Per capita disease burden measured as DALY rate has dropped by about a third in India over the past 26 years. However, the magnitude and causes of disease burden and the risk factors vary greatly between the states. The change to dominance of NCDs and injuries over CMNNDs occurred about a quarter century apart in the four ETL state groups. Nevertheless, the burden of some of the leading CMNNDs continues to be very high, especially in the lowest ETL states. This comprehensive mapping of inequalities in disease burden and its causes across the states of India can be a crucial input for more specific health planning for each state [5] India faces a double disease burden. Concrete measures need to address the rising epidemic of NCDs but also keep the momentum towards progress on preventable infectious diseases, maternal and child mortality. NCDs along with injuries make up the largest disease burden in India (62% of DALYs) [6]

1. Dissertation Title
Correlation study between Human Development Indices and
Epidemiological Transition Ratio Among Indian States.
Presented By
Subhash Chandra
PGDPHM 2019-20
Roll no- 296
Supervise By
Dr.Rajesh Kumar
Assistant Professor
Department of RBM- NIHFW

2. Presentation outline
1. Introduction and Background
2. Rational of Study
3. Rol
4. Objectives
5. Methodology/Research Design
6. Results
7. Discussion
8. List of References

3. 3
Introduction and Background
The Epidemiological transition—the shift from infectious and deficiency
diseases to chronic non communicable diseases—was a unidirectional process,
beginning when infectious diseases were predominant and ending when non
communicable diseases dominated the causes of death.
It has, however, become apparent that this transition is more complex and
dynamic: the health and disease patterns of a society evolve in diverse ways as
a result of demographic, socioeconomic, technological, cultural,
environmental and biological changes.
It is rather a continuous transformation process, with some diseases
disappearing and others appearing or re-emerging. This also indicates that
such a process is not unidirectional. [1]

4. 4
Introduction and Background
Epidemiological transition ratio is defined as the ratio of DALYs caused by
Communicable, Maternal, Neonatal and Nutritional Diseases (CMNNDs) to
those caused by Non Communicable Diseases (NCDs) and injuries.
A ratio greater than one indicates a higher burden of CMNNDs than NCDs and
injuries, while a ratio less than one indicates the opposite. The lower the ratio,
the greater the contribution of NCDs and injuries to a state’s overall disease
burden. [2]
The theory of epidemiologic transition focuses on the complex change in
patterns of health and disease and on the interactions between these patterns
and their demographic, economic and sociologic determinants and
consequences. An epidemiologic transition has paralleled the demographic
and technologic transitions in the now developed countries of the world and is
still underway in less-developed societies [3]

5. 1
Introduction & background
. The Human Development Index (HDI) is a summary measure of average achievement in
key dimensions of human development:
1. A long and healthy life,
2. Being knowledgeable and have a
3. Decent standard of living.
The HDI is the geometric mean of normalized indices for each of the three dimensions. The
health dimension is assessed by life expectancy at birth, the education dimension is
measured by mean of years of schooling for adults aged 25 years and more and expected
years of schooling for children of school entering age. The standard of living dimension is
measured by gross national income per capita. [4]

6. Rational of Study
• Per capita disease burden measured as DALY rate has dropped by about a third
in India over the past 26 years. However, the magnitude and causes of disease
burden and the risk factors vary greatly between the states.
• The change to dominance of NCDs and injuries over CMNNDs occurred about a
quarter century apart in the four ETL state groups. Nevertheless, the burden of
some of the leading CMNNDs continues to be very high, especially in the lowest
ETL states.
• This comprehensive mapping of inequalities in disease burden and its causes
across the states of India can be a crucial input for more specific health planning
for each state [5]
• India faces a double disease burden. Concrete measures need to address the
rising epidemic of NCDs but also keep the momentum towards progress on
preventable infectious diseases, maternal and child mortality. NCDs along with
injuries make up the largest disease burden in India (62% of DALYs) [6]

7. 7
Review of literature
India has undergone heterogeneous economic growth over the past few decades, which would be
expected to lead to wide variations in health and disease distribution in different parts of the
country. This growth should be used to enhance major long-term enablers of societal development,
of which population health is a crucial aspect that would further boost economic growth. [6]
During the last decade as a consequence of rapid demographic transition and growing proportion
of the adult and older population, the epidemiological profile of low and middle income countries
reflects the diseases of adults rather than childhood while retaining high exposure to risk factors
associated with infectious diseases, leaving poor rural areas and urban slums with persisting high
rates of infections and childhood deaths alongside richer urban areas where adults die prematurely
of noncommunicable diseases [7]

8. 8
Review of literature
Many countries witnessed deaths from infectious and parasitic diseases being replaced by
death due to chronic/degenerative diseases during the early stages of mortality reduction. It
shifted the burden of diseases and death from younger to adult and older ages and this process
came to be coined as epidemiological transition [8] Like other developing countries, India is
undergoing rapid epidemiological transition and change in the mortality pattern as a result of its
socioeconomic and demographic changes [9]
the state of Kerala has been reported to have had much better health indicators than the rest
of India for the past several decades [10] The Government of India focuses more development
efforts on the Empowered Action Group (EAG) states in north India and the states of the
northeast region of India, which often have poorer health indicators than the rest of India [11]

