Cancer Specialist Warns India Will Lose 40 Years of Health Gains to NCD Deluge
Dr. D. Raghunadha Rao reveals tobacco cessation clinics exist only on paper, finds 300 oncology residents don’t know pharmacological withdrawal, warns one hookah session equals 1.5 cigarette packs, and predicts India’s life expectancy gains from 32 to 72 years will vanish without urgent action, Rashmi Kumari of Neo Science Hub, reports.
“It is very easy to stop smoking. I have done it several times,” quipped Dr. D. Raghunadha Rao, Professor of Medical Oncology at MNJ Cancer Hospital, Hyderabad, citing Mark Twain before delivering a devastating assessment: the humorist’s observation—that he resumed smoking as many times as he quit—captures why India’s tobacco cessation infrastructure exists only on paper, why even cancer specialists don’t know how to perform pharmacological withdrawal, and why the nation’s hard-won life expectancy gains from 32 years in 1948 to 72 years today face imminent reversal from a deluge of non-communicable diseases.
Speaking at Session III on “Advancements in Health and Nutrition – Lab to Society” at the National Conclave at the B.M. Birla Science Centre on Thursday(January 8, 2026), Dr. Rao—one of India’s distinguished leaders in medical oncology with more than four decades of service in cancer care, clinical research, training, and patient advocacy—delivered a presentation that combined hard epidemiological data with biting critique of implementation failures, demonstrating how India’s impressive victories over infectious diseases have created the conditions for a chronic disease epidemic the healthcare system is unprepared to address.
The session, chaired by Dr. Ahmed Kamal, Prime Minister Professor at Osmania University and Former Outstanding Scientist at CSIR-IICT, Hyderabad, focused on preparing for health challenges that will define India’s trajectory toward Viksit Bharat 2047.
The Infectious Disease Victory: From 32 to 72 Years
Dr. Rao began by acknowledging remarkable achievements. “Most of us know when we had independence and over the past 75 years, what did we actually achieve in the health sector in India. We have achieved a substantial reduction in the incidence of tuberculosis as well as dying from tuberculosis between 2015 and 2023, a substantial fall in deaths from malaria, a substantial elimination of kala-azar below one case per 10,000, and a substantial fall below 1 percent in case fatality rate for dengue fever.”
The list continued: “We did achieve the elimination of lymphatic filariasis, and we have increased our efforts at disease surveillance. We also have had a substantial fall in maternal mortality as well as infant mortality. That means you are unlikely to die either having delivered a baby or having been delivered.”
The overall impact appears in a single statistic: “When we had independence in 1948, our life expectancy at birth was a mere 32 years. Now women are expected to live 74 years at birth.”
With a touch of dark humor referencing an earlier speaker’s comment, Dr. Rao noted: “I was actually amused by what he said—’If you starve the nation, they don’t go to war.’ I don’t know whether that is true, but if you feed the armies, they go to war. That means we have controlled a good amount of deaths because of infectious diseases.”
The methods were systematic: “Most of the deaths were from infectious diseases. All the conditions listed—malaria, kala-azar, dengue fever—are all infectious diseases. We have controlled them because of mass vaccination programs. We have eliminated smallpox from the face of the earth.”
The polio eradication is nearly complete: “Except for a few cases in Pakistan and Afghanistan, we have eliminated polio also. If you want to work on smallpox, you’ll only find it now in a laboratory somewhere in the world.”
The Demographic Transition: Aging Into Chronic Disease
But success creates new challenges. “What is happening is as we age—that means as our life expectancy increases, we survive the teens, we become young adults, we grow to be adults, and then we grow old—as the population ages, what increases is non-communicable disease,” Dr. Rao explained.
The definition matters: “By non-communicable, I mean that you don’t actually have a vector transmitting the disease. That means it is not transmitted from person to person by a bug or by a virus or something like that.”
His assessment was stark: “We are going to have a deluge of non-communicable diseases.”
The 2016 Burden: Already Overwhelming
Dr. Rao presented disease burden estimates from 2016—nearly a decade old but illustrative of trends. “Huge numbers of cardiovascular diseases, ischemic heart diseases, stroke—by stroke I mean cerebrovascular accident—and chronic obstructive pulmonary disease, huge numbers of asthma, and huge numbers of diabetes.”
