India: Health of the Nation's States, IHME, 2019 states leading risk factors responsible for both communicable and non-communicable diseases are dietary risks, air pollution, high systolic blood pressure, high plasma glucose levels, tobacco use, alcohol, Smoking, and child malnutrition. All of them along with some other health risks contribute to a disease that leads mortality.

The epidemiological shift of diseases in India began in 1951 when malaria, leprosy, and smallpox infections (like many other infectious diseases, including measles) have recorded for the first time. New infections such as Guinea worm and Polio emerged in 1981. Moreover, the plague became an epidemic in 1986 led to 8000 deaths in children.

By 2000, Guinea Worm Disease was eradicated from the country; Polio was on the verge of being eradicated; Malaria, Leprosy, Kala Azar, and Filariasis were near extinction (National Health Policy, 2002). Later on, there has been a burden of emerging diseases in rural areas such as Tuberculosis, avian flu, H1N1 pandemic, Malaria, rare diseases, and a problem of Antimicrobial resistance (Balarajan Y, 2011). The emergence of new multi-drug resistance (MDR) led to many health challenges accompanied by older rivals of TB, Malaria, Leprosy, and many other diseases (N. Taneja, 2018). Now the dominance of non- communicable diseases, such as Cancer, Cardiovascular diseases, Heart diseases, COPD, and so on leading to more mortality (India: Health of the Nation's States, IHME, 2021).

In India, deaths could be attributed to behavioural and metabolic risk factors – including dietary risks, high blood pressure, pollution, tobacco, and high fasting plasma glucose; however, malnutrition and WASH are attributable to significant risks for communicable disease and deaths. As evidence, it is estimated that only 60% Indian population maintain basic sanitation and hygiene. Children under two years have lower nutrition levels, so they are either underweight or overweight, contributing to double of the disease burden. Just 50% of women aged 15-49 get antenatal care of at least four visits (UNICEF, 2019). Moreover, Smoking also contributes to 1 million deaths every year. Tobacco is the biggest killer that accounts for 9.5% of all deaths (GATS, second round, 2017). Tobacco use has also been a risk factor for Cardiovascular Diseases (CVDs), Chronic Obstructive Pulmonary Disease (COPD), and many types of Cancer and Tuberculosis. However, it has been continuously falling, but Hypertension or high blood pressure is a significant contributor to cardiovascular diseases and endemics in India.

About 5% of adults aged 18 years or above were obese in 2016. (NCD Country profiles, World Health Organization, 2018). However, the rising prevalence of all these risks are some of the most significant health challenge.