Public health priorities for India
Authors: Rakhi Dandona
Journal: The Lancet Public Health (2022)

Indian states are in different phases of epidemiological transition, resulting in large variations in disease burden across the states.1India State-Level Disease Burden Initiative CollaboratorsNations within a nation: variations in epidemiological transition across the states of India, 1990–2016 in the Global Burden of Disease Study.Lancet. 2017; 390: 2437-2460Summary Full Text Full Text PDF PubMed Scopus (524) Google Scholar However, the public health priorities across the country remain similar. Addressing the availability of relevant and robust data for meaningful planning of programmes and policies is a gap that needs urgent consideration to improve population health and the continuum of care.2Niti AayogGovernment of IndiaHealth system for a new India: building blocks.https://www.niti.gov.in/sites/default/files/2019-11/NitiAayogBook_compressed_1.pdfDate: 2019Date accessed: January 5, 2021Google Scholar People in India are living longer than ever before, but what they die of is still an extrapolation based on verbal autopsies in a sample of deaths and is not based on medically certified cause of death.3Office of the Registrar General of IndiaGovernment of IndiaSample Registration System.https://censusindia.gov.in/Vital_Statistics/SRS/Sample_Registration_System.aspxDate: 2020Date accessed: December 1, 2021Google Scholar, 4Office of the Registrar General of IndiaGovernment of IndiaReport on medical certification of cause of death 2019. Government of India, New Delhi2021Google Scholar Only 21% of all registered deaths in India had a medically certified cause of death available in 2019.4Office of the Registrar General of IndiaGovernment of IndiaReport on medical certification of cause of death 2019. Government of India, New Delhi2021Google Scholar This inadequacy in the availability of medical certification of cause of death has fundamental implications for the country's health system and policy efforts to improve health of the population that lives in India. Addressing this gap in data is among the most urgent public health priority for the country. India generates a substantial amount of data on various aspects of health under the many national and state health programmes. However, these data remain fragmented, inadequate, non-standardised, and tedious to collate and interpret. Improving the data quality and integration of data is another major priority. In recent years, substantial effort has gone into the use of technology to improve data availability, but data quality is yet to receive similar attention.2Niti AayogGovernment of IndiaHealth system for a new India: building blocks.https://www.niti.gov.in/sites/default/files/2019-11/NitiAayogBook_compressed_1.pdfDate: 2019Date accessed: January 5, 2021Google Scholar Much of the data in the health management information system (HMIS) is generated on maternal and child health, and yet neonatal mortality—a key indicator—is still not readily available.5Ministry of Health and Family WelfareGovernment of IndiaHMIS: Standard reports.https://hmis.nhp.gov.in/#!/standardReportsDate: 2021Date accessed: December 1, 2021Google Scholar Immediate attention is also needed within the HMIS to track and improve data on health services for conditions beyond maternal and child health for India to address the increasing burden of non-communicable conditions and injuries, which can also facilitate priority-setting for public health resource allocation to improve population health. The factors that influence health outcomes extend well beyond the authority remits of the health ministry. The continuing burden of malnutrition in India highlights the need for coordinated and intersectoral action between the relevant ministries to address this complex and persistent health challenge.6Swaminathan S Hemalatha R Pandey A et al.The burden of child and maternal malnutrition and trends in its indicators in the states of India: the Global Burden of Disease Study 1990–2017.Lancet Child Adolesc Health. 2019; 3: 855-870Summary Full Text Full Text PDF PubMed Scopus (152) Google Scholar Another example is the neglect of injuries, despite their substantial burden. Injuries are reported as accident (unintentional injuries) and crime (intentional injuries) on the basis of data from police records by the National Crime Records Bureau, under the Ministry of Home Affairs, which are fraught with under-reporting and inadequate reporting of risk factors and do not provide individual-level data that are needed for strategising injury prevention to save lives and to prevent disability.7Dandona R Bertozzi-Villa A Kumar GA Dandona L Lessons from a decade of suicide surveillance in India: who, why and how?.Int J Epidemiol. 2017; 46: 983-993PubMed Google Scholar Therefore, an urgent public health need is to co-create key priorities between the key sectors and ministries for successful intersectoral initiatives by sharing the accountability for the right to health across the government as a whole, to achieve the 2030 Sustainable Development Goals.8WHOAdvancing the right to health: the vital role of law. World Health Organisation, Geneva2017Google Scholar To track COVID-19 infections and vaccination, India responded by linking the COVID-19-related health services for individuals with a unique identification number, thereby documenting that it is possible to link records at such a large scale. The Ayushman Bharat Digital Mission which aims to integrate health infrastructure for the country, has developed a system to generate a unique health identification number for each person across the variety of health-care providers; however, the use of this number is currently optional.9National Health AuthorityMinistry of Health and Family WelfareGovernment of India2021. Ayushman Bharat Digital Mission.https://abdm.gov.in/home/digital_systemsDate accessed: December 2, 2021Google Scholar As a priority, the availability of the unique health identification number should be made mandatory to ensure that each individual is unique in the health system, and has health records available seamlessly over the life course for continuity of care.2Niti AayogGovernment of IndiaHealth system for a new India: building blocks.https://www.niti.gov.in/sites/default/files/2019-11/NitiAayogBook_compressed_1.pdfDate: 2019Date accessed: January 5, 2021Google Scholar The critical gaps in data availability and quality cannot be ignored for India to effectively address and measure progress towards improving population health, which would require an integrated government response and multi-sectoral action. How the second most populous country addresses these public health priorities will have implications for the global health agenda. I declare no competing interests.