A new state-by-state health analysis in India finds that over two decades heart- and lung-related conditions, as well as other non-communicable diseases (NCDs), have surpassed infectious diseases, such as diarrhea and tuberculosis, as the nation's leading killers. The extent of this difference, however, varies significantly among the nation's 29 states and seven union territories.

The study, which covers 1990 through 2016, concludes that while child and maternal malnutrition has dropped substantially, this remains the most pernicious risk factor causing loss of healthy life. Moreover, road injuries and suicides are leading contributors to death among young people, with a nearly four-fold difference in suicide rates among different Indian states.

"India has come a long way, but our individual state estimates reveal major health inequalities between the 'nations' within this nation," said Dr. Lalit Dandona, Distinguished Professor at the Public Health Foundation of India in New Delhi.

"Over the past two decades the Government of India has launched many initiatives and programs to address a variety of diseases and risk factors. With the availability of state-specific findings now identifying the diseases and risk factors that need most attention in each state, we can act more effectively to improve health in every state of the country.

This has the potential of reducing the major health inequalities observed currently between the states, and this would also help achieve better health outcomes for India as a whole."

The study, published today in the international medical journal The Lancet, notes that life expectancy at birth improved from about 60 years of age in 1990 to just over 70 years in 2016 for females, and from about 58 years to nearly 67 years for males. However, among states, there are inequalities of up to 10 years.

The overall loss of healthy life from all diseases and conditions together was about one-third less per person in India in 2016 as compared to 1990 In addition, water quality and sanitation conditions have improved over the past 26 years, but they remain major factors in disease transmission. Air pollution also has emerged as a growing health risk in India

Urbanization and aging have led to increasing poor health conditions related to non-communicable diseases in all states. Even states with similar levels of development showed striking differences in rates of death and illness from some leading NCDs.

"Larger and more organized efforts, supported by greater financial and human resources, are needed to control the growing burden of NCDs and injuries," said Dr. Dandona.

Other highly preventable risks, such as diets high in salt and low in vegetables and fruit, high blood pressure, high cholesterol, and high body mass index, are contributing to the growing burden of non-communicable diseases.  

"The study and our related policy report have significant policy implications for Indian health officials, said Dr. Christopher Murray, IHME's Director."This research is the culmination of many years of work and it represents a starting point from which, we hope, new initiatives will be developed to improve the lives and livelihoods of many of India's 1.3 billion people."