In 1980, non-communicable diseases (NCDs) such as cancers, cardiovascular diseases, chronic respiratory diseases, diabetes, and so on, caused 60% of all deaths globally, while the remaining were the result of communicable, maternal, neonatal, and nutritional diseases1. Steadily increasing over the years, the figure stood at 82% in 2018, with NCDs becoming the dominant cause of deaths across the world. Looking at the group of low SDI (Socio-Demographic Index) countries2, the split of the total disease burden between NCDs and other diseases, has gone from 30-70 to about half-and-half during 1980-2018 (Global Burden of Disease (GBD) Study, 2021, Institute of Health Metrics and Evaluation (IHME))3 – implying that NCDs are no longer “diseases of affluence” as once considered. This shift reflects a clear global transition in the pattern of disease burden over the past four decades.
Figure 1. Cause of death (%), Global, Population level
Source: Global Burden of Disease Study (GBD), 2021, IHME. The rest of the figures are based on the same dataset.
Note: The ‘stacked area chart’ shows the global composition of causes of death (in percentage terms) from 1980 to 2018, disaggregated into two broad categories: Communicable, maternal, neonatal, and nutritional diseases (CMNNDs) (light green) and non-communicable diseases (NCDs) (dark green). Injuries have been included along with NCDs in Figure 1 and Figure 2.
Figure 2. Cause of death (%), Low SDI countries, Population level
Note: The stacked area chart shows the changing pattern of causes of death in low-SDI (Socio-Demographic Index) countries between 1980 and 2018, with the light green area representing CMNNDs and the dark green area depicting NCDs.
Safe from polio, prone to diabetes
A few decades ago, across the world, communicable diseases like diarrhea, tuberculosis, and measles featured in the top 10 causes of death. A key focus of global and country-level health policies involved programmes against specific diseases. Strides were made in preventive vaccination, surveillance and outbreak responses, development of antibiotics, and health education and awareness among the populations. While the fight is by no means over for certain diseases, fewer lives are now lost to communicable diseases. For instance, wild poliovirus cases have fallen by over 99% since 1988 (from 350,000 to single digits) with about 20 million paralysis cases and 1.5 million deaths averted globally. With regard to malaria, annual global deaths dropped from a peak of around 1.8 million in 2004, to 597,000 in 2023; 12.7 million malaria deaths have been prevented since the year 2000 (World Health Organization (WHO), 2025).
At the same time, lifestyles have been changing, putting people at greater risk of developing NCDs4. As Bloom et al. (2012) explain, “The rise in the prevalence and significance of NCDs is the result of complex interaction between health, economic growth and development, and it is strongly associated with universal trends such as…rapid unplanned urbanization and the globalization of unhealthy lifestyles.” Structural transformation away from agriculture and the rise of mechanisation implies that most of us no longer need to engage in manual work to make a living or even to manage household chores. In parallel, unhealthy, processed foods have become more readily available and at lower costs than natural foods. For example, based on a sample of 10,111 NCD patients in the United States, Li et al. (2023) show that smoking, insufficient physical activity, sedentary behavior, and a pro-inflammatory diet significantly impact the all-cause mortality of the patients. Further, there are synergetic effects, such that some combinations of these high-risk lifestyle factors cause more harm than others.
Earlier NCDs were thought of diseases that mainly affected the elderly: these illnesses caused 85% of deaths in the 70+ age group and 79% of deaths among 50-69 year olds in 1980, with the figure being about half for the young (Figure 3). Although the older age groups continue to bear a larger burden of NCDs, the annualized rate of increase has been steepest for the 15-49 year olds, which is the working-age population and also encompasses the female reproductive years. The trend underscores a role for early-life interventions and preventive care to address the rising burden of chronic, lifestyle diseases in this demographic group.
Figure 3. Annualized increase in share of deaths due to NCDs, Global, 1980-2018
Notes: (i) The bar graphs show the percentage of deaths caused by NCDs in 1980 (dark green bars) and 2018 (light green bars) across three age groups (15-49, 50-69, and 70+ years) on the left-hand side vertical axis. (ii) The line graph plots the annualized rate of change (%) in this indicator for each age group over the 38-year period, on the right-hand side vertical axis.
Non-communicable diseases and risk factors: Differences across genders
At the global level, in 2018, the difference between the rate of NCD deaths among working-age females versus working-age males stood at 6 percentage points (p.p.) – the widest it had been since 1980. Moreover, there is a consistent upward trend since 2010.
Figure 4 below home in on the working-age populations in China, India, and sub-Saharan Africa (SSA). In China, in 1980, the percentage of deaths caused by NCDs among women exceeded that among men by 4 p.p. This gap expanded to 9 p.p. by 2018. For India, the male figure in 1980 was higher than females, with a difference of 9 p.p. The gap began narrowing in the 2000s and the figures for females and males were almost the same during 2014-2017. It was after this period that the share of NCD deaths among women started to exceed that among men5. Turning to the case of SSA, working-age women and men had very similar rates of NCD deaths through the 1980s. In the years that followed, NCDs were responsible for a greater proportion of deaths among men vis-á-vis women, the difference being in the range of 4-6 p.p. between 1995 and 2013. The gap reduced thereafter, falling to about 2 p.p. by 2018.
