India's population in 2024 as per World Bank is 1.45 billion. Being the world's most populous country and one of its fastest-growing economies, India experiences both challenges and opportunities in context of public health. India is a hub for pharmaceutical and biotechnology industries; world-class scientists, clinical trials and hospitals yet country faces daunting public health challenges like child undernutrition, neonatal and maternal mortality, rising non‑communicable diseases, and road traffic accident cases.
The Human Rights Measurement Initiative finds that India is fulfilling 80.5% of what it should be fulfilling for the right to health based on its level of income. When looking at the right to health with respect to children, India achieves 92.1% of what is expected based on its current income. In regards to the right to health amongst the adult population, the country achieves only 85.6% of what is expected based on the nation's level of income. India falls into the "very bad" category when evaluating the right to reproductive health because the nation is fulfilling only 63.7% of what the nation is expected to achieve based on the resources (income) it has available.
Major health indicators
The life expectancy at birth has increased from 49.7 years in 1970–1975 to 67.9 years in 2010–2014. For the same period, the life expectancy for females is 69.6 year and 66.4 years for males. In 2018, the life expectancy at birth is said to be 69.1 years.
The infant mortality rate has declined from 74 per 1,000 live births in 1994 to 37 per 1,000 live births in 2015. However, the differentials of rural (41) and urban (25) as of 2015 are still high. In 2016, the infant mortality rate was estimated to be 34.6 per 1,000 live births.
The under-five mortality rate for the country was 113 per 1,000 live births in 1994 whereas in 2018 it reduced to 41.1 per 1,000 live births.
The maternal mortality ratio has declined from 212 per 100 000 live births in 2007–2009 to 167 per 100 000 live births in 2011–2013. However, the differentials for state Kerala (61) and Assam (300) as of 2011–2013 are still high. In 2013, the maternal mortality ratio was estimated to be 190 per 100 000 live births.
The total fertility rate for the country was 2.3 in rural areas whereas it has been 1.8 in urban areas during 2015.
The most common cause of disability adjusted life years lost for Indian citizens as of 2016 for all ages and sexes was ischemic heart disease (accounting for 8.66% of total DALYs ), 2nd chronic obstructive pulmonary disease (accounting for 4.81% of total DALYs), 3rd diarrhea (accounting for 4.64% of total DALYs) and 4th lower respiratory infections (accounting for 4.35% of total DALYs).
As per the figures about the child mortality rate which is quite a big hurdle for the government, the 2nd most common cause of DALYs lost for children under 5 years of age was diseases like diarrhea, lower respiratory tract infections and other communicable diseases (accounting for 22,598.71 DALYs per 100 000 population) as of 2016 which can be preventable.
A demographic study found that, compared to 2019, life expectancy at birth was 2.6 years lower and mortality was 17% higher in 2020, implying 1.19 million excess deaths in 2020. The study also found, in contrast to global patterns, females in India experienced a life expectancy decline that was 1 year larger than losses for males. In addition, the researchers found that in 2020, the life expectancy of an upper-caste Hindu dropped 1.3 years, compared to 2.7 years for those of a 'scheduled caste' and 5.4 years for Indian Muslims. The study results were contested by the Government of India.
Health conditions and risk factors Oral health in India
Oral health refers to optimum functioning of mouth (smile, swallow, chew, taste, etc.), proper dentition and ability to perform various movements of facial muscles, jaws and other orofacial structures without pain and discomfort.
Status of oral health both affects and gets affected by specific systemic health conditions. Many systemic diseases, such as; diabetes, can be suspected by examining oral signs and symptoms. Poor oral health is also a risk factor of cardio-vascular diseases, stroke, digestive issues, pre-term birth, low birth weight, preeclampsia etc.Batra, P., Saini, P., & Yadav, V. (2020). Oral health concerns in India. Journal of oral biology and craniofacial research, 10(2), 171–174. https://doi.org/10.1016/j.jobcr.2020.04.011
According to Global Oral Health Status Report: Towards Universal Health Coverage for Oral Health by 2030 (WHO report), Globally, oral diseases affect 3.5 billion people and every three out of four people lives in middle-income countries. In India, there has been a steady increase in the burden of oral diseases since last two decades.Ramanarayanan, V., Janakiram, C., Joseph, J., & Krishnakumar, K. (2020). Oral health care system analysis: A case study from India. Journal of family medicine and primary care, 9(4), 1950–1957. https://doi.org/10.4103/jfmpc.jfmpc_1191_19 High prevalence of dental caries is notable among children and adults, due to high sugar consumption. It subsequently leads to high prevalence of periodontal diseases and edentulism.
Squamous cell carcinoma is the most common form of oral cancer in India and primarily affects middle age population (31–50 years). Epidemiologically, Kerala has the lowest and West Bengal has the highest incidence of oral cancer. For India, self-examination is the most effective method for early diagnosis of oral cancer.
Risk factors for all kind of dental diseases include; high dietary sugar, areca nut, alcohol and tobacco (gutkha, khaini, mawa, etc.) consumption, smoking, etc.
