The silent epidemic: Pakistan’s battle with non-communicable diseases

Pakistan stands at the precipice of a public health crisis, not from an infectious outbreak, but from a quieter, more insidious threat: non-communicable diseases (NCDs). These diseases–cardiovascular ailments, diabetes, chronic respiratory conditions, mental health disorders, and cancers–are our present reality. Until 2010, communicable diseases–those transmitted from person to person–dominated our health burden. However, that year marked a grim milestone: NCDs surpassed communicable diseases in causing deaths. In 2010, an estimated 681,003 Pakistanis died due to NCDs, compared to 675,332 from communicable illnesses. This gap has only widened since. Over the past three decades, deaths due to NCDs have nearly doubled from 426,809 in 1990 to over 830,000 in 2019. The burden has expanded from 29.9% of all disease impact in 2000 to a staggering 43.7% in 2019. Pakistan is, in many ways, a mirror of global patterns: 74% of all deaths worldwide are now due to NCDs, 86% of which occur in low- and middle-income countries. Nearly half of these deaths occur before the age of 70. What drives these staggering numbers? The answer lies in a mix of behavioral, environmental, and genetic risk factors–with personal lifestyle choices playing the central role. The biggest irony is that many of these deaths are preventable. Take smoking, for instance. A deeply personal choice, yet one with public consequences. Tobacco use is one of the leading causes of NCDs. The World Health Organization (WHO) links it to approximately 85% of lung cancer cases. It damages almost every organ of the body. Yet, as of 2021, 31.7% of Pakistani men and 7.3% of women over age 15 were estimated to smoke. However, even those who choose not to smoke aren’t safe. Second-hand smoke (SHS) remains a major threat. A study by researchers at Aga Khan University found SHS exposure in an alarming 95% of children in Pakistan and Bangladesh. Exposure to these toxins puts children and non-smokers at equal risk of NCDs. Environmental risks like poor air quality and sedentary urban living add to the crisis. Meanwhile, genetic predispositions–exacerbated by prevalent cousin marriages–compound risks, especially for diabetes and heart disease. However, emerging research in epigenetics offers a silver lining: healthy behaviors and improved environments can reduce the expression of harmful genes. The statistics are alarming: one in four adults above 20 in Pakistan now has type II diabetes. One in three over the age of 45 suffers from high blood pressure–a precursor to fatal cardiovascular diseases increasingly found in younger populations. One in nine Pakistani women is likely to be diagnosed with breast cancer at some point in her life. What ties many of these diseases together are common risk factors: tobacco use, poor diet, physical inactivity, and air pollution. These often co-exist, and their combined effect is deadly. Addressing this avalanche of chronic disease will require a sustained, multi-sectoral response. This means: Policy reform and regulation: Strict control of tobacco, sugary drinks, and fast food industries that thrive on promoting unhealthy behaviors. Public awareness and education: Mass campaigns, health literacy programs, and school-based interventions to instill lifelong healthy habits. Healthcare infrastructure: Investment in preventive care, early screening, and chronic disease management–particularly in underserved areas. Environmental action: Urban planning that encourages physical activity, green spaces, clean air, and a crackdown on environmental pollutants. Research and data: Building robust surveillance systems to track NCD trends and outcomes, so policy can be data-driven and adaptive. NCDs are not fleeting illnesses; they are chronic, debilitating, and often fatal. Tackling them requires a commitment that is just as enduring–from our health systems, our governments, our communities, and ourselves. We cannot afford to treat this silent epidemic with silence.