India’s Rural Deaths: A Problem Unnoticed
An ASAR Data Story
By ASAR Blogs Team
Calculations & Visualizations
Pratik Gavhane & Jatin Terde
Ideation
Siddhesh Zadey
Drafting
Siddhesh Zadey & Madhav Bansal
Review & Editing
