First-of-its-kind Collaborative Initiative on State-level Disease Burden Estimation in India Launched

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India has been going through a major epidemiological transition over the past 25 years. The burden of premature death and health loss due to non-infectious conditions such as heart disease, stroke, diabetes, chronic obstructive lung disease and road traffic has increased massively, and the burden due to lower respiratory infections, tuberculosis, diarrhea and neonatal disorders still remains unacceptably high. The extent of the burden due to these major conditions is expected to vary significantly across the various population groups and the states of India. National-level estimates do not provide enough detail for targeted-action. Hence reliable sub-national estimation of disease burden in India is crucial for an informed health system response to improve population health.

The Indian Council of Medical Research (ICMR), the Public Health Foundation of India (PHFI) and the Institute for Health Metrics and Evaluation (IHME) at the University of Washington under the aegis of Ministry of Health and Family Welfare, Government of India have launched a collaborative initiative on state-level disease burden estimation in India. In this effort, the robust methods of the Global Burden of Disease (GBD) study, developed by a global network of researchers coordinated by IHME, will be utilized to generate rigorous estimates of all the major drivers of health loss at the state level in India. In addition to the scientific papers, the initiative will produce multilevel disseminations through policy-briefs, workshops and seminars to raise the discourse and monitor changing disease trends. State-of-the-art GBD interactive visualization tools will be used to bring to life the initiative findings. This will allow a variety of contrasts between states, which will be particularly useful for policy makers in understanding trends of disease and risk factor in order to plan further action.

This initiative would work closely with a network of academic partners across India, and importantly with policy makers at the national and state level for guidance and utilization of the findings to improve health programmes and planning.

India has a huge landscape with tremendous regional health variations. Disease burden estimations at the state-level in India based on sound research would provide the foundation for public policy. Well researched estimations can enable judicious targeting and help decide what needs to be done where, for whom, and when. Conversely, the absence of such good quality empirical data can affect programme designing and consequently outcomes. India has ample evidence of such impacts, often due to the mismatch between disease burden and its causal factors, and the interventions adopted and priorities in resource allocation. Therefore, it is clear that the onset of disease needs to be averted, and when it occurs it should be treated quickly. For policies to ensure this, it is necessary that we have an evidence-based understanding of the extent of disease burden, the population groups that are the most vulnerable, and what interventions are needed to avert premature death or needless suffering at the state-level in India.

There is substantial variation across India in disease burden trends which needs to be systematically understood at sub-national levels. The need of the hour is to have a robust scientific approach to identify and estimate the significant contributors to ill-health across each state in order to plan a response specific to the local situation. This collaborative effort will be a first-of-its-kind that examines the extent, pattern, and trends of diseases and risk factors across the states of the country. said Dr. Soumya Swaminathan, Director-General of ICMR and Secretary, Health Research, in the Government of India

The contribution of risk factors such as high blood pressure, blood sugar and cholesterol, and that of poor diet and alcohol use, to health loss has doubled in India over the past two decades, and air pollution and tobacco smoking continue to be major contributors to health loss. However, the extent of these risk factors varies considerably across the states of India. The efforts of the State-level Disease Burden Initiative would help refine the understanding of these variations across India, which would inform appropriate strategies for the different states of India,said Prof. K. Srinath Reddy, President of PHFI.

Many Indian states are bigger than most countries in the world. Planning for health improvements for one-sixth of the world population living in India without accounting for variations in disease burden trends across the states cannot yield optimal outcomes. The collaborative effort of the State-level Disease Burden Initiative, which would involve a large variety and number of stakeholders in India, is a unique opportunity that would generate better evidence for the disease trend variations across India and also enable development of relevant data generation systems to inform health planning on an ongoing basis at local levels in India said Prof. Lalit Dandona, who will serve as the Director of this joint initiative.

IHME leads the Global Burden of Disease study which is a systematic scientific effort to quantify the comparative magnitude of health loss due to diseases, injuries and risk factors by age, sex and geographies for specific points in time along with measures of uncertainty.

GBD has about 1400 collaborators in more than 100 countries. Besides the country-level estimates, sub-national level estimates have recently been produced for China and UK as part of the GBD study, which are proving very useful in enhancing health planning in these countries at the local levels. Similarly, there is great potential to improve health in India through this collaborative initiative as it will facilitate action based on reliable estimates of disease burden and risk factors at the state level. said IHME Director Prof. Christopher Murray, who leads the GBD study globally.

This collaborative initiative is expected to contribute substantially to appropriate health policy and system development through production of reliable state-level disease burden estimates as well as improvement of systems to produce these estimates on an ongoing basis to monitor changing trends at the local levels.

The Indian Council of Medical Research (ICMR), is the apex government body in India for the formulation, coordination and promotion of biomedical and health research. It is one of the oldest medical research bodies in the world. Besides the headquarters in New Delhi, ICMR has 32 research institutes, centres and units across India. ICMR funds both intramural and extramural research in India. The priorities of ICMR coincide with the national health priorities and have the goal of reducing the total burden of disease and to promote health and well-being of India population. As part of this agenda, ICMR is interested in improving the estimates of disease burden and risk factors in India, especially at the sub-national levels, for better health planning, policy framing and fund allocation. For more information please visit http://www.icmr.nic.in

The Public Health Foundation of India (PHFI) is a premier public health institution in India with presence across the country. It collaborates with multiple constituencies including Indian and international academia, state and central governments, multi- and bi-lateral agencies, and civil society groups. The vision of PHFI is to strengthen India public health institutional and systems capability and provide knowledge to achieve better health outcomes for all through strengthening training, research and policy development in public health. As part of this vision, PHFI has major interest in improving the robustness of sub-national disease burden estimates to inform health action and in evaluating the impact of large-scale population health interventions. For more information please visithttp://www.phfi.org

The Institute for Health Metrics and Evaluation (IHME) is a global research institute at the University of Washington in Seattle that provides independent, rigorous, and comparable measurement of the world most important health problems and evaluates the strategies used to address them. IHME aims to identify the best strategies to build a healthier world by measuring health, tracking program performance, finding ways to maximize health system impact and developing innovative measurement systems to provide a foundation for informed decision-making that will ultimately allocate resources to best improve population health. For more information please visit http://www.healthdata.org

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