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What is killing India?

www.livemint.com, Jyotsna Singh
10 Feb 2016

New data reveals that one in two deaths in the country, estimated in the period 2010-13, are due to non-communicable diseases

The biggest killer in the age group of 15-29 years is suicide—it accounts for just under one in five deaths.

The biggest killer in the age group of 15-29 years is suicide—it accounts for just under one in five deaths.
 
New Delhi: The office of the Census Commissioner served a warning on Monday: Lifestyle diseases have emerged as the biggest cause of deaths in India.
 
According to new data, non-communicable diseases (NCDs) have emerged as the leading cause of deaths in India, accounting for as many as half the deaths between 2010 and 2013. However, for urban areas, NCDs account for nearly 60% of deaths.
 
Cardiovascular diseases are the biggest killers within NCDs. Premature births and low birthweight have emerged as the main reasons for deaths of children below the age of 29 days, the new data revealed.
 
“Increased life expectancy and lifestyle changes are at the root of this spike. As fewer people die of infections like diarrhoea in childhood, there is an increased possibility of them dying of chronic diseases in older age,” said K. Srinath Reddy, president, Public Health Foundation of India, a Delhi-based research institute under public-private partnership.
 
“With changes in lifestyle, like lack of exercise and consumption of food with less nutrition, these chances further increase. The urban poor are the worst affected as they face lifestyle changes without access to healthy food like nuts and fruit,” he added.



The top 10 causes of deaths in India have remained the same since 2004-06, with a slight change in order. Cardiovascular diseases are followed by ill-defined causes, respiratory diseases, malignant and other neoplasms (cancers), and perinatal conditions (complications related to pregnancy).
 
A comparison with data from 2004-06, the last time such data was released by the Commissioner, shows the share of communicable disease as the cause of deaths has fallen by almost 10 percentage points. In 2004-06, 36.7% of deaths occurred due to communicable diseases and lack of nutrition. This went down to 27.74% in 2010-13.
 
NCDs accounted for 45.4% of deaths in 2004-06, the figure rising to 49.21% in 2010-13. While the share of NCDs increased in both urban and rural areas, the difference is striking. In rural areas, deaths due to NCDs were 46.9%, much lower than urban areas where their contribution is 57%. This means that more than half the people in urban India die due to non-communicable diseases such as cancer, heart attacks and stroke.
 
Among NCDs, heart diseases are the biggest cause of mortality, accounting for 23.3% of all deaths. This has increased from 19.9% in 2004-05.
 
T.S. Kler, executive director, cardiac sciences, Fortis Escorts Heart Institute, said, “Cardiovascular diseases have become a major cause of deaths across the country. Lifestyle itself is a major factor, where lack of proper exercise, unhealthy food habits, diabetes, rise of obesity, hypertension, etc, are leading cardiovascular diseases. Now, every fourth person in urban India is prone to heart disease. Moreover, diabetes may also cause heart disease in the longer run.”
 
The numbers released on Monday also showed that the proportion of infant deaths declined to 10.3% of total deaths in 2010-13 from 14.9% in 2004-06.
 
The proportion of under-five deaths has also declined sharply from 19.4% in 2004-06 to 12.5% in the latest data, consistent with the latest findings of National Family Health Survey-4 (NFHS), which showed that there had been a decline in malnourishment and undernourishment in children aged below five years in the decade since NFHS-3, in 2005-06.

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Suicide the leading cause of death in 15-29 age group
 
However, a disturbing number that has emerged is that among neonatal deaths, premature birth and low birth weight cause almost every second death, increasing by 10.7 percentage points from 37.4% in 2004-06 to 48.1% in 2010-13. Reasons for mortality that have shown a decline include birth asphyxia or suffocation during birth, pneumonia and sepsis.
 
“The ones that have come down are more amenable to public healthcare facilities. You can manage birth asphyxia only in a hospital setting. As institutional deliveries have increased to almost 80%, its share in deaths is bound to reduce. Similarly, sepsis and pneumonia can be better managed in the presence of health practitioners,” said Vandana Prasad, paediatrician and national convener of the Public Health Resource Network, a non-profit organization.
 
She added that, in general, premature births are the leading cause of neonatal deaths across the world.
 
Kishore Kumar, chairman and managing director of Cloudnine Hospitals, which runs children’s hospitals, said, “The major reason for neo-natal deaths in India is the lack of infrastructure, specially in government hospitals and medical colleges. Rural population is not exposed to proper neo-natal care.”
 
Shine Jacob contributed to this story.