India’s dubious distinction: “In fact, you may know that India is considered to be the diabetic capital of the world. We have the highest incidence of young people who are thin—not very thin, but diabetic. That is very typical of a South Indian diabetic.”
He referenced the state-level disease burden data Dr. Swaminathan had mentioned earlier. “This is exactly the figures that she generated at state level, but I put it up for the whole country.”
The mortality picture from 2016: “Mortality from non-communicable diseases—28.1 percent from cardiovascular disease, 10.9 percent from COPD, and 8.3 percent from cancers. Together, roughly they will form about 45 percent of the deaths or mortality in 2016 attributable to non-communicable diseases.”
The premature mortality statistics are sobering: “Four common non-communicable diseases accounted for 23 percent of the total premature mortality between the age of 30 to 70 years.”
Dr. Rao emphasized the dual challenge: “What are the causes for the incidence on the left side, and what is the mortality on the right side? The incidence of non-communicable diseases is going to skyrocket in this country, and then it is going to also increase the number of people dying because of non-communicable diseases. This is important for us to concentrate on.”
The Root Causes: Educational Policy and Lifestyle
Dr. Rao identified behavioral and systemic drivers. “There are many risk factors associated with non-communicable diseases, but chiefly I would attribute it to two things—and this is going to throw me over—the change in educational policy.”
His critique was specific and pointed: “Narayanas and Chaitanyas can coach students between 4 AM and 10 PM. They just get about six hours of being at home. When they’re asleep, they’re not physically active. So in fact, from their most productive age group, especially the adolescents when the hormones kick in, you are likely to put on weight, become heavier and heavier.”
The obesity epidemic demonstrates the consequences: “Let us take a city like Delhi, where obesity in school students, adolescent school students, was a mere 3-5 percent in girls and about 4 percent in boys, suddenly shot up to 35 percent according to a study by Dr. Soumya Swaminathan.”
The Behavioral Risk Factors: Tobacco, Alcohol, Diet, Inactivity
Dr. Rao catalogued the major behavioral drivers. “Tobacco use has increased. Smokeless tobacco has actually—I will show you a little bit. Alcohol. Unhealthy diet. Unhealthy diet actually means lack of anything from vegetable origin. Fruits and green leafy vegetables are vegetables. Physical inactivity. And she also mentioned air pollution, both indoor and outdoor.”
The physiological outcomes follow predictably: “It results in overweight, obesity, raised blood pressure, raised blood sugar, and a total increase in cholesterol or serum lipids.”
The commonality across conditions is striking: “This is common to all the non-communicable diseases. That’s the most interesting part. Of all the non-communicable diseases I have shown you, if you want to find common ground, the common ground is what is seen in the behavioral risk factors and the physiological outcomes of those risk factors, which leads to all these non-communicable diseases—cardiovascular, chronic respiratory disease, COPD, diabetes, non-alcoholic fatty liver disease, as well as cancer.”
The Hookah Myth: Worse Than Cigarettes
Dr. Rao demolished a common misconception with specific numbers. “The major risk factors I have listed here: tobacco, smoking as well as smokeless. In fact, the higher the hookah use, the greater is going to be the number of deaths from lung cancer.”
The mathematics are damning: “Each hookah session lasts roughly 20 minutes to 40 minutes as opposed to a cigarette session which typically lasts about 12 minutes. The amount of nicotine you inhale from the hookah pool is equivalent to smoking, in one hookah session, one and a half packets of cigarettes.”
His warning was direct: “So don’t think that because you are smoking a hookah and you went to a cafe with your girlfriend or boyfriend—if I may put it like that, or reverse it—you are going to have any less chance of developing lung cancer. No, it’s not likely to be true.”
The synergistic effects compound risk: “If you actually add tobacco and alcohol for oral cancers, it’s not one plus one equals two—it actually becomes four. Alcohol is the best solvent for carcinogens in tobacco, and it can carry them far away from where it is acting.”
The Evidence Base: Multiple National Surveys
Dr. Rao challenged potential skepticism. “Do I have some basis to say this, or am I just talking on the top of my head? No. We have absolutely very good evidence to show.”
