[op-ed snap] States of healthcare


Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Not Much

Mains level: Health related studies, research, etc. are important for the Mains exam. Also, they are specially mentioned in the Mains syllabus.



  1. Data from Global Burden of Disease study(given in the article) will help states chart their individual Health Targets
  2. States need to beef up disease monitoring systems

How health status changes around the world?

  1. Health status of populations across the world changes over time in response to socio-economic, demographic, nutritional, scientific, technological, environmental and cultural shifts
  2. Reason behind health transitions: Such health transitions have been especially profound in the past half-century due to sweeping
    (1) industrialisation,
    (2) rapid urbanisation and
    (3) relentless globalisation in most parts of the world

Why is it necessary to understand these health transitions?

  1. It is necessary to understand, and even predict, the patterns and dynamics of health transition so that multi-sectoral actions can be taken to protect and promote the health of populations

Why was ‘Global Burden of Disease’ initiated?

  1. The Global Burden of Disease study was initiated 26 years ago to chart the changing patterns of disease-related death and disability from 1990 onwards
  2. Working areas: Since then, estimates are periodically provided for years of life lost to premature mortality as well as for years of disease-related disability that is weighted for severity
  3. A combined measure of these two metrics is expressed as the loss of Disability Adjusted Life Years (DALYs) attributable to any disease or risk factor

First-of-its-kind Indian effort to map state-level disease burdens

  1. It was undertaken by over 1,000 experts of the Public Health Foundation of India, in partnership with the Indian Council of Medical Research and the team that leads the global study
  2. The results, reported recently, highlight significant trends common to all states as well as important differences between them

Results of the study:
Life expectancy at birth improved in India

  1. Life expectancy at birth improved in India from 59.7 years in 1990 to 70.3 years in 2016 for females, and from 58.3 years to 66.9 years for males
  2. However, life expectancy of women in Uttar Pradesh is 12 years lower than that of women in Kerala, while the life expectancy of men in Assam is 10 years lower than that of men in Kerala

Under-five mortality rate

  1. The under-five mortality rate has reduced substantially in all states in these 25 years
  2. But there was a four-fold difference in this rate between the highest, in Assam and Uttar Pradesh, as compared with the lowest in Kerala in 2016
  3. India has wide gaps to bridge: The under-five mortality of India is six times higher than Sri Lanka and burden of child and maternal malnutrition 12 times higher than in China

Different classes of diseases

  1. Communicable, maternal, neonatal, and nutritional diseases contributed to 61 per cent of India’s disease burden in 1990. This dropped to 33 per cent in 2016
  2. But the share of non-communicable diseases in the disease burden increased from 30 per cent in 1990 to 55 per cent in 2016
  3. Statewise trends: Kerala, Goa, and Tamil Nadu have the largest dominance of non-communicable diseases and injuries over infectious and associated diseases
  4. But this ratio is much lower in Bihar, Jharkhand, Uttar Pradesh, and Rajasthan

Five leading individual causes of disease burden in India

  1. In 2016, three of the five leading individual causes of disease burden in India were non-communicable
  2. The ischaemic heart disease and the chronic obstructive pulmonary disease are the top two causes
  3. And stroke the fifth leading cause

Causes behind different diseases

  1. A group of risks including unhealthy diet, high blood pressure, high blood sugar, high cholesterol, and overweight, which mainly contribute to ischaemic heart disease, stroke and diabetes
  2. Ambient air pollution and household air pollution both rank high as risk factors in 2016
  3. The former rising(air pollution) and the latter(household pollution) declining in the past 25 years

The study will help us in making Health strategy of individual states

  1. These data highlight the need to develop specific strategies to address the major contributors to disease burden within each state
  2. The data will help to tailor customised state-level responses while summated time trends will help the National Health Policy to set and track the progress towards country-level targets

The way forward

  1. The broad national agenda should be elimination of malnutrition, reduction of child and maternal mortality, control of infectious diseases and containment of risk factors contributing to non-communicable diseases
  2. This report provides each state the GPS to chart their individual journeys towards those goals, from different starting points.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
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