Overall, it appears that economic development is associated with higher and more unequal risk of NCDs. As countries become richer, people with lower socioeconomic status, especially women, are at greater risk of developing NCDs (Brindley et al. 2025).
Figure 4. Cause of death from NCDs (%) in China, India, and SSA
Note: This figure presents the percentage of total deaths attributable to NCDs among females and males, for different age categories, for the regions of China, India, and sub-Saharan Africa (SSA), covering the time period 1980-2018.
Figure 5 below shows the global number of deaths attributable to major Level 2 risk factors6 in 2021, by gender, as well as how the burden is distributed across the major NCDs. Notably, the leading risk factor among both women and men is high systolic blood pressure. A majority of the deaths associated with this risk factor occur due to cardiovascular diseases (52-55%), with 15% caused by diabetes and kidney diseases7. For females as well as males, there are three other risk factors that figure in the top-five: (i) dietary risks, largely leading to cardiovascular diseases but also diabetes and kidney diseases, and neoplasms; (ii) air pollution, leading to the above mentioned NCDs plus chronic respiratory diseases; and (iii) high fasting plasma glucose, which manifests as diabetes and kidney diseases, cardiovascular diseases, neurological disorders, and neoplasms.
The fifth leading risk factor for women is high BMI (body-mass index), while it is ranked lower for men. On the other hand, tobacco, which is only next to high systolic blood pressure in causing male deaths, is a lot less significant among women.
Thus, the data highlight both shared and sex-specific health threats, with implications for designing gender-responsive prevention and management strategies as the NCD burden continues to rise globally.
Figure 5. Deaths attributable to Level 2 risk factors, Global, 2021
A. Females
B. Males
Note: The horizontal stacked bar charts show the global number of deaths attributable to major Level 2 risk factors in 2021, separately for females (top chart) and males (bottom chart). Each bar represents a specific risk factor, and the different colored segments reflect the distribution of the burden across the major NCDs.
Figure 6 below shows how the prevalence and severity of exposure to NCD risk factors has been changing among females globally and in particular regions. Across the board, and especially for low-middle SDI countries, there is a fast increase in exposure to the risk factor of high BMI. This is closely followed by high fasting plasma glucose, which has relatively greater prominence in high SDI and low-middle SDI countries. These risk factors are tied to individual lifestyles in complex ways, and are hence, harder to influence via public health programmes. On the other hand, exposure to factors such as dietary risks, high LDL cholesterol, and kidney dysfunction seems to have stabilized – perhaps an outcome of broad policy measures such as nutrition labelling requirements, trans-fat use regulation, sodium reduction strategies, and so on – even as further reductions remain challenging. Finally, women’s use of tobacco has shown a decline in all regions, likely linked to public awareness campaigns and taxation.
Figure 6. Annualized rate of change in exposure to risk factors, Females, 1990-2018
Notes: (i) This heatmap displays the Annualized Rate of Change (ARC) in Summary Exposure Value (SEV) for major Level 2 risk factors among females from 1990 to 2018, for specified regions. (ii) SEV measures the prevalence and severity of exposure to a risk factor on a scale from 0 to 100. SEV has been age-standardized. (iii) ARC tells us how fast the exposure has been increasing or decreasing annually. (iv) Green shades indicate positive values of ARC, that is, an increase in exposure to a risk factor. Darker the green, the greater is the increase. On the other hand, purple shades indicate negative values of ARC, that is, a decrease in exposure to a risk factor. Darker the purple, the greater the decrease.
Women’s health: Broadening the agenda
Women face a “triple burden of disease” including problems related to reproductive health, communicable diseases and NCDs. In the 1980s, maternal mortality, that is, deaths caused by complications from pregnancy or childbirth, was alarmingly high. For the group of SDI countries, the Maternal Mortality Ratio (MMR) stood at 605 per 100,000 live births in 1980. The figure was even higher for India, at 613, while it was 503 for SSA. A key reason was insufficient access and awareness vis-á-vis institutional deliveries, with several births delivered at home without the presence of Skilled Birth Attendants.
Accordingly, in the context of women’s health, the attention of policy as well as research was on making motherhood safe. Over time, the rise in institutional deliveries together with advancements in medical knowledge, technology, and infection control, led to a worldwide decline in MMR. Among SDI countries, the 1980 figure almost halved by the year 2018. Although there is still some way to go in addressing fatalities pertaining to motherhood, these decades also saw an epidemiological transition towards NCDs, as discussed above, warranting a wider approach to women’s health. Women with PCOS experience greater incidence of NCDs such as stroke and cancer.
