While India is growing healthier, not every Indian and every state and Union Territory can be said to be growing healthy at the same pace. Also, the burden of lifestyle diseases such as diabetes and respiratory disorders in India has increased since 1990. This understanding was highlighted in the India: Health of the Nation’s States, a report which analysed the total disease burden of all Indian states and Union territories between 1990 and 2016.
According to the report, as a result of urbanisation and aging, the burden non-communicable diseases (NCDs) is large and rapidly rising in all states. The incidence of NCDs rose from 30 percent of the total disease burden in 1990 to 55 percent in 2016. However, mortality due to communicable, maternal, neonatal and nutritional diseases (CMNNDs) declined from 61 percent in 1990 to 33 percent in 2016, it said.
Difference in disease profile across states
The change, however, is not uniform. According to the report, NCDs accounted for 37.9 percent deaths in 1990 and 61.8 percent deaths in 2016, however, the occurrences of NCDs varies across states. While NCDs dominate infectious and associated diseases in Kerala, Goa, and Tamil Nadu, the dominance is lower in Bihar, Jharkhand, Uttar Pradesh and Rajasthan. Also, while Punjab witnessed an increase in burden of disease due to lifestyle diseases like diabetes, between 1990 and 2016, Uttar Pradesh witnessed a rise in chronic obstructive pulmonary disease, tuberculosis and diarrhoea.
Whereas, in the North East, Tripura saw 159 percent higher cases of iron-deficiency anemia as compared to its neighbour Manipur, where neonatal disorders, tuberculosis, and road injuries are higher. The bottom line being that huge anomaly exists when it comes to burden of disease and health of Indians across the country, highlighting the fact that a universal healthcare programme may not be as effective as one may have had thought.
While mortality due to communicable, maternal, neonatal and nutritional diseases (CMNNDs) declined from 61 percent in 1990 to 33 percent in 2016, it's still very high in many states. The report points out that states like Rajasthan, Madhya Pradesh, Uttar Pradesh, Bihar, Jharkhand, Chhattisgarh and Odisha, which are classified as Empowered Action Group (EAG) states and two northeastern states like Assam and Meghalaya continue to show a relatively high prevalence of CMNNDs, above the national average in 0-14 years. The burden of NCDs was also high in these states in the population aged 40 and above.
Child and maternal malnutrition continues
The report stresses on rectifying child and maternal malnutrition problem as one of the highest priorities for health improvement in India. "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 (measured as total disability-adjusted life years (DALYs)) in India in 2016," the report points out.
"This burden is highest in the major EAG states and Assam, and is higher in females than in males," it adds.
The report says that 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," it said.
Unsafe water and sanitation improving, but not enough yet
The report informs that unsafe water and sanitation was the second leading risk in 1990 but dropped to seventh in 2016 contributing to 5 percent of total disease. The risk it states is also higher in EAG states and Assam and among females. "The per person disease burden due to unsafe water and sanitation was 40 times higher in India than in China in 2016," the report says focussing on the potential of the current government's Swachh Bharat Abhiyan.
Outdoor pollution even as indoor pollution reduces
The report also points out that outdoor air pollution was responsible for six percent of the total disease burden in India in 2016, at a time a thick grey smog hung low over Delhi-NCR leaving residents gasping for breath. After child and maternal malnutrition, air pollution was the second leading risk factor in India as a whole.
According to the study report, the disease burden due to air pollution remained high in India between 1990 and 2016, as it caused non-communicable and infectious diseases such as cardiovascular and respiratory diseases and infections.
Rising risks for cardiovascular diseases and diabetes
One of the major highlights was just how more Indians are falling prey to lifestyle diseases. The report shows an increase in the incidence of diabetes and ischaemic heart disease between 1990 and 2016 by 174 and 104 percent respectively. In 2016, three of the five leading causes of disease burden in India were non-communicable, with ischaemic heart disease and chronic obstructive pulmonary disease as the top two causes, among all the Indian states and Union territories that were studied as part of the report.
Though the risk was highest in Punjab, Tamil Nadu, Kerala, Andhra Pradesh, and Maharashtra in 2016, the contribution of these risks has increased in every state of the country since 1990, the report pointed out.
The differences in the health profile of the Indian states, the study stresses has highlighted even further on the need for understanding the health situation of each state. What it means is that India needs targetted health policy aimed to resolve the issues in every state differently.
The study conducted by the Indian Council of Medical Research, Public Health Foundation of India and Institute for Health Metrics and Evaluation is the first comprehensive analysis of the health of India's 1.34 billion citizens. It was published in The Lancet journal.
With inputs from PTI
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Updated Date: Mar 30, 2018 14:42:59 IST