A collaborative global study on disease burden brings some good news: people worldwide are living longer, and fewer are succumbing to infectious diseases like HIV/AIDS, tuberculosis, diarrhea, and malaria compared to 1990.
However, this positive development comes with a stark contrast. Non-communicable diseases (NCDs) now cause two-thirds of all global deaths. In India, in particular, major NCDs leading to fatalities include ischemic heart disease, stroke, diabetes, cancer, and mental health conditions.
The Global Burden of Disease (GBD) Study 2023, recently published in leading medical journals, identified ischemic heart disease—a condition where the heart muscle receives insufficient blood flow, leading to oxygen and nutrient deprivation—as the foremost cause of death globally in 2023.
Stroke ranked as the third deadliest disease in 2023, closely followed by lower respiratory infections and diabetes. This marks a significant shift from 1990, when lower respiratory infections were third, stroke fourth, ischemic heart disease fifth, and diabetes twentieth.
Decreasing Mortality, Increasing Disparities
The study noted the fall in global mortality rates but also flagged the rise in health inequalities and chronic lifestyle-related diseases. Christopher Murry, director of the Institute for Health Metrics and Evaluation at the University of Washington and a contributor to the study, emphasized that the rapid growth of the aging population and changing risk factors signal a new era of global health challenges. He called the GBD study’s findings a ‘wake-up call,’ urging leaders to act decisively against these unsettling public health trends.
India’s “Double Burden” of Disease
Hemen Sarma, an associate professor at Bodoland University in western Assam and another contributor to the GBD 2023 study, explained that India reflects this global pattern. However, the nation faces a unique ‘double burden,’ grappling with a surge in lifestyle-related disorders while still contending with persistent infectious diseases in various regions.
Sarma highlighted that despite a significant improvement in India’s life expectancy, now averaging over 70 years, the number of healthy years lived free from disease or disability is considerably lower. He added that while the GBD 2023 data praises India for its drastic reduction in infant and maternal mortality, the country now confronts escalating dangers from hypertension, obesity, diabetes, and air pollution.
According to the study’s findings, released recently in Berlin, nearly half of all global deaths and disabilities could be averted by tackling key changeable risk factors. These include high blood sugar, elevated body mass index (BMI), high blood pressure, smoking, and exposure to particulate air pollution.
Understanding the Analysis
For the GBD 2023, researchers meticulously examined 375 diseases and 88 risk factors across 204 countries and 660 subnational regions. Their analysis revealed a global reduction of approximately 26% in death and disability rates from infectious and nutritional diseases between 2010 and 2023. Conversely, there was a significant increase in disability-adjusted life years (DALYs)—a measure of total healthy life years lost—primarily driven by conditions such as anxiety, depression, and other ailments associated with contemporary lifestyles.
Dr. Sarma emphasized that the challenge extends beyond treating illnesses; it’s about preventing them through environmental and behavioral transformations. He stated, ‘India’s future health will depend on how effectively we address pollution, food systems, and mental well-being.’
A Sobering Outlook for India
The Journal of the American College of Cardiology (JACC) paper, specifically focusing on the burden of cardiovascular diseases and risk factors from 1990 to 2023, presented a particularly concerning scenario for India. In 2023 alone, cardiovascular diseases in India accounted for a substantial 19.2 million deaths.
Alarmingly, the researchers cautioned that India’s younger demographic is equally vulnerable. Factors like rapid urbanization, a sedentary lifestyle, heightened stress levels, and shifts in dietary habits are contributing to an increase in early-onset heart disease. This challenge is further complicated by issues of underdiagnosis and insufficient follow-up care in rural areas.
Furthermore, the GBD 2023 data pointed to a worldwide mental health crisis, noting a 63% increase in anxiety disorders and a 26% rise in depression since 2010. Mental illness has now become one of the top ten contributors to global health loss, disproportionately affecting young adults.
Tragically, in India, suicide continues to be a primary cause of death for individuals aged 15-29. Despite this, mental health receives less than 1% of the national health budget, and widespread social stigma often discourages people from seeking necessary assistance, the study revealed.
Dr. Sarma asserted, ‘Mental health must be recognized and addressed as a mainstream health issue. Its impact extends to productivity, education, and social stability. Investing in mental well-being is fundamentally an investment in national development.’
The study also raised concerns about the rising mortality rate among women due to cardiovascular disease, which is now approaching that of men. In South Asia, a significant obstacle to tackling this issue is the ‘invisible patient’ phenomenon, where women often postpone seeking treatment or care until their illness has reached advanced stages.
The GBD 2023 study identified South Asia as having the highest rates of DALYs attributable to air pollution. Particulate matter pollution, in particular, was pinpointed as the second leading environmental cause of disease burden worldwide and India’s most pressing public health crisis.
Dr. Sarma emphasized this connection: ‘The environment is inextricably linked to health. Clean air, safe food, and green infrastructure are just as crucial for well-being as hospitals and medicines.’
The researchers concluded that India needs to significantly increase its healthcare expenditure, currently around 2% of its GDP—among the lowest in the G20. They observed that public hospitals are severely overcrowded, and primary healthcare services in rural areas remain critically under-resourced.