HEALTH CRI­SIS: FROM LIFE­STYLE DIS­EASE TO MAL­NU­TRI­TION

Life ex­pectancy at birth goes up 10 years since lib­er­al­i­sa­tion

Business Standard - - FRONT PAGE - ARCHIS MO­HAN & AB­HISHEK WAGHMARE

In­di­ans have gained nearly a decade of life ex­pectancy since 1990, women more so than men, a first of its kind study re­leased on Tues­day has re­vealed. But that is a rare bit of good news as India faces a se­vere life­style cri­sis, with its dis­ease bur­den from com­mu­ni­ca­ble diseases such as di­ar­rhoea and tu­ber­cu­lo­sis to non­com­mu­ni­ca­ble diseases like heart dis­ease and di­a­betes, the study has found. 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.

Life ex­pectancy at birth im­proved from 59.7 years in 1990 to 70.3 years in 2016 for women. For men, life ex­pectancy in­creased from 58.3 years to 66.9 years. But here again, state level in­equal­i­ties are stark, with a range of 66.8 years in Ut­tar Pradesh to 78.7 years in Ker­ala for women, and 63.6 years in As­sam to 73.8 years in Ker­ala for men in 2016, the re­port said.

The first state-level dis­ease bur­den and risk fac­tors es­ti­mates to im­prove health and plan­ning for ev­ery state in India is a col­lab­o­ra­tive work by the In­dian Council of Med­i­cal Re­search (ICMR), the Pub­lic Health Foun­da­tion of India (PHFI), the In­sti­tute for Health Met­rics and Eval­u­a­tion (IHME) and the Union Min­istry of Health and Fam­ily Wel­fare.

The re­searchers divided India's states into four groups ac­cord­ing to their level of de­vel­op­ment or epi­demi­o­log­i­cal tran­si­tion, us­ing the ra­tio of ill­ness and pre­ma­ture death caused by com­mu­ni­ca­ble, ma­ter­nal, neona­tal, and nu­tri­tional diseases (CMNNDs) ver­sus non­com­mu­ni­ca­ble diseases (NCDs) and in­juries as an in­di­ca­tor.

India is un­der­go­ing a ma­jor epi­demi­o­log­i­cal tran­si­tion in con­so­nance with so­cial and eco­nomic de­vel­op­ment. Con­tri­bu­tion of com­mu­ni­ca­ble diseases to deaths in India re­duced from 53.6 per cent to 27.5 per cent, while that of NCDs rose from 37.9 per cent to 61.8 per cent, the study says.

India’s dis­abil­ity ad­justed life years, or DALYs — one com­bined mea­sure of the health loss bur­den tak­ing into ac­count both pre­ma­ture mor­tal­ity and dis­abil­ity — from com­mu­ni­ca­ble diseases re­duced from 60.9 per cent of the to­tal DALYs to 32.7 per cent, while DALYs from NCDs rose from 37.9 per cent to 61.8 per cent.

It found that three of the five lead­ing killers in India in 2016 were NCDs — is­chaemic heart dis­ease, chronic ob­struc­tive pulmonary dis­ease and stroke.

Un­veil­ing the study in Gu­ru­gram, VicePres­i­dent M Venka­iah Naidu said the find­ings show that the over­all dis­ease bur­den per per­son in some states of India was al­most twice as much as in some other states, and the bur­den rate due to the lead­ing diseases ranges from five to ten times be­tween the states. “The spe­cific dis­ease bur­den trends for each state in this re­port pro­vide a ref­er­ence for plan­ning in­ter­ven­tions that are needed to ad­dress the ma­jor dis­ease prob­lems in each state,” he said.

Some of the more pros­per­ous states like Goa, Tamil Nadu and Ker­ala con­trib­ute the largest share of NCDs. These in­clude di­a­betes, chronic res­pi­ra­tory diseases, men­tal health and neu­ro­log­i­cal dis­or­ders, can­cers, car­dio­vas­cu­lar diseases, chronic kid­ney diseases and mus­cu­loskele­tal dis­or­ders.

In con­trast, mal­nu­tri­tion con­tin­ues to be a curse in some of the poorer states, also called the Em­pow­ered Ac­tion Group (EAG), like Ch­hat­tis­garh, Bi­har, Mad­hya Pradesh, Jhark­hand, Ra­jasthan, Odisha, Ut­tarak­hand, Ut­tar Pradesh and As­sam. It found a higher in­ci­dence of mal­nu­tri­tion among women.

For in­stance, Pun­jab could rightly be called the heart at­tack cap­i­tal of India, with the high­est deaths per 100,000 pop­u­la­tion at 261. Rel­a­tively un­der-de­vel­oped Odisha has a rate of 72. On the other hand, Odisha shows the worst death rate among di­ar­rhoea diseases at 129, while Pun­jab does well at 34.

The re­port also notes that un­der-five mor­tal­ity rate has de­creased sig­nif­i­cantly in all states. But, in the states that recorded the high­est num­ber of such mor­tal­i­ties, such as As­sam and Ut­tar Pradesh, the rates were four times that of the states with the low­est in­ci­dence, such as the rel­a­tively more pros­per­ous Ker­ala.

The re­port states that India has made sub­stan­tial gains in health since 1990, with the over­all health loss from all diseases and con­di­tions about one-third less per per­son in 2016. But, progress has been mixed.

Lower res­pi­ra­tory in­fec­tions and di­ar­rhoea diseases were the third and fourth lead­ing causes of health loss in 2016, ac­count­ing for about nine per cent of all pre­ma­ture death and ill health. But there are wide dif­fer­ences be­tween states in terms of over­all progress.

De­spite signs of progress, di­ar­rhoea diseases, iron-de­fi­ciency anaemia, and tu­ber­cu­lo­sis still cause a dis­pro­por­tion­ate amount of ill health, and claim more lives, than is ex­pected for India's stage of de­vel­op­ment, par­tic­u­larly in states in the early stages of epi­demi­o­log­i­cal tran­si­tion. The re­port used data from cen­suses, large-scale na­tional house­hold sur­veys, dis­ease sur­veil­lance data, and ad­min­is­tra­tive records of health ser­vices, dis­ease reg­istries, and a wide range of other health stud­ies con­ducted across India. 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.

It found that the fastest-grow­ing causes of ill health over the past 26 years were di­a­betes (in­creased by 174 per cent) and is­chaemic heart dis­ease (up 104 per cent). Rapid ur­ban­i­sa­tion is re­spon­si­ble for ris­ing deaths and health loss from road in­juries in most states since 1990, high­light­ing the lack of a com­pre­hen­sive na­tional pol­icy for in­jury pre­ven­tion, re­searchers said.

"The re­sults show that the bur­den due to non­com­mu­ni­ca­ble dis­ease and in­juries has over­taken the bur­den due to in­fec­tious and ma­ter­nal child diseases in ev­ery state of India, though this hap­pened in some states about three decades ago and in other states more re­cently," Union Health Min­is­ter J P Nadda said. He said the more de­vel­oped states that had this tran­si­tion a long time ago need to go on a war foot­ing to con­trol the rapidly ris­ing bur­den of ma­jor NCDs and in­juries.

"The con­tri­bu­tion of non-com­mu­ni­ca­ble diseases to health loss, fu­elled by un­healthy di­ets, high blood pres­sure, blood sugar and over­weight, has dou­bled in India over the past two decades. Air pol­lu­tion and to­bacco smok­ing con­tinue to be ma­jor con­trib­u­tors to health loss,” said Dr K Sri­nath Reddy, pres­i­dent, PHFI.

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