Figure 7. Maternal Mortality Ratio, 1980-2018
Note: This graph shows the maternal mortality ratio (MMR), measured as maternal deaths per 100,000 live births, from 1980 to 2018, globally and for specified regions.
Hence, the underlying risk factors – behavioral, biological, social, or cultural – across poor reproductive and non-reproductive health of women appear to be similar. These studies advocate for allocating adequate resources to the prevention, management, and treatment of NCDs among females, as this has the potential to improve their reproductive health as well. There is an urgent need to integrate maternal health services with those that identify and manage women at high risk of NCDs, and to adopt a life-course approach to women’s health, as outlined by the WHO (Peters et al. 2016).
A key aspect is medical research. While it is now better known in high-income countries that medical research on cardiovascular diseases has mostly been conducted with males and cannot simply be applied to females in terms of occurrence, management, and outcomes of the disease, there are still gaps in low- and middle-income countries (LMICs) and with regard to other diseases (Peters et al. 2016). For instance, there ought to be greater representation of female participants in metabolic health studies, given that there are sex differences in the prevalence, pathophysiology, and responses to treatment of metabolic disorders like type 2 diabetes. This can also help address knowledge gaps at the intersection of hormonal health and female reproductive health (Athar et al. 2024).
Hence, the idea is not to undermine the maternal and child health agenda but to expand and adapt it – in line with the changing disease patterns among women.
Features of NCDs that make a gender-sensitive approach imperative
NCDs are often termed as ‘silent killers’, with the disease progressing slowly and major symptoms only appearing at more advanced stages. Owing to the complexity of NCDs and technological developments, diagnostic tests can be quite expensive. Healthcare-seeking behaviors and health awareness matter, as the timing of diagnosis has implications for the outlook of the disease. Taking the example of diabetes, if an individual is diagnosed as prediabetic, there is evidence that lifestyle interventions have some success in delaying the onset of the disease (Lindström et al. 2006).
Further, NCDs tend to be chronic, warranting long-term adherence to treatment and follow-up. Based on nationally representative data from India for the year 2014, Ladusingh et al. (2018) demonstrate that women’s out-of-pocket medical and non-medical expenses on NCDs are highest with regard to NCDs, relative to other diseases including those pertaining to reproductive health.
In resource-constrained settings, the associated costs may be especially hard for female household members to prioritize, for example, medication for asymptomatic conditions such as cholesterol (Jan et al. 2018). Besides, gendered norms dictate that women shoulder caregiving responsibilities within the household, which may include care of NCD-stricken males – at the cost of their own care and medical treatment, as well as participation in paid work or education. Thus, the social and economic burden of NCDs is closely linked with gender and this aspect needs further study (García‐Morales et al. 2024). In the absence of targeted public health efforts towards preventive care, early detection, and effective management of these conditions among women, the growing burden of NCDs can exacerbate existing gender inequalities.
When limited household resources are spent on seeking healthcare for male rather than female members (as discussed in detail in the previous blog), is this reflective of a ‘rational’ economic choice that prioritizes the health of breadwinners (who are more likely to be male in LMICs) or an entrenched pro-male bias (also imbibed by females)? We explore this in our next blog in September.
FOOTNOTES
1For the purpose of these figures, “Injuries” as a cause of death have been counted along with NCDs. Since the proportion of deaths attributable to injuries has not changed much over the years, it does not affect the analysis of trends in NCDs relative to other diseases in any significant manner.
2 Low SDI countries, as defined by IHME, refer to countries characterized by poor health outcomes, low educational attainment, and low income per capita. There is considerable overlap between this group and those classified as low-income countries by the World Bank based solely on gross national income (GNI) per capita. This is particularly true in sub-Saharan Africa where several countries like Chad, Mozambique, Niger, etc., have both low income levels and broader socio-demographic disadvantage.
3 While this dataset currently covers the period up to 2021, we cut off at 2018, which is prior to the Covid-19 pandemic, to more clearly see the longer-term evolution in the disease composition across NCDs and other diseases. All data analysis in this blog draws on the same data source.
4 There are also non-modifiable risk factors such as genetic make-up.
5 This coincides with a period of sharp decline in the female labour force participation in India, particularly in rural areas. The national figure fell from 35% in 2005 to 27% in 2012, settling at this low level until the Covid-19 pandemic (World Bank). The associated lifestyle changes, such as the withdrawal from manual agricultural work, may plausibly be linked to rising NCDs among women.
6 The GBD study includes a hierarchical structure of risk categories. The risk factors that we discuss here fall under the second tier of this structure. The tiers represent broader groupings of specific risk exposures such as air pollution or dietary factors, aggregated under a single thematic cluster. The reason for focusing on Level 2 is that these are more granular and actionable, allowing for clearer attribution to specific causes and targeted policy or programmatic interventions.
7 Smaller residual categories such as skin diseases have not been shown here and hence the percentages do not add up to 100.
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