Public Health And Vital Statistics: India
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[[File: Top causes of death in india, 2016.jpg|Top causes of death in india, 2016 <br/> From: [http://epaper.timesgroup.com/Olive/ODN/TimesOfIndia/shared/ShowArticle.aspx?doc=TOIDEL%2F2017%2F11%2F15&entity=Ar00506&sk=20265F12&mode=text Lifestyle diseases biggest killer even in most backward states, November 15, 2017: ''The Times of India'']|frame|500px]] | [[File: Top causes of death in india, 2016.jpg|Top causes of death in india, 2016 <br/> From: [http://epaper.timesgroup.com/Olive/ODN/TimesOfIndia/shared/ShowArticle.aspx?doc=TOIDEL%2F2017%2F11%2F15&entity=Ar00506&sk=20265F12&mode=text Lifestyle diseases biggest killer even in most backward states, November 15, 2017: ''The Times of India'']|frame|500px]] | ||
| − | [[File: Share in total deaths, state-wise, 1990-2016.jpg|Share in total deaths, state-wise, 1990-2016 <br/> From: [http://epaper.timesgroup.com/Olive/ODN/TimesOfIndia/shared/ShowArticle.aspx?doc=TOIDEL%2F2017%2F11% | + | [[File: Share in total deaths, state groups-wise, 1990-2016- communicable, maternal, neonatal and nutritional; non-communicable; injuries.jpg|Share in total deaths, state groups-wise, 1990-2016- communicable, maternal, neonatal and nutritional; non-communicable; injuries <br/> From: [http://epaper.timesgroup.com/Olive/ODN/TimesOfIndia/shared/ShowArticle.aspx?doc=TOIDEL%2F2017%2F11%2F16&entity=Ar01403&sk=341E9131&mode=text Lifestyle diseases biggest killer even in most backward states, November 16, 2017: ''The Times of India'']|frame|500px]] |
Revision as of 18:50, 17 November 2017
This is a collection of articles archived for the excellence of their content. |
Contents
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Health indicators
2005 to 2015: significant improvement in health indicators
Sushmi Dey, India got healthier in last 10 yrs: Study , March 1, 2017: The Times of India
India's health indicators show significant improvement over the last decade with a decline in infant mortality complimented by a better sex ratio, more institutional deliveries and wider vaccine coverage.
The population rate is also a showing positive change, according to the new set of government data gathered during the fourth phase of National Family Health Survey .“The results show that if we invest and design good programmes in health, results will follow,“ health secretary C K Mishra said.
Haryana projected a commendable change in its sex ra tio at birth. While 762 females were born per 1,000 males in Haryana during NFHS 3 (2005-06), the ratio improved to 836 females per 1,000 males in the survey in 2014-15.
But the sex ratio at birth improved marginally nationally with 919 females born against 1,000 males during the fourth phase of the survey . During 2005-06, 914 females were born per 1,000 males. India's total fertility rate also declined to 2.2 from 2.7 over last decade, inching closer to the replacement level of 2.1. Overall, the level declined by 1.2 children per woman from NFHS 1 to NFHS 4. The data shows Uttar Pradesh showcased maximum decline in TFR, which dropped from 2.7 to 1.1in last eight years. Infant mortality rate declined from 57 to 41 per 1,000 live births between the third and the fourth phase of the survey. The institutional deliveries witnessed a dramatic growth of 40 percentage points from 38.7% in NFHS 3 to 78.9% in NFHS 4. Institutional births in public health facilities increased by 34.1% during the period.
The immunisation coverage across the country improved to almost 70% of fully immunised children at present from 44% in 2005-06.
India recorded a 10 percentage point decline in stunting from 48% during the third phase of the survey to 38.4% in the fourth round.Percentage of under-weight children declined from 42.5% to 35.7% in eight years.
C-sections falling in govt hospitals
C-section deliveries are increasing rapidly in private hospitals across the country, whereas public hospitals have recorded a decline over the last decade, shows data from the fourth phase of the National Family Health Survey. In private hospitals, C-section surgeries increased from 27.7% in NFHS3 to 40.9% in the fourth phase, whereas in public hospitals it declined from 15.2% to 11.9% during the period. Sushmi Dey TNN
The major ailments
1990-2016/ health hazards
Child and maternal malnutrition continues to be the biggest health hazard in India since 1990, while deteriorating air quality came a close second, according to a recent report in one of the world’s oldest medical journals.
The report published in the Lancet journal has found that besides malnutrition and rising air pollution, dietary risks, high systolic blood pressure and diabetes were other major risk factors in India in 2016. In 1990, air pollution was the third largest risk factor in the country but it moved to the second rank in 2016.
