Burden of disease shifts to non-communicable ailments 

Burden of disease shifts to non-communicable ailments 

Context:
The ‘India State Level Disease Burden’ report, prepared as part of the Global Burden of Disease(GBD) Study 2016 published in Lancet.

Introduction:

• The Indian States Disease Burden Initiative is a joint initiative of Indian Council of Medical Research, Public Health Foundation of India and Institute for Health Metrics and Evaluation in collaboration with Union health ministry.
• This is the first time burden of disease has been studied at state-level.
• Till now only national-level data was available, masking varying disease patterns in states.
• The study used multiple data sources to map State-level disease burden from 333 disease conditions and injuries, and 83 risk factors for each State from 1990 to 2016.

Key Highlights of the report:

1- On Non-Communicable diseases:

• The study has found that every State in India has a higher burden from non-communicable disease and injuries than from infectious disease.
• The contribution of non-communicable diseases to health loss fuelled by unhealthy diets, high blood pressure, and blood sugar- has doubled in India over the past two decades.
• Air pollution and tobacco smoking continue to be major contributors to health loss.
• The report provides the first comprehensive set of state-level disease burden data, risk factors estimates, and trends for each state in India, is expected to inform health planning with a view towards reducing health inequalities among States.
• Lifestyle diseases like heart and chronic respiratory diseases now kill more people than communicable ones like tubercolosis or diarrhoea in every state in India, including the most backward.
• The least developed states that recently transitioned are having to grapple with having a higher burden of NCDs while they continue to have a high burden of infectious and maternal child diseases, the report pointed out.
  

2- On Communicable diseases:

• The report pointed out that communicable diseases constitute almost two-thirds of the disease burden in India.
• The report studies the period from 1990 to 2016 and shows that communicable diseases constitute almost two-thirds of the disease burden in India from a little over a third in 1990. Despite the transition, which is associated with development, malnutrition remains the single top risk for health loss.
• Malnutrition is still the single largest risk factor responsible for 15% of the total disease burden in India in 2016.
• The leading individual cause of death in India in 2016 was inchaemic heart disease.
• The proportion of all deaths in India due to communicable, maternal, neonatal and nutritional diseases reduced from 53.6% in 1990 to 27.5% in 2016, while those due to non-communicable disease increased from 37.9% to 61.8%, and those due to injuries changed from 8.5% to 10.7%.

3- On Life Expectancy:

• The Life expectancy at birth jumping 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.
• Although Life expectancy at birth has improved at the national level, inequalities between states continue – ranging from 66.8 years in Uttar Pradesh to 78.7 years in Kerala for females, and 63.6 years in Assam to 73.8 years in Kerala for males in 2016.

4- On Diarrhoea, TB among top causes of death:

• 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.
• The leading individual cause of death in India in 2016 was inchaemic heart disease, the death rate from which was twice as much as the next leading cause.
• But there were wide variations with the highest death rate among the states from this disease being 12 times the lowest.

On Non-communicable diseases (NDC):

• The other non-communicable diseases (NCD) in the top 10 individual causes of death included chronic obstructive pulmonary disease (COPD), stroke, diabetes, and chronic kidney disease.
• Communicable diseases such as diarrhoeal diseases, lower respiratory infections, and tuberculosis, and road injuries and suicides were also in the top 10 causes of death. The death rates from diarrhoeal diseases and tuberculosis were also higher in the least developed states and had a 12-fold and seven-fold variation in rates, respectively, between states.
• Contribution of non-communicable diseases to health loss had doubled in the past two decades. While air pollution and tobacco continue to be major contributors to health loss, the extent of these risk factors varies considerably across states.

Causes:

• The contribution of air pollution to disease burden has remained high in India between 1990 and 2016, with levels of exposure among the highest in the world.
• 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, constructions, and waste burning.
• 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% of the total disease burden in India 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.

State wise data:

• The first group to make the transition in 1986 included Kerala, Tamil Nadu, Goa, Himachal Pradesh and Punjab. The last group to do so, accounting for the highest number of people (588 million), made the transition almost a quarter of a century later, in 2010. This group included Bihar, Uttar Pradesh, Madhya Pradesh, Chhattisgarh, Jharkhand, Rajasthan and Odisha. India as a country made the transition in 2003.
• Though life expectancy at birth has improved at the national level, inequalities between states continue – ranging from 66.8 years in Uttar Pradesh to 78.7 years in Kerala for females, and 63.6 years in Assam to 73.8 years in Kerala for males in 2016.
• The biggest change is seen in the overall disease pattern in the country.
• In 1990, 61% of the total disease burden in India was attributed to communicable, maternal, neonatal, and nutritional diseases.
• This figure has dropped to 33% in 2016. At the same time, the contribution of non-communicable diseases (heart disease, cancers, respiratory diseases, neurological disorders) has risen to 55% from 30% in 1990. Kerala, Goa, and Tamil Nadu have the largest dominance of non-communicable diseases and injuries while they are relatively lower in Bihar, Jharkhand, Uttar Pradesh and Rajasthan.
• The proportion of all deaths in India due to communicable, maternal, neonatal and nutritional diseases reduced from 53.6% in 1990 to 27.5% in 2016, while those due to non-communicable diseases increased from 37.9% to 61.8%, and those due to injuries changed from 8.5% to 10.7%.
  

Purpose of report:

• The purpose was to produce an open-access, public good knowledge base, which has the potential of making fundamental and long-term contributions to improving health in every state the country, through provisions of the best possible composite trends of disease burden and risk factor for policy makers to utilize in their decision making.
• 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.

What is communicable disease?

• Communicable, or infectious diseases, are caused by microorganisms such as bacteria, viruses, parasites and fungi that can be spread, directly or indirectly, from one person to another. Some are transmitted through bites from insects while others are caused by ingesting contaminated food or water.
• A variety of disease-producing bacteria and viruses are carried in the mouth, nose, throat and respiratory tract. Conditions such as leprosy, tuberculosis (TB) and different strains of influenza (flu) can be spread by coughing, sneezing, and saliva or mucus on unwashed hands.
• Sexually transmitted infections (STIs) such as HIV and viral hepatitis are spread through the exposure to infected bodily fluids such as blood, vaginal secretions and semen. Hepatitis is a significant concern in the African Region and the majority of people living with hepatitis B and C are unaware of their infections.
• Insects play a significant role in the transmission of disease. Bites from Anopheles mosquitoes transmits malaria parasites that can wreak havoc on high-risk populations such as children under age 5 and pregnant women. Yellow fever has also seen resurgence due to reduced vaccination efforts. Many neglected tropical diseases are caused by unsafe water, poor housing conditions and poor sanitation in the Region.

What is non-communicable disease?

• Noncommunicable diseases (NCDs), also known as chronic diseases, tend to be of long duration and are the result of a combination of genetic, physiological, environmental and behaviours factors.
• The main types of NCDs are cardiovascular diseases (like heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructive pulmonary disease and asthma) and diabetes.
• NCDs disproportionately affect people in low- and middle-income countries where more than three quarters of global NCD deaths – 31 million – occur.

Conclusion:

The data released by report has the potential of making fundamental and long-term contributions to improving health in every state.