S.NO. CONTENT PAGE NO.

1. DEFINITION OF HEALTH 2- 4

2. CONCEPT OF HEALTH 4-6

3. DIMENISION OF HEALTH 6-7

4. CURRENT STATUS OF HEALTH 7-21

5. DISEASES BURDEN IN INDIA 21-30

6 MEASURES OF BURDEN OF DISEASES 30-31

7 CONCLUSION 31-32

8 RESEARCH STUDIES 32-33

9 REFERENCE 33-34

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 DEFINITION OF HEALTH
"Health" is one of those terms which most people find it difficult to define, although they are
confident of its meaning. Therefore, many definitions of health have been offered from time to time.

(WHO definition)

The widely accepted definition of health is that given by the World Health Organization (1948) in the
preamble to its constitution, which is as follows:

"Health is a state of complete physical, mental and social well-being and not merely an absence of
disease or infirmity"

In recent years, this statement has been amplified to include the ability to lead a "socially and
economically productive life"

The WHO definition of health has been criticized as being too broad. Some argue that health cannot
be defined as a "state" at all, but must be seen as a process of continuous adjustment to the changing
demands of living and of the changing meanings we give to life. It is a dynamic concept. It helps
people live well, work well and enjoy themselves.

Inspite of the above limitations, the concept of health as defined by WHO is broad and positive in its
implications; it sets out the standard, the standard of "positive" health. It symbolizes the aspirations
of people and represents an overall objective or goal towards which nations should strive.

Operational definition of health

The WHO definition of health is not an "operational" definition, i.e., it does not lend itself to direct
measurement. Studies of epidemiology of health have been hampered because of our inability to
measure health and well-being directly. In this connection an "operational definition" has been
devised by a WHO study group . In this definition, the concept of health is viewed as being of two
orders. In a broad sense, health can be seen as a condition or quality of the human organism
expressing the adequate functioning of the organism in given conditions, genetic or environmental".

In a narrow sense-more useful for measuring purposes -health means: (a) there is no obvious
evidence of disease, and that a person is functioning normally, i.e., conforming. within normal limits
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of variation to the standards of health criteria generally accepted for one's age, sex, community, and
geographic region; and (b) the several organs of the body are functioning adequately in themselves
and in relation to one another, which implies a kind of equilibrium or homeostasis a condition
relatively stable but which may vary as human beings adapt to internal and external stimuli.

New philosophy of health

In recent years, we have acquired a new philosophy of health, which may be stated as below:

1. health is a fundamental human right

2. health is the essence of productive life, and not the result of ever increasing expenditure on
medical care
3. health is intersectoral
4. health is an integral part of development
5. health is central to the concept of quality of life
6. health involves individuals, state and international responsibility
7. health and its maintenance is a major social investment
8. health is a worldwide social goal

CONCEPT OF HEALTH
Health is a common theme in most cultures. In fact, all communities have their concepts of health, as
part of their culture. Among definitions still used, probably the oldest is that health is the "absence of
disease". In some cultures, health and harmony are considered equivalent, harmony being defined as
being at peace with the self, the community, god and cosmos". The ancient Indians and Greeks
shared this concept and attributed disease to disturbances in bodily equilibrium of what they called
"humors"

. Modern medicine is often accused for its preoccupation with the study of disease, and neglect of the
study of health. Consequently, our ignorance about health continues to be profound, as for example,
the determinants of health are not yet clear; the current definitions of health are elusive; and there is
no single yardstick for measuring health. There is thus a great scope for the study of the
"epidemiology" of health.

However, during the past few decades, there has been a reawakening that health is a fundamental
human right and a worldwide social goal; that it is essential to the satisfaction of basic human needs

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and to an improved quality of life; and, that it is to be attained by all people. In 1977, the 30th World
Health Assembly decided that the main social target of governments and WHO in the coming
decades should be "the attainment by all citizens of the world by the year 2000 of a level of health
that will permit them to lead a socially and economically productive life", for brevity, called "Health
for All" (1). With the adoption of health as an integral part of socio-economic development by the
United Nations in 1979 (2), health, while being an end in itself, has also become a major instrument
of overall socio-economic development and the creation of a new social order. In the year 2000, the
Millennium Development Goals, and more recently in the year 2015, the Sustainable Development
Goals kept health centrally positioned to ensure healthy lives and promote well-being for all at all
ages.)

CHANGING CONCEPTS

An understanding of health is the basis of all health care. Health is not perceived the same way by all
members of a community including various professional groups (e.g., biomedical scientists, social
science specialists, health administrators, ecologists, etc) giving rise to confusion about the concept
of health. In a world of continuous change, new concepts are bound to emerge based on new patterns
of thought. Health has evolved over the centuries as a concept from an individual concern to a
worldwide social goal and encompasses the whole quality of life. A brief account of the changing
concepts of health is given below:

1. Biomedical concept

Traditionally, health has been viewed as an "absence of disease", and if one was free from disease,
then the person was considered healthy. (This concept, known as the "biomedical concept" has the
basis in the "germ theory of disease" which dominated medical thought at the turn of the 20th
century. The medical profession viewed the human body as a machine, disease as a consequence of
the breakdown of the machine and one of the doctor's task as repair of the machine . Thus health, in
this narrow view, became the ultimate goal of medicine

The criticism that is levelled against the biomedical concept is that it has minimized the role of the
environmental, social, psychological and cultural determinants of health. The biomedical model, for
all its spectacular success in treating disease, was found inadequate to solve some of the major health
problems of mankind (e.g., malnutrition, chronic diseases, accidents, drug abuse, mental illness,
environmental pollution, population explosion) by elaborating the medical technologies.

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(Developments in medical and social sciences led to the conclusion that the biomedical concept of
health was inadequate.

