The Indian Council of Medical Research (ICMR) in association with  Public Health Foundation of India (PHFI) and the Institute for Health Metrics and Evaluation (IHME), University of Washington, Seattle, USA, has launched the state level disease burden initiative in India.

This is the first of its kind collaborative initiative in India to generate state-level disease burden and risk factors estimation in India utilising the robust global burden of disease (GBD) methodologies in understanding regional and national disease and risk factor trends.

The ICMR's initiative in this regard is significant with over 1.25 billion population, every sixth person in the world lives in India, and many states of India have populations larger than that of most countries. For example, while the most populous 20 countries in the world have a population of over 65 million, 7 of the 29 states in India have this population including three exceeding 100 million. Reliable sub-national estimation of disease burden in India is therefore crucial for an informed health system response to improve population health, as national level estimates do not provide enough nuance for specific action needed in large heterogeneous India.

In order to address the need for reliable state-level estimates for disease burden and risk factors for effective action to improve health at the local levels in India, the ICMR has embarked on this collaborative initiative on state-level disease burden estimation in India. ICMR and PHFI have both worked extensively on various aspects of disease burden estimation in India and use of this in policy making, and IHME leads the global burden of disease (GBD) study. GBD 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 1200 collaborators in over 100 countries. Findings from the GBD study in 2010 and 2013 have been published and are used extensively. These findings are quoted widely and are considered the most robust estimates of disease burden globally. Besides the country-level estimates, state or province level estimates have recently been produced for China, Mexico and UK as part of the GBD study, which are proving very useful in enhancing health planning in these countries at the local levels.

ICMR and PHFI in collaboration with the ministry of health would produce state-level disease burden and risk factors estimates in India. In this effort, they would collaborate with IHME to utilise the robust methods developed by the GBD study as suitable for state-level estimation of disease burden in India. This initiative would work closely with a network of academic partners across India, and importantly it would work closely with policy makers at the Centre and in the states for guidance and utilisation of the findings to improve health programmes and planning. The GBD interactive visualisation tools show the study findings for the groups and years of interest, and allow a variety of contrasts between diseases and countries/states, which would be particularly useful for policy makers in understanding trends of disease and risk factor in order to plan further action.

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 during this period, and the burden due to lower respiratory infections, tuberculosis, diarrhea and neonatal disorders has decreased but still remains unacceptably high. However, 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. 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.