Lifestyle triggers major shift in disease burden across India

Lester Mason
November 15, 2017

This has huge implications for policymakers because it means that one health policy and uniform health schemes may not be workable for all the states.

The report is a joint effort by the Department of Health Research, Indian Council of Medical Research and the Public Health Foundation of India. Over 200 experts from 100 Indian institutions participated in this initiative.

The report used data from censuses, vital registration, sample registration system, large-scale national household surveys, other population-level surveys and cohort studies, disease surveillance data, disease programme-level data, administrative records of health services, disease registries, and a wide range of other studies conducted across India. The highest rate was recorded in Assam and Uttar Pradesh compared to the lowest in Kerala previous year.

The report provides the first comprehensive set of findings for the distribution of diseases and risk factors across every state of India from 1990 to 2016, utilizing all available data and in close engagement with many leading health scientists of India.

The under-five mortality rate has come down substantially from in all states, but there was a four-fold difference in the rate between the highest (Assam and Uttar Pradesh) and the lowest (Kerala), highlighting the vast health inequalities between the states.

The contribution of injuries to the total disease burden has increased in most states since 1990, affecting the young adults (15-39 years of age) the maximum. This figure has dropped to 33% in 2016. The burden of premature death and health loss due to non-infectious conditions such as heart disease, stroke, diabetes, chronic obstructive lung disease and road traffic has increased massively, and the burden due to lower respiratory infections, tuberculosis, diarrhea and neonatal disorders still remains unacceptably high. For example, Bihar, Jharkhand, Uttar Pradesh, Rajasthan, Madhya Pradesh and Haryana experienced a higher health burden from air pollution compared to states like Delhi, Karnataka, Maharashtra, Goa and others.

Disease burden due to child and maternal malnutrition in India was 12 times higher per person than in China in 2016 even as the life expectancy at birth in the country improved by over a decade, said a report on Tuesday.

"Many Indian states are bigger than most countries in the world".

"This problem is major in the Empowered Action Group states (states that receive special development attention from the government) and Assam, and higher in females", said the report which analysed disease burden for each state from 1990 to 2016. Air pollution was the second leading risk factor in India, contributing to India's burden of cardiovascular diseases, chronic respiratory diseases and lower respiratory infections.

Meanwhile, unsafe water and sanitation, which was the second-leading risk responsible for disease burden in 1990, dropped to the seventh position in 2016. "On the other hand, the states that have had this transition more recently, such as the EAG states, now have rising risk for non-communicable diseases and also continue to have a high burden of infectious and maternal-child diseases". The burden of household air pollution has decreased during this period due to decreasing use of solid fuels for cooking, and that of outdoor air pollution has increased due to a variety of pollutants from power production, industry, vehicles, construction, and waste burning.

A first-of-its kind report on the 'India State-Level Disease Burden, ' released on Tuesday, has revealed severe inequalities in the disease burden in different States, suggesting the need for more specific health planning.

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