2. Ecological concept

Deficiencies in the biomedical concept gave rise to other concepts. The ecologists put forward an
attractive hypothesis which viewed health as a dynamic equilibrium between man and his
environment, and disease a maladjustment of the human organism to environment. Dubos . defined
health saying Health implies the relative absence of pain and discomfort and a continuous adaptation
and adjustment to the environment to ensure optimal function". Human, ecological and cultural
adaptations do determine not only the occurrence of disease but also the availability of food and the
population. explosion. The ecological concept raises two issues, viz. imperfect man and imperfect
environment. History argues strongly that improvement in human adaptation to natural environments
can lead to longer life expectancies and a better quality of life even in the absence of modern health
delivery services

3. Psychosocial concept

Contemporary developments in social sciences revealed that health is not only a biomedical
phenomenon, but one which is influenced by social, psychological, cultural, economic and political
factors of the people concerned These factors must be taken into consideration in defining and
measuring health. Thus health is both a biological and social phenomenon.

4. Holistic concept

The holistic model is a synthesis of all the above concepts. It recognizes the strength of social,
economic, political and environmental influences on health. It has been variously described as a
unified or multidimensional process involving the well-being of the whole person in the context of
his environment. This view corresponds to the view held by the ancients that health implies a sound
mind, in a sound body, in a sound family, in a sound environment. The holistic approach implies that
all sectors of society have an effect on health, in particular, agriculture, animal husbandry, food,
industry, education, housing, public works. communications and other sectors . They emphasis is on
the promotion and protection of health.

DIMENSIONS OF HEALTH
1. Physical Health

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 • Efficient body functioning with normal physiological processes.
• Freedom from illness, injury, or pain.

• Proper nutrition, fitness, and immunity.

2. Mental Health
• Ability to think clearly, reason, and make sound decisions.
• Emotional balance, coping with stress, and resilience.
• Absence of mental disorders (e.g., anxiety, depression).
3. Social Health
• Ability to interact and form healthy relationships.
• Adaptability in social environments.
• Maintaining harmony in family, work, and community.
4. Spiritual Health
• Sense of purpose, meaning, and values in life.
• Connection with self, nature, or a higher power (if religious).
• Inner peace and ethical living.
5. Emotional Health
• Managing emotions effectively (anger, joy, sadness).
• Self-awareness and emotional intelligence.
6. Vocational Health (Occupational Health)
• Satisfaction and fulfilment in one’s work.
• Work-life balance and a safe work environment.
7. Environmental Health
• Living in a clean, safe, and sustainable environment.
• Awareness of ecological impacts on health

CURRENT STATUS OF HEALTH

Even after 74 years of independence, we do not have a health care system that can efficiently
look after the health status of our people. India has a large share of poor, illiterate, and
malnourished of the world. Majority of our people do not have basic health care facilities.
There is always the dichotomy between the affluent opting for five stars treatment at
institutions having world class infrastructure, while the poor go to over -crowded public care
facilities where no adequate care is provided forcing them to leave everything to fate. Health
care is expensive and beyond their reach.

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 ➢ A deep analysis of the lifestyle of people would help in assessing some aspects of the
prevailing public health situation in India. With the ever increasing life expectancy,
the epidemiological transition points towards greater incidence of non-communicable
or life style diseases. India is an exception to other countries in that nearly 4/5 th of its
health care expenditure is out of pocket.
➢ Communicable and non - communicable diseases have still to be brought under
effective control as well as eradicated. Blindness, leprosy and tuberculosis continue to
have a high incidence. HIV/ AIDS pandemic make the situation worse.
➢ High incidence of diarrheal disease as well as other preventive and infectious disease,
especially among infants and children, lack of clean and safe drinking water, poor
hygiene and sanitation, poverty and ignorance are among the major contributory
causes of the high incidence of disease and mortality.
➢ Only 31% of the rural population has access to potable water and only 0.5% of people
enjoy basic sanitation.

CURRENT HEALTH STATISTICS

➢ Population
▪ In India, the current population is 1,438,069,596 as of 2023 with a projected
increase of 17% to 1,679,589,259 by 2050.
➢ Population growth rate
0.89%
HEALTH STATUS
➢ New HIV infections
▪ The number of new HIV infections per 1,000 uninfected population, by sex, age
and key populations as defined as the number of new HIV infections per 1,000
persons among the uninfected population.

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In India, the rate of new HIV infections (per 1000 uninfected population) has been 0.1 [0.1 - 0.1]
infections per 1000 in 2023

➢ Tuberculosis incidence
▪ The estimated number of new and relapse tuberculosis (TB) cases arising in a
given year. All forms of TB are included, including cases in people living with
HIV.
In India, the tuberculosis incidence (per 100 000 population) has improved by 127 cases per 100 000
from 322 [110 - 644] in 2000 to 195 [164 - 228] in 2023

➢ Malaria incidence
▪ The number of new malaria cases per 1000 population at risk per year. Population
at risk is defined as population living in areas where malaria transmission occurs.
▪ In India, the malaria incidence (per 1000 population at risk) has improved by 17.3
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 cases per 1000 from 19.9 [15.5 - 25.9] in 2000 to 2.6 [1.9 - 3.4] in 2022.

➢ Hepatitis B
▪ The prevalence of hepatitis B surface antigen (HBsAg)-positive, adjusted for
sampling design. Numerator: Number of survey participants with HBsAg positive
test. Denominator: Number in survey with HBsAg result.
In India, the hepatitis B surface antigen (HBsAg) prevalence among children under 5 years has been
0.16% [0.14% - 0.19%] in 2020

➢ Probability of dying from non-communicable diseases (NCDs)

▪ Probability (%) of dying between age 30 and exact age 70 from any of
cardiovascular diseases, cancer, diabetes, or chronic respiratory diseases (SDG
indicator 3.4.1).
▪ Probability of dying from non-communicable diseases (NCDs) - 22% [16.5% -
27.7%] stable since 2018

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 ➢ Under five mortality (Neonatal Mortality Rate)
▪ Number of deaths during the first 28 completed days of life per 1000 live births in
a given year or other period.

