In the first comprehensive analysis of health of India’s 1.34 billion citizens encompassing almost a fifth of world’s population, a study on Monday revealed that the Indian population has gained nearly a decade of life expectancy since 1990, but with vast inequalities between states. The study, published in the noted medical journal Lancet, said that while India had gained life expectancy, there are vast inequalities between states, ranging from 66.8 years in Uttar Pradesh to 78.7 years in Kerala for women.

It estimates the key drivers of ill health, disability, and premature death in all 29 states, many of which have populations the size of large countries, and include people from over 2,000 different ethnic groups. The researchers divided India’s states into four groups according to their level of development or epidemiological transition, using the ratio of illness and premature death caused by communicable, maternal, neonatal, and nutritional diseases (CMNNDs) versus non-communicable diseases (NCDs) and injuries as an indicator. “Individual states in India are in different phases of epidemiological transition, and this has resulted in wide inequalities in the magnitude and progress against various diseases and their causes,” said Lalit Dandona, from the Public Health Foundation of India in Gurugram. “Rather than taking a more generic approach, these new estimates will be crucial to steering health policy to take account of specific health problems and risks in each state, and ultimately achieving the government’s vision of assuring health for all,” said Dandona, who led the study. The Indian population has gained nearly a decade of life expectancy since 1990, rising to 66.9 years in men and 70.3 years in women. Since 1990, India has made substantial gains in health, with the overall health loss from all diseases and conditions about one-third less per person in 2016 than in 1990. However, progress has been mixed, with greater improvements in states at the most advanced phases of development (eg, Kerala and Goa), compared to those in the earlier stages (eg, Assam, Uttar Pradesh and several other poorer north Indian states). Child health remains a particular concern, with high levels of neonatal and under-5 disease relative to other age groups.The under-5 mortality rate has reduced substantially since 1990 in all states, but rates in Assam and Uttar Pradesh are four times higher than in Kerala, indicating major health inequalities. The burden from CMNNDs has decreased. Yet, diseases that primarily cause illness and death in children and mothers continue to dominate in the country. Lower respiratory infections and diarrhoeal diseases were the 3rd and 4th leading causes of health loss in 2016, accounting for about 9 per cent of all premature death and ill health. Moreover, there are wide differences between states in terms of overall progress.

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