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The 2030 Agenda for Sustainable Development adopted by the United Nations in 2015 recognizes noncommunicable diseases (NCDs) as a major public health challenge. Sustainable Development Goal (SDG) 3 includes target 3.4 to reduce premature NCD mortality by one‐third by 2030. This review article analyzes the progress towards the attainment of targets within 3.4, the gaps in meeting the targets, and implementation challenges correlated with those gaps. A literature review was performed in September 2020 to identify the published literature and data discussing the SDGs and NCDs, its progress since 2015, and the associated challenges. The analysis reveals SDG target 3.4 is interrelated to at least nine SDGs. There have been many positive SDG initiatives, but the progress has been slow. Data from various countries show that only two out of the ten NCD progress indicators are being met by at least half of the 176 countries who signed the SDGs. The ongoing COVID‐19 pandemic is expected to further aggravate the prevalence and hinder the progress towards the achievement of goals and the targets of the SDGs. The next decade is critical to advance progress on reducing NCDs across countries. The article concludes with a commentary and recommended actions. A combination of prevention, early detection, and treatment are the key to achieve the SDG 3.4 targets. Increased funding and commitments at international and national levels are required to bring about the transformative changes.

Evidence from India, a country with unique and distinct food intake patterns often characterized by lifelong adherence, may offer important insight into the role of diet in breast cancer etiology. We evaluated the association between Indian dietary patterns and breast cancer risk in a multi-centre case-control study conducted in the North Indian states of Punjab and Haryana. Eligible cases were women 30–69 years of age, with newly diagnosed, biopsy-confirmed breast cancer recruited from hospitals or population-based cancer registries. Controls (hospital- or population-based) were frequency matched to the cases on age and region (Punjab or Haryana). Information about diet, lifestyle, reproductive and socio-demographic factors was collected using a structured interviewer-administered questionnaire. All participants were characterized as non-vegetarians, lacto-vegetarians (those who consumed no animal products except dairy) or lacto-ovo-vegetarians (persons whose diet also included eggs). The study population included 400 breast cancer cases and 354 controls. Most (62%) were lacto-ovo-vegetarians. Breast cancer risk was lower in lacto-ovo-vegetarians compared to both non-vegetarians and lacto-vegetarians with odds ratios (95% confidence intervals) of 0.6 (0.3–0.9) and 0.4 (0.3–0.7), respectively. The unexpected difference between lacto-ovo-vegetarian and lacto-vegetarian dietary patterns could be due to egg-consumption patterns which requires confirmation and further investigation.

The study was primarily aimed at estimating the prevalence of hypertension and pre-hypertension and the risk factors of hypertension in the North Indian state of Punjab. It also aimed at assessing the magnitude of undiagnosed cases of hypertension in the community and ascertaining the blood pressure control status of those on treatment. A non-communicable disease risk factor survey (based on WHO-STEPS approach) was done in the state of Punjab, India in a multistage stratified sample of 5127 individuals. The study subjects were administered the WHO STEPS-questionnaire and also underwent anthropometric and blood pressure measurements. Overall prevalence of HTN among the study participants was found out to be 40.1% (95% CI: 38.8-41.5%) whereas prevalence of pre-hypertension, isolated diastolic and isolated systolic hypertension were 40.8% (39.5-42.2%), 9.2% (8.4-10.0%) and 6.5% (5.9-7.2%) respectively. Age group (45-69 years), male gender, social group, marital status, alcohol use, obesity and salt intake (> = 5 gms/day) were the risk factors significantly associated with HTN. Among all persons with HTN, only 30.1% were known case of HTN or on treatment, among whom nearly 61% had controlled blood pressure. Patients with uncontrolled BP were more frequently male, obese patients, with sedentary lifestyle and patients with diabetes. The study reported alarmingly high prevalence of hypertension, especially of undiagnosed or untreated cases amongst the adult population, a significant proportion of whom have uncontrolled blood pressure levels. This indicates the need for systematic screening and awareness program to identify the undiagnosed cases in the community and offer early treatment and regular follow up.