9. 9
Review of literature
It may be pointed out that in the past, mortality reduction in Kerala was comparable with
that of developed countries. However, studies linking shift in causes of death and age at
time of death within the epidemiological theories are scarcely attempted in the state.
This lacuna becomes severe when evaluating the contributors of mortality reduction such
as environmental and behavioral changes, nutritional improvement, healthcare facilities,
social and economic factors and the timely intervention of the state governments
Changes in the healthcare strategy are necessary to address additional challenges
emanating from chronic/degenerative diseases as well as concentration of deaths in adult
and older age groups . [12]
Quality of health services that have contributed to the epidemiologic transition. The
discoveries and technological developments of the twentieth century, such as the
development of antibiotics and antimicrobial agents, insecticides, vaccines and diagnostic
and therapeutic technologies, have resulted in remarkable progress in the prevention and
control of many diseases and in the effective management of many others. [13]

10. Objectives
General Objective-
General Objective – To analyze the correlation between Human
development Indices and Epidemiological transition Ratio among
Indian state.
Specific Objectives –
• To Review the Epidemiological transition Ratio and Respective
Human development Indices of Indian states
• To prove the hypothesis between Human development Indices and
Epidemiological transition Ratio of Indian states.

11. Methodology
Type of Data Secondary Data - Two indices as
• Human development index 2019 India by United nation
development program (UNDP) and
• Epidemiological transition ratio status of India (ICMR study
Disease Burden of States- 2017) used for analysis.
Research Design Correlation study
Statistical Analysis Spearman Rank Order correlation coefficient
Using Excel
Statistical
Interpretation
Values always range between -1 (strong negative relationship) and +1
(strong positive relationship). Values at or close to zero imply weak or
no linear relationship

12. Results & Discussion
By normal standard, the association between the human development
indices and Epidemiological ratio has been considered statistically
significant .
Results –Result shown the Positive correlation value (0.77)
i.e a Linear relationship of two variables
According the result Accept the Alternate Hypothesis (that there is a
positive correlation between Human Development Indices and
Epidemiological transition)

13. • The state Kerala, Goa Himachal Pradesh and Punjab have strong linear
relationship between HDI and ETR (High rank in HDI and ETR), the
bottom rank states Bihar, Uttar Pradesh, Jharkhand, Assam,
Chatishgarrh and Madhya Pradesh have also strong linear relationship
(Low rank HDI to respective ETR)
• The states Delhi,Haryana, Skkim and Mizoram does not have Linear
relationship (Have High HDI but Low rank in ETR) vice versa Andhra
Pradesh and West Bengal have Low rank in HDI respective to their
ETR. Rest of state have moderate relationship to HDI and ETR.

14. These findings highlight the fact that India’s states will require very different policy approaches
according to the nature of the disease burden they are facing.
The wide variations between the states in this epidemiological transition are reflected in the range
of the contribution of major disease groups to the total disease burden
Kerala, Goa, and Tamil Nadu have the largest dominance of non-communicable diseases and
injuries over infectious and associated diseases, whereas this dominance is present but relatively
the lowest in Bihar, Jharkhand, Uttar Pradesh, and Rajasthan.

15. Suggestion
• Interventions to reduce risk from non-communicable diseases
should be applied through the life course.
• Promoting Healthy Behavior to reducing risk
• Enhancing Health service delivery
• Early Diagnosis
• Financing to support NCD Care
• Policy and Regulation

16. References
1. Thttp://www.emro.who.int/emhj-volume-2-1996/volume-2-issue-1/article2.html
2. India : Health of the Nation's States The India state Level Disease Burden Initiatives ICMR
3. http://www.emro.who.int/emhj-volume-2-1996/volume-2-issue-1/article2.html
4. http://hdr.undp.org/en/content/human-development-index-hdi
5. Nations within a nation: variations in epidemiological transition across the states of India, 1990–2016 in the Global
Burden of Disease Study The Lancet
6. Bose MLSocial and cultural history of ancient India. 2nd edn. International Monetary Fund World economic outlook
update. http://www.imf.org/en/Publications/WEO/Issues/2017/07/07/world-economic-outlook-update-july-2017
7. Kannan KP Thankappan KR Ramankutty V Aravindan KP Kerala: a unique model of development.
8. Ministry of Health and Family Welfare Government of India National Health Mission.
http://nhm.gov.in/nhm/nrhm.htmlDate: Sept 1, 2017
9. Global, regional, and national disability-adjusted life-years (DALYs) for 332 diseases and injuries and healthy life
expectancy (HALE) for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of
Disease Study 2016. Lancet. 2017; 390: 1260-1344