Lifestyle triggers major shift in disease burden across India

Alicia Farmer
November 15, 2017

This is the first time burden of disease has been studied at state-level. This has huge implications for policymakers because it means that one health policy and uniform health schemes may not be workable for all the states. Over 200 experts from 100 Indian institutions participated in this initiative.

The first ever comprehensive estimates & trends of disease burden & risk factor for every state of India, prepared by the India State-level Disease Burden Initiative, in its first ever such report has found that there are large differences between states in the changing disease profile in the country. 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 from 63.6 years in Assam to 73.8 years in Kerala for males in 2016.

There was a corresponding increase in the contribution of non-communicable diseases from 30% of the total disease burden in 1990 to 55% to 2016, and of injuries from 9% to 12%.

The under-five mortality rate has come down substantially from 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.

The extent of the crisis becomes clear when the Disability Adjusted Life Years, or DALY rate-disease burden expressed as the number of years lost due to ill-health, disability or early death-is taken into consideration.

In 1990, of the total disease burden in India, 61% was due to communicable, maternal, neonatal, and nutritional diseases. This figure has dropped to 33% in 2016.

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Tobacco also emerged as a significant contributor to cardiovascular diseases, diabetes and certain cancers it was responsible for 6% of the total disease burden in India in 2016.

On the other hand, malnutrition is particularly severe in so-called Empowered Action Group (EAG) states that are socioeconomically backward-Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Odisha, Rajasthan, Uttaranchal and Uttar Pradesh and Assam. It also said that besides malnutrition and the air pollution, dietary risks, high systolic blood pressure and diabetes posed as some of the major risk factors in India in 2016.

"Many Indian States are bigger than most countries in the world".

Explaining such variations, a researcher at Public Health Foundation of India said that the people in these states must have comorbidities, which is additional diseases or disorders related to the main disease.

Air pollution, which was the third largest risk factor in the country in 1990, moved to the second position in the year 2016. Non-communicable diseases contributed a whopping 59.2 percent to the State's overall disease burden. 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 findings show that the overall disease burden per person in some states of India is nearly 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", said vice president Venkaiah Naidu on the occasion of the report launch.

The burden from 333 diseases and injuries and 84 risk factors were computed for each state as part of the Global Burden of Disease Study 2016. Worse, this health crisis is characterised by widening disparity between India's relatively more prosperous and poorer states and can potentially impair its demographic dividend.

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