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In India, the neonatal mortality rate (per 1000 live births) has improved by 67 deaths per 1000
live births from 85 [78 - 93] in 1969 to 18 [16 - 21] in 2022

➢ Under five mortality (children under 5 years of age)

▪ Probability of a child born in a specific year or period dying before reaching the
age of five, if subject to age-specific mortality rates of that period.

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 ➢ Maternal mortality ratio
▪ Number of maternal deaths during a given time period per 100 000 live births
during the same time period.
▪ In India, the maternal mortality ratio (per 100 000 live births) has improved by
544 deaths per 100 000 live births from 647 [514 - 862] in 1985 to 103 [93 -
110] in 2020.

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 ➢ Life Expectancy

▪ In India, life expectancy at birth (years) has improved by 4.11 years from 63.2
[62.6 - 63.8] years in 2000 to 67.3 [66.9 - 67.8] years in 2021.
▪ In India, healthy life expectancy at birth (years) has improved by 4.02 years from
54.1 [53.4 - 54.9] years in 2000 to 58.1 [57.5 - 58.9] years in 2021

RISK FACTORS
➢ Hypertension
▪ The prevalence of hypertension (defined as having systolic blood pressure ≥140
mmHg, diastolic blood pressure ≥90 mmHg, or taking medication for
hypertension) among adults aged 30 to 79.

▪ 31.1% [26.2% - 36%] Age-standardized prevalence of hypertension among

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 adults

aged 30-79 years (%).

➢ Tobacco use
▪ Percentage of the population aged 15 years and over who currently use any
tobacco product on a daily or non-daily basis.
▪ 26.1% [21.2% - 31%] Age-standardized prevalence of tobacco use among persons
15 years and older (%).
➢ Alcohol consumption
▪ Total amount of alcohol consumed per adult (15+ years) over a calendar year, in
litres of pure alcohol. (SDG 3.5.2)
▪ 4.92 [2.65 - 7.38] Total alcohol per capita (≥ 15 years of age) consumption (litres
of pure alcohol)
➢ Adult obesity
▪ The percentage of adults aged 18+ years with a body mass index (BMI) of 30
kg/m2 or higher.
▪ 7.3% [6.5% - 8.1%] Age-standardized prevalence of obesity among adults (18+
years) (%).
➢ Children and adolescents obesity
▪ The percentage of defined population with a body mass index (BMI) greater than
2 standard deviation above the median, according to the WHO references for
school-age children and adolescents.
▪ In India, the prevalence of obesity among children and adolescents aged 5 to 19
years has worsened by 3.3 percentage points from 0.1% [0.1% - 0.2%] in 1990 to
3.4% [2.6% - 4.4%] in 2022.
▪ 3.4% [2.6% - 4.4%] worsening since 2021 Prevalence of obesity among children
and adolescents (5–19 years) (%).
➢ Stunting under 5
▪ The prevalence of stunting (height-for-age <-2 standard deviation from the
median of the World Health Organization (WHO) Child Growth Standards)
among children under 5 years of age.
▪ In India, the prevalence of stunting in children under 5 has improved by ▼ 18.3
percentage points from 50% [47.8% - 52.3%] in 2000 to 31.7% [29.2% - 34.3%]
in 2022.
▪ 31.7% [29.2% - 34.3%] Prevalence of stunting in children under 5 (%)
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 ➢ Wasting under 5

✓ The prevalence of wasting (weight for height <-2 standard deviation from the
median of the World Health Organization (WHO) Child Growth Standards)
among children under 5 years of age.
✓ 18.7% [18.4% - 19.1%] Prevalence of wasting in children under 5 (%).

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SERVICE COVERAGE

➢ Interventions against NTDs

▪ The number of people requiring treatment and care for any one of the neglected
tropical diseases (NTDs) targeted by the WHO NTD Roadmap and World Health
Assembly resolutions and reported to WHO.
▪ In India, the reported number of people requiring interventions against Neglected
Tropical Diseases (NTDs) has decreased by 180,656,623 people from
837,413,970 in 2010 to 656,757,347 in 2022.
▪ 656.8 million, reported number of people requiring interventions against NTDs.

➢ Births attended by skilled health personnel

▪ Proportion of births attended by skilled health personnel (generally doctors,
nurses or midwives but can refer to other health professionals providing childbirth
care) is the proportion of childbirths attended by professional health personnel.
▪ According to the current definition
✓ These are competent maternal and newborn health (MNH) professionals
educated, trained and regulated to national and international standards.
✓ They are competent to provide and promote evidence-based, human-rights based,
quality, socio-culturally sensitive and dignified care to women and newborns,
facilitate physiological processes during labour and delivery to ensure a clean
and positive childbirth experience; and identify and manage or refer women
and/or newborns with complications.
▪ In India, the proportion of births attended by skilled health personnel has been
43% in 2000.
▪ 43% Proportion of births attended by skilled health personnel (%).

➢ DTP3 immunization coverage among 1-year-olds

▪ The percentage of surviving infants who received the 3 doses of diphtheria and
tetanus toxoid with pertussis containing vaccine (DTP3) in a given year.

