health in india health in india india's population in 2021 as per world bank is 1.39 billion. being the world's second-most-populous country and one of its fastest-growing economies, india experiences both challenges and opportunities in context of public health. india is a hub for pharmaceutical and biotechnology industries; world-class scientists, clinical trials and hospitals yet country faces daunting public health challenges like child undernutrition, high rates of neonatal and maternal mortality, growth in noncommunicable diseases, high rates of road traffic accidents and other health related issues. historical development of life expectancy, 1881 to 2019 development of child mortality rate in india since 1960 the human rights measurement initiative finds that india is fulfilling 80.5% of what it should be fulfilling for the right to health based on its level of income. when looking at the right to health with respect to children, india achieves 92.1% of what is expected based on its current income. in regards to the right to health amongst the adult population, the country achieves only 85.6% of what is expected based on the nation's level of income. india falls into the "very bad" category when evaluating the right to reproductive health because the nation is fulfilling only 63.7% of what the nation is expected to achieve based on the resources (income) it has available. major health indicators the life expectancy at birth has increased from 49.7 years in 1970–1975 to 67.9 years in 2010–2014. for the same period, the life expectancy for females is 69.6 year and 66.4 years for males. in 2018, the life expectancy at birth is said to be 69.1 years. the infant mortality rate has declined from 74 per 1,000 live births in 1994 to 37 per 1,000 live births in 2015. however, the differentials of rural (41) and urban (25) as of 2015 are still high. in 2016, the infant mortality rate was estimated to be 34.6 per 1,000 live births. the under-five mortality rate for the country was 113 per 1,000 live births in 1994 whereas in 2018 it reduced to 41.1 per 1,000 live births. the maternal mortality ratio has declined from 212 per 100 000 live births in 2007–2009 to 167 per 100 000 live births in 2011–2013. however, the differentials for state kerala (61) and assam (300) as of 2011–2013 are still high. in 2013, the maternal mortality ratio was estimated to be 190 per 100 000 live births. the total fertility rate for the country was 2.3 in rural areas whereas it has been 1.8 in urban areas during 2015. the most common cause of disability adjusted life years lost for indian citizens as of 2016 for all ages and sexes was ischemic heart disease (accounting for 8.66% of total dalys ), 2nd chronic obstructive pulmonary disease (accounting for 4.81% of total dalys), 3rd diarrhea (accounting for 4.64% of total dalys) and 4th lower respiratory infections (accounting for 4.35% of total dalys). as per the figures about the child mortality rate which is quite a big hurdle for the government, the 2nd most common cause of dalys lost for children under 5 years of age was diseases like diarrhea, lower respiratory tract infections and other communicable diseases (accounting for 22,598.71 dalys per 100 000 population) as of 2016 which can be preventable. health issues malnutrition main article: malnutrition in india malnutrition refers to deficiencies, excesses or imbalances in a person's intake of energy and/or nutrients. the term malnutrition covers 2 broad groups of conditions. one is undernutrition – which includes stunting (low height for age), wasting (low weight for height), underweight (low weight for age) and micronutrient deficiencies or insufficiencies (a lack of important vitamins and minerals). the other is overweight – overweight, obesity and diet-related noncommunicable diseases (such as heart disease, stroke, diabetes and cancer). according to a 2005 report, 60% of india's children below the age of three were malnourished, which was greater than the statistics of sub-saharan african of 28%. world bank data indicates that india has one of the world's highest demographics of children suffering from malnutrition – said to be double that of sub-saharan africa with dire consequences. india's global hunger index india ranking of 67, the 80 nations with the worst hunger situation places it even below north korea or sudan. 44% of children under the age of 5 are underweight, while 72% of infants have anemia. it is considered that one in three malnourished children live in india. states where malnutrition is prominent: uttar pradesh: most children here, in india's densest state by population, under the age of 5 are stunted due to malnutrition. tamil nadu: the state, despite high education, has a prominent child malnutrition problem. a national family health survey reveals that 23% of children here are underweight, while 25% of chennai children show moderately stunted growth. madhya pradesh: 2015 data reveals that madhya pradesh has india's highest number of malnourished children – 74.1% of them under 6 suffer from anemia, and 60% have to deal with malnutrition. jharkhand and bihar: at 56.5%, jharkhand has india's second highest number of malnourished children. this is followed by bihar, at 55.9%. forms protein–energy malnutrition (pem): also known as protein-calorie malnutrition iron-deficiency: nutritional anemia which can lead to lessened productivity, sometimes becoming terminal vitamin a deficiency: which can lead to blindness or a weakened immune system iodine deficiency: which can lead to serious mental or physical complaints vitamin b complex deficiency: can lead to insufficient birth weight or congenital anomalies such as spina bifida. in children infants and preschool children conditionprevalence % low birth weight22 kwashiorkor/marasmus#<1 bitot's spots#0.8–1.0 iron deficiency anaemia (6–59 months)70.0 underweight (weight for age)* (<5 years)#42.6 stunting (height for age)* (<5 years)#48.0 wasting (weight for height)*#20.0 childhood overweight/obesity6–30 * : <median -2sd of who child growth standards # : nnmb rural survey – 2005–06 a well-nourished child is one whose weight and height measurements compare very well within the standard normal distribution of heights and weights of healthy children of same age and sex. a child without sufficient nutrients in its daily intake is not only exposed to physical and motor growth delays, but also to heightened risk of mortality, reduced immune defenses and decreased cognitive and learning capacities. malnutrition