While India’s problems with communicable, maternal, neo-natal and nutritional diseases (CMNNDs) like diarrhoea and tuberculosis are well-known, they were relatively easier to fix, at least in theory. So, if you managed to fix the water supply—no mean task, in actual practice of course—you could eliminate diarrhoea and even malnutrition as a result; in other cases, including diarrhoea, developing and then distributing vaccines was a sure-fire cure. And to the extent, more of them were related to poverty, economic growth and, say, urbanisation, would take care of part of the problem, though there is still a long way to go, especially in the poorer states. What has happened, simultaneously, however, is the arrival on non-communicable diseases (NCD) that are the result of lifestyles, pollution and dietary changes—this includes cancer, heart diseases and diabetes. As a result, according to the recently released India: Health of the Nation’s States report, brought out by Indian Council of Medical Research, the Public Health Foundation of India and the Institute for Health Metrics and Evaluation, while 61% of India’s disease burden comprised poor-man’s diseases or CMNNDs till as late as 1990, this fell to 33% in 2016; NCDs, on the other hand, rose from 31% to 55%.
The rise in NCDs has meant that the spread of disease is quite unique across different states. While the burden from ischaemic heart disease, stroke, and diabetes, is already very high in Punjab and Tamil Nadu, followed by Kerala, Andhra Pradesh and Karnataka, it is relatively lower in poorer states and the North East. At the same time, five of the top 10 individual diseases in the country remain the CMNNDs like diarrhoea, anaemia and tuberculosis. A Rajasthan, for instance, has a large tuberculosis problem while Bihar has a child and maternal malnutrition problem and a Jharkhand needs to tackle diarrhoea urgently. The gap between various states has also got quite stark. So, India has seen a 36% fall in per capita disease burden since 1990, but there is a two-fold difference between the states that have the lowest rates (Kerala and Goa) and the states having the highest (Assam, UP and Chhattisgarh).
While there is a 12-fold gap between the states with the highest and lowest per capita diseases burden from unsafe drinking water, the best-performing state, Goa, has a burden that is seven times higher than China’s. With India facing both poor man’s diseases as well as rich man’s ones simultaneously, this makes the task of public healthcare that much more difficult. The 1.2% of GDP that India spends on healthcare was always too little but was still acceptable when simpler solutions like a rotavirus vaccine existed and, once discovered and administered, were applicable on a large scale. With each heart patient needing separate treatment, on the other hand, India’s health budget is woefully inadequate; and with lifespans increasing, so are the costs of keeping the population healthy. And the fact that the disease burdens differ so dramatically across states also means that uniform solutions can’t be applied across different states. For public health professionals, the task has got much tougher while the strains on their budgets have increased dramatically.