A new World Health Organization report brings together evidence showing that poorer, less educated and rural women in India were less likely to receive breast and cervical cancer early-detection tests. It also highlights differences in hypertension care, smokeless tobacco use and access to clean cooking fuel.
Published on 20 October, State of inequality: Noncommunicable diseases and their risk factors is WHO’s first comprehensive global assessment of these inequalities within countries. The India examples draw on earlier studies, some using data collected more than a decade ago.
Noncommunicable diseases (NCDs) include cancer, cardiovascular diseases, diabetes and chronic respiratory diseases. Many require early detection and continuing care. The report analyses 35 indicators across these conditions and major risk factors, drawing on nine multicountry data sources.
What The Report Finds
The report cites a 2025 study of breast and cervical cancer testing that analysed responses from 353,518 women in India’s 2019–21 National Family Health Survey. It found that nine per 1,000 women had ever received a breast cancer examination, while 20 per 1,000 had ever received a cervical cancer test. Poorer women, women without formal education and rural women were less likely to participate in early-detection tests than their respective counterparts. The relative gap between richer and poorer women was wider in rural areas than in urban areas.
For hypertension, or persistently high blood pressure, WHO highlights differences across several stages of care. A 2020 study covering India and Nepal found regional variation in wealth- and education-related inequalities in hypertension prevalence, awareness, treatment and control. The distinction matters: a person must first know they have high blood pressure, then obtain treatment and continue managing it. The study’s analysis of India used 2015–16 survey data for people aged 15–49, so its findings describe that population at the time.
Unequal Exposure To Risk
WHO also examines differences in exposure to factors that increase the risk of chronic disease. In India, one example is smokeless tobacco.
A 2021 study cited in the report analysed India’s 2016–17 Global Adult Tobacco Survey. It found that 24.6% of rural adults aged 15 and above used smokeless tobacco, compared with 15.2% of urban adults. Use was 33% among people in the lowest wealth group, compared with 7.3% among those in the highest. It was also higher among people with less than primary education than among those with college education or above: 30.7% compared with 7.5%.
Household air pollution offers another example. WHO cites a 2023 study which found that the share of Indian households using clean cooking fuel rose from 25% in 2005–06 to 44% in 2015–16. But uptake was slower among the poorest households, especially in lower-income states. LPG use among the poorest fifth of households rose from 0.2% to 2.5% over that period. Among the middle wealth group, it rose from 19.2% to 37.4%. The figures show how an increase in national coverage can leave substantial differences between groups.
Dietary research cited by WHO also points to income. A 2021 study of caste-related differences in fruit and vegetable consumption, using 2011–12 survey data, found lower consumption among disadvantaged castes, with income differences accounting for much of the gap. The relationship varies by indicator. Another study of fruit and vegetable consumption found higher consumption in rural households, female-headed households and households dependent on agricultural livelihoods. Understanding inequalities therefore requires examining the groups and circumstances relevant to each risk.
Why It Matters
Preventing and managing chronic illness requires more than a single visit to a health facility. An abnormal cancer test may require further examination, diagnosis, treatment and follow-up. Hypertension and diabetes can require regular monitoring and reliable access to medicines over many years.
For households, continuing care can involve repeated travel, time away from work and treatment costs. Services that reach people early and remain accessible over time can support health through working life and into older age, making chronic disease care relevant to India’s workforce and family needs.
The WHO report points to the importance of strengthening service delivery, including the distribution of health workers, access to essential medicines and diagnostics, referral systems and links between communities and health facilities.
The Way Forward
WHO’s accompanying The hidden inequalities behind noncommunicable diseases: From evidence to action identifies three priorities: expand proven interventions, use data broken down by population group to direct resources towards greater needs, and routinely measure inequalities to monitor progress.
The main report sets out ways to put those priorities into practice. For healthcare, it calls for better access to screening, diagnostics and essential medicines, alongside stronger referral systems and continuity of care. This would help connect an initial test to diagnosis, treatment and follow-up.
For tobacco, WHO recommends combining taxation with accessible support to help people quit. It suggests that tobacco-tax revenue could support health coverage or cessation services for low-income groups, and that counselling could be integrated into community health centres and low-cost clinics.
The report also points to action beyond health facilities. Measures to improve diets can include subsidies, school meals or food vouchers that make healthier food more accessible to disadvantaged communities. Reducing household air pollution requires energy and housing policies that improve access to clean cooking fuels.
WHO’s summary of the report and brief emphasises addressing financial and geographical barriers, reaching underserved rural and urban communities, and involving people living with chronic diseases in shaping programmes.
For India, the findings show why national coverage alone is not enough to measure progress. Tracking who receives a cancer test, who gets hypertension treatment and who can access cleaner cooking fuel—by income, education and location—can help identify where services and resources need to reach further.