LAUSR

The Government of India recently launched the ambitious National Health Protection Mission, also referred to as Ayushman Bharat (which means “bless India with long healthy life”), Pradhan Mantri Jan Arogya Yojana, or Modicare. This scheme has two main pillars: strengthening of universal comprehensive primary health care and a health insurance scheme to cover 500 million people in need to reduce catastrophic out-of-pocket health spending. The 1·3 billion population of India has vast socioeconomic and health diversity across the country. In November, 2017, the India State-Level Disease Burden Initiative reported the first assessment of trends in all of the major diseases and risk factors in every state of India from 1990 to 2016 using the single framework of the Global Burden of Disease study, which generated considerable policy interest. Five Articles published today by this Initiative report further detailed analyses of several major noncommunicable diseases (NCDs) and suicide across the states of India over a quarter of a century. This new evidence can be a useful input for the state-specific planning of Ayushman Bharat, as disability-adjusted life-years (DALYs; a composite metric of premature mortality and morbidity recommended by the Health Policy of India for disease burden monitoring) from NCDs and injuries have together exceeded those from communicable diseases in every state of India, contributing 57–86% of the total DALYs among the states in 2016. The Government of India is focused on the need to address the high and increasing burden of NCDs and injuries in the country. Briefly, the integrated National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke established NCD units in each state last year to increase the momentum for the prevention and management of major NCDs at the district level, including screening for high blood pressure and blood glucose and for oral, breast, and cervical cancers. The National Tobacco Control Programme is facilitating reduction of the prevalence of smoking in India. The Food Safety and Standards Authority of India last year proposed a tax and advertisement ban on unhealthy foods. The availability of non-polluting cooking fuels for lowincome households has increased under the nationwide Pradhan Mantri Ujjwala Yojana scheme. India also has initiatives related to suicide, including the National Mental Health Policy and the Protection of Women from Domestic Violence Act. The government has planned the establishment of 150 000 health and wellness centres across India to provide comprehensive primary health-care services that would help to deal with NCDs and injuries along with communicable diseases, as part of Ayushman Bharat. Deliberations on operationalising this effort, led by the Government of India and involving the key decision makers from all states and a range of other stakeholders, point to the acute interest of the government in strengthening prevention and management of the full range of diseases and risk factors in each state. The Government of India is keen to use the latest available evidence to maximise the impact of Ayushman Bharat. In relation to this opportunity, we summarise the key policy implications of the findings of the India StateLevel Disease Burden Initiative. One striking finding is that the age-standardised increase in the prevalence of ischaemic heart disease and diabetes, as well as their DALYs, has generally been highest in the less developed states of India, where the burden of another major NCD, chronic obstructive pulmonary disease (COPD), and communicable diseases is already high. Among the major risk factors for ischaemic heart disease, stroke, and diabetes, the prevalence of high blood pressure, high cholesterol, high fasting plasma glucose, and overweight has increased in all parts of India. The high exposure to ambient and household air pollution in the less developed northern states is contributing to the high burden of COPD in these states, in which the case-fatality rate of COPD is twice as high as in the more developed states. Additionally, ageing of the population is adding to the increasing burden of NCDs. These findings emphasise the need for the prevention and management of major NCDs to receive as much policy attention in these states as the reduction of the still high burden of communicable and childhood diseases. Published Online September 12, 2018 http://dx.doi.org/10.1016/ S0140-6736(18)32172-X