By Invitation. Invest in a healthy generation for the years ahead

For the first time in the country, disease was mapped at a State level by the Indian Council of Medical Research, Public Health foundation of India and the Institute for Health Metrics and Evaluation in a report that was released late last year.

And it found that non-communicable disease and injuries have together overtaken infectious and childhood diseases in terms of the disease burden in every State of the country. Though the more developed States in the South saw this transition about 30 years ago, the poorer States are seeing this change happen over the past few years. Infectious and childhood diseases continue to be significant problems, especially in the Empowered Action Group States, and are responsible for the high burden of premature deaths in children under 5 years.

So the reality that India awakens to in a new year is that it faces a rising burden of cardiovascular diseases, cancer, mental health problems and chronic respiratory diseases, while not being free from infections like TB and diarrhoea. In fact, injuries, falls and suicide account for 12 per cent of the disease burden and are also increasing yearly.

The State-level Disease Burden study reveals that three types of risks are the most common in the country: undernutrition, air pollution, and a group of risks causing cardiovascular disease.

Child and maternal undernutrition is still the single largest risk factor in India, responsible for 15 per cent of the total disease burden in 2016. Undernutrition increases the risk of contracting common infections, and stunting in early childhood permanently affects physical and cognitive development. The burden of undernutrition is 12 times higher per person in India than in China! While this risk factor is relatively worse in the major northern EAG States and Assam, it is the leading risk in over three-fourths of Indian States.

Second, air pollution levels in India are among the highest in the world, making it the second leading risk factor that caused 10 per cent of the total disease burden in India. We know that it increases the risk of cardiovascular diseases, chronic respiratory diseases, respiratory infections and cancer, and are learning more about its other effects, like potentially inducing diabetes and lowering birth weights. The burden of outdoor air pollution has increased in all parts of the country since 1990 due to pollutants from power production, industry, vehicles, construction and waste burning. However, the burden of household air pollution has reduced due to decreasing use of solid fuels for cooking and schemes such as the PM Ujjwala Yojana, which offers subsidised LPG connections to poor families. Air pollution is higher in north India, with the vast majority of the population exposed to this risk, but it is considerable even in the southern States.

The third major group of risks include unhealthy diet, high blood pressure, high blood sugar, high cholesterol and overweight, which together increase the risk of heart attacks, stroke and kidney failure. These factors accounted for a tenth of the total disease burden in India in 1990, but in 2016, this increased to 25 per cent! The rates of diabetes and obesity are increasing in all States, and worryingly, the poor are showing accelerated rates. High blood pressure affects about a quarter of adults – and most are unaware of it. Unhealthy diets – rich in carbohydrate and poor in protein, fibre and micronutrients – are a double whammy, contributing to both malnutrition and obesity!

Luckily, all these are reversable and preventable risk factors. We need a concerted multi-sectoral response that includes the health, food, agriculture, environment, petroleum, housing and urban development sectors and cooperation between the Central and State governments. We have a choice – we can invest now to ensure a generation of healthy Indians, or face a future with huge healthcare bills and non-productive individuals. Besides, these interventions are good not just for humans, but for the environment as well, so it’s a win-win!

The writer is Deputy Director-General (Programmes) with the World Health Organization, Geneva. Views expressed are personal.

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