The health status of Indians has been improving since Independence. The life expectancy of a person born in India in 1960 was 40 years, which has increased to about 70 years now. Of every 1000 live children born in India in 1960, about 160 died in the first year, but now this death rate of infants is about a fourth of that level, stated Vice President of India M Venkaiah Naidu while releasing the findings of ‘India State Level Disease Burden’ report of Indian Council of Medical Research (ICMR) in presence of J P Nadda, Union Minister of Health and Family Welfare, Anupriya Patel, Minister of State for Health and Family Welfare, Dr. Soumya Swaminathan, Secretary (DHR) and DG (ICMR), Dr. Srinath Reddy, President, PHFI and Dr. Vinod Paul, Member, NITI Aayog, Government of India.
The India State-level Disease Burden Initiative, a joint initiative between the Indian Council of Medical Research (ICMR), Public Health Foundation of India (PHFI), and Institute for Health Metrics and Evaluation (IHME) in collaboration with the Ministry of Health and Family Welfare, Government of India along with experts and stakeholders associated with over 100 Indian institutions, released the first comprehensive set of state-level disease burden, risk factors estimates and trends for each state in India to inform health planning to reduce health inequalities amongst states in India. These estimates are based on analysis of all identifiable epidemiological data from India over quarter of a century.
Addressing the participants, the Vice President of India stated that achieving good health for all of India’s population is an important goal of the Government of India and a foundation for further social and economic development, Vice President added.
In his address, the Vice President cautioned that in order to do better, several things need to happen. These include higher priority for health in the country’s policy making and enhanced resources for preventive and public health measures. “There should be adequate mechanisms at the ground level for keeping Indians healthy and for suitable healthcare when they fall sick. We should also have a solid knowledge system that enables comprehensive tracking of the health and disease burden trends in every part of the country,” the Vice President elaborated.
Speaking at the function, J P Nadda stated that the Health Ministry along with the state governments and other important partners in the country is making serious efforts to enunciate provision for health services that are suitable for the health situation of particular state, mainly through the public sector. “In this regard, the data and results shared by the India State-level Disease Burden Initiative today in its report, scientific paper, and the online visualization tool will serve as a useful guide for fine-tuning data driven health planning specific for health situation of each state of the country,” Nadda added.
Nadda further informed that the estimates released are based on utilization of all available epidemiological data. It show that the per person burden due to major infectious disease, that is, diarrheal diseases, lower respiratory infections, and tuberculosis is 7 to 9 times higher in the states like Bihar, Odisha, U.P, Assam, Rajasthan, M.P. and Jharkhand than in other states. “ Likewise, the burden due to the leading non-communicable diseases, that is, ischemic heart disease, stroke, diabetes, chronic obstructive lung disease is 4-9 times higher in some states than in other states,” Nadda said.
Nadda further said that the disease profile of each state released showing the contribution of specific diseases and risk factors to the overall health loss can be a useful guide for states when they develop their Project Implementation Plans for health. The open-access visualization tool that is being released shows disease and risk trends in each state 1990 to 2016 in a simple manner, which can be of much use for policy makers. I hope that the planners and experts in each state will use the findings released and engage with the India State-level Disease Burden Initiative to further improve health in their respective states, Nadda added.
Speaking at the function, Anupriya Patel, MoS (HFW) said that the data and results shared by the India State-level Disease Burden Initiative in its report, scientific paper, and the online visualization tool will serve as a useful guide for fine-tuning health planning in each state of the country. “The burden due to non-communicable disease and injuries has overtaken the burden due to infectious and maternal-child diseases in every state of India, though this happened in some states about three decades ago and in some other states more recently. This means that the more developed states that had this transition a long time ago need to go on a war footing to control the rapidly rising burden of major non-communicable diseases and injuries,” Anupriya Patel stated.
The India State-level Disease Burden Initiative, a joint initiative between the Indian Council of Medical Research (ICMR), Public Health Foundation of India (PHFI), and Institute for Health Metrics and Evaluation (IHME) in collaboration with the Ministry of Health and Family Welfare, Government of India along with experts and stakeholders associated with over 100 Indian institutions, released the first comprehensive set of state-level disease burden, risk factors estimates and trends for each state in India to inform health planning to reduce health inequalities amongst states in India. These estimates are based on analysis of all identifiable epidemiological data from India over quarter of a century.
Also present at the function were JVR Prasada Rao, Former Secretary, Ministry of Health & Family Welfare, Government of India, Dr. Chris Murray, Director, Institute of Health Metrics & Evaluation, University of Washington, Seattle, USA along with other senior officers of the Ministry and representatives of development partners.
