India State-Level Disease Burden Report

The India State-Level Disease Burden Report, a first-of-its-kind assessment of causes for diseases in each State from 1990 to 2016, was released recently. A team of scientists evaluated the diseases causing the most premature deaths and ill-health in each State. It found out, for instance, that life expectancy at birth in the country has improved significantly.

What is worrying?

However, the report indicated many health inequalities among States, noting that while there was a fall in the under-five mortality in every State there was also a four-fold difference in the rate of improvement among them. “The per person burden from many of the leading infectious and non-communicable diseases varied 5-10 times between States,” the report pointed out with researchers attributing this to differences in the development status, environment, lifestyle patterns, preventive health measures and curative health services between the States.

“In the most developed States this transition took place about 30 years ago, but in the poorest States this transition has taken place only over the past few years,” the report said.

Who suffers most?

It explained that infectious and childhood diseases continue to be significant problems in the poor Empowered Action Group States of north India (Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Odisha, Rajasthan, Uttar Pradesh and Uttarakhand and Assam), which still contributes 37-43% of the total disease burden. These diseases are responsible for the inordinately high burden of premature deaths and morbidity suffered by children under five years of age in these States.

The results show that non-communicable disease and injuries have together overtaken infectious and childhood diseases in terms of disease burden in every State, but the magnitude of this transition varies markedly between the poor States and the more developed States, according to the report which is now being used as an important tool for health planners in India to improve health of the people more effectively.

What led to the report?

It was the result of a collaboration between the Indian Council of Medical Research, the Public Health Foundation of India, the Institute for Health Metrics and Evaluation at the University of Washington, and senior experts and stakeholders from about 100 institutions across India. The India State-Level Disease Burden Initiative was led by Dr. Lalit Dandona, who serves as the director of this initiative, and was guided by Dr. Soumya Swaminathan, Deputy Director- General, World Health Organisation.

The technical paper was published the same day on this data in the journal The Lancet, and an online open-access interactive visualisation tool was released that allows easy understanding of the disease burden details in every State and their trends over a quarter century. The report is the result of two years of intense scientific work and collaborative effort. The Global Burden of Disease methodology was used for this analysis, which is the most widely used disease burden estimation approach globally.

How will it help?

The India State-Level Disease Burden Initiative will update estimates annually for each State based on new data that become available. It will also provide more detailed findings: for example, next year it plans to report the rural-urban differences in disease burden for each State. Detailed topic-specific reports and publications will be produced for major diseases and risk factors for deeper insights to plan their control. The policy applications of these findings include planning of State health budgets, prioritisation of interventions relevant to each State, informing the government’s Health Assurance Mission in each State, monitoring of health-related Sustainable Development Goals targets, and assessing the impact of large-scale interventions based on time trends of disease burden. In addition, the data gaps identified in this estimation process will inform which areas of the health information system of India need to be strengthened.

Another important aspect of this major collaborative effort is that scientific capacity is being enhanced in India to generate and analyse large-scale health data, as well as to utilise it to improve our health.