The report also analyses the variations in epidemiological transition – a change in mortality rates brought about by medical advancements – across Indian states. According to the findings, underdeveloped states, including Bihar, Jharkhand, Uttar Pradesh, Rajasthan, Madhya Pradesh and Haryana have recorded a low epidemiological transition level (ETL), and thereby suffer from a higher health burden from these risk factors.
Delhi may be one of the most polluted cities but it faces a marginally lower health impacts, when compared to states like Bihar. If calculated in terms of life years lost due to air pollution, or what medical experts call disability adjusted life years (DALYs), Delhi has a DALY rate of 1890, when compared to Bihar (4308) and Uttar Pradesh (4390).
A Centre for Science and Environment (CSE) researcher, who analysed the data for Delhi said, “Diseases that are triggered by air pollution including cardiovascular diseases, chronic respiratory diseases (COPD), and cancers have shown dramatic increase since 1990. In 1990 COPD was ranked 13 among leading causes of illness and lost life years. But this has now shot up to rank 3. Similarly, Ischaemic heart disease that is greatly influenced by air pollution has gone up from rank 5 to number 1, diabetes from rank 22 to rank 5 and stroke from rank 16 to rank 15.”
Explaining the reason for such variations, Bhargav Krishna, a research fellow at Public Health Foundation of India, said, “The population in these states may be suffering higher comorbidities – the presence additional diseases or disorders related to the main disease. The use of solid fuels, a major contributor to air pollution is also higher in these states.”
Medical experts led by the Indian Council of Medical Research (ICMR) and Institute of Health Metrics and Evaluation (IHME), who conducted the study, confirmed that number of death and disability caused by diarrhoea and other communicable diseases have declined, but diseases closely linked with air pollution and smoking, including heart ailments, have increased significantly.
Another report released by the Lancet Commission said each year over 9 million deaths occur worldwide due to air and water pollution.
Air pollution is at the top of the list contributing to over 6 million deaths. India remains one of the worst affected countries where 1.9 million premature deaths occur due to deteriorating ambient air quality.
The report published in Lancet has found that besides malnutrition and rising air pollution, dietary risks, high systolic blood pressure and diabetes were other major risk factors in India in 2016. In 1990, air pollution was the third-largest risk factor in the country but it moved to the second rank in 2016
2005-15: Heart attacks, lung obstruction, strokes
Together Account For One-Third Of All Deaths
Heart attacks, lung obstruction and strokes are the three top causes of death in India, accounting for over one-third of deaths. Along with diabetes and chronic kidney diseases, they make five non-communicable diseases that are part of the top ten causes of death.
Communicable diseases in the top 10 include lower respiratory tract diseases like bronchitis and pneumonia, diarrhoea, TB and diseases occurring to prematurely born babies. Road injuries are the tenth most prevalent cause of death. Together, these 10 make up 60% of the 10.3 million deaths every year.
The even mix of communicable diseases and non communicable ones caused by organs failing due to age or lifestyle choices, puts India in the middle of a disease transition seen across the world.
These results are from the Global Burden of Diseases 2015, an estimation of 249 causes of death in 195 countries by an international team of researchers led by the Seattle-based Institute of Health Metrics and Evaluation, and published recently in Lancet. “With improvement in tre atment by antibiotics and better understanding, deaths by infectious diseases have declined while sedentary lives, longer lifespans and other lifestyle habits have pushed up the proportion of non-communicable diseases in India,“ said Dr Amit Sengupta, an expert affiliated to the Peoples' Health Movement. The persistence of three eminently treatable in fectious diseases and the lack of care in eliminating preterm baby deaths points to the still lagging healthcare system, as also lack of safe drinking water and sanitation,“ he added.
India's position in the middle of the transition from a poor, healthcare-deficient country to an advanced country is brought out starkly when compared with examples from such countries.In Niger, one of the poorest countries in the world, with a per capita gross domestic product less than one-fifth of India's, eight of the top ten causes of death are communicable diseases. At the other extreme, Norway , with per capita gross domestic product over ten times that of India, has just one communicable disease -lower respiratory tract infections -among its top ten, with the other nine being non-communicable diseases.
China, which started off from conditions similar to India, has moved much further towards the advanced end of the transition. It too has only one infectious diseases among its top ten causes of death.
Both India and China have road injuries as one of the major causes of death due to large populations and a rapidly growing number of vehicles on the roads. The large number of types of vehicles (from cycles and bullock carts to fast moving cars) also contributes to high number of road injuries.
A striking feature of India's death-causing diseases profile is that all the noncommunicable diseases are increasing while all the infectious diseases are declining compared with a decade ago. Diabetes as a cause of death has grown at a chilling 35% between 2005 and 2015, chronic kidney disease by 21% and heart attacks by 17% even as communicable disease deaths have dropped by 20 to 30% while preterm baby deaths dropped by 40%.
