The double burden of disease: navigating communicable and non-communicable threats

In hospital wards, families frequently confront an unkind truth: a sick child with tuberculosis, while the father experiences a heart attack due to undiagnosed diabetes. This is the double burden of disease faced by Pakistan, the constant battle against infectious diseases alongside a rising epidemic of chronic conditions. ¹ Developing nations like our own are caught in this transition, with their health systems stretched to the breaking point. Immediate integrated measures are required. Noncommunicable diseases (NCDs) account for 75% of all deaths worldwide during non-pandemic times. Among developing and developed nations, four out of five premature NCD deaths are due to cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes. In Pakistan, NCDs are estimated to cause around 52-60% of deaths, while communicable diseases and nutritional problems account for another 37%. Tuberculosis is particularly severe, as Pakistan is among the top five countries for TB, with nearly 140 daily deaths from the disease. Pakistan also has a very high rate of diabetes; one in every three adults (31.4%) suffers from this condition, amounting to 34.5 million affected people aged 20-79 as of 2024. In addition, hypertension, obesity, and cardiovascular disease are major concerns resulting from modernization, unhealthy nutrition, tobacco use, and environmental pollution. ³ These conditions claim the lives of many young people. Moreover, high out-of-pocket healthcare spending pushes families into poverty, while households facing both undernutrition and obesity encounter additional challenges. Rapid urbanization and changing lifestyles are driving a fast rise in NCDs, while infectious diseases such as TB, hepatitis, and dengue remain common across the country. Yet there is hope, as integrating health services helps save resources. For Pakistan, addressing the double burden requires scaling up several measures: improving primary healthcare through programs such as the Sehat Sahulat Program, integrating NCD and TB services, monitoring risk factor behaviours, and launching aggressive public awareness campaigns about salt, sugar, smoking, and physical inactivity. Schools, mosques, and workplaces should serve as vehicles for change. Data analysis and research into local risk factors would help guide the right investments. The private sector, civil society, and international organizations must collaborate to ensure affordable medicines, climate resilience, and adequate funding for these programs. While individuals need to be encouraged to adopt healthy lifestyle choices, political will and government investment are vital to tackling this challenge. ², ³