local physician, “cancer cannot be attributed to polluted water alone”. He emphasised that changes in lifestyle, diet, neglect of the natural environment, reduced physical activity and adoption of western and urban consumer habits, largely driven by globalisation have played a significant role. He also highlighted the adverse effects of excess use of fertilisers on human and livestock health.

A major shift in agricultural practices occurred in the late 20th century, when farmers moved from traditional diverse cropping systems to sugarcane monoculture. More recently, paddy cultivation has begun to be practiced alongside sugarcane, a shift from previous agricultural patterns.

The change is largely as a response to environmental pressures and increased crop damage by wild and stray cattle. The surge in stray cattle is linked to policy changes under the current Bharatiya Janata Party government, including restrictions on cattle trade and livestock market.

Simultaneously, shrinking forest cover has driven wild animals into farmlands, further impacting crop choices. As a mitigation option, farmers have shifted to paddy cultivation that are less likely to be grazed. 

Development policies in Western Uttar Pradesh have evolved over three political phases. The first, led by Chaudhary Charan Singh, promoted intensive groundwater extraction for sugarcane farming using modern machinery. His successor, Ajit Singh, continued this trajectory, while the third phase under Hukum Singh acknowledged the ecological consequences, especially groundwater depletion.

To address this, a series of check dams were constructed along the Krishni River near Gangnauli to recharge groundwater. While the river once flowed well due to healthy rainfall and a functioning canal system, recent years have seen reduced rainfall and dried canals. As a result, check dams now hold stagnant, polluted water from nearby sugar mills and industries, which seeps into the groundwater and re-enters the food chain through irrigation.

The situation in Gangnauli reflects broader trends seen in rural India, where economic pressures and industrialisation have led to environmental degradation and significant health challenges, exacerbated by poor healthcare infrastructure. The nearest Primary Health Centre is about 10 kilometres away and accessible only by private transport. With just five ASHA workers and four Anganwadi workers for the entire village, frontline health services are severely strained. 

In the absence of adequate public healthcare, residents rely on around 10 informal healthcare providers. Diagnostic facilities, particularly for cancer, are inadequate, prompting most patients to seek care in Delhi.

After his surgery, Om Singh continued regular follow-ups at Safdarjung Hospital, New Delhi until the COVID-19 pandemic disrupted his visits in 2020. Unable to travel, he located a retired Safdarjung doctor practicing in Baraut near Delhi Road and has since continued his treatment there.

Meanwhile, many others in the village struggle to access proper care. Residents expressed concern that if comprehensive screening were conducted locally, a significant number of undiagnosed cases would likely emerge.

Like Gangnauli, rural areas in developing countries largely due to changing environment, lack of healthcare infrastructure, culture and life style changes caused by global influence and most importantly agricultural shifts are responsible for increasing NCDs. 

Asrarul Haque Jeelani is a guest faculty at the department of social work, Jamia Millia Islamia, New Delhi. Md Adil Hussain is an independent researcher based in New Delhi. Views expressed are the authors’ own and don’t necessarily reflect those of Down To Earth.