A recent study published in The Lancet revealed that India’s rate of neurological disorders have more than doubled in just the last 29 years.
The study reveals strokes to be one of the most common causes of death in the country, accounting for 699,000 deaths, amounting to 7.4 percent of the total deaths in the country in 2019. They note that a systematic review of the burden of neurological disorders at the subnational level is not readily available for India. The study, therefore, aimed to provide a level of understanding of the burden of these diseases between states and union territories. The findings are dire, noting significant variation in disease burden across states, which the paper claims to warrant a state-specific health response.
Among the diseases included in the study are noncommunicable neurological disorders. These include stroke, headache disorders, epilepsy, cerebral palsy, Alzheimer’s disease and other dementias, brain and central nervous system cancer, Parkinson’s disease, multiple sclerosis, motor neuron diseases, and other neurological disorders), as well as communicable neurological disorders (encephalitis, meningitis, and tetanus) and injury-related neurological disorders (traumatic brain injuries and spinal cord injuries).
“The contribution of non-communicable neurological disorders to total DALYs [disability adjusted life-years] in India doubled from four percent in 1990 to 8.2 percent in 2019, and the contribution of injury-related neurological disorders increased from 0.2 percent to 0.6 percent,” the study said. “The largest contributors to the total neurological disorder DALYs in India were stroke (37·9 percent [29.9–46.1]), headache disorders (17.5 percent [3.6–32.5]), epilepsy (11·3 percent [9.0–14.3]), cerebral palsy (5·7 percent [4.2–7.7]), and encephalitis (5·3 percent [3·7–8·9]).”
A key factor to consider in terms of DALYs and healthcare outcome in regards to neurological disorders is the disparity between states in healthcare infrastructure. As previously reported by Health Issues India, “rural areas often have such poorly developed healthcare infrastructure in their area that access to such basic medicines as paracetamol or ibuprofen is sporadic at best.”
The vast majority of India’s population reside in rural villages. As of 2018, 66 percent of India’s population are defined as living in rural communities according to the World Bank. Despite this, the vast majority of India’s healthcare infrastructure is focused within the more densely populated urban centres.
The lack of healthcare infrastructure also translates to a lack of knowledge regarding healthcare. In many cases risk factors and early warning signs are entirely overlooked, leading to far worse health outcomes further down the line. In the case of neurological disorders, headaches are a common early sign that can translate into far more serious conditions. They are, however, commonly overlooked by both individuals and the health system.
“Headache is the [most common] neurological disorder affecting one in three Indians, and is often neglected in terms of public health priority. It is the second leading contributor to the disease burden from neurological disorders in India. Migraine affects females more than males, greatly affecting adults in the working age population. Headaches, especially migraine, need to be recognised as a public health problem and included under the national NCD [noncommunicable disease] programme,” said N. Girish Rao, professor at the National Institute of Mental Health and Neurosciences and a co-author of the paper.
The study notes that known risk factors for neurological disorders are issues such as high blood pressure, air pollution, dietary risks, high fasting plasma glucose, and high body-mass index. These risk factors are a common issue in many NCDs, such as heart disease and cancer. They have also shown a marked increase in tandem with both a rise in NCD cases as well as, as the study demonstrates, neurological disorders.
Throughout the last few decades India has seen a societal shift. The rapid industrialisation of the country has seen a shift in lifestyles for many, swapping rural lifestyles in exchange for the greater economic benefits of the city. While this has resulted in economic growth, it has also meant a greater degree of people living in highly polluted areas.
Along with the change in setting, occupational changes have meant that many who would otherwise be working in manual labour jobs now work in an office setting, leading generally more sedentary lifestyles. Dietary shifts have seen largely vegetarian diets rich in fresh fruit and vegetables traded in for unhealthy, “western-style” diets that include large amounts of processed food, containing high volumes of unhealthy fats and sugar.
These factors, the paper determines, combined with India’s aging population, have led to the burgeoning numbers of neurological disorders being reported. If India is to address the issue, far more must be done to prepare the health system to properly cope with the burden. Resources must be allocated as and when they are needed, given the disparities between states. Data such as this is vital in such an endeavour.