He cited multiple data sources: “This is the National Family Health Survey done between 1998 and 2016 when she [Dr. Swaminathan] was the director. The Global Adult Tobacco Survey. District Level Household and Facility Surveys done roughly between the same times on tobacco use and raised blood pressure. These are periodical surveys.”
Tobacco Use: Universal Increase Across All Demographics
Dr. Rao’s data demonstrated that tobacco use has increased across every demographic category. “Any tobacco use—smokeless tobacco and smoked tobacco—seems to have increased across whatever way you want to survey it.”
By economic status: “Did I take the economic categories—poor, poorer, poorest, rich, richer, richest? Doesn’t matter. It has increased.”
By education: “Or do I want to take it as illiterate, primary school, middle school, secondary school, and graduate? Did not matter. It again increased between 2000 and 2012.”
By caste: “Or do I want to take it as scheduled caste, scheduled tribe, backward class, other class? It did not matter in any way. It still raised.”
His summary was emphatic: “Irrespective of what your socio-economic background was, the incidence of smokeless tobacco and smoked tobacco had increased.”
The Causal Chain: From Drivers to Disease
Dr. Rao outlined the progression: “There are some underlying drivers, there are some behavioral risk factors, and they result in metabolic and physiological risk adaptation. What happens then, finally, it affects the non-communicable diseases.”
His advice to parents was characteristically direct: “If you are very diligent, put your child in a municipal school with a big playground, but not in a Chaitanya and a Narayana, because they need that exercise to burn those excess calories. And please don’t buy them a motorcycle, otherwise they will end up on the outer ring road, hitting somebody or something in between.”
The Policy Response: 2023 National Program
Dr. Rao acknowledged official recognition of the problem. “We know that we have a big problem. Do we have a solution? Looks like they did formulate a solution as late as 2023—not so far away, just about two years. We are only, I think, eight days into the year, but doesn’t matter.”
The National Programme for Prevention and Control of Non-Communicable Diseases was “projected to be operational for about 8 years from 2023 to 2030. So we still have some more time to operationalize it and see whether we can get somewhere.”
The program’s scope is ambitious: “It was supposed to be a national multi-sectoral action plan involving union ministries and state governments.”
But structural constraints limit implementation. “Unfortunately, what the nation thinks at the federal level or at the center, as we call it, need not reflect in the state, simply because health and education are state subjects. They are not federal subjects. So it can only give you a guideline, but it can’t force you unless what we did in COVID happened—that means you declare it as a national emergency and then take away powers. Even as an individual, your powers can be removed.”
The Implementation Reality: Tobacco Cessation Clinics That Don’t Exist
Dr. Rao moved from policy to ground reality with devastating examples. “We need to build the capacity of healthcare providers. Let me give you an example. For a long time, there is actually a program to have tobacco cessation clinics. I don’t know whether anybody has ever heard about it, but I went about all the districts in Andhra Pradesh and Telangana looking for the so-called tobacco cessation clinic.”
His finding: “There’s nothing of that sort in any of the government hospitals. You may quote me. Or in any of the district hospitals, community health centers, or primary health centers. Nothing of that sort actually exists. It exists only on paper.”
The Training Gap: Cancer Specialists Who Don’t Know Withdrawal
Dr. Rao’s next revelation was even more shocking. “I took a random sample of over 300 medical oncology residents and asked them: do you know how to perform a pharmacological tobacco cessation?”
The context is essential: “If I withdraw somebody from something to which they are addicted, I will get two components. One, a physiological response which can affect the person. Or a psychological response where it will drive them berserk. So you can’t withdraw tobacco as if the next moment you can cut it. Otherwise you will be like Mark Twain.”
The Mark Twain quote brought the point home: “I have stopped smoking. It is very easy to stop smoking. I have done it several times, he said. That means he resumed it as many times.”
The clinical requirement: “It is important to understand that you need to support a person who is willing to stop smoking in a clinic. That is a pharmacological and a psychological intervention.”
The survey result: “No, none of them have any idea of how it is going to be done. I am talking of cancer specialists. Forget about chest physicians, forget about a general physician sitting in a community health center.”
Training Manuals That Aren’t Used
Dr. Rao noted the irony of unused resources. “There are many national non-communicable disease programs—for blindness, for mental health, for deafness, for fluorosis, for geriatrics, for tobacco control, oral programs, oral cancer programs, trauma, burns, transplant, palliative care. And there are as many training manuals available for these programs, all of them built with the assistance of the International Union Against Cancer. UICC’s programs—all of them are mapped according to them.”
