Women in UP live 12 years lesser than their Kerala sisters, reveals Lancet report

On an average a woman in Uttar Pradesh will live twelve years lesser than in Kerala. This is one of the many glaring findings of the India State-Level Disease Burden Initiative report published in top medical journal Lancet on Tuesday.

For the first time ever, India has released numbers of state-wise burden of diseases tracking trends over the past thirty years which highlights disparities between states.

National-level data can obscure disparities across India’s varied landscape, so a detailed understanding of health challenges at the state level is necessary to ensure that policies are responsive to the specific context of each state, it says.

While Assam, Uttar Pradesh and Chattisgarh have the highest disease burden rates, while Kerala and Goa have the lowest rates.

For example, in Assam, men live close to three years lesser than the national average at 63.6 years while in Kerala they live over seven years more at 73.8 years.

“In Uttar Pradesh, average life expectancy of females in 2016 is 66.8 years, close to four years lesser than the national average of 70.3 years, while in Kerala it is eight years more than the national average at 78.7 years,” it states.

“Life expectancy in whole of India has improved over three decades but is still lower by eleven years than in China and Sri Lanka,” said Lalit Dandona, Director, India State-Level Disease Burden Initiative.

For India is a double-whammy of non-communicable diseases increasing across states, with states of Punjab and Tamil Nadu have the highest disease burden due to diabetes, while on the other hand states like Uttar Pradesh, Bihar, Jharkhand and Odisha are tackling highest disease burden due to infections because of unsafe water, shoddy sanitation and non-practice of hand washing, leading to deaths due to diarrhoea especially in children under five years of age.

Taking a potshot at the Swacch Bharat Abhiyan, the report states that situation of unsafe water and sanitation is improving but “not enough yet.”

“The sweeping increase of the burden due to this combination of risks in every part of the country indicates emphatically that major efforts need to be put in place to control their impact in every state before the situation gets totally out of control,” the report warns.

Until this date, the report states that risk of malnutrition is “unacceptably high.” After thirty years it remains the single largest risk factor for disease in India. Around 15 per cent of total disease burden in India is child and maternal malnutrition.

It is higher in states of Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh , Rajasthan and Assam and is higher in females than males. Per person disease burden is 12 times more than in China and the lowest burden is that of Kerala, but even that is 2.7 times higher than China. The report warns, “It is a situation after decades of nutritional interventions in the country and must be rectified as one of the highest priorities for health improvement in India.”

Five per cent of total disease burden is due to unsafe water and sanitation and causes diarrhoea. It states, “The improvement in exposure to this risk from 1990 to 2016 was least in the Empowered Action Group states, indicating that higher focus is needed in these states for more rapid improvements. Remarkably, the per person disease burden due to unsafe water and sanitation was 40 times higher in India than in China in 2016.”

While household air pollution is improving the outdoor air pollution is “worsening,” the report further says. The burden due to outdoor air pollution is highest in a mix of northern states, including Haryana, Uttar Pradesh, Punjab, Rajasthan, Bihar, and West Bengal. Kerala, Goa, Tamilnadu have lowest rates. “The contribution of air pollution to disease burden remained high in India between 1990 and 2016, with levels of exposure among the highest in the world,” it says.

India has 72 per cent more per capita disease burden than China and Sri Lanka. Much remains to be done, said Dandona. “Six times more children under-5 die in India than in Sri Lanka. We have four times more Tuberculosis and three times more iron deficiency anaemia than countries which have same socio-demographic factors.”

“This is document desired by us and respective state governments for a very long time. It is a crucial and timely report. To this date, lower respiratory tract infections, Tuberculosis, Diarrhoea and Anaemia remains high along with burden of suicides and road injuries,” said Anupriya Patel, Minister of State for Health and Family Welfare.

While in states like Kerala the transition from dominance of infectious diseases to non-communicable diseases began as long ago as 1995, in some states like Chattisgarh the transition has occurred only about two years ago, almost twenty years later, said Dr Soumya Swaminathan, Secretary, Department of Health Research, Ministry of Health and Family Welfare (MoHFW).

Numbers matter

Estimated deaths due to communicable diseases, maternal, neonatal and nutritional diseases -

Empowered Action Group (EAG) states - 34.6%

North-east states - 32.1%

Other states - 20.2%

Estimated deaths due to non-communicable diseases -  

Empowered Action Group (EAG) states - 55.1%

North-east states - 58.8%

Other states - 68.5%

(EAG states include Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Orissa, Rajasthan, Uttaranchal and Uttar Pradesh)

States with worse disease burden -

Ischemic Heart Disease - Haryana, Andhra Pradesh, Karnataka

High Blood Pressure - Punjab, Tamil Nadu, West Bengal

High Blood Sugar - Punjab, Tamilnadu

Malnutrition - Bihar

Unsafe Water, Sanitation, Handwashing - Uttar Pradesh, Bihar, Jharkhand, Odisha

Ambient Air Pollution - Haryana, Uttar Pradesh

Diarrhoea Diseases - Jharkhand

Lower Respiratory Tract Infections - Rajasthan

Chronic Obstructive Pulmonary Disorder - Uttar Pradesh, Rajasthan, Uttarakhand

Road injuries - Uttarakhand, Haryana, Punjab, Jammu and Kashmir