India: Health of the Nation’s States
The India State-Level Disease Burden Initiative
This report was initiated in 2015 and released on 14 November 2017 and is a joint effort of the Indian Council of Medical Research, the Public Health Foundation of India and the Institute for Health Metrics and Evaluation. The report can be accessed here.
Burden of disease report:
This report is a massive step in organising a wide level of information across the country. It would be helpful to the policy makers in understanding where concerted efforts are needed. Here are some interesting statistics from the report.
Even though absolute numbers of the following have decreased, the variation among states is staggering.
1. Life expectancy: Since 1990, there is an increased in life expectancy. In 1990, life expectancy at birth in India was 58.3 years for males and 59.7 years for females. By 2016, life expectancy at birth increased to 66.9 years for males and 70.3 years for females.
2. Epidemiological transition: From being 60.9% in 1990, communicable diseases have reduced to 32.7% of the total DALYs (Disability Adjusted Life Years).
3. Contributors to death: Compared to 1990, the burden of communicable disease has lessened to half (53.6 to 27.5%), however burden of non-communicable diseases (37.9 to 61.8%) and injuries (8.5 to 10.7%) has increased.
4. Years of life lost (YLL): is a measure that quantifies the number of years of life a person loses at the age of their death, based on the highest life expectancy for their age group anywhere in the world. Some major contributors to YLL according to the report:
- Ischaemic Heart Disease (Group other than EAG)
- Stroke (North Eastern States)
- Infections and Neonatal causes? (EAG and North Eastern States)
- Suicides (All States)
- Road Injuries (All States)
According to gender, YLL had more effect on males in cases of Ischaemic heart diseases and road accidents while women were affected due to diarrhoea and infectious diseases like lower respiratory diseases.
5. Years lived with disability (YLDs): is a measure that takes into account both the number of individuals suffering from disability (or non-fatal poor health as a result of a particular disease or injury), and also the severity of the disability. The contribution of YLDs to the total disease burden (DALYs) increased in India from 17% in 1990 to 33% in 2016. Anaemia was the most common cause of YLD (11% of all disability) and caused more YLD in females than males.
6. Risk factors causing disease burden: Risk factors are the drivers of diseases and injuries that cause premature death and disability. After maternal and child malnutrition, air pollution (both ambient and indoor) is the biggest cause of disease burden in India! Other causes in decreasing order are: dietary risks, systolic blood pressure, high fasting plasma glucose, tobacco, sanitation, cholesterol, BMI, alcohol/drugs, occupational risks, impaired kidney function, unsafe sex, environmental risks, low physical activity, low bone mineral density, sexual abuse and violence.
The report also analyses the disease burden of each state. This is a great tool for lawmakers and policy advisers to tailor make their suggestions according to the need of the region.