A toolkit to think local 

A toolkit to think local 

Context:

Policymakers in India need reliable disease burden data at subnational levels.

Introduction:

• The findings of the India State-Level Disease Burden Initiative will aid in decentralised health planning.
• Till now, a comprehensive assessment of the disease causing the most premature deaths and ill health in each State, the risk factors responsible for this burden and their time trends have not been available.
• To address this knowledge gap, India State-Level Disease Burden Initiative has analysed and described these trends for every State from 1990 to 2016.
• The report was recently published in the journal Lancet.

Findings of the study:

• The findings of the study are based on analysis of data from all available sources. This includes vital registration, the sample registration system, large-scale national household surveys, other population-level surveys and cohort studies, disease surveillance data, disease programme data, administrative records of health services, disease registries, among others.
• The estimates were produced as part of the Global Burden of Disease Study 2016, which uses standardized methods in a unified framework.
• The key metric used to access burden is disability-adjusted life years(DALY), which is the sum of the number of years of life lost due to premature death and a weighted measure of the years lived with disability due to a disease or an injury.

State wise picture:

• The per person disease burden, measured as DALY rate, has dropped in India by 36% from 1990 to 2016, but there are major inequalities among States with the per person DALY rate varying almost two fold between them.
• The burden of most infectious and childhood disease has fallen, but the extent of this varies substantially across India.
• Diarrhoeal diseases, lower respiratory infections, iron-deficiency anaemia, neonatal disorder, and tuberculosis still continue to be major public health problems in many poorer northern States.
• The contribution of major non-communicable disease categories to the total disease burden has increased in all States since 1990.
• These include cardiovascular disease, diabetes, chronic respiratory diseases, mental health and neurological disorders, musculosketal disorder, cancers, and chronic kidney disease.
• The high burden of infectious and childhood disease in poorer States along with non-communicable disease poses challenge for these States.
• State-specific DALY rates for many leading individual disease varies five to tenfold between States.
• The findings of the study reveal that three types of risks-under nutrition, air pollution, and a group of risks causing cardiovascular disease and diabetes-are akin to national emergencies as these have the potential to significantly blunt the rapid social and economic progress to which India aspires.

Reasons responsible for disease burden:

• There is declining trend in child and maternal undernutrition, still this is the single largest risk factor in India, responsible for 15% of the total disease burden in 2016.
• Undernutrition increases the risk of neonatal disorders, nutritional deficiencies, diarrhoeal disease, and lower respiratory and other common infections. This is 12 times higher per person in India than in China.
• The risk factor is relatively worse in the major northern poor States and Assam; it is amazingly the leading risk in over three-fourths of the States across India.
• Air pollution levels in India are among the highest in the world, making it the second leading risk factor in 2016, responsible for 10% of the total disease burden in the country.
• Air pollution causes risk of cardiovascular diseases, chronic respiratory disease, respiratory infections, and cancer.
• The unacceptably high disease burden due to undernutrition and air pollution in most of India must be brought to an end through systematic large-scale interventions with robust short-and long-term goals.
• A group of risks that include unhealthy diet, high blood pressure, high blood sugar, high cholesterol and overweight, which increase the risk of ischaemic heart disease, stroke and diabetes, contributed a tenth of the total disease burden in India in 1990, but increased to a quarter of the total burden in 2016.

Health planning:

The new knowledge base and the annual updates planned by the India State-Level Disease Burden Initiative will provide important inputs for the date-driven and decentralized health planning and monitoring recommended by the National Health Policy 2017 and the NITI Aayog Action Agenda 2017-2020.

Way ahead:

• There is need for State-specific health planning instead of generic planning.
• The disease burden can be reduced by addressing the risk factors for major diseases.
• Planning based on local trends can improve the health of populations more effectively.