Child and maternal malnutrition remain the single largest risk factor, responsible for 15 per cent of the total disease burden of India in 2016. Two years after Swachh Bharat Abhiyan was launched, the per person disease burden due to unsafe water and sanitation was 40 times higher in India than in China in 2016. The contribution of air pollution to disease burden remains high, with levels of exposure among the highest in the world, causing cardiovascular diseases, chronic respiratory diseases, and lower respiratory infections.
These are some of the findings of the first ever comprehensive spread of diseases study and risk factors across every state of India from 1990 to 2016, utilizing all available data. The study on State-level disease burden was released by the Vice President Venkaiah Naidu on Tuesday. A joint initiative 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, it is the first such state-level estimate and trends for each state in India.
Summing up the findings, an article in The Lancet said: “Per capita disease burden measured as DALY (disability adjusted life year) rate has dropped by about a third in India over the past 26 years. However, the magnitude and causes of disease burden and the risk factors vary greatly between the states. The change to dominance of NCDs (non-communicable diseases)and injuries over CMNNDs (from communicable, maternal, neonatal, and nutritional diseases) occurred about a quarter century apart in the four ETL (epidemiological transition level) state groups. Nevertheless, the burden of some of the leading CMNNDs continues to be very high, especially in the lowest ETL states. This comprehensive mapping of inequalities in disease burden and its causes across the states of India can be a crucial input for more specific health planning for each state as is envisioned by the Government of India’s premier think tank, the National Institution for Transforming India, and the National Health Policy 2017.”
States were divided into four epidemiological transition level (ETL) groups on the basis of the ratio of DALYs from communicable, maternal, neonatal, and nutritional diseases (CMNNDs) to those from non-communicable diseases (NCDs) and injuries combined in 2016.
The report noted: “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. 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. As a stark contrast, 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. This situation after decades of nutritional interventions in the country must be rectified as one of the highest priorities for health improvement in India.” Set up in 2001, Empowered Action Group (EAG) comprises of eight states – Bihar, Jharkhand, MP, Chhatisgarh, Orissa, Rajasthan, Uttar Pradesh and Uttaranchal – which have lagged behind in containing population growth.
Highlighting India’s dual malnutrition burden of over and under nutrition, the report also found that of the total disease burden in India in 1990, a tenth was caused by 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. The contribution of this group of risks increased massively to a quarter of the total disease burden in India in 2016.
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, pre-term birth complications, and tuberculosis. 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 per cent of the total disease burden, mainly through diarrhea-related diseases and other infections. However, the report noted: “. The burden due to this risk is also highest in several EAG states and Assam, and higher in females than in males. The improvement in exposure to this risk from 1990 to 2016 was least in the EAG states, indicating that higher focus is needed in these states for more rapid improvements. Remarkably, the per person disease burden due to unsafe water and sanitation was 40 times higher in India than in China in 2016. The massive effort of the ongoing Swachh Bharat Abhiyan in India has the potential to improve this situation.”
Speaking at the launch VP Venkaiah Naidu said: “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.”