India State Level Disease Burden Report

India State Level Disease Burden Report, 2017

Relevancy:

  • GS Prelims, GS mains paper I and II
  • Policies, Governance, Health indicators, State level disease burden report (2017)

Recently:

  • A report titled “India State-Level Disease Burden” was released recently.
  • The report is first of its kind and presents assessments of causes of diseases in each state for the perios 1990 to 2016.
  • A team of scientists evaluated the diseases causing the most premature deaths and ill-health in each State.

Indications of the report:

  • Life expectancy at birth in the country has improved significantly.
  • There exist many health inequalities among States: While there was a fall in the under-five (U-5) mortality in every State there was also a four-fold difference in the rate of improvement among them.
  • 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 from 63.6 years in Assam to 73.8 years in Kerala for males in 2016.
  • 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 measured as DALYs (Disability Ajusted Life Years), 61% was due to communicable, maternal, neonatal, and nutritional diseases (termed infectious and associated diseases in this summary for simplicity) 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% in 2016, and of injuries from 9% to 12%.
  • 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, preterm birth complications, and tuberculosis.
  • The burden caused by these conditions generally continues to be much higher in the Empowered Action Group (EAG) and North-East state groups than in the other states, but there were notable variations between the states within these groups as well.
  • The burden also differed between the sexes, with diarrhoeal disease, iron-deficiency anaemia, and lower respiratory infections higher among females, and tuberculosis higher among males.
  • The proportion of total disease burden caused by infectious and associated diseases was highest among children, which contributed to the disproportionately higher overall disease burden suffered by the under-5 years age group.
  • 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.
  • Among the leading non-communicable diseases, the largest disease burden or DALY rate increase from 1990 to 2016 was observed for diabetes, at 80%, and ischaemic heart disease, at 34%.
  • 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.
  • Child and maternal malnutrition contributes to disease burden mainly through increasing the risk of neonatal disorders, nutritional deficiencies, diarrhoeal diseases, lower respiratory infections, and other common infections
  • Unsafe water and sanitation was the second leading risk responsible for disease burden in India in 1990, but dropped to the seventh leading risk in 2016, contributing 5% of the total disease burden, mainly through diarrhoeal diseases and other infections.

Causes of differences among the states:

  • The differences can be attributed to differences in the development status, environment, lifestyle patterns, preventive health measures and curative health services between the States.
  • In the most developed States this transition took place about 30 years ago, but in the poorest States this transition has taken place only over the past few years.

Applications of the data:

  • The policy applications of these findings include planning of State health budgets, prioritisation of interventions relevant to each State, informing the government’s Health Assurance Mission in each State, monitoring of health-related Sustainable Development Goals targets, and assessing the impact of large-scale interventions based on time trends of disease burden.
  • The data gaps identified in this estimation process will inform which areas of the health information system of India need to be strengthened.

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