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 ▪ In India, the diphtheria-tetanus-pertussis (DTP3) immunization coverage
among 1 year olds has improved by 33 percentage points from 58% in
2000 to 91% in 2023.
▪ 93% Diphtheria-tetanus-pertussis (DTP3) immunization coverage among
1-year- olds (%).
Among the major achievements of the country, the notable are:
(I) the declining trend in vaccine preventable disorders due to improvement in immunization
coverage and

(ii) sincere efforts being made for eradication of poliomyelitis through country-wide Pulse
Polio Immunization Program

• After the successful eradication of Smallpox; now Guinea worm disease is on the verge
of eradication. The last nine cases of Guinea worm disease were reported in 1996 from
Jodhpur, Rajasthan and the country is likely to be declared free from Guinea worm
soon.
• Leprosy has also shown a declining trend. The prevalence of leprosy has declined from
3.9/1000 in 1985 to 0.7/1000 in 1995 and in the Ninth Five Year Plan it is proposed to
integrate leprosy eradication program with general health services where prevalence is
less than 0.5/1000.
• Tuberculosis is also one of the major public health problems in the country. We have
an estimated 14 million cases of tuberculosis; 1/4th of which are infectious. Every year
1.5 million new cases occur and 0.5 million die due to this disease. The revised National
Tuberculosis Control Program which envisages to have a cure rate of 85 per cent and
case detection of 70 per cent, is expected to contain the problem of TB in the country.
• Malaria control has emerged as a major challenge for the country. In 1998, 9.37 lakh
malaria cases were reported of which 43 per cent were due to Plasmodium falciparum.
• Seventeen thousand cases of kalaazar with 255 deaths were reported from 36 districts
of Bihar and 10 districts of West Bengal in 1997.
• Japanese Encephalitis was also reported in 1997 (2200 cases and 670 deaths).
• Water borne diseases like diarrhoea, dysentery, gastro-enteritis, enteric fever, viral
hepatitis, etc. still occur in countless numbers in India.
• A large section of our population, especially women and children suffer from various
grades of under nutrition and malnutrition.
• And now non-communicable diseases are also emerging as a major public health
problem. In fact, the rate of decline of morbidity has not been up to the desired level,
though mortality has come down considerably in these years.
• When one considers the health and related policies in India, we find that we have well
formulated policy guidelines in terms of National Policies for Health, Nutrition,
Education, Children, etc.

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 • These policies provide an overall framework for health and development and reflect
political commitment.
• The Constitution of the country, the directive principles and the national policies
provide the broad guidelines for mobilisation and distribution of resources in such a
way as to meet the health needs of the masses.
• The constitutional amendments from time to time and their ratification by the State
assemblies also provide the guidelines to planners and administrators to direct the
resources to the priority areas.
• Since health is a State subject, the implementation aspect is the responsibility of the
States. Inadequate resource availability in the States may affect the policy
implementation.
• However, decentralisation in health and development planning as envisaged under the
Panchayati Raj Act provides an opportunity for community participation in
developmental programmes.
• The resources allocated to the health sector form an important determinant of health
services in the country. The outlay in health and health related sectors have been
increasing over the Five Year Plans. But, as the percentage of total outlay for health has
remained constant over the successive Five Year Plans at around 2-3 per cent of GDP
as compared to the figure of 10 per cent in developed countries, the major financial
expenditure (about 60%) is towards the payment of salaries of health personnel only in
the country.
• Now the government is mobilising additional financial resources for health through
various international organisations. The private and corporate sectors are also being
encouraged through several incentives and concessions so as to involve them in health
and family welfare services.
• Over the years the country has expanded the health care delivery system and has by and
large, adequate availability of health manpower, except for a few categories, and
training institutes.
• We have a vast infrastructure spread across the length and breadth of the country (1.3
lakh sub centres , 22600 primary health centres and 2600 community health centres)
The Reproductive and Child Health Programme with a budget of Rs. 5111 crore is one
of the biggest programmes started in the Ninth Five Year Plan.
• Revised National TB Control Programme using the DOTS strategy, Multi Drug
Therapy (MDT) for leprosy, newer strategies being introduced for control of Malaria,
Kalaazar, Filariaisis, etc. are sure to yield positive results in due course of time.
• With a view to further strengthen the secondary health care delivery system,
government has already initiated State Health Care System Projects in Andhra Pradesh,
Karnataka, Punjab and West Bengal and it is being extended to seven more States with
IDA assistance from the World Bank.
• Having experienced and understood the limitations of public sector, efforts are being
made for privatisation of health care services as well as health care financing. There
cannot be health without simultaneous social and economic development. There has
been huge expansion of our industrial infrastructure and our economic growth is

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 certainly looking up, yet the main challenge remains to narrow down the disparity
between haves and havenots.
• There are many poverty alleviation and income generation programmes which indicate
political commitment but the major issue is to make these benefits percolate down to
the needy and poor.
• Various international organisations and United Nations Agencies also provide
significant material and technical assistance to health and family welfare programmes
in the country.
• The WHO continues to collaborate in promoting and developing health care facilities.
World Bank has provided assistance to various National Health Programmes (leprosy,
blindness, etc.) and some Area Projects.
• Other agencies like ODA, DANIDA, SIDA, etc. are also providing significant
partnership for improving health and family welfare services.
• However, one of the main issues for international partnership in health is the terms and
conditions of assistance, which need to be suitable to the recipient countries. The
international partnership should strengthen the national health systems.
• Future Challenges for Health Services After having reviewed the current health status
and health system in the country, the author talks about certain challenges which our
health system is likely to face in the near future.
• The communicable diseases, perhaps the biggest challenge would be HIV/AIDS.
• The estimated 33.4 million cases of HIV in the world, 95 per cent are in developing
countries.
• Other communicable diseases such as Malaria, Tuberculosis, Kalaazar and Japanese
Encephalitis are likely to continue to pose challenges to the country in the coming years.
Moreover, newer diseases reported from other parts of the world may also be
considered while planning future health systems.
• Plague reported from Surat in India in September 1994 had resulted in similar economic
loss to the country.
• The Meningitis epidemic in Africa in 1997 resulted in 41,699 cases and 4900 deaths.
• The emerging and re-emerging infectious diseases may be attributed to social events
like war or civil conflicts, rapid urbanization and industrialization, migration of
population, agricultural practices and food production, ecological changes which may
be manmade or natural; human behavior changes, improved health care facilities for
diagnosis and management, microbial adaptation by development of drug resistance,
changes in virulence and toxin production, mutation, etc.
• The health infrastructure in developing countries has been inadequate to meet these
challenges. There are inadequate funds, poor surveillance and lack of trained
manpower.
• Non-communicable diseases will become a major public health problem in the country
due to changing life styles, increasing stress and tensions due to changes in social and
cultural systems in the society.
• Other factors like increase in life expectancy, resulting primarily from decline in child
mortality, control of infectious diseases, extensive use of antibiotics, improvement in

