The India State-Level Disease Burden Initiative was launched in October 2015. It is a collaboration between the Indian Council of Medical Research (ICMR), the Public Health Foundation of India (PHFI), Institute for Health Metrics and Evaluation (IHME), and senior experts and stakeholders currently from about 100 institutions across India. This Initiative reported an unprecedented comprehensive assessment of the diseases causing the most premature deaths and ill-health in each state of the country, the risk factors responsible for this burden, and their trends spanning 26 years from 1990 to 2016. The burden from 333 disease conditions and injuries and 84 risk factors was computed for each state of India as part of the Global Burden of Disease Study 2016.

Report, Technical Paper and Visualization Tool

The report “India: Health of the Nation’s States — The India State-Level Disease Burden Initiative” describing the findings was released by the Hon’ble Vice-President of India, Shri M Venkaiah Naidu, along with the Hon’ble Union Minister of Health and Family Welfare Shri J P Nadda and the Hon’ble Minister of State for Health and Family Welfare Smt Anupriya Patel in New Delhi on 14 November 2017. Many national and state-level policy makers, academics and other stakeholders participated in this event.

A technical paper on these findings “Nations within a nation: variations in epidemiological transition across the states of India, 1990–2016 in the Global Burden of Disease Study” was published in the international medical journal The Lancet on the same day, and an open access interactive visualization tool India GBD Compare was also released which allows easy understanding of the disease burden trends over time across the states.

Major findings

The per person disease burden, measured as disability-adjusted life year (DALY) rate, dropped in India by 36% from 1990 to 2016, but there are major inequalities among the states with the per person DALY rate varying almost two-fold between them. The results show that non-communicable diseases and injuries together have overtaken infectious and childhood diseases in terms of disease burden in every state of the country, but the magnitude of this transition varies markedly between the poor states and the more developed states. In the most developed states this transition took place about 30 years ago, but in the poorest states this transition has taken place only over the past few years. It is important to note though that diarrhoeal diseases, lower respiratory infections, iron-deficiency anaemia, neonatal disorders, and tuberculosis still continue to be major public health problems in many poorer northern states.

The contribution of most major non-communicable disease categories to the total disease burden has increased in all states since 1990. These include cardiovascular diseases, diabetes, chronic respiratory diseases, mental health and neurological disorders, musculoskeletal disorders, cancers, and chronic kidney disease. The contribution of injuries to the total disease burden has also increased in most states since 1990, with the leading ones being road injuries, suicides, and falls. Overall, the state-specific DALY rates for many leading individual disease conditions vary five- to ten-fold between the states, and major differences are also observed for individual diseases between neighbouring states that are at similar levels of development.

The study highlights undernutrition, air pollution, and a group of risks causing cardiovascular disease and diabetes, as the major risk factors contributing to health loss in the country. Child and maternal undernutrition is still the single largest risk factor in India, responsible for 15% of the total disease burden in 2016. Air pollution levels in India are among the highest in the world, which is responsible for 10% of the total disease burden in the country. The burden of ambient air pollution has increased in every part of India since 1990. A group of risk factors including unhealthy diet, high blood pressure, high fasting plasma glucose, high cholesterol and overweight, have increased in every state of India, which together now contribute a quarter of the total disease burden in the country.

This comprehensive assessment of diseases and risks trends over a quarter century for each state of India, using a single standardized framework, is expected to provide useful inputs for the data-driven and decentralized health planning specific to the situation of each state that has recently been recommended by the National Health Policy of India and the National Institution for Transforming India (NITI).

The India State-Level Disease Burden Initiative plans to update the estimates annually for each state, and provide more detailed findings, as new data become available. The data gaps identified in this estimation process will inform which aspects of the health information system of India need to be strengthened. The work of this Initiative is overseen by an Advisory Board of eminent policymakers and involves extensive engagement of several domain expert groups.


Media Coverage

The dissemination event and the findings were covered extensively in media reports and editorials, which include:

About ICMR

The Indian Council of Medical Research (ICMR) is the apex government body in India for the formulation, coordination, and promotion of biomedical and health research. It is one of the oldest medical research bodies in the world. Besides the headquarters in New Delhi, ICMR has 32 research institutes, centres, and units across India. ICMR funds both intramural and extramural research in India. The priorities of ICMR coincide with the national health priorities and have the goal of reducing the total burden of disease and promoting the health and well-being of India’s population. As part of this agenda, ICMR is interested in improving the estimates of disease burden and risk factors in India, especially at the subnational levels, for better health planning, policy framing, and fund allocation.

About PHFI

The Public Health Foundation of India (PHFI) is a premier public health institution in India with presence across the country. It collaborates with multiple constituencies including Indian and international academia, state and central governments, multi- and bi-lateral agencies, and civil society groups. The vision of PHFI is to strengthen India’s public health institutional and systems capability and provide knowledge to achieve better health outcomes for all through strengthening training, research and policy development in public health. As part of this vision, PHFI has major interest in improving the robustness of subnational disease burden estimates to inform health action and in evaluating the impact of large-scale population health interventions.

About IHME

Founded in 2007, the Institute for Health Metrics and Evaluation (IHME) is a global health research institute at the University of Washington in Seattle that provides independent, rigourous, and comparable measurement of the world’s most important health problems and evaluates the strategies used to address them. IHME aims to identify the best strategies to build a healthier world by measuring health, tracking program performance, finding ways to maximise health system impact, and developing innovative measurement systems to provide a foundation for informed decision-making that will ultimately allocate resources to improve population health.