State of the nation's health

India needs a state-specific, disease-specific approach

Many of the broad findings of a report titled “India: Health of the Nation’s States” published on Tuesday may not have come as a surprise. For a while now, it is known that India has shown an improvement in health care outcomes as it experienced higher economic growth rates and governments, both at the central and state levels, increasingly ran programmes to meet this objective. It is also known that despite the improvement over the past two decades, India remains way behind its neighbours such as China. Also, the overall figures mask the huge state-wide divergence. All these bits of understanding have gone into public policy making with different states trying to learn from each other, apart from central programmes trying to scale up regional successes. Yet, the comprehensive study, the first of its kind, will be of immense value to policymakers as well other stakeholders for the wealth of data that helps go beyond the obvious.

While there was some clarity about state-level trends on some key health indicators, there was no comprehensive assessment of the diseases, or indeed the risk factors, that caused the maximum hurt — in the form of premature deaths and disabilities — in a particular state. It is this gap that the report has tried to plug. The key metric used to provide a comprehensive standardised comparison of health loss caused by different diseases and risk factors, between geographic units, sexes, and age groups, and over time, is disability-adjusted life years (DALYs), 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 injury. The results of this study not only provide a clearer picture of what ails different states but also leave crucial clues for policymakers.

For instance, the disease profile of India has changed dramatically between 1990 and 2016. The total disease burden, measured as DALYs, due to communicable, maternal, neonatal and nutritional diseases (or infectious and associated diseases) has come down from 61 per cent in 1990 to just 33 per cent in 2016. While that is good news, the report provides data to prove that non-communicable diseases now contribute more to India’s disease burden than communicable diseases. In the last 26 years, diabetes increased by 174 per cent and ischaemic heart disease (IHD) went up by 104 per cent. IHD and chronic obstructive pulmonary disease were the leading causes of premature death and ill-health in 2016, overtaking lower respiratory infections and diarrhoeal diseases. However, the transition does not mean that communicable diseases are taken care of.

Another key insight is the significant variation in the burden from leading diseases and risk factors between states that have physical proximity and are at similar levels of development and epidemiological transition. The report shows this by comparing different pairs of states such as Madhya Pradesh and Uttar Pradesh, Manipur and Tripura, and Punjab and Himachal Pradesh and underscores its central message: The chances of improving India’s overall health targets will go up significantly if the biggest health problems and risks in each state are tackled with a targeted approach, instead of a more generic one. In other words, much like the devil, the solution too, lies in the details. The report can be gainfully utilised for data-driven and decentralised health planning and monitoring recommended by the National Health Policy 2017 and the NITI Aayog Action Agenda 2017-2020.