Health

Indians Are Living Longer But Not Just as Healthier

Right of way for everyone. Credit: Meena Kadri/Flickr, CC BY-NC-ND 2.0

Right of way for everyone. Credit: Meena Kadri/Flickr, CC BY-NC-ND 2.0

Life expectancy in India has increase over the years with men living longer by 6.9 years and women by 10.3 years. The latest data on life expectancy between 1990-2013, however, also shows healthy life expectancy didn’t increase as much: men gained 6.4 years and women gained 8.9 years. Life expectancy for women in India still outpaces that of men, 68.5 years compared to 64.2 years.

Healthy life expectancy takes into account not just mortality but the impact of non-fatal conditions and summarises years lived with disability and years lost due to premature mortality. The increase in healthy life expectancy has not been as dramatic as the growth of life expectancy, implying that people are living more years with illness and disability.

In India, the leading causes of health loss, as measured by disability-adjusted life-years (DALYs), in 2013 were ischemic heart disease (IHD), chronic obstructive pulmonary disease, lower respiratory infections, tuberculosis, neonatal preterm birth complications, neonatal encephalopathy, diarrhoeal diseases, cerebrovascular disease, road injury, and low back and neck pain.

Overall, neonatal encephalopathy and tuberculosis were not among the leading causes of health loss globally.

The study, ‘Global, regional and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy for 188 countries, 1990-2013: quantifying the epidemiological transition’, published in The Lancet on August 27, examines fatal and nonfatal health loss across countries. The study was conducted by an international consortium of researchers working on the Global Burden of Disease study, including from the Public Health Foundation of India (PHFI), and led by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington.

Top causes of DALYs

Causes of health loss differed by gender in India. For Indian men, the top-five causes of DALYs in 2013 were:

  1. IHD
  2. Tuberculosis
  3. Obstructive pulmonary disease
  4. Neonatal encephalopathy
  5. Neonatal preterm birth complications.

For women, the top five causes of DALYs in 2013 were:

  1. IHD
  2. Lower respiratory infections
  3. Diarrhoeal diseases
  4. Obstructive pulmonary disease
  5. Neonatal preterm birth complications

For Indian men, the fastest-growing leading causes of health loss between 1990 and 2013 were:

  1. Self-harm, which increased at rates of 149.9%
  2. IHD, at 79.9%
  3. Cerebrovascular disease, at 59.8%

Only IHD was in the top-10 causes of male DALYs in 1990.

For women, the largest increases among the leading causes of DALYs in 1990-103 occurred for:

  1. IHD (69%)
  2. Depressive disorders (66.1%)
  3. Cerebrovascular disease (36.8%)

Only IHD was among the 10 leading causes of health loss for women in 1990.

“Healthy life expectancy in India is 12 years lower for women and 8 years lower for men than in neighbouring Sri Lanka,” said study co-author Dr. Lalit Dandona, a professor at PHFI and IHME and led the work of this study in India. “This difference indicates that substantial health improvements in India are possible and that public policy should make this a top priority in order to enable India reach its optimal development potential.”

TB’s haunt

The study also examines the role that socio-demographic status – a combination of per capita income, population age, fertility rates, and average years of schooling – plays in determining health loss. Researchers’ findings underscore that this accounts for more than half of the differences seen across countries and over time for certain leading causes of DALYs, including maternal and neonatal disorders. But the study notes that socio-demographic status is much less responsible for the variation seen for ailments including cardiovascular disease and diabetes.

“It is unacceptable that tuberculosis continues to be among the top five leading causes of disease burden in India in 2013, as it was a quarter century ago,” said Dr. Soumya Swaminathan, Director General of the Indian Council of Medical Research. “Systematic evidence-based approaches for tuberculosis control and ultimate elimination have to be rapidly implemented in India to improve the situation.”

Attributing longevity to marked declines in death and illness caused by HIV/AIDS and malaria in the past decade and advances made in addressing communicable, maternal, neonatal, and nutritional disorders, the study says health has improved significantly around the world. Global life expectancy at birth for both sexes rose by 6.2 years (from 65.3 in 1990 to 71.5 in 2013), while healthy life expectancy at birth rose by 5.4 years (from 56.9 in 1990 to 62.3 in 2013).