According to the WHO 'oral health country profile' below is the prevalence of main oral health issues: + Oral Disease Burden in India (2019) Oral Health Issue Prevalence (%) Untreated caries of deciduous teeth in children (1–9 years) 43.3 Untreated caries of permanent teeth in people (5+ years) 28.8 Severe periodontal disease in people (15+ years) 21.8 Edentulism in people (20+ years) 4
+ Oral and lip cancer (2020) Male Female Total Number of new cases 104,661 31,268 135,929 Incidence rate (%) 14.8 4.6 9.8 + Prevalence of Risk Factors (WHO, 2019) Risk Factor Male Female Total Per capita availability of sugar (g/day) .... .... 53.8 Prevalence of current tobacco use, 15+ years (%) 42.4 13.7 28.1 Per capita alcohol consumption, 15+ years (litres of pure alcohol/year) 9.1 1.9 5.6
Root Issues
However, the number of dentists in 2011 was 117,825 and approximate number for 2020 is 309,700, but still, majority people are devoid of proper dental treatment. Reasons for this gap, 1) unequal distribution of dentists in urban (70%) and rural (30%) areas, 2) 90% services provided by private practitioners and only 10% through the government settings, and 3) Negligeable % of insurance coverage for dental treatments. As a result, oral diseases cause high economic burden.Vundavalli S. (2014). Dental manpower planning in India: current scenario and future projections for the year 2020. International dental journal, 64(2), 62–67. https://doi.org/10.1111/idj.12063
Possible solutions Limit sugar, tobacco, alcohol and araca nut consumption through awareness programs Promotion of the use of fluoride containing toothpaste Oral health promotion programs Public-Private partnership Well-structured oral health surveys Integration of oral health with medical health
Malnutrition
Malnutrition refers to deficiencies, excesses or imbalances in a person's intake of energy and/or nutrients. The term malnutrition covers 2 broad groups of conditions. One is undernutrition – which includes stunting (low height for age), wasting (low weight for height), underweight (low weight for age) and micronutrient deficiencies or insufficiencies (a lack of important vitamins and minerals). The other is overweight – overweight, obesity and diet-related noncommunicable diseases (such as heart disease, stroke, diabetes and cancer).
According to a 2005 report, 60% of India's children below the age of three were malnourished, which was greater than the statistics of sub-Saharan African of 28%. World Bank data indicates that India has one of the world's highest demographics of children suffering from malnutrition – said to be double that of sub-Saharan Africa with dire consequences. India's Global Hunger Index India ranking of 67, the 80 nations with the worst hunger situation places it even below North Korea or Sudan. 44% of children under the age of 5 are underweight, while 72% of infants have anemia. It is considered that one in three malnourished children live in India.
States where malnutrition is prominent:
Uttar Pradesh: Most children here, in India's densest state by population, under the age of 5 are stunted due to malnutrition. Tamil Nadu: The state, despite high education, has a prominent child malnutrition problem. A National Family Health Survey reveals that 23% of children here are underweight, while 25% of Chennai children show moderately stunted growth. Madhya Pradesh: 2015 data reveals that Madhya Pradesh has India's highest number of malnourished children – 74.1% of them under 6 suffer from anemia, and 60% have to deal with malnutrition. Jharkhand and Bihar: At 56.5%, Jharkhand has India's second highest number of malnourished children. This is followed by Bihar, at 55.9%.
Forms
Protein–energy malnutrition (PEM): also known as protein-calorie malnutrition Iron-deficiency: nutritional anemia which can lead to lessened productivity, sometimes becoming terminal Vitamin A deficiency: which can lead to blindness or a weakened immune system Iodine deficiency: which can lead to serious mental or physical complaints Vitamin B complex deficiency: can lead to insufficient birth weight or congenital anomalies such as spina bifida.
In children
+Infants and preschool childrenhttp://ninindia.org/DietaryGuidelinesforNINwebsite.pdf Dietary Guidelines for NIN Condition Prevalence % Low birth weight 22 Kwashiorkor/Marasmus# <1 Bitot's spots# 0.8–1.0 Iron deficiency anaemia (6–59 months) 70.0 Underweight (weight for age)* (<5 years)# 42.6 Stunting (height for age)* (<5 years)# 48.0 Wasting (weight for height)*# 20.0 Childhood overweight/obesity 6–30 * : <Median -2SD of WHO Child Growth Standards
# : NNMB Rural Survey – 2005–06
A well-nourished child is one whose weight and height measurements compare very well within the standard normal distribution of heights and weights of healthy children of same age and sex. A child without sufficient nutrients in its daily intake is not only exposed to physical and motor growth delays, but also to heightened risk of mortality, reduced immune defenses and decreased cognitive and learning capacities. Malnutrition can negatively impact long-term health and socio-economic outcomes. As with serious malnutrition, growth delays also hinder a child's intellectual development. Sick children with chronic malnutrition, especially when accompanied by anemia, often have a lower learning capacity during the crucial first years of attending school.
In adults
+Adults (prevalence) Condition Unit Males Females Urban Rural# Tribal^ Urban Rural# Tribal^Chronic energy deficiency (BMI <18.5) % 33.2 40.0 36.0 49.0Anaemia in women (including pregnant women) % 75 Iodine deficiency - Goitre millions 54 Iodine deficiency – Cretinism millions 2.2 Iodine deficiency – Still births (includes neo-natal deaths) 90,000 Obesity related chronic diseases (BMI >25) % 36.0 7.8 2.4 40.0 10.9 3.2 Hypertension % 35.0 25.0 25.0 35.0 24.0 23.0 Diabetes mellitus (year 2006) % 16.0 5.0 16 5.0 Coronary heart disease % 7–9 3–5 7–9 3–5 Cancer incidence rate per million 113 123
* : <Median -2SD of WHO Child Growth Standards
# : NNMB Rural Survey – 2005–06
^ : NNMB Tribal Survey – 2008–09