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 nutritional standards and access to health services, etc. have also contributed to increase
in life expectancy in the population.
• With increase in the number of aged people, there will be higher incidence and
prevalence of diseases like Hypertension; IHD, Diabetes, Cancers and the whole range
of geriatrics problems.
• The estimated number of cancer cases in India are two million and every year seven
lakh new cases are detected and three lakh die due to cancer in the country.
• The prevalence of mental disorders is estimated to be 10-15 per cent.
• Various studies put the prevalence of diabetes from 0.95 per cent to 3.8 per cent in
urban areas and 0.6 to 1.93 per cent in rural areas of the country.
• About 40 million are estimated to suffer from Coronary Vascular diseases.
• The prevalence of IHD is estimated to be varying from 4.6 to 14.1 per 1000 population.
• There are approximately 12.5 million economically blind in India and 80 per cent of
this blindness is due to cataract.
• Nearly 60 million have endemic goitre and an estimated 8.8 million have mental or
psychomotor handicap due to iodine deficiency.
• 156 deaths due to road accidents occur every day in the country. All these numbers will
swell in the coming decades.
• Environmental degradation, pollution and green house effect have significantly affected
the very ecology of our planet. Sub soil water levels are going down.
• In due course of time, it appears as if all of us will be living in a big-2 green house.
• We should therefore, expect more allergic, respiratory, neoplastic and Iatrogenic
diseases also. Indeed, if health is seen not just as the absence of disease but also as a
central goal of human development, then the protection of environment and protection
and improvement of health are mutually supportive.
• In future, the environmental health is going to be a big challenge for the health
managers.

DISEASE BURDEN IN INDIA RECENT TRENDS (2024)

India is undergoing an epidemiological transition, with a dual burden of communicable
(infectious) and non-communicable diseases (NCDs), along with emerging challenges
like mental health disorders and climate-related health risks.

MAJOR HEALTH PROBLEMS

1. Non-Communicable Diseases (NCDs) – Leading Cause of Death & Disability

NCDs account for over 65% of deaths in India (WHO, 2024).

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 A)Cardiovascular Diseases (CVDs) Burden in India

• Leading cause of death in India: 28-30% of all deaths (Park’s 27th ed.).
• WHO (2024): CVDs account for 34% of NCD deaths (~4.5 million deaths/year).
• Prevalence:
o Hypertension: 30% of adults (1 in 3 Indians) (NFHS-5).
o Coronary Artery Disease (CAD): 50-60 million cases (ICMR).
o Heart Failure: ~8-10 million cases.

CHALLENGES

A. Gaps in Care

• Detection: Only 40% of hypertensives are diagnosed.

• Treatment: Just 12% achieve BP control (NFHS-5).
• Rural-Urban Divide:
o Urban: Better access to cath labs (but late-stage cases).
o Rural: Lack of ECG/echo facilities → undiagnosed CAD.

B. Economic Burden

• Cost of CVD care: ₹50,000–5 lakhs/year (catastrophic spending for 30% families).
• Workforce shortage: <5,000 cardiologists for 1.4B population.

GOVERNMENT PROGRAMS

1. NPCDCS (National Programme for CVD, Diabetes, Stroke):

o Screens for hypertension/diabetes in PHCs.
o Coverage: Only 30% districts (as of 2024).
2. Pradhan Mantri National Dialysis Programme:
o Focus on CKD due to hypertension/diabetes.
3. Ayushman Bharat: Covers CABG/stent procedures.

B) Diabetes Burden in India

Prevalences & Mortality

• Total cases: 101 million (WHO 2024) – 2nd highest globally after China.
• : Estimated 77 million (2019), showing rapid rise.
• Prevalence:
o Adults (20+ yrs): 11.4% (NFHS-5 vs. 7.5% in NFHS-4).
o Urban vs. Rural: 14% urban, 8% rural (ICMR-INDIAB 2023).
o Prediabetes: 136 million (15.3% of adults).
• Deaths: 1.5 million/year (WHO) – linked to CVD, kidney failure.

CHALLENGES

. Gaps in Care (NFHS-5)

• Awareness: Only 50% of diabetics know their status.

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 • Treatment: Just 36% receive regular care.
• Control: <10% achieve target HbA1c (<7%).

B. Rural-Urban Divide

• Urban: Better diagnostics but lifestyle risks (junk food, stress).

• Rural: Lack of screening → late-stage detection.

GOVERNMENT PROGRAMS

1. NPCDCS (National Programme for Diabetes):

o Screens for diabetes in PHCs (covers 30% districts).

2. Ayushman Bharat: Covers diabetes meds (metformin, insulin).
3. Pradhan Mantri Bhartiya Janaushadhi Pariyojana:

o Subsidized glucometers/strips.

C) Chronic Respiratory Diseases (CRDs) in India

Prevalence & Mortality

• Overall Burden: CRDs account for ~10% of all deaths in India (WHO 2024).
• Leading CRDs:
o Chronic Obstructive Pulmonary Disease (COPD):
▪ Prevalence: ~7-10% of adults (>30 yrs) (ICMR).
▪ Deaths: ~1 million/year (2nd leading cause of death among NCDs).
o Asthma:
▪ Prevalence: ~3-5% of all age groups (Park’s 27th ed.).
▪ Childhood Asthma: ~10-15% in urban areas (NFHS-5).
o Occupational Lung Diseases:
▪ Silicosis: 3 million workers at risk (mining, construction).

CHALLENGES

Gaps in Care (

• Underdiagnosis: 70% of COPD cases undetected in rural areas.

• Treatment Access: <10% receive inhalers (vs. 50% in urban areas).
• Pulmonologist Shortage: 1 per 500,000 population.

