Rising population and socio-economic transition in the country have led to rapid urbanization and unplanned expansion of cities, as more and more people are migrating from rural areas to urban centers in search of better livelihood opportunities. "This has placed increased demand on urban infrastructure, services and public places, leading to upsurge in disease burden through increased susceptibility to risks for NCDs". Following these changes in the socio-economic environment of individuals, risk factors for NCDs have become widespread. Market liberalization and agricultural subsidies have made unhealthy products easily available at reduced prices, which are causing negative health outcomes.
Some of the behavioral risk factors of NCDs are closely interlinked to poverty, low education, poor diet, inequitable access to health services, and gender disparity. Diabetes (particularly type 2) was previously seen as a disease of affluence, which now seem misleading, as approximately 70% of the world's diabetic people live in low and middle income countries, with high prevalence in world's poorest cities, where access to health care and social support is either not available, or is very limited. Low intake of fruits and vegetables and lower levels of physical activity coupled with unhealthy food consumption is now being witnessed among the urban poor in India. Tobacco, seen as the single largest preventable risk factor, disproportionately affects the poor and the less educated. The inequities in vulnerability and exposure to tobacco use (social, psychological, health status, exposure to tobacco through advertising, lack of cessation services) is clearly evident, and often leads to prolongation of tobacco use among the adolescents and adults from poor socio-economic backgrounds. In the case of mental disorders, the risk is determined by an interface of genetic, biological, social, psychological factors. Increased rates of depression are associated with NCDs, and socio-economically disadvantaged groups bear uneven burden of negative health outcomes, with poor access to mental health services. Evidence gathered so far indicates higher burden of alcohol-attributable disease among people of lower socio-economic sections, despite lesser overall consumptions levels, as health outcomes depend not only on the amount but also on the type and quality of alcohol consumed.
High NCD mortality in India, which is attributed among other reasons to a weak health system, leads to high and many a times catastrophic out-of-pocket expenditure on health. For a country like India, which is facing scarce resources, prevention of diseases, particularly NCDs that are expensive to treat, is the most cost-effective strategy. India spent nearly INR 846 billion out of pocket on health care expenses in the year 2004, amounting to 3.3% of India's Gross domestic product (GDP) for that year. This marked a substantial increase from INR 315 billion spent out of pocket on health care in the year 1995-96 (about 2.9% of India's GDP in the year 1995-96). Out of this, a total out of pocket health expenditure on NCDs including heart diseases, hypertension, respiratory diseases, orthopedic problems, kidney diseases, neurological disorders, cancer, accidents, and injuries was INR 99.61 billion in 1995-1996, which has increased to INR 400.31 billion in 2004. Access to basic health care in itself is a challenge in India and contributes to health inequalities as this is mainly influenced by wider social determinants of health and infrastructural support. Thus, combating NCDs requires effectively addressing these social determinants of health, through comprehensive action focusing on prevention and control of NCDs.