SHILLONG: India’s tribal populations—once celebrated for their active, healthy lifestyles—are now undergoing rapid lifestyle changes marked by reduced physical activity and increased consumption of processed foods. The result? A worrying rise in health complications linked to this swift transformation.
And Meghalaya is no stranger to this transformation. Did you know that non-communicable diseases (NCDs) such as hypertension, diabetes, and related illnesses are steadily rising across the state? What was once a way of life has now become a distant memory—those days, just 30 to 40 years ago, when walking was an integral part of daily routines. Today, walking feels like a chore, even as health experts continue to stress its many benefits.
The Problem:
Did you know that nearly one in four people in Meghalaya suffers from hypertension? A 2023 study, published in The Lancet Diabetes & Endocrinology and conducted by the Madras Diabetes Research Foundation (MDRF) in collaboration with the Indian Council of Medical Research (ICMR), with funding from the Union Ministry of Health and Family Welfare, revealed that while Meghalaya’s hypertension prevalence of 24.3% was the lowest among all states and territories studied, the burden of the disease—the combined social, economic, and health impact—was the highest in the country.
In terms of diabetes, Meghalaya falls within the low-to-mid range, with a reported prevalence of 5% to 7.4%. However, medical professionals in the state dispute this figure, suggesting the actual numbers may be significantly higher than anticipated.
On a national scale, an article published in the Journal of the Association of Physicians of India (JAPI) in February 2023 estimated that approximately 220 million adults in India—over one in four—suffer from hypertension. Prevalence among adults over 20 years of age is 32.6% in women and 38.7% in men.
Meanwhile, the ICMR-INDIAB study of 2023 reported that the prevalence of diabetes and other metabolic non-communicable diseases (NCDs) in India is considerably higher than previously estimated. India had around 101 million people living with diabetes, with an additional 11.4% of adults affected by pre-diabetes.
Despite these alarming statistics, government programmes largely focus on treatment, with far less emphasis on primary prevention. The age-old adage, “Prevention is better than cure,” sadly seems to hold little weight in this case.
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The Interventions:
To tackle these pressing health challenges, structured interventions are urgently needed. In response, three health institutions joined forces with a shared goal: to reduce cardiometabolic risks among adolescents and young adults in tribal communities across Northeast India.
Introducing The Shillong Project—a collaborative initiative by Dr. H. Gordon Roberts Hospital in Shillong, Christian Medical College (CMC) in Vellore, and the Baker Heart and Diabetes Institute in Melbourne, Australia, funded by Global Alliance for Chronic Diseases (GACD)/National Health and Medical Research Council (NHMRC), Australia.
How did it come about? Dr. Meban Kharkongor of Dr. H. Gordon Roberts Hospital, Shillong, noted that the alarming rise of NCDs in the state prompted the launch of this action plan. “Our initial findings in rural tribal areas indicate a worrying increase in these cases—something we had not anticipated,” he said.
He explained, “This project aims to identify individuals, particularly young adults, who are at high risk of such health complications and to encourage behavioural changes before it’s too late.”
Dr. Kharkongor added that for those already living with these diseases, the approach remains treatment, but the project’s goal is to intervene early—before the problem significantly affects individuals.
Similarly, Dr. Sebin G. Abraham from CMC, Vellore, highlighted that although the number of NCD cases in Meghalaya is still lower compared to southern states, the concerns are real. “I think this is a good time to act before the state faces the same challenges we are witnessing in our region right now,” he said.
Meanwhile, Kai Wallens from the Baker Heart and Diabetes Institute in Melbourne, Australia, reflected on the project’s progress over the past 18 months. “The progress has been extensive, though challenging at times due to the distance. We meet regularly online, constantly updating and providing expertise and key strategies for each stage of the project. One challenge is cross-cultural adaptation—what works in the West may not be acceptable here,” he said, while expressing optimism about the project’s outcomes.
The Journey:
Launched in 2024, The Shillong Project aims to improve cardiometabolic health among young people in Meghalaya by co-designing, implementing, and evaluating multi-level, multi-component lifestyle interventions.
In the months since its inception, health professionals conducted a comprehensive needs assessment and an in-depth analysis of the prevailing health situation, selecting Mawphlang as the pilot village. Here, consultations, interviews, and discussions were held with a wide range of stakeholders—including community and church leaders, healthcare providers, school authorities, teachers, students, and parents.
The findings were presented at a one-day workshop held at the Courtyard by Marriott on October 7. Community representatives highlighted key health challenges and systemic gaps, while also suggesting interventions aligned with the cultural context of the region.
“There is a lack of health education programs, limited awareness, and poor accessibility to resources, compounded by connectivity issues. We have also observed that there are no systematic follow-ups after health programs to ensure lasting behaviour change. Misconceptions and a lack of understanding further widen the knowledge gap,” said Rev. W.W. Wahlang of the Mawphlang Presbyterian Church.
He emphasized the need for community-based, culturally sensitive programs that engage all stakeholders—including the Church—which, he noted, plays a significant role in influencing behavioural change.
Meanwhile, a student from Mawngap District Christian Multipurpose Higher Secondary School expressed optimism about the project’s progress, saying:
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“These discussions and consultations keep us informed and aware of various health risks, while also showing us ways to protect ourselves and our families from such diseases. The approach is simple—start walking, eat healthy, and learn to say no to bad habits. It may seem difficult, but it is definitely not impossible.”
Similarly, other stakeholders emphasized the importance of working together to build a healthier community—not necessarily immediately, but over the next 20–30 years—provided the community embraces the interventions and adopts lasting behaviour changes.
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A Healthier Future:
The focus here is on Prevention. “We are not expecting immediate results; our vision is for the next 20-30 years,” Dr. Meban Kharkongor of Dr. H. Gordon Roberts Hospital, Shillong, said.
The Shillong Project represents a forward-looking, collaborative effort to tackle the rising burden of non-communicable diseases in Meghalaya.
By focusing on prevention, early intervention, and culturally sensitive, community-driven strategies, the initiative aims to empower young people and the broader community to make healthier lifestyle choices.