Head and neck cancer (HNC) is a major public health problem in India. This article presents the HNC burden in different regions of India. The published population-based cancer registries (PBCRs) data from the National Cancer Registry Programme, Bengaluru, and the Tata Memorial Centre, Mumbai, India, were utilised. The 37 PBCRs were divided into six regions including central, east, north, northeast, west and south. The age-standardised incidence rate of HNC was 25.9 (95% CI 25.7–26.1) and 8.0 (95% CI 7.9–8.1) per 100,000 population, respectively, in males and females. HNC accounted for about 26% of all cancer cases in males and 8% in females. The risk of developing HNC was 1 in 33 for males and 1 in 107 for females. The northeastern registries reported the highest incidence rate 31.7 per 100,000 population in males followed by northern (28.5), central (28.3), western (24.4), southern (23.9) and eastern (18.3). In females, the incidence was in the range of 6.2–10.1 per 100,000 population. For all PBCRs together, the HNC burden was two to three times higher in the age group 60+ as compared to 20–39 years. The HNC burden in India is higher than in the USA, UK, Australia, Africa and Brazil. The PBCRs from the south-east Asia region such as the Colombo district, Sri Lanka, as well as Siraha, Saptari, Dhanusha and Mohattari – Nepal have also reported a high burden of HNC. All regions reported mouth as a leading cancer site followed by tongue, larynx, hypopharynx and tonsil except the northeastern region registries where hypopharynx was the top leading cancer. The burden of other sites of HNC is low. Raising awareness of the disease and associated risk factors, providing early detection services, as well as easy access to diagnosis and treatment are required. The government should focus on building the infrastructure and capacity building to control this disease.

To assess and classify all private and government schools located in a northern city of India for accreditation as health promoting schools and comparative health profile assessment of selected higher accredited schools with lower accredited and non-accredited schools Quasi experimental study with pre and post assessment with comparison of higher with lower accredited schools. The current study was conducted in 206 schools of Chandigarh City of Northern India. Comparative health profile assessment was undertaken in 8 schools with 754 children from higher accredited (platinum, gold, silver) and 8 schools with 700 children from lower accredited (bronze) and non-accredited (below bronze) schools. Multicomponent and multilevel intervention was undertaken with self-quality improvement by schools with help of a manual of accreditation of school as health promoting schools. Key intervention included capacity building, technical visits, supportive supervision, sensitization of policymakers and key stakeholders, implementation of policy initiatives, use of social media, technical support and monitoring of activities. Out of 206 schools, 203 participated in the baseline assessment and 204 in the endline assessment. The response rate was 99%. Two schools which refused participation were excluded and not assessed. Schools (N = 17) which participated in the 2011-2013 study were excluded from analysis. There was a statistically difference (p = 0.01) in the improvement of accreditation level of the baseline and endline assessment after intervention(p<0.05). Overall, the proportion of schools at the gold level increased from 1(0.5%) in 2016 to 71(38%). Silver level from 9(5%) to 57 (31%) of schools after intervention. The response rate in health profile assessment in higher(8) and lower(8) accredited schools was 95.9% and 92.7% respectively. The health profile of children higher accreditation level schools (N = 754) were found better in hygiene practices protective factors (peer support at school, parental or guardian supervision), handling stress and less prone to injury as compared to lower accreditation level schools (N = 700),(p<0.05). The health promoting school programme was found to be feasible and effective and lead to significant improvement in accreditation level as compared to baseline assessment after continuous self-quality improvement by schools(p<0.05). The health profile of children studying in higher accredited schools was better as compared to lower accredited schools.