The training infrastructure theoretically exists: “For non-communicable diseases at every level, from the ASHA worker all the way to the district level and to the teaching hospital level.”
The reality: “No, but you don’t find that happening at all.”
The Data Gap: We Don’t Know How Many People Smoke
Dr. Rao highlighted a fundamental surveillance failure. “The most important part we found was—what Dr. Swaminathan has told you—do we have the actual figures of how many people smoke in India? There are pockets of small areas where it has been done, but we need a comprehensive picture.”
The 2047 Vision: Predictive, Responsive, Integrated System
Dr. Rao discussed aspirations for comprehensive health infrastructure. “By 2035, that is roughly about 12 years away from our 2047 goal—2047, I think, was coined roughly to tell you that in 1947 we got our independence, so 2047 we will be the healthiest nation in the world.”
His assessment was blunt: “No, I don’t think so. It’s not going to be like that.”
What’s needed: “We require a predictive, responsive, integrated, tiered system. This is the most important vision for that. You need to leverage public health surveillance to know what is happening in the community. What is the health of the nation? Health of the nation doesn’t mean wealth of the nation, but that’s a different question—that is what an American term means.”
Unique Health Identifiers: Privacy Concerns
Dr. Rao outlined recommendations from a NITI Aayog study done in consultation with the University of Manitoba. “This is a beautiful study. They said that all of us need—if you see the Aadhaar hardware, like you have an Aadhaar card—even if you are healthy, we need to have a unique identification number which can uniquely help identify. That means at birth, everybody should have a unique health identifier given with a unified health or medical record which is accessible to the person who owns it, with standard data sharing protocols.”
But concerns remain: “Once again, we come back to what safeguards can be built with personal health records for yourself and for others to handle it. It should not become another scam in which somebody is stealing your data from the internet. This is important to understand.”
From Advocacy to Action: The Critical Gap
Dr. Rao acknowledged data abundance. “There are many challenges most of you are aware of. Everybody will quote our numbers. Numbers and figures actually don’t help you.”
The essential requirement: “The major thing we need to understand is you need to have some sort of advocacy moving on to action. If it remains as a policy document, nothing is going to happen.”
The international funding dimension: “For obtaining a Bill Gates Foundation fund or a World Bank fund, the policy document is very helpful. But on the ground, if you ask an NGO what did you achieve in the past 20 or 30 or 40 or 50 years, it will be zero.”
The Stark Warning: Losing 40 Years of Gains
Dr. Rao concluded with a sobering assessment that brought his presentation full circle. “All that we achieved, what we consolidated as a gain of 32 years in 1948 to 72 years this year—we are going to lose very soon.”
The life expectancy gains that took 75 years to achieve through mass vaccination, disease elimination, and improved maternal and infant mortality face reversal from the chronic disease epidemic India is unprepared to address.
The Implementation Chasm
Dr. Rao’s presentation distinguished itself through unsparing honesty about the gap between policy and implementation. While acknowledging the 2023 National Programme for Prevention and Control of Non-Communicable Diseases represents official recognition of the problem, he systematically demonstrated that ground reality bears little resemblance to policy documents.
Tobacco cessation clinics exist on paper but not in any government hospital, district hospital, community health center, or primary health center across Andhra Pradesh and Telangana—states he personally surveyed. Training manuals developed with international assistance sit unused. Even cancer specialists—300 medical oncology residents he surveyed—lack basic knowledge of pharmacological tobacco withdrawal.
This implementation failure isn’t incidental but systemic. Health and education remain state subjects, limiting federal enforcement capacity. Without emergency measures like those deployed during COVID-19, the center cannot compel state action even when national policy documents articulate comprehensive strategies.
The Educational System as Disease Vector
Dr. Rao’s critique of coaching academies like Narayana and Chaitanya—keeping adolescents occupied from 4 AM to 10 PM, leaving only six hours at home mostly for sleep—represented a bold indictment of educational practices rarely questioned in discussions focused narrowly on academic outcomes.
His argument: when adolescents spend their most hormonally active years sedentary, obesity becomes inevitable. The Delhi data—adolescent obesity jumping from 3-5 percent to 35 percent—demonstrates consequences at population scale.
