How Communities in South Asia’s Cities Are Fighting Diabetes and Heart Disease Themselves

Non-communicable diseases such as type 2 diabetes, hypertension, cardiovascular disease, chronic respiratory conditions and cancers have become the leading cause of premature death across South Asia, and the burden is falling hardest on the region’s rapidly expanding cities. A new scoping review published in BMC Public Health by researchers from University College London, HERD International in Nepal, the University of Oxford, the Diabetic Association of Bangladesh and BRAC James P Grant School of Public Health set out to map what is actually known about community-driven interventions aimed at preventing these diseases in urban South Asian settings. The findings paint a picture of genuine promise shadowed by a stubborn evidence gap: communities across the region are mobilising to change health behaviours, but the studies documenting those efforts are small, short-lived and rarely connected to the health systems that would need to sustain them.

The research team systematically searched MEDLINE, Embase, Scopus and Web of Science from their inception through July 28, 2026, supplementing the searches with grey literature to capture programme reports and evaluations that never reach mainstream journals. To be eligible, studies had to report on interventions in which communities themselves played an active role in preventing non-communicable diseases or their risk factors among urban populations in South Asia. The reviewers charted and synthesised the data descriptively and thematically, and classified the different ways communities were engaged using Gram and colleagues’ “classroom–club–collective” typology, a framework that distinguishes between didactic knowledge transfer, group-based support structures and collective mobilisation for change.

Only 14 studies met the inclusion criteria, a strikingly small evidence base for a region that contains some of the world’s largest and fastest-growing urban populations. Eleven of the studies came from India, two from Nepal and one from Sri Lanka, leaving enormous countries such as Pakistan, Bangladesh, Afghanistan and Bhutan essentially unrepresented in the peer-reviewed literature on this question. The interventions that did appear focused primarily on type 2 diabetes, hypertension, cardiovascular risk, mental health and tobacco use, while chronic respiratory diseases and cancers received only limited attention despite being major components of the regional non-communicable disease burden.

One of the most consistent findings was that every single study reported positive short-term outcomes, whether behavioural, psychosocial or intermediate clinical measures. Communities were engaged in the design, delivery, adaptation or mobilisation of the interventions through a recognisable cast of local actors: peer educators who shared health information within their own neighbourhoods, women’s self-help groups that folded health activities into existing savings and lending structures, mothers’ groups, trained community volunteers, and youth clubs and advocates. In a region where formal health services are often overstretched and trust in institutions can be fragile, these embedded social networks appear to function as channels through which prevention messages and screening opportunities actually reach households.

The review also examined the mechanisms through which these interventions operated and the contextual factors that shaped their results. Implementation success was repeatedly constrained by urban poverty, time scarcity, restrictive gender norms and limited infrastructure, conditions that determine whether a woman can attend a weekly group meeting, whether a man working multiple informal jobs can take time for a screening, and whether a neighbourhood even has a safe space in which to gather. Conversely, the enablers that recurred across studies included the use of trusted social networks, deliberate cultural adaptation of intervention content, and the presence of local leadership capable of legitimising new health behaviours within community norms.

Notably absent from almost all of the studies was any meaningful role for communities in evaluation. The reviewers found that community involvement in designing or conducting evaluations was rare, which means the evidence base reflects largely external assessments of programmes that communities helped run but rarely helped judge. This asymmetry matters for the field’s development, because evaluation is where questions of sustainability, scalability and genuine community ownership are typically settled, and its absence signals that most interventions remained externally designed projects delivered to communities rather than initiatives owned by them.

The structural weaknesses of the literature are equally consequential. Most of the interventions were small-scale and short-term, and the review found them weakly integrated into health systems. In practical terms, this means that a peer-education programme or a self-help group intervention that produced measurable improvements in blood pressure awareness or glycaemic knowledge during a funded study period often had no defined pathway to continue once the research ended, no formal connection to urban primary health care services, and no mechanism for the lessons learned to influence municipal or national non-communicable disease strategies such as India’s National Programme for Prevention and Control of Non-Communicable Diseases.

The authors conclude that the literature does suggest real potential for community-driven approaches to support non-communicable disease prevention in urban South Asia by mobilising local communities, but they are explicit that current evidence remains insufficient to establish effectiveness. A scoping review can map what exists and identify patterns, but the underlying studies were not designed to provide the rigorous causal estimates that policy makers require. The positive short-term signals across all 14 studies are encouraging, yet without longer follow-up periods, comparison groups and standardised outcome measures, the field cannot determine which models of community engagement deliver durable reductions in disease incidence or mortality.

The path forward, according to the review, requires greater institutional support, integration with urban health systems, and sustained investment in longitudinal, mixed-methods implementation research that centres community leadership as a core component of prevention and control strategies. This is a methodological argument as much as a programmatic one: implementation research examines how interventions function in real-world conditions, why they succeed or fail in particular contexts, and how they can be adapted and scaled, and the mixed-methods component matters because the contextual factors identified here, from gender norms to time poverty, resist capture by quantitative measures alone.

The work was funded by the Medical Research Council, UK under the Global Alliance for Chronic Diseases Healthy Cities Research Programme, reflecting growing international recognition that urbanisation is reshaping the epidemiology of chronic disease in low- and middle-income countries. As South Asian cities continue to absorb tens of millions of new residents over the coming decades, the question the review leaves open is whether the region’s remarkable stock of community institutions, from self-help groups to youth clubs, can be converted from promising but isolated pilot efforts into a durable, health-system-embedded architecture for prevention. The answer, the evidence so far suggests, will depend less on whether communities are willing to act than on whether health systems and funders are willing to build around them.

Subject of Research: Community-driven interventions for the prevention of non-communicable diseases in urban South Asia

Article Title: Community-driven interventions for the prevention of non-communicable diseases (NCDs) in urban South Asia: a scoping review

Article References: Khan, N., Karki, S., Bhattarai, B., Sharma, A., Ahmed, S. A. U., Hossain, M. M., Koay, A., Arjyal, A., Fottrell, E., & Morrison, J. (2026). Community-driven interventions for the prevention of non-communicable diseases (NCDs) in urban South Asia: a scoping review. BMC Public Health. https://doi.org/10.1186/s12889-026-29883-9

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29883-9

Keywords: non-communicable diseases, community-driven interventions, urban health, South Asia, scoping review, type 2 diabetes, hypertension, health systems, community participation, public health, implementation research, health promotion