Since the adoption of the Global action plan on antimicrobial resistance in 2015 notable progress has been made in combating antimicrobial resistance. In 2024, 178 countries had developed multisectoral national action plans, with many drawing directly on the global action plan. However, only 20 of these countries have dedicated funding for implementation, 93 have a functioning multisectoral coordinating mechanism and 121 are implementing them. Furthermore, very few national action plans address inequities in adverse health and social consequences of antimicrobial resistance, including from gender, disability and human rights perspectives. Current efforts to curb antimicrobial resistance have stalled. Without faster implementation of effective interventions, including antimicrobial stewardship, water, sanitation and hygiene infrastructure, therapeutics and vaccines, antimicrobial resistance is estimated to reduce global life expectancy by 1.8 years by 2035.  The landscape of global health governance has changed dramatically since the action plan was established. Several cross-border public health crises have occurred, including a pandemic; unprecedented diplomatic challenges for multilateral organizations; and the alteration of the health funding landscape. Nonetheless, public health institutions have strengthened in many parts of the world, and the global health architecture for antimicrobial resistance is maturing through the establishment of institutions such as the Global Leaders Group on Antimicrobial Resistance and the AMR Multi-Stakeholder Partnership Platform. The international health community increasingly recognizes that antimicrobial resistance is not only a human, biomedical and regulatory issue, but also a social, animal, ecological and economic one. Social science research on antimicrobial resistance has gained traction in the last decade, employing a diverse set of theoretical perspectives to better understand topics ranging from antimicrobial stewardship to political coordination. As the action plan commitments will be updated in 2026, an opportunity exists to employ a broader social science scope to accelerate national antimicrobial resistance interventions. In January 2025, the Global Strategy Lab convened leading antimicrobial resistance social scientists from a variety of disciplines to determine which new ways of understanding antimicrobial resistance could catalyse and incentivize action. Three conceptions stood out as important to revisions of the action plan: antimicrobial resistance as socio-ecological dynamics, antimicrobials as essential infrastructure4 and antimicrobial resistance as collective action problems. In this article, we propose that these three social sciences conceptions can be applied to global action plan revisions to improve how problems are defined and their solutions implemented. These three concepts can also engage important new partners to ensure antimicrobial resistance policies are sufficiently equitable, sustainable and multisectoral.

Background A variety of mobile-based health technologies (mHealth) have been developed for use by community health workers to augment their performance. One such mHealth intervention—ReMiND program, was implemented in a poor performing district of India. Despite some research on the extent of its effectiveness, there is significant dearth of evidence on cost-effectiveness of such mHealth interventions. In this paper we evaluated the incremental cost per disability adjusted life year (DALY) averted as a result of ReMiND intervention as compared to routine maternal and child health programs without ReMiND. Methods A decision tree was parameterized on MS-Excel spreadsheet to estimate the change in DALYs and cost as a result of implementing ReMiND intervention compared with routine care, from both health system and societal perspective. A time horizon of 10 years starting from base year of 2011 was considered appropriate to cover all costs and effects comprehensively. All costs, including those during start-up and implementation phase, besides other costs on the health system or households were estimated. Consequences were measured as part of an impact assessment study which used a quasi-experimental design. Proximal outputs in terms of changes in service coverage were modelled to estimate maternal and infant illnesses and deaths averted, and DALYs averted in Uttar Pradesh state of India. Probabilistic sensitivity analysis was undertaken to account for parameter uncertainties. Results Cumulatively, from year 2011 to 2020, implementation of ReMiND intervention in UP would result in a reduction of 312 maternal and 149,468 neonatal deaths. This implies that ReMiND program led to a reduction of 0.2% maternal and 5.3% neonatal deaths. Overall, ReMiND is a cost saving intervention from societal perspective. From health system perspective, ReMiND incurs an incremental cost of INR 12,993 (USD 205) per DALY averted and INR 371,577 (USD 5865) per death averted. Conclusions Overall, findings of our study suggest strongly that the mHealth intervention as part of ReMiND program is cost saving from a societal perspective and should be considered for replication elsewhere in other states.