. Rural-Urban Divide

• Urban: Pollution-driven asthma, better diagnostics.

• Rural: Biomass fuel → COPD, lack of spirometry.

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 GOVERNMENT PROGRAMS

1. NPCDCS (CRD Component):

o Spirometry in district hospitals (limited coverage).

2. Pradhan Mantri Ujjwala Yojana:

o LPG subsidies to reduce biomass fuel use.

3. National Clean Air Programme (NCAP):

o Targets 30% reduction in PM2.5 by 2026

D)Cancer Burden in India

Incidence & Mortality

• Annual New Cases: ~1.5 million (2024 estimate, ICMR).

• Annual Deaths: ~900,000 (3rd leading cause of NCD deaths after CVD & COPD).
• 5-Year Prevalence: ~3.5 million living with cancer.

Most Common Cancers

Cancer % of Key Risk High-Burden

Type Total Factors States
Cases
Breast 14.5% Obesity, late Punjab,
pregnancies, Kerala, Delhi
genetics
Oral 12.5% Tobacco (khaini, UP, Bihar,
paan, smoking) Northeast
Cervical 10.5% HPV infection, Bihar, MP,
poor hygiene Jharkhand
Lung 8.5% Smoking, air Kerala,
pollution Mizoram,
Karnataka
Colorectal 6.5% Processed meat, Urban areas
low fiber diet (Delhi,
Mumbai)

Gender-Wise Distribution

• Men: Oral (25%), Lung (10%), Stomach (7%).

• Women: Breast (28%), Cervical (14%), Ovarian (6%).

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 CHALLENGES

. Gaps in Care (ICMR-NCRP 2024)

• Screening Coverage: <5% for cervical, <10% for breast cancer.

• Treatment Access:
o Radiotherapy: Only 450 machines for 1.4B people (WHO recommends 1 per
million).
o Oncologists: 1 per 2,000 patients (need 3x more).
• Financial Toxicity: 60% of families face catastrophic expenses.

. Rural-Urban Divide

• Urban: Better diagnostics but lifestyle risks (obesity, alcohol).

• Rural: Higher tobacco use → oral cancer; lack of screening.

GOVERNMENT PROGRAMS

1. National Cancer Control Programme (NCCP):

o Focus on prevention (tobacco control) + early detection.

2. Ayushman Bharat: Covers chemotherapy/surgery for 15 common cancers.
3. HPV Vaccination Pilot: Introduced in 6 states (cervical cancer prevention).

E) Mental Health Disorders

Prevalence & Disability

• Overall Prevalence: 10-15% of the population (150-200 million affected).

• Common Disorders:
o Depression: 5% (57 million cases).
o Anxiety Disorders: 3.5% (40 million).
o Severe Mental Illness (SMI): 1-2% (Schizophrenia, Bipolar Disorder).
o Substance Use Disorders: 2-3% (Alcohol: 4.5% men; Tobacco: 28% men).

GOVERNMENT PROGRAMS

o National Mental Health Programme (NMHP):

o District Mental Health Program (DMHP): Covers 704 districts (limited staff).
o Tele-MANAS: 24/7 helpline (received 1M calls since 2022).
o Mental Healthcare Act (2017): Decriminalizes suicide, mandates insurance.
o

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 2 )COMMUNICABLE DISEASES
Despite progress, infections remain a major challenge, especially in rural and marginalized
populations.

A) Tuberculosis (TB) Burden in India

Incidence & Mortality

• Annual New Cases: ~2.8 million (27% of global TB cases).

• Daily TB Deaths: ~1,200 deaths/day (≈ 438,000/year).
• Case Fatality Rate: 12% (higher than global average of 9%).

Types of TB in India
Type % of Cases Key Features
Pulmonary TB 75% Affects lungs; highly infectious
Extra-Pulmonary TB 25% Lymph nodes, abdomen, spine, brain
Drug-Resistant TB 2.5% MDR-TB (Multi-Drug Resistant)
TB-HIV Coinfection 4% Higher mortality (20-30%)

DIAGNOSIS & TREATMENT GAPS

A Diagnosis Challenges

• Underreporting: Only 72% of cases detected (2024 target: 90%).

• Delayed Diagnosis: Average 2.5 months delay (worsens transmission).

• B. Treatment Issues

Problem Impact Stats

Default Rates 8% patients quit treatment early ↑ MDR-TB risk
Drug-Resistant TB 50,000 MDR-TB cases/year Treatment cost: ₹5-7 lakhs
Private Sector Gaps 50% TB cases treated informally Poor reporting to govt.

GOVERNMENT PROGRAMS

1. Revised National TB Control Program (RNTCP):

o Free diagnostics (CBNAAT, X-ray) & drugs (DOTS therapy).

2. Nikshay Poshan Yojana: ₹500/month nutritional support for TB patients.
3. TB Mukt Bharat 2025: Aiming for elimination (<50 cases/lakh population).

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 B) HIV/AIDS Burden in India
Prevalence

• People Living with HIV (PLHIV): ~2.4 million (2023 estimate, NACO).
• Annual New Infections: ~60,000 (Declined by 48% since 2010).
• AIDS-Related Deaths: ~42,000/year (Down from 150,000 in 2010).
• Prevalence Rate: 0.22% (Adults 15–49 yrs) – Lower than global avg. (0.7%).

Modes of Transmission

Route % of New Infections Trend

Heterosexual Sex 85% Declining due to awareness
MSM/Transgender 8% Rising in urban areas
Parent-to-Child 2.5% Reduced to <5% with ART coverage
Injecting Drugs 4% Concentrated in Northeast

CHALLENGES

A. Testing & Diagnosis

• Undiagnosed Cases: 15% of PLHIV unaware of status (≈360,000 people).

• Late Diagnosis: 30% start ART at advanced stages (CD4 <200).