limits the productivity of all those who are its victims, and thus serves to perpetuate poverty. as with serious malnutrition, growth delays also hinder a child's intellectual development. sick children with chronic malnutrition, especially when accompanied by anemia, often have a lower learning capacity during the crucial first years of attending school. in adults adults (prevalence) conditionunitmalesfemales urbanrural#tribal^urbanrural#tribal^ chronic energy deficiency (bmi <18.5) %33.240.036.049.0 anaemia in women (including pregnant women) %75 iodine deficiency - goitremillions54 iodine deficiency – cretinismmillions2.2 iodine deficiency – still births (includes neo-natal deaths)90,000 obesity related chronic diseases (bmi >25) %36.07.82.440.010.93.2 hypertension %35.025.025.035.024.023.0 diabetes mellitus (year 2006) %16.05.0165.0 coronary heart disease %7–93–57–93–5 cancer incidence rateper million113123 * : <median -2sd of who child growth standards # : nnmb rural survey – 2005–06 ^ : nnmb tribal survey – 2008–09 due to their lower social status, girls are far more at risk of malnutrition than boys of their age. partly as a result of this cultural bias, up to one third of all adult women in india are underweight. inadequate care of these women already underdeveloped, especially during pregnancy, leads them in turn to deliver underweight babies who are vulnerable to further malnutrition and disease. obesity obesity in india has grown to epidemic levels in india in the 21st century, with morbid obesity affecting 5% of the population. one factor that may impact the rise of obesity in india is the growing establishment of fast-food and mithai shops within india. fast-food is among one of india’s largest growing markets, especially amid the covid-19 pandemic where it saw tremendous growth due to the speed of service and no-contact model. moreover, the rise of food-delivery apps such as zomato and swiggy in india has allowed access to fast-foods on an unparalleled level in india. by increasing the ease of access to such unhealthy foods, indians are more likely than ever before to choose such options rather than cooking at home. in 2021, the most ordered-foods on swiggy were biryani and paneer butter masala, both of which are highly fattening when ordered from restaurants. such delivery apps also use what some may consider predatory business tactics to hook customers on to their services. first time customers are offered a month's worth of free delivery and discounts to build their reliance on delivery apps, so even after the trial ends the customers continue paying and ordering food. even prior to covid and online food ordering services, fast food has been readily available around the streets of indian cities, just minutes away from most residential areas. ever since mcdonalds entered india in 1996, numerous fast food chains have followed suit including dominos, pizza hut, burger king, and kfc. according to a study conducted by the international journal of community medicine and public health in 2016, “over 70% urban indians consume fast foods from take away restaurants once a month or more frequently.” this highlights the ease by which the common indian citizen can encounter and purchase fast food due to its unbeatable price and accessibility. the frequency and scale at which indians consume fast food is alarming as such high caloric foods are “steeply damaging human health and lead to metabolic changes and conditions such as obesity, as well as high blood pressure, raised blood glucose, and cholesterol.” this is a cause for concern as all of these conditions are among the leading causes of death (not including diseases) in india. the journal also found that children of pregnant and lactating women eating fast foods are more prone to obesity. communicable diseases diseases such as dengue fever, hepatitis, tuberculosis, malaria and pneumonia continue to plague india due to increased resistance to drugs.this diagram shows the percentage distribution of morbidity reported in communicable diseases in 2016 in india according to the national health profile 2017 this diagram shows the percentage distribution of mortality reported in communicable diseases in 2016 in india according to the national health profile 2017 in 2011, india reported a 'totally drug-resistant' form of tuberculosis . india is the highest tb burden country in the world in terms of absolute number of incident cases that occur each year. tb primarily affects people in their most productive years of life. while two-thirds of the cases are male, tb takes disproportionately larger toll among young females, with more than 60 per cent of female cases occurring by the age of 34 years. in 2018, the truenat test, an indigenously developed technology under the "make in india" initiative, was deployed in about 350 phcs. this led to marked increase in access to highly sensitive molecular tests with augmented capacity for resistance testing at the peripheral level. hiv/aids in india is ranked third highest among countries with hiv-infected patients. national aids control organisation, a government apex body is making efforts for managing the hiv/aids epidemic in india. diarrheal diseases are the primary causes of early childhood mortality. these diseases can be attributed to poor sanitation and inadequate safe drinking water. india has the world's highest incidence of rabies. malaria has been a seasonal health problem in india from a very long time. the maximum number of malaria cases and deaths have been reported mostly form the rural parts of orissa. the overall prevalence of the disease has diminished in 2012 and 2013 however there is a slight increase in 2014 and again started decreasing from 2015. who (world health organization) adopted a strategy in may-2015, that provides a technical guidance to countries emphasizing the importance of scaling up malaria responses and moving towards elimination of malaria. this is known as the global technical strategy for malaria (2016-2030) . a major scale-up of malaria responses will not only help countries reach the health-related targets for 2030, but will contribute to poverty reduction and other development goals. kala-azar is the second largest parasitic killer in the world. most of the cases (76%) were found in bihar in 2016. dengue and chikungunya transmitted by aedes mosquitoes, is another problem of concern in india. dengue outbreaks have continued since the 1950s but severity of disease has increased in the last two decades. in 2016,