Life expectancy has increased, but noncommunicable diseases (NCDs) and infectious diseases continue to take a toll and access to healthcare is far from equitable across the country. This is according to the latest National Health Profile released by the Union Ministry of Health and Family Welfare earlier this week.
“A healthy India is no longer a dream. India has had notable achievements since independence in 1947,” the report reads. “[Infant] mortality and crude death rate has been reduced considerably. Life expectancy at birth has increased, infant mortality and crude death rates have been greatly reduced, diseases such as smallpox, polio and guinea worm have been eradicated, and leprosy is at the verge of getting eliminated.”
Life expectancy up, but challenges remain
Life expectancy in India stood at 49.7 years in the 1970-75 period. In the 2012-16 period, life expectancy increased to 68.7 years – up from the 2011-15 period, when life expectancy stood at 68.3 years. Life expectancy is higher for women than men in India. Life expectancies for these demographics are 70.2 years and 67.4 years respectively.
While the increased life expectancy figures are good news, there are still a plethora of challenges facing public health in India. These are exacerbated by the country’s low expenditure on health, which stands at 1.28 percent of gross domestic product (GDP), as of the 2017-18 period.
Whilst an increase from the 2016-17 period, when expenditure stood at 1.02 percent of GDP, government spending is still insufficient to address India’s health needs. This fuels a high rate of out-of-pocket expenditure on health which data indicates accounts for around eighty percent of the total health spending in India. This drives millions into poverty: 55 million find themselves in this situation because of their medical bills.
NCDs in India
The health issues affecting Indians include NCDs, which affect significant numbers of people throughout the country. According to the National Health Profile, 6.51 crore people attended NCD clinics during the survey period. Of these, 6.19 percent were diagnosed with hypertension; 4.75 percent e were diagnosed with diabetes; 0.16 percent were diagnosed with cardiovascular diseases; and 0.1 percent were diagnosed with cancer.
Figures indicate 5.2 million lives are lost to NCDs every year. They are the dominant cause of death in the country, accounting for 61.8 percent of all deaths in India in 2016. Heart disease is the leading cause of death in India, followed by cancer. Both are NCDs.
Both diseases are on the rise. India has witnessed a fifty percent increase in heart disease rates in the past 25 years, it was reported earlier this year. Meanwhile, cancer – of which India accounts for the third-highest number of cases in the world behind China and the United States – was projected in 2014 to increase fivefold by 2025. Cancer rates are expected to almost double by 2040 to twenty lakh, from 11.6 lakh cases in 2016. India’s burden of both diseases is complicated by staffing shortages: the country has a deficit of both oncologists and cardiologists.
Other NCDs, such as diabetes, hypertension, and lung disease, plague the country in significant numbers and are projected to increase. Type-2 diabetes patients – India’s fastest-growing disease – will number 98 million cases by 2030, compared to almost 73 million in 2017. Overall cases are expected to increase to 134 million by 2025. Deaths due to the disease numbered 254,500 in 2017. Hypertension, meanwhile, is responsible for 10.8 percent of deaths in India. An estimated 224 million people live with the condition in the country.
The country also faces a high burden of lung disease. In the case of chronic obstructive pulmonary disease (COPD), India loses a million lives every year. The country is regarded as the COPD capital of the world: cases increased from 28.1 million in 1990 to 55.3 million in 2015.
A number of factors contribute to the country’s high burden of NCDs. Rising rates of obesity, fuelled by unhealthy eating habits and sedentary lifestyles; exposure to air pollution; high levels of tobacco use; and diets rich in salt, sugar, and fats are among the risks. Furthermore, low awareness of many of these conditions – despite their high prevalence and death toll – allows for many cases to go undiagnosed, to the point where treatment is difficult and survival outcomes are drastically reduced.
Infectious diseases still an issue
Even as NCDs are on the rise and dominate as India’s disease burden and causes of mortality, infectious diseases remain a key challenge as the National Health Profile serves to remind the country. The disease burden of NCDs versus communicable conditions does vary between states: fourteen percent to 43 percent for infectious diseases and other conditions (maternal, neonatal, and nutritional diseases) and 48 percent to 75 percent for NCDs.
Of infectious diseases, acute respiratory infections is the overwhelming leader on morbidity, responsible for 69.47 percent. Acute diarrhoeal diseases are responsible for 21.83 percent; typhoid is responsible for 3.82 percent; tuberculosis for 1.76 percent; pneumonia for 1.54 percent; malaria for 0.66 percent; and other diseases for 0.93 percent. Of mortality, pneumonia is responsible for 30.65 percent; acute respiratory infections for 27.21 percent; acute diarrhoeal diseases for 10.55 percent; H1N1 (swine flu) for 8.03 percent; acute encephalitis syndrome for 4.63 percent; viral hepatitis for 4.25 percent; encephalitis for 3.86 percent; typhoid for 2.9 percent; and other diseases for 7.92 percent.