B. Emerging Threats

• Drug Resistance: 5% of ART recipients show resistance (NACO 2023).

• Youth Vulnerability: 35% of new infections in ages 15–25 (low condom use).

TREATMENT & PREVENTION (NACO 2024)

A. Progress in ART Coverage

• Antiretroviral Therapy (ART) Coverage: 82% of PLHIV (1.9 million on treatment).

• Viral Suppression: 75% of those on ART have undetectable viral loads.

B. Key Programs

1. National AIDS Control Program (NACP-V):

o Free ART, condom distribution, targeted interventions for high-risk groups.

2. Mission SAMPARK: Re-engaging lost patients (20% dropouts in ART).
3. PMTCT (Prevention of Parent-to-Child Transmission):

o Reduced transmission from 30% to <5%.

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 C) Vector-Borne Diseases (VBDs) in India
Malaria

• Park’s Data:
o Annual cases: ~2–3 million (mostly P. falciparum).
o Endemic states: Odisha, Chhattisgarh, Jharkhand.
• WHO 2024:
o Deaths: ~7,000/year (down from 15,000 in 2010).

Dengue & Chikungunya

• Park’s Data:
o Dengue cases: ~100,000–200,000 annually (peak in monsoon).
o Chikungunya outbreaks: Karnataka, Maharashtra, Delhi.
• NFHS-5:
o Urban spread: Linked to poor waste management.

Disease Annual Deaths Primary Vector Endemic States

Cases
(2023)
Malaria ~2.1 million ~7,000 Anopheles mosquito Odisha,
Chhattisgarh,
Jharkhand
Dengue ~250,000 ~500 Aedes aegypti Kerala, Tamil
Nadu, Delhi, UP
Chikungunya ~80,000 ~50 Aedes Karnataka,
aegypti/albopictus Maharashtra,
Gujarat
Japanese ~6,000 ~1,500 Culex mosquito Assam, UP, Bihar,
Encephalitis Tamil Nadu
(JE)
Lymphatic ~50 million Chronic Culex mosquito Bihar, UP,
Filariasis (LF) at risk disability Jharkhand
Kala-azar (VL) ~3,000 ~50 Sandfly Bihar, Jharkhand,
West Bengal

High-Risk Populations

• Malaria: Tribal communities (forest areas).

• Dengue: Urban poor (slums with water storage).
• JE: Rural children (<15 yrs).
• Kala-azar: Marginalized farmers (mud houses).

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 NATIONAL CONTROL PROGRAMS (NVBDCP 2023)

A. Disease-Specific Strategies

1. Malaria Elimination (2030 Target):

o Indoor Residual Spraying (IRS): In 100+ high-burden districts.

o Long-Lasting Insecticidal Nets (LLINs): Distributed in tribal areas.
2. Dengue Control:

o Fogging & Larval Surveillance: In urban hotspots.

o Community Awareness: "Dry Day" campaigns (remove stagnant water).
3. Kala-azar Elimination (2024 Target):

o House Spraying: Synthetic pyrethroids in endemic villages.

o Active Case Detection: Door-to-door screening in Bihar/Jharkhand

D. Diarrheal Diseases & Hepatitis

DIARRHEAL DISEASES

A. Epidemiological Burden

• Annual Cases: 1.2 billion episodes (under-5 children: 3-4 episodes/year).

• Deaths: ~100,000/year (13% of under-5 mortality).
• Leading Causes:
o Rotavirus: 40% of severe diarrhea cases.
o E. coli, Cholera, Shigella: Common in outbreaks.

B. Risk Factors (NFHS-5 & Park’s )

Factor Impact Population Affected
Poor Sanitation 40% of rural households lack Rural areas, urban slums
toilets
Unsafe Drinking 60% of diarrheal cases linked to Children <5 yrs
Water water
Malnutrition Wasting ↑ diarrhea severity 19% under-5 kids wasted
(NFHS-5)
Low ORS Use Only 50% receive ORS Low-literacy states (Bihar,
UP)

C. Prevention & Control (ICMR Guidelines)

1. Rotavirus Vaccine: Introduced in Universal Immunization Program (UIP).

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 2. ORS/Zinc Coverage: Promoted via ASHA workers.
3. Swachh Bharat Mission: Reduced open defecation (↓ diarrhoea cases by 30%)

VIRAL HEPATITIS

Types & Prevalence

Type Transmission Prevalence High-Risk Groups

Hepatitis Fecal-oral 30-40% by age 10 Children in slums
A (water/food)
Hepatitis Blood/body fluids 3-4% (carrier rate) Healthcare workers, IDUs
B
Hepatitis Blood exposure 0.5-1% Blood transfusion recipients
C
Hepatitis Fecal-oral Outbreaks in Pregnant women (20%
E floods mortality)

B. National Control Programs

1. Hepatitis B Vaccine: Included in UIP (93% coverage in 2023).

2. National Viral Hepatitis Program: Screens high-risk groups for B/C.
3. Safe Blood Transfusion: Mandatory testing for HBV/HC

3 .Maternal & Child Health Issues

• Maternal Mortality Ratio (MMR): Declined to ~100 per 100,000 live
births (NFHS-5).
• Infant Mortality Rate (IMR): ~28 per 1,000 live births.
• Malnutrition:
o Stunting (low height-for-age): ~35% children under 5.
o Wasting (low weight-for-height): ~19%.
o Anemia: ~50-60% women & children.

4. Injuries & Other Public Health Challenges

• Road Traffic Accidents: ~150,000 deaths/year.
• Air Pollution: Contributes to ~1.6 million premature deaths annually.
• Climate Change: Increases risks of heatwaves, vector-borne diseases.

