A comprehensive study, the first of its kind, reveals that a health crisis is spanning the entire spectrum of ailments, from lifestyle-related diseases to the persistent scourge of malnutrition.
While life expectancy rose, data revealed that six out of 10 Indians (in 1990 it was less than one in three) now succumb to non-communicable diseases (NCDs) like heart diseases, child and maternal malnutrition is the leading cause of premature death and poor health and the burden of tuberculosis is the highest in the world.
Worse, this disease burden varies, indicating a widening health gap between the nation’s wealthy and poorer states. The India State-level Disease Burden Initiative, was a joint study conducted by the Indian Council of Medical Research, Public Health Foundation of India (PHFI), and Institute for Health Metrics and Evaluation.
Unaddressed it could undermine efforts to transform India’s economic potential.
The study also puts the spotlight on the country’s spending on healthcare; at present it is 1.2% of gross domestic product.
Kerala, Goa, and Tamil Nadu, relatively prosperous states, have the largest share of NCDs such as cardiovascular diseases, diabetes, chronic respiratory diseases, mental health and neurological disorders, cancers, musculoskeletal disorders and chronic kidney disease.
“The contribution of NCDs to death and disability in India continues to grow at an alarming rate —a ticking time bomb that is increasingly affecting not just our health but our economy as well," Vivekanand Jha, executive director, The George Institute for Global Health, an international medical research institute, said.
The burden of most infectious and associated diseases came down from 1990 to 2016, but five of the 10 individual leading causes of the disease burden still belonged to this group: diarrhoeal diseases, lower respiratory infections, iron-deficiency anaemia, neonatal preterm birth, and tuberculosis.
Malnutrition is particularly severe in so-called empowered action group (EAG) states that are socioeconomically backward—Assam, Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Odisha, Rajasthan, Uttaranchal and Uttar Pradesh. Malnutrition is higher among females.
The extent of the crisis becomes clear when the Disability Adjusted Life Years, or DALY, rate—that is, disease burden expressed as the number of years lost due to ill-health, disability or early death—is taken into consideration. It was nine-fold for diarrhoeal diseases and tuberculosis, and seven-fold for lower respiratory infections in 2016.
The under-five mortality rate has come down substantially 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.
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.
“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 NCDs and injuries," said J. P. Nadda, minister of health and family welfare.
Arguing similarly, Anoop Misra, chairman, Fortis-C-DOC Centre for Diabetes, Metabolic Diseases and Endocrinology, said, “In health problems, India is suffering from double jeopardy—diseases related to under- and over-nutrition. Those states where health transition is rapidly occurring (increase in heart disease, diabetes) are also most urbanized and mechanized. But such changes are dynamic, and will quickly march over to other states. In view of this, several national control programmes need not only strengthening but capacity building to tackle deluge of NCDs."