Closing the Loop: Integrating Workplace Health into Primary Prevention of NCDs in India – Lessons from Tamil Nadu

Background Non-communicable diseases (NCDs) continue to represent a growing epidemic, accounting for nearly two-thirds of death and adding a significant economic burden through lost productivity. Tamil Nadu, one of India’s most industrialized states, bears a particularly substantial burden, with 63% of its disease burden attributed to NCDs. Workplaces, where millions of adults spend the majority of their daytime, present a high-risk environment while offering strategic opportunities for prevention. This study aimed to explore how organized sectors can function as platforms for NCD screening and care. Methods Utilizing qualitative methodologies, we conducted 201 in-depth interviews with health officials, industry managers, workplace health providers, and employee representatives across a variety of factories and institutions. Each interview was accompanied by structured observation, daily debriefings, iterative transcription checks, and independent coding by two researchers to ensure methodological rigor. The team developed themes through consensus, triangulating perspectives from both industry and health systems. Results The findings revealed a contradictory trend with systemic enablers like effective coordination of the district health department and Employees’ State Insurance, resource availability and proactive social responsibility engagement enhanced reliability and reinforced continuity of care. Conversely, barriers included Human Resource shortages, logistical delays, rigid shift schedules, and stigma surrounding NCDs which hindered participation. Industries promoting employee wellness through their leadership, functional occupational health units, and flexible scheduling achieved majority of worker participation, whereas others faced challenges. Conclusions The study reiterates that successful workplace NCD screening is possible because of the program but with deeper trust, leadership, and employee-centered design it will achieve the intended outcomes. Integrating these elements into Tamil Nadu’s industrial landscape can transform workplaces into sustainable nodes of preventive health.