His prescription was characteristically direct: “Put your child in a municipal school with a big playground” rather than coaching academies without physical activity infrastructure. This advice, delivered at a conclave focused on science communication and national development, challenged assumptions about what constitutes quality education.
The Mark Twain Insight: Why Cessation Requires Support
Dr. Rao’s use of Mark Twain’s observation about repeatedly quitting smoking illustrated a profound clinical insight: addiction cannot be overcome through willpower alone. Physiological and psychological withdrawal require managed clinical intervention combining pharmacological support and psychological counseling.
Yet the infrastructure for such support doesn’t exist, and even specialists lack training to provide it. The result: individuals cycle through repeated quit attempts, resuming tobacco use each time because unsupported withdrawal proves unsustainable—exactly as Mark Twain experienced and described with dark humor.
The Hookah Delusion: Quantifying Risk
Dr. Rao’s specific numbers about hookah use—sessions lasting 20-40 minutes versus 12 minutes for cigarettes, nicotine intake equivalent to 1.5 cigarette packs per session—demolished the widespread misconception that hookahs represent safer alternatives to cigarettes.
His framing—warning young people not to assume cafe hookah sessions with romantic partners carry less lung cancer risk—connected epidemiological data to actual behavior in ways likely to resonate with audiences who might otherwise tune out health warnings.
The alcohol-tobacco synergy calculation—that combined effects equal four times rather than double the risk—similarly translated interaction effects into comprehensible terms.
Universal Tobacco Increase: No Demographic Exceptions
Perhaps most troubling, Dr. Rao’s data demonstrated tobacco use increasing across every demographic segment: rich and poor, educated and illiterate, all caste categories. This universal increase suggests structural drivers beyond individual choice—marketing, availability, social normalization—that simple health education campaigns cannot counter.
The Data We Don’t Have
Dr. Rao’s observation that India lacks comprehensive figures on smoking prevalence—only “pockets of small areas”—highlighted a fundamental surveillance gap. Without knowing how many people smoke, where they’re concentrated, and demographic patterns, targeted interventions become impossible.
This connects to his discussion of unique health identifiers: comprehensive longitudinal health data could enable predictive, responsive systems. But privacy concerns about data theft creating “another scam” demonstrate the trust deficit that complicates even beneficial digitalization efforts.
The Zero Achievement Assessment
Dr. Rao’s assessment that NGOs working on non-communicable diseases for “20 or 30 or 40 or 50 years” have achieved “zero” represented a devastating critique of civil society efforts that often receive praise for awareness-raising work.
His implicit argument: without translation into clinical capacity—actual cessation clinics, trained providers, pharmacological intervention capability—awareness campaigns and policy documents accomplish nothing. The Bill Gates Foundation and World Bank may fund based on policy documents, but population health outcomes require functioning implementation.
The Viksit Bharat 2047 Irony
Dr. Rao’s pointed observation that 2047 was “coined roughly to tell you that in 1947 we got our independence, so 2047 we will be the healthiest nation in the world” followed immediately by “No, I don’t think so. It’s not going to be like that” captured the gap between aspirational rhetoric and trajectory based on current trends.
Without urgent action closing the implementation gap, India’s direction points toward losing four decades of life expectancy gains rather than achieving health leadership.
The Lab-to-Society Failure in Healthcare
Dr. Rao’s presentation demonstrated how the lab-to-society gap manifests in healthcare: epidemiological research identifies risk factors, clinical research develops interventions, policy documents articulate programs, international organizations provide technical assistance and funding, training manuals get produced—and yet nothing reaches the community health center, the district hospital, or the patient who needs tobacco cessation support.
This isn’t a knowledge gap but an implementation chasm. The science is settled, the interventions are known, the policies are written, the training materials exist. What’s missing is the political will, administrative capacity, and accountability mechanisms to ensure that paper programs become functional clinical services.
The Democratic Deficit
Underlying Dr. Rao’s critique is a democratic argument: public health gains belong to the public, having been achieved through public investment and collective effort. The reversal of those gains represents a betrayal of the social contract, particularly when the knowledge and tools to prevent that reversal exist but remain unimplemented.
