India: The burden of non-communicable diseases is increasing, says study

The India State-level Disease Burden Initiative, a collaboration 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

80-yr-old undergoes complex heart surgery, discharged in 24 hours

The report on the India State Level Disease Burden was released at the event describing the findings in detail, along with the technical paper published in the journal Lancet and an open-access interactive visualisation tool that allows understanding of the trends in a simple way.

  • Under-5 mortality rate is improving in every state but this rate has a 4-fold difference between states, indicating major health inequalities
  • Every state of India now has a higher burden of non-communicable diseases and injuries than from infectious diseases, the extent of which varies widely between the states
  • EAG states face the major challenge of controlling the increasing non-communicable diseases as well as the persistent infectious diseases
  • The per person burden from many of the leading infectious and non-communicable diseases varies 5 to 10 times between different states
  • Malnutrition continues to be the single largest risk for health loss in India, which is higher among females and is particularly severe in EAG states and Assam

 The  Vice President of India, Shri  Venkaiah Naidu stated “A systematic compilation of the burden of all diseases and the risk factors behind them is needed for each state of India to plan health and other services that address the specific situation of each state. This report by the India State-level Disease Burden Initiative provides these comprehensive estimates for each state from 1990 to 2016 for the first time in India, and offers insights into the health inequalities between the states of India.  The findings show that the overall disease burden per person in some states of India is almost twice as much as in some other states, and the burden rate due to the leading diseases ranges five to ten times between the states.”

 The burden from 333 disease conditions and injuries and 84 risk factors were computed for each state of India as part of the Global Burden of Disease Study 2016.  In order to understand the specific disease trends among states at different levels of epidemiological transition, the states were divided into groups based on the ratio of Disability Adjusted Life Years (DALYs) from infectious and associated diseases to DALYs from non-communicable diseases and injuries combined.

Union Minister for Health and Family Welfare, Shri J P Nadda said, “The National Health Policy 2017 has recommended disease burden tracking to monitor health improvements across the country. The data and results in this report of the India State-level Disease Burden Initiative can serve as a useful guide to fine-tuning health planning in each state of the country. I hope that the planners and experts in each state will use the findings in this report and engage with the India State-level Disease Burden Initiative to further improve health in their respective states.”

Dr Soumya Swaminathan, Director-General of ICMR and Secretary, Health Research, Government of India, who closely guided the work of the India State-level Disease Burden Initiative said, “After two years of intense collaborative effort that included many leading health experts and policy makers in India, it is a matter of great satisfaction that this report, technical paper and the visualization tool are available for use, in which the disease burden and risk factors trends in every state of the country from 1990 to 2016 are elucidated.”

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.
  • 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 per cent 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.