2007-16: The most widespread maladies: food deficiencies, TB
Diabetes Affects 5% Indians, Cancer 0.15%
It is common -and natural -to think of diseases in terms of death. Often, diseases are measured by death -so many people die of heart attacks, so many of dengue, etc. While this is important, there is another dimension not measured by body counts.It is the scale of suffering and pain felt by people who live with diseases.
Talk to any middle class urban Indian and they will know of somebody who has had cancer. So, is cancer wildly spreading in India? In the last decade, the number of people with cancer has increased 46%, one of the fastest spreads. Part of it is due to much better identification, part because of longer life, and a part also because of lifestyle and diet choices.
But here's the thing: Cancer affects 0.15% of all Indians and deaths due to it were 8% of all deaths in 2016. It's deadly , it's spreading, but cancer is nowhere near as prevalent as we perceive anecdotally .
The two health conditions that affect most Indians are nutritional deficiencies of various kinds, like protein, vitamin, iron and others -about 46% of the population suffers from this affliction -and tuberculosis, which affects nearly 39% of the population. Heart and blood circulation related diseases and diabetes are two examples of really big diseases in India. They are also non-communicable like cancer, that is, they don't spread through external agents. Heart diseases affect 5.5 crore people and diabetes some 6.5 crore. Both cause huge loss to quality of life and limit the ability of patients to lead a productive life. Death rates are much more in the case of heart diseases, as they affect seniors more and treatments are expensive. Diabetes causes suffering and if neglected, death.But only about 3% of deaths are due to diabetes in itself.
This emerges from the recently released 2016 edition of the Global Burden of Disease data in the medical journal Lancet, and made available spanning several years by the Seattle-based Institute of Health Metrics and Evaluation. Indian data is collated from domestic surveys, registries, cause of death data and unit level SRS data recently made accessible by the government to GBD.
Two health conditions that are incredible in scale and sweep in India are none of the above. The biggest debilitating health condition is nutritional deficiencies of various kinds like protein, vitamin, iron and others. Over 60 crore people, or about 46% of the population suffers from this affliction.Lethargy , exhaustion, weakness, inability to concentrate are some of the common and preliminary symptoms. In children, it causes serious damage to both mental and physical growth. This is a completely `curable' condition because just a better diet would eliminate most of it. Over the past decade, it has increased at 8%.
Another big ticket disease is TB affecting nearly 52 crore people (39%). Although death rates have declined by nearly a third, TB's spread has increased by 20% in a decade. Infections, including those that cause diarrhoea or coughs, cause immense suffering to over 8 crore people (6.4%). Many other diseases are very widely spread, like skin diseases and neurological diseases.Gynecological disorders and infant diseases are also common.Policy makers need to think about prevalence as much as deaths by these diseases.
2016, top 10 causes
See graphic:
Top 10 causes of deaths in India, and worldwide, 2016
The principal causes of death/ 2016
From: Lifestyle diseases biggest killer even in most backward states, November 15, 2017: The Times of India
From: Lifestyle diseases biggest killer even in most backward states, November 16, 2017: The Times of India
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. This was revealed in the India State-Level Disease Burden Initiative’s Report.
The report notes that while all states have thus made what’s called the ‘epidemiological transition’ there remain wide variations in their disease profiles with some having made that transition as early as 1986, and others as recently as 2010.
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.
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.
“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,” noted the report.
Diarrhoea, TB among top causes of death along with road injuries
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 ischaemic 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. 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.
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. The India 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.
Ischemic heart disease, top cause leading to death
Ischemic heart disease is the top killer across most states, November 15, 2017: The Times of India
From: Ischemic heart disease is the top killer across most states, November 15, 2017: The Times of India
Urbanisation, Aging Population Pose Major Challenge
The first ever comprehensive estimate on state-wise burden of diseases brings out the wide variation in disease profile, burden and risk factors of the various states, many of them bigger than most countries in the world. From diarrhoea being the top killer in a couple of states to Alzheimer’s, a corollary of higher life expectancy, making it to a state’s leading causes of death the variation between states is huge.
While all states have transitioned to a disease profile where non-communicable diseases account for the largest share of diseases, barring Tamil Nadu, Kerala and Goa, diarrhoea, a disease of gross underdevelopment, is still among the top killers in every state. Another communicable disease, tuberculosis too continues to figure among the top killers in most states barring the southern states, and Goa and Punjab where it is diabetes which has climbed into the list of top killers.
What is uniform across almost all states is that ischemic heart disease is the top killer except in Assam where it is stroke and in Odisha and Jharkhand where it is diarrhoea. Overall disease burden by diabetes rose the highest in the country, by 174% in the last 26 years, followed by the burden of heart disease which rose by 104%. Jammu and Kashmir, Punjab, Uttarakhand and Haryana saw very high death rate from road injuries even if they did not figure among the top killers in these states.