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 Measures of Burden of Diseases

Burden of disease is measured to understand the impact of health problems on a population,

using indicators that capture both death and disability.
The main measures are:
1. Mortality Indicators
• Crude Death Rate (CDR):
Number of deaths per 1,000 population per year.
• Age-Specific Death Rate (ASDR):
Death rate specific to a certain age group.
• Infant Mortality Rate (IMR):
Deaths of infants under 1 year of age per 1,000 live births.
• Maternal Mortality Ratio (MMR):
Maternal deaths per 100,000 live births.
2. Morbidity Indicators
• Incidence Rate:
Number of new cases of a disease in a specific time period.
• Prevalence Rate:
Total number of existing cases (new + old) at a given time.
3. Composite Indicators (Very important!)
These combine mortality and morbidity into a single number:
• Disability-Adjusted Life Years (DALYs)
Measures total burden by combining years of life lost due to premature death (YLL) and
years lived with disability (YLD).
Formula:
DALY = YLL + YLD
➔ 1 DALY = 1 year of healthy life lost.
• Years of Life Lost (YLL)
Measures years lost due to early death compared to a standard life expectancy.
• Years Lived with Disability (YLD)
Measures years lived with illness or disability, weighted by severity.
• Quality-Adjusted Life Years (QALYs)
Measures years of life adjusted for quality — 1 QALY = 1 year in perfect health.

Conclusion
The concept of health has evolved beyond treating diseases to promoting total well-being.
Current trends show that non-communicable diseases, mental health problems, and lifestyle-
related issues are rapidly increasing, even as infectious diseases continue to affect large
sections of society.
The burden of disease has shifted dramatically, especially in developing nations, creating a
dual challenge: managing old health threats while tackling new ones.
Addressing these issues requires holistic, multisectoral efforts, stronger healthcare systems,

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 widespread health education, policy reforms, and innovative technological solutions.
Without these, the gap in health outcomes will continue to grow — especially for vulnerable
populations

RESEARCH STUDIES
TITE= Burden of noncommunicable diseases and implementation
challenges of National NCD Programmes in India
Authors: Thakur JS, Paika R, Singh S.

Published: 2020 May 18

Key finding of study

Rising Burden of NCDs

• NCDs accounted for 61.8% of all deaths in India in 2016, up from 53.6% in 1990.
• Among individuals aged 40–69 years, 73.2% of deaths were due to NCDs.
• Disability-Adjusted Life Years (DALYs) due to NCDs increased from 30.9% in 1990
to 55.4% in 2016.

2. Major Contributors to NCD Burden

• The leading contributors to NCD-related mortality and morbidity include:

o Cardiovascular diseases (CVDs)
o Chronic respiratory diseases
o Cancers
o Diabetes and other endocrine disorders

3. Implementation Challenges of National NCD Programmes

• Human Resources: There is a shortage of trained healthcare professionals, with many

positions filled by contractual staff lacking adequate training.
• Health Information Systems: The absence of a robust Management Information
System (MIS) hampers effective monitoring and evaluation of NCD programmes.
• Financial Constraints: Low budget allocations and underutilization of funds, coupled
with irregular supply of essential medicines and consumables, impede programme
effectiveness.
• Awareness and Control: Surveys in Punjab and Haryana revealed low awareness,
treatment, and control rates among individuals with hypertension and diabetes.

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 • Health Promotion: Inadequate investment in Information, Education, and
Communication (IEC) and Behaviour Change Communication (BCC) activities limits
public awareness and engagement.
• Multisectoral Coordination: Lack of coordination among various sectors and
stakeholders hinders the comprehensive implementation of NCD prevention and
control strategies.

4. Recommendations

• Strengthen Health Systems: Enhance training for healthcare workers, ensure

consistent supply of essential medicines, and improve infrastructure at all levels of
healthcare delivery.
• Develop Robust Data Systems: Implement comprehensive health information systems
to facilitate effective monitoring, evaluation, and evidence-based decision-making.
• Increase Funding: Allocate adequate financial resources to NCD programmes,
ensuring efficient utilization for maximum impact.
• Enhance Public Awareness: Invest in IEC/BCC activities to educate the public about
NCD risk factors, prevention, and management.
• Foster Multisectoral Collaboration: Engage various sectors, including education,
urban planning, and agriculture, to address the social determinants of health and
implement a holistic approach to NCD prevention and control.

2 .TITLED "India's escalating burden of non-communicable diseases"

Author :Perianayagam Arokiasamy

published on October 3, 2018, in The Lancet Global Health

Key Findings of the Study

• Earlier Onset of NCDs: In India, NCDs such as cardiovascular diseases, chronic

respiratory diseases, and diabetes tend to manifest approximately a decade earlier (from age
45) compared to developed countries, where onset typically occurs from age 55.The Lancet

• Double Burden of Disease: India faces a dual challenge of addressing both persistent
infectious diseases and the rising prevalence of NCDs, leading to a compounded health
burden.

• Data Limitations: There is a lack of detailed, high-quality data on NCDs in India, which
hampers effective research and policy-making.

• State-Level Variations: The burden of NCDs varies significantly across different states,
necessitating state-specific strategies and interventions.

• Policy Implications: The study underscores the need for comprehensive policies and
programs to address the escalating NCD burden, including the implementation of national
programs focused on the prevention and control of NCDs.

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 BIBLIOGRAPHY

BOOKS
• Gulani K.K., Textbook of Community Health Nursing – Principles and
Practices, 3rd Edition, Delhi, Kumar Publication House, 2019, page no – 65
to 67.

• Park. K, Essentials of Community Health Nursing, 24th Edition, Jabalpur,

Banarsidas Bhanot Publication, 2017, page no- 31 to 32.

• Lal S, Textbook of Preventive & Social Medicine, 3rd Edition, New

Delhi, CBS Publication, 2011, page no - 165 to 169.

JOURNALS

• Challenges and opportunities in community nursing. Jptcp.com. 2023

Nov 17.
https://www.jptcp.com/index.php/jptcp/article/view/5974/5778

• Journal of Community Health Nursing, Volume 41, Issue 4 (2024).Taylor &

Francis. https://www.tandfonline.com/journals/hchn20

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