India: Health of the Nation’s States

With almost one-fifth of the world’s population living in India, the health status and the drivers of health loss are expected to vary between different parts of the country and between the states. Accordingly, effective efforts to improve population health in each state require systematic knowledge of the local health status and trends. While state-level trends for some important health indicators have been available in India, a comprehensive assessment of the diseases causing the most premature deaths and disability in each state, the risk factors responsible for this burden, and their time trends have not been available in a single standardised framework. The India State-level Disease Burden Initiative was launched in October 2015 to address this crucial knowledge gap with support from the Ministry of Health and Family Welfare of the Government of India. This is a collaborative effort between the Indian Council of Medical Research, Public Health Foundation of India, Institute for Health Metrics and Evalua ion, and experts and stakeholders from about 100 institutions across India. The work of this Initiative is overseen by an Advisory Board consisting of eminent policymakers and involves extensive engagement of 14 domain expert groups with the estimation process. Based on intense work over two years, this report describes the distribution and trends of diseases and risk factors for every state of India from 1990 to 2016.

Methods and Data

The estimates were produced as part of the Global Burden of Disease Study 2016. The analytical methods of this study have been standardised over two decades of scientific work, which has been reported in over 16,000 peer-reviewed publications, making it the most widely used approach globally for disease burden estimation. These methods enable standardised comparisons of health loss caused by different diseases and risk factors, between geographic units, sexes, and age groups, and over time in a unified framework. The key metric used for this comparison is disability-adjusted life years (DALYs), which is the sum of the number of years of life lost due to premature death and a weighted measure of the years lived with disability due to a disease or injury. The use of DALYs to track disease burden is recommended by India’s National Health Policy of 2017. Through an elaborate process, all data sources and inputs available to estimate disease burden in every state and union territory of India were identified and attempts were made to access these data. These included censuses, vital registration, Sample Registration System, large-scale national household surveys, other population-level surveys and cohort studies, disease surveillance data, disease programme-level data, administrative records of health services, disease registries, and a wide range of other studies conducted across India. Access to several important datasets was facilitated by senior government officials. Data were included in the analysis if they met quality and inclusion criteria.