People in India are living longer, but healthy life expectancy has increased more slowly and a complex mix of fatal and nonfatal ailments cause a tremendous amount of health loss, according to a new analysis of 306 diseases and injuries in 188 countries.

Thanks to a marked decline in death and illness caused by HIV/AIDS and malaria in the past decade and advances made in addressing communicable, maternal, neonatal, and nutritional disorders, health has improved significantly around the world. Global life expectancy at birth for both sexes rose by 6.2 years (from 65.3 in 1990 to 71.5 in 2013), while healthy life expectancy at birth rose by 5.4 years (from 56.9 in 1990 to 62.3 in 2013).

Healthy life expectancy takes into account not just mortality but the impact of nonfatal conditions and summarises years lived with disability and years lost due to premature mortality. The increase in healthy life expectancy has not been as dramatic as the growth of life expectancy, and as a result, people are living more years with illness and disability.

This is also true in India. Life expectancy increased by 6.9 years for men between 1990 and 2013 and 10.3 years for women in the same period. But healthy life expectancy increased by less, men gained 6.4 years and women gained 8.9 years. Life expectancy for women in India still outpaces that of men, 68.5 years compared to 64.2 years.

“Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990-2013, quantifying the epidemiological transition” examines fatal and nonfatal health loss across countries. Published in The Lancet on August 27, the study was conducted by an international consortium of researchers working on the Global Burden of Disease (GBD) study, including from the Public Health Foundation of India (PHFI), and led by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington.

For most countries, changes in healthy life expectancy for males and females between 1990 and 2013 were significant and positive, but in dozens of countries, including Botswana, Belize, and Syria, healthy life expectancy in 2013 was not significantly higher than in 1990.

The study’s researchers use DALYs, or disability-adjusted life years, to compare the health of different populations and health conditions across time. One DALY equals one lost year of healthy life. DALYs are measured as the sum of years of life lost due to early death and years of healthy life lost due to disability.

In India, the leading causes of health loss, as measured by DALYs, in 2013 were ischemic heart disease (IHD), chronic obstructive pulmonary disease (COPD), lower respiratory infections, tuberculosis, neonatal preterm birth complications, neonatal encephalopathy, diarrhoeal diseases, cerebrovascular disease, road injury, and low back and neck pain. Neonatal encephalopathy and tuberculosis were not among the leading causes of health loss globally.

Causes of health loss differed by gender in India as well. For Indian men, the top-five causes of DALYs in 2013 were IHD, tuberculosis, COPD, neonatal encephalopathy, and neonatal preterm birth complications. For women, the top five were IHD, lower respiratory infections, diarrhoeal diseases, COPD, and neonatal preterm birth complications. For Indian men, the fastest-growing leading causes of health loss between 1990 and 2013 were self-harm, IHD, and cerebrovascular disease, which increased at rates of 149.9 per cent, 79.9 per cent, and 59.8 per cent, respectively. Only IHD was in the top-10 causes of male DALYs in 1990. For women, the largest increases among the leading causes of DALYs occurred for IHD (69 per cent), depressive disorders (66.1 per cent), and cerebrovascular disease(36.8 per cent). Only IHD was among the 10 leading causes of health loss for women in 1990.

The study also examines the role that socio-demographic status – a combination of per capita income, population age, fertility rates, and average years of schooling – plays in determining health loss. Researchers’ findings underscore that this accounts for more than half of the differences seen across countries and over time for certain leading causes of DALYs, including maternal and neonatal disorders. But the study notes that socio-demographic status is much less responsible for the variation seen for ailments including cardiovascular disease and diabetes.