“The findings show that the overall disease burden per person in some states of India is almost twice as much as in some other states, and the burden rate due to the leading diseases ranges five to ten times between the states,” said vice president Venkaiah Naidu on the occasion of the report launch.
The report identifies two factors that will pose a major challenge to the Indian health system in the coming decades — urbanisation and ageing of the population. All states have started seeing the effects of these two factors and many will see an acceleration of these as unplanned urbanisation picks up pace and life expectancy increases coupled with reduced cases of early deaths.
It remains to be seen how India and its states will cope with these looming challenges.
2017: Main causes of death
Cardiovascular Diseases Most Lethal Killers
Nearly 61% of deaths in India are now attributed to non-communicable diseases (NCDs), including heart disorders, cancer and diabetes, according to data released by the World Health Organisation (WHO) on Monday .Almost 23% of the population is at risk of premature death due to such diseases.
The UN agency has warned countries, including India, against premature deaths caused by NCDs and said governments must immediately step up efforts to tackle them. “Limited na tional progress has been made in the fight against NCDs -primarily cardiovascular and chronic respiratory diseases, cancers and diabetes -which are the world's biggest killers, and claim the lives of 15 million people aged 30 to 70 years annually,“ the WHO said.
According to the data, NCDs are responsible for 70% of deaths worldwide. In India, diseases like cancer, diabetes and heart problems were estimated to have killed a total of 58,17,000 people in 2016. While the percentage of deaths from NCDs is still lower in India as compared to many other countries, experts are concerned the burden is rapidly increas ing because of changing lifestyles and factors like pollution, and tobacco and alcohol consumption.
Four risk factors responsible for a significant proportion of these diseases are tobacco use, unhealthy diet, physical inactivity , and harmful use of alcohol. The major metabolic risk factors are obesity , raised blood pressure, raised blood glucose and raised blood cholesterol levels, the report says.
Cardiovascular diseases (coronary heart disease, stroke, and hypertension) contribute to 45% of all NCD deaths, followed by chronic respiratory disease (22%), cancer (12%) and diabetes (3%).
Cancer, diabetes and heart diseases alone account for 55% of all premature deaths in India in the age group of 30-69 years.
“Bolder political action is needed to address constraints in controlling NCDs, including the mobilisation of domestic and external resources and safeguarding communities from interference by powerful economic operators,“ said Tedros Adhanom Ghebreyesus, director-general of WHO.
Of late, the health ministry has initiated several measures to tackle the increasing burden of NCDs. For instance, the ministry has started a massive free doorto-door screening programme for early detection of cancer, heart disorders and diabetes. The programme, flagged off in February , aims to cover 200 districts by 2018.The government has also started schemes to set up cancer centres across the country. While 31 such hospitals have already been built, 49 more are to be set up by 2020.
Polio
Polio-free India
India Today.in , Striding into the future “India Today” 15/12/2016
2014
Polio-free India
Striding into the future
On March 27, the World Health Organization (WHO) declared India free from polio, which Bill Gates described as "the greatest global health achievement that I have witnessed". The war was declared as won as the last reported case of 'wild poliovirus' in India was in January 2011. This was a leap forward for what was once known as the largest 'endemic reservoir of polio' in the world, registering between 50,000 and 100,000 cases of paralytic polio every year. It marked the culmination of a decades-long campaign: In India, large-scale polio vaccination began in 1978, with the Expanded Program on Immunisation, which by 1984 had covered about 40 per cent of the infants in the country. In 1985, with the launch of the Universal Immunisation Program, the cover was extended. The success of these two programmes was that reported cases decline from 28,000 in 1987 to 3,200 in 1995. Saturated coverage sustained by a multi-media blitzkrieg against polio with the launch of the Pulse Polio Immunisation Programme in 1995 contributed to its success.
Walking habits, inactivity, obesity
2017: Indians 8th laziest among 46 nations
Table 1
From Large-scale physical activity data reveal worldwide activity inequality, Nature, journal,
Summary of dataset statistics for the 46 countries with more than 1000 subjects (693,806 subjects in total; Methods). Countries are ordered by number of subjects in sample. Country-level analyses are restricted to these 46 countries. Percentages are in parentheses. NA refers to missingness in data. Table continued on table 2 with additional columns.
Table 2
From Large-scale physical activity data reveal worldwide activity inequality, Nature, journal,
Summary of dataset statistics for the 46 countries with more than 1000 subjects (693,806 subjects in total; Methods). Countries are ordered by number of subjects in sample. Country-level analyses are restricted to these 46 countries. Percentages are in parentheses. NA refers to missingness in data. (Continued from table 1.)
