Vast health inequalities among states

New Delhi: India's overall disease burden per person has dropped by 36 per cent between 1990 and 2016, health researchers said on Tuesday in a report that captures the changing causes of serious ill-health and reveals vast inequalities among states.

The report, published in The Lancet, a medical research journal, has identified diabetes, coronary heart disease and chronic obstructive pulmonary disease among the fastest growing causes of ill-health, overtaking respiratory infections and diarrhoea.

The findings show that despite significant declines in prevalence, maternal, child and nutritional diseases remain a problem in many states while diet, obesity and air pollution are new threats, causing premature deaths and disability.

"We see some striking differences between the states - the magnitude of the difference is staggering," Lalit Dandona, professor at the Public Health Foundation of India, New Delhi, who led the efforts to assess the disease burden.

Jharkhand, for instance, has rates of deaths and disease caused by diarrhoeal diseases nine times higher than the levels in Goa, while Rajasthan has deaths and disability rates from respiratory illness seven times the levels found in Kerala.

The disease burden caused by infectious, maternal, neonatal and nutritional diseases has declined from 61 per cent in 1990 to 33 per cent in 2016.

The burden of non-communicable diseases such as coronary heart disease and stroke, among others, increased from 30 per cent to 55 per cent during the same period.

Even states with similar development levels show significant differences in non-communicable diseases.

Punjab, for instance, has much higher levels of premature deaths and illness caused by diabetes and coronary heart disease, but low rates of chronic obstructive pulmonary disease, compared to neighbouring Himachal Pradesh.

"We now have data to highlight specific diseases and risk factors that need attention in each state," Dandona told The Telegraph.

"This will enable policy makers to act more effectively and help reduce the major inequalities between states," the professor added.

The report has found a 17 per cent increase in the proportion of India's population exposed to dangerous levels of air pollution between 1990 and 2016.

Bihar, Rajasthan and Uttar Pradesh are among states with the highest levels of premature deaths and disability caused by air pollution.

"The rise in the disease burden linked to air pollution is due to both an increase in the population exposed to poor air quality and increases in the concentrations of pollutants in the atmosphere," Kalpana Balakrishnan, a coauthor of the paper, said.

Dandona said the persistence and extent of malnutrition in the country is another surprise.

The report has identified malnutrition as the primary cause of premature deaths or disability among people in 23 of 28 states in 2016, just as it was in 1990.

Only in Bengal, Goa, Punjab, Maharashtra and Tamil Nadu, high blood pressure or dietary factors have in 2016 overtaken malnutrition in 1990 as the primary cause of premature deaths or disability.


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