Key Findings:
· – Life expectancy at birth improved in India from 59.7 years in 1990 to 70.3 years in 2016 for females, and from 58.3 years to 66.9 years for males. There were, however, continuing inequalities between states, with a range of 66.8 years in Uttar Pradesh to 78.7 years in Kerala for females, and 63.6 years in Assam to 73.8 years in Kerala for males in 2016.
· – The per person disease burden dropped by 36% from 1990 to 2016 in India. However, there was an almost two-fold difference in this disease burden rate between the states in 2016, with Assam, Uttar Pradesh, and Chhattisgarh having the highest rates, and Kerala and Goa the lowest rates.
· – The under-5 mortality rate has reduced substantially from 1990 in all states, but there was a four-fold difference in this rate between the highest in Assam and Uttar Pradesh as compared with the lowest in Kerala in 2016, highlighting the vast health inequalities between the states.
· – Of the total disease burden in India, 61% was due to communicable, maternal, neonatal, and nutritional diseases in 1990, which dropped to 33% in 2016. There was a corresponding increase in the contribution of non-communicable diseases from 30% of the total disease burden in 1990 to 55% to 2016, and of injuries from 9% to 12%. Infectious and associated diseases made up the majority of disease burden in most of the states in 1990, but this was less than half in all states in 2016. There were wide variations between the states. Kerala, Goa, and Tamil Nadu have the largest dominance of non-communicable diseases and injuries over infectious and associated diseases, whereas this dominance is present but relatively the lowest in Bihar, Jharkhand, Uttar Pradesh, and Rajasthan.
· – The burden of most infectious and associated diseases reduced in India from 1990 to 2016, but five of the ten individual leading causes of disease burden in India in 2016 still belonged to this group: diarrhoeal diseases, lower respiratory infections, iron-deficiency anaemia, neonatal preterm birth, and tuberculosis. The range of disease burden or DALY rate among the states of India was nine-fold for diarrhoeal disease, seven-fold for lower respiratory infections, and nine-fold for tuberculosis in 2016, highlighting the need for titrating efforts based on the specific trends in each state.
· – The contribution of most of the major non-communicable disease groups to the total disease burden has increased all over India since 1990, including cardiovascular diseases, diabetes, chronic respiratory diseases, mental health and neurological disorders, cancers, musculoskeletal disorders, and chronic kidney disease. In 2016, three of the five leading individual causes of disease burden in India were non-communicable, with ischaemic heart disease and chronic obstructive pulmonary disease as the top two causes and stroke as the fifth leading cause. The range of disease burden or DALY rate among the states in 2016 was nine-fold for ischaemic heart disease, four-fold for chronic obstructive pulmonary disease, and six-fold for stroke, and four-fold for diabetes.
· – The contribution of injuries to the total disease burden has increased in most states since 1990. The highest proportion of disease burden due to injuries is in young adults. Road injuries and suicides are the leading contributors to the injury burden in India. The range of disease burden or DALY rate varied three-fold for road injuries and six-fold for suicide among the states of India in 2016.
· – A group of risks including unhealthy diet, high blood pressure, high blood sugar, high cholesterol, and overweight, which mainly contribute to ischaemic heart disease, stroke and diabetes, caused about 25% of the total disease burden in India in 2016, up from about 10% in 1990. There were large variations between states in the degree to which these risks are rising.
· – While the disease burden due to child and maternal malnutrition has dropped in India substantially since 1990, this is still the single largest risk factor responsible for 15% of the total disease burden in India in 2016. This burden is highest in the major EAG states and Assam, and is higher in females than in males. The disease burden due to child and maternal malnutrition in India was 12 times higher per person than in China in 2016. Kerala had the lowest burden due to this risk among the Indian states, but even this was 2.7 times higher per person than in China.
· – The disease burden due to unsafe water and sanitation has also reduced significantly in India, but this burden is still 40 times higher per person in India than in China. The EAG States and Assam have a particularly high burden due to this risk.
· – The contribution of air pollution to disease burden has remained high in India between 1990 and 2016, with levels of exposure among the highest in the world. 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. The level of exposure to air pollution is highest in the EAG states.
These findings are expected to contribute substantially to appropriate health policy and system development through production of reliable state-level disease burden estimates as well as improvement of systems to produce these estimates on an ongoing basis to monitor changing trends at the local levels. This initiative intends to produce more detailed topic-specific publications and policy reports for major diseases and risk factors for further granular insights to plan their control. Annual production of state-level disease burden estimates is planned, with estimates improving with increasing availability of data. Additional disaggregation of estimates is planned, for example, rural-urban estimates for each state next year, and geospatial mapping at a fine-grid level for key diseases and risk factors. Capacity building in India to generate and analyse large-scale health data using strong methods is anticipated over the next five years of this work.