Meanwhile, a number of diseases have high fatality rates compared to the number of cases according to the National Health Profile. Rabies, as previously reported by Health Issues India, incurred a fatality rate of 100 percent in India. Other diseases had high mortality rates, such as Japanese encephalitis (eleven percent); acute encephalitis syndrome (six percent); encephalitis (five percent); meningococcal meningitis (four percent); neonatal tetanus (four percent); diphtheria (two percent); viral meningitis (one percent); cholera (one percent); and non-neonatal tetanus (one percent).
The National Health Profile goes into significant detail on India’s communicable disease burden. In 2018, India reported 13,194,775 cases of acute diarrhoeal disease; 11,382 cases of acute encephalitis syndrome, 10,045 cases of encephalitis, and 1,674 cases of Japanese encephalitis; 41,996,260 cases of acute respiratory infection; 57,813 cases of chikungunya; 651 cases of cholera; 101,192 cases of dengue fever; 11,720 cases of diphtheria; 55,470 cases of gonococcal infection; 4,380 cases of kala-azar; 20,895 cases of measles; 3,382 cases of meningococcal meningitis and and 13,110 cases of viral meningitis; 181 cases of neonatal tetanus and 9,104 cases of non-neonatal tetanus; 18,006 cases of pertussis (whooping cough); 928,485 cases of pneumonia; 110 cases of rabies; 15,595 cases of syphilis; 2,308,537 cases of typhoid; and 143,974 cases of viral hepatitis.
Whilst conditions such as chikungunya and malaria have decreased, they remain challenges nonetheless. India has committed itself to ending malaria by 2030, but reports millions of cases every year. More than 8.4 million cases were reported in 2017 according to the National Health Profile and while this declined to 3.99 million cases in 2018, the disease clearly remains a challenge. With drug resistance complicating India’s response to numerous communicable conditions, it is clear that efforts need to be scaled up and vigilance is instrumental on the part of health authorities in their response.
The National Health Profile touts efforts to expand vaccination coverage in the country. “India has attained significant progress in achieving immunization coverage through Universal Immunization Programme (UIP),” it said. “In 2013, India along with [the] South East Asia Region, declared [its] commitment towards measles elimination and rubella/congenital rubella syndrome (CRS) control by 2020. [The] MR [measles rubella] vaccine campaign is targeted towards 410 million children across the country. ‘Mission Indradhanush’ aimed to fully immunize more than ninety percent of newborns by 2020 through innovative and planned approaches. A total of 528 districts were covered during the various phases of this Mission.
However, it goes on to note, “India has come a long way in immunisation but has to traverse far before achieving its targets.” To this end, India has announced that it will step up its immunisation campaign. Of the 260 lakh children born every year in India, 31.2 lakh do not complete a full round of immunisation according to the Government, showing there is a clear need to ramp up immunisation efforts.
The National Health Profile lends an insight into India’s other health indicators. “[The] estimated birth rate declined from 25.8 in 2000 to 20.4 in 2016 while the death rate declined from 8.5 to 6.4 per 1000 population over the same period,” it said. “The natural growth rate declined from 17.3 in 2000 to 14 in 2016 as per the latest available information.” On fertility, the report notes that “the [total fertility rate]…in twelve States has fallen below two children per woman and 9 States have reached replacements [sic] levels of 2.1 and above.” This news comes against a backdrop of increasing rates of infertility across the country.
“In recent years India has made ground-breaking progress in reducing the maternal mortality ratio (MMR) by 77 percent from 556 per 100000 live births in 1990 to 130 per 100000 live births in 2016,” the report states, adding that “the urban-rural divide traditionally seen in institutional births has been largely closed. Overall 75 percent of rural births are now supervised as compared to 89 percent in urban areas.”
Of health insurance, the National Health Profile writes “health insurance in India is a growing segment. Yet, it hasn’t taken off fully and several measures are needed to improve and expand insurance coverage.” Ayushman Bharat, which provides health insurance coverage to economically vulnerable populations, is a major overture by the Centre to this end and dispensed hospital treatments worth Rs 7,500 crore to beneficiaries with the number of treatments numbering at roughly 46.4 lakh within its first year.
The National Health Profile shows what India has achieved on health and development and what challenges remain. Evidently, the challenges are manifold. Going forward, India must commit to continuing to address its multifaceted disease burden, bridge the urban-rural divide, and strengthen its health schemes to promote universal health coverage across the country and realise the vision of a healthy India.
India’s National Health Profile 2019 can be accessed here.