THE FIRST ever “health of the nation” state-level disease burden study has turned on its head the perception that some states, placed higher on the development ladder, are better than others in terms of health. The study shows that UP, MP, Bihar, Rajasthan, Jharkhand, Chhattisgarh, Odisha and Uttarakhand, in the government’s Empowered Action Group (EAG), continue to battle child and maternal malnutrition. However, it also shows that states such as Tamil Nadu, Kerala, Punjab and Goa have become hubs of non-communicable diseases (NCDs), including cancer and lifestyle-linked issues like heart ailments and diabetes.
In other words, while states like Bihar and UP are still battling diarrhoea deaths in children, those that have won that war, now have newer battles to fight.The report, ‘India: Health of the Nation’s States India State-level Disease Burden Initiative’, was released by Vice President M Venkaiah Naidu on Tuesday. Its findings have been summed up in The Lancet.
The report says, “Among the leading NCD individual causes, the DALY rate for ischaemic heart disease was highest in Punjab and Tamil Nadu, followed by Haryana, Andhra Pradesh, Karnataka, Gujarat, and Maharashtra. For COPD (Chronic Obstructive Pulmonary Disease), the highest DALY rates were in Rajasthan, Uttarakhand, and Uttar Pradesh, followed by Himachal Pradesh, Haryana, and Jammu & Kashmir.”
Ischaemic heart diseases are caused by narrowed heart arteries that can lead to a heart attack.
DALY (Disability Adjusted Life Years) is an internationally recognised metric to rate a disease or health condition, and is calculated as the sum of years of life lost due to premature mortality and the years lost due to disability in people living with a health condition or suffering its consequences. A higher DALY metric indicates a severe disease burden.
”The DALY rate for stroke was the highest in West Bengal, followed by Odisha, Tripura, Assam and Chhattisgarh. Tamil Nadu had the highest DALY rate for diabetes, followed by Punjab, Karnataka, Kerala, Goa and Manipur,” the report says.
The eight states under the EAG receive special attention from the central government and comprise those that have lagged behind in containing population growth. Referring to infectious diseases or those caused by malnutrition, the report found that the DALY rate for diarrhoeal diseases was highest in Jharkhand, Odisha and Bihar, followed by UP and Assam in 2016. Regarding DALY rates for communicable diseases, the report found:
Lower respiratory infections: Highest in Rajasthan, Bihar, UP, MP and Assam, followed by Uttarakhand and Chhattisgarh. Iron-deficiency anaemia: Highest in Bihar, Assam and Jharkhand, followed by Rajasthan, MP and UP. Neo-natal preterm birth complications: Highest in Rajasthan, Chhattisgarh, Madhya Pradesh, and Assam.
Tuberculosis: Highest in UP, followed by Assam, Gujarat, Rajasthan, Odisha, Chhattisgarh, Jharkhand and MP.
The report includes states like Tamil Nadu, Kerala and Punjab in the highest bracket for NCDs, for which prevention is a primary counter-strategy. This indicates that states with better health systems, as seen in infant mortality and immunisation rates, are failing on the prevention front.
Dr Soumya Swaminathan, deputy director-general for programmes, WHO, and former director-general, Indian Council of Medical Research (ICMR), said, ”The NCD burden is high in the southern states and Punjab. Lifestyle is a factor. But it is also possible that because for years, especially since the National Rural Health Mission was started in 2005, the focus of primary health centres and sub centres has been on reproductive and child health because infant and maternal mortality rates were among the MDGs (Millennium Development Goals). So they have not been focussing on prevention or spreading awareness about dietary requirements. That is why the National Health Policy talks about shifting towards tackling NCDs.”
The report also found that life expectancy at birth had improved 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 UP 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.
The contribution of injuries to the disease burden increased in most states since 1990, with young adults forming the highest proportion. Road injuries and self-harm, including suicides, were the leading contributors to the injury burden, the report shows.
The DALY rate for road injuries was the highest in Jammu & Kashmir, Uttarakhand, Haryana, and Punjab, followed by Rajasthan and UP. For self-harm, the highest DALY rates were in Tripura, Karnataka and Tamil Nadu, followed by Andhra Pradesh, West Bengal and Telangana.
Referring to the report, Vice President Naidu said, “This report…provides 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.”
Prof Lalit Dandona, director, Public Health Foundation of India (PHFI), Gurgaon, who led the study, told The Indian Express: ”The analysis aims to equip the government with evidence to identify specific state-level health challenges and priorities for intervention.”
The health study focused on key drivers of ill health, disability and premature death in all states and union territories, and included people from over 2,000 ethnic groups. It covered 333 diseases and injuries, and 84 risk factor trends, for each state between 1990 and 2016, as part of the Global Burden of Disease 2016 study.
”Individual states in India are in different phases of epidemiological transition, and this has resulted in wide inequalities in the magnitude and progress against various diseases and their causes. This report has major policy implications for national and local governments,” said Dandona, who is also director, All India State-level Disease Burden Initiative, which was launched by the Ministry of Health with the ICMR, PHFI, and the Institute for Health Metrics and Evaluation, in 2015.