His final warning—that India will “lose very soon” the consolidation from 32 to 72 years life expectancy—served not as fatalistic resignation but as urgent call to action. The deluge of non-communicable diseases is predictable, quantifiable, and preventable. That it proceeds despite this knowledge represents a choice, not an inevitability.
Building Viksit Bharat requires not just scientific advancement but functional translation of existing knowledge into clinical services that actually reach citizens. Without that implementation—tobacco cessation clinics that exist in reality not just on paper, providers trained in pharmacological withdrawal, surveillance systems that know how many people smoke, and accountability for converting policy documents into population health outcomes—the 2047 vision will prove another moving goalpost in a long history of unmet targets.
About Dr. D. Raghunadharao
Dr. D. Raghunadharao is one of India’s distinguished leaders in Medical Oncology, with more than four decades of dedicated service in cancer care clinical research, training, and patient advocacy. He is known for his deep expertise in chemotherapy and comprehensive cancer management.
Dr. Rao has served in leading medical institutions in Hyderabad, and patients and peers regard him as one of India’s notable oncology specialists, particularly valued for his clinical judgment, compassionate care, and contributions to cancer treatment practices. His work is marked by a rare blend of scientific rigor, clinical precision, and deep compassion for patients and families.
Establishing Cancer Care Infrastructure
Dr. Raghunadharao is a stalwart in establishing cancer hospitals, cancer registries, and molecular oncology labs. He established a comprehensive cancer centre at Visakhapatnam under the Department of Atomic Energy, Government of India.
Dr. Raghunadharao led the government doctors in Cancer Screening & Prevention under the NRHM-NCD program during 2011 to 2013. His collaborations with several prestigious organizations including Breast International Group, University of Oxford Osmania University, Central University, NIN, CCMB, and ICRISA in pre-clinical and clinical research activities pioneered phase I trials among drug development companies over 50 clinical trials in India since 1993. He has over 280 publications in peer-reviewed journals.
Academic Leadership and Recognition
Dr. Raghunadharao is an elected Fellow of the American College of Physicians, Royal College of Physicians of London, and Andhra Pradesh Academy of Sciences. He is presently President of Andhra Pradesh Academy of Sciences.
He was awarded Dr. B C Roy National Award for Excellence in Promotion of Oncology by Medical Council of India.
Public Health Advocacy and Ground Reality
As demonstrated in his presentation at the National Conclave, Dr. Rao brings firsthand knowledge of implementation gaps between health policy and ground reality. His personal surveys across districts in Andhra Pradesh and Telangana searching for tobacco cessation clinics that exist on paper but not in practice exemplify his commitment to understanding actual service delivery rather than accepting policy documents at face value.
His survey of 300 medical oncology residents revealing universal lack of knowledge about pharmacological tobacco withdrawal demonstrates his willingness to document uncomfortable truths about training gaps even within his own specialty.
Communication Philosophy
Dr. Rao’s communication style combines clinical precision with accessibility, using memorable devices like the Mark Twain quote about repeatedly quitting smoking, specific calculations comparing hookah sessions to cigarette packs, and direct advice to parents about choosing schools with playgrounds over coaching academies.
His willingness to challenge sacred cows—from prestigious coaching institutes to NGO effectiveness to the feasibility of Viksit Bharat health targets—distinguishes his approach from typical health communication that emphasizes awareness without accountability for implementation.
Vision for Non-Communicable Disease Response
Dr. Rao advocates for moving from advocacy to action, from policy documents to functional clinical services, from awareness campaigns to trained providers delivering evidence-based interventions. His emphasis on the implementation chasm reflects decades of experience watching well-designed programs fail to translate into population health impact.
His warning that India will soon lose the life expectancy gains from 32 to 72 years represents not pessimism but urgent realism: without closing the gap between paper programs and clinical reality, the demographic and epidemiological transition from infectious to chronic disease will reverse India’s public health achievements.
In his presentation at the National Conclave, Dr. Raghunadharao demonstrated that building Viksit Bharat requires not just scientific knowledge or policy articulation but the politically unglamorous work of ensuring tobacco cessation clinics actually exist, providers actually receive training they can apply, and surveillance systems actually know population health status—the lab-to-society translation that determines whether scientific advances benefit or bypass the citizens who fund them.
— NSH Digi Desk