IntroductionSettings-based approaches to health promotion, involving holistic and multidisciplinary methods, which integrate action across risk factors are important. Major advantage of focusing on these settings is the continuous and intensive contact with the participant. Despite the apparent advantages of addressing non-communicable diseases (NCDs) using targeted interventions for several developed country settings, a relative lack of evidence of effectiveness of such interventions in low/middle-income countries has led to poor allocation of resources towards these interventions. The focus is therefore on the settings rather than any one condition, and we therefore expect the findings to generalise to NCD prevention and control efforts. We intend to estimate the effectiveness of targeted interventions in low/middle-income countries.Methods and analysisWe will search PubMed, Excerpta Medica Database, OVID, WHO Library and The Cochrane Library from the year 2000 to March 2018 without language restrictions. Study designs to be included will be randomised controlled trials. The primary outcome of effectiveness will be the percentage change in population having different behavioural risk factors. Subgroup analyses will be performed, and sensitivity analyses will be conducted to assess the robustness of the findings.Ethics and disseminationNo ethical issues are foreseen. The Institute Ethics Committee of the Post Graduate Institute of Medical Education and Research approved the doctoral research protocol under which this review is being done. Dissemination will be done by submitting scientific articles to academic peer-reviewed journals. We will present the results at relevant conferences and meetings.Study designSystematic review.PROSPERO registration numberCRD42016042647; Pre-results.

Context: Health promotion (HP) has been an integral part of all national programs although it has been a low priority in India, which has resulted in a failure to achieve the desired results. Settings and Design: Situation analysis of information education communication (IEC)/behavior change communication (BCC)/HP activities within the existing national health programs was undertaken in the district of Hoshiarpur in Punjab and the district of Ambala in Haryana during 2013-14. Materials and Methods: Facility-based assessments were done by conducting in-depth interviews with stakeholders, program officers, medical officers, health workers, and counselors. Household survey (332 individuals) and exit interview (102 interviews) were conducted to assess the knowledge of the community regarding key risk factors. Results: There was a high vacancy in the mass media division with 40% (2 out of 5) and 89% (8 out of 9) of the sanctioned positions vacant in Hoshiarpur and Ambala, respectively, with low capacity of staff and budget. There was no annual calendar, logbook of activities with poor recording of IEC material received and disseminated. The knowledge of community members regarding key risk factors such as tobacco use, salt intake, blood pressure level, anemia, and tuberculosis was 77.3%, 26.4%, 16.4%, 32.7%, and 91.8%, respectively, in the district of Ambala as compared to 77.5%, 37.5%, 33.3%, 25.8%, and 88.3%, respectively, in the district of Hoshiarpur. The village health and sanitation committee (VHSC) in the district of Hoshiarpur and village level core committee (VLCC) in the district of Ambala were found to be nonfunctional with no Iec/Bcc activities in the covered villages in the last month. Monitoring and supervision of Iec/Bcc activities were poor in both the districts. Conclusions: Iec/Bcc/HP is a neglected area in national health programs in the selected districts with inadequate budget, human resources with poor implementation, and requires strengthening for better implementation of the national health programs.

BackgroundEnvironmental influence plays a major role in determining health status of individuals. Punjab has been reported as having a high degree of water pollution due to heavy metals from untreated industrial effluent discharge and high pesticide consumption in agriculture. The present study ascertained the association of heavy metal and pesticide exposure on reproductive and child health outcomes in Punjab, India.MethodsA cross-sectional community-based survey was conducted in which 1904 women in reproductive age group and 1762 children below 12 years of age from 35 villages in three districts of Punjab were interviewed on a semistructured schedule for systemic and general health morbidities. Medical doctors conducted a clinical examination and review of records where relevant. Out of 35 study villages, 25 served as target (exposed) and 10 as non-target (less exposed or reference). Effluent, ground and surface water, fodder, vegetables and milk (bovine and human) samples were tested for chemical composition, heavy metals and pesticides.ResultsSpontaneous abortion (20.6 per 1000 live births) and premature births (6.7 per 1000 live births) were significantly higher in area affected by heavy metal and pesticide pollution (p<0.05). Stillbirths were about five times higher as compared with a meta-analysis for South Asian countries. A larger proportion of children in target area were reported to have delayed milestones, language delay, blue line in the gums, mottling of teeth and gastrointestinal morbidities (p<0.05). Mercury was found in more than permissible limits (MPL) in 84.4% samples from the target area. Heptachlor, chlorpyriphos, β-endosulfan, dimethoate and aldrin were found to be more than MPL in 23.9%, 21.7%, 19.6%, 6.5% and 6.5% ground water samples respectively.ConclusionAlthough no direct association could be established in this study, heavy metal and pesticide exposure may be potential risk factors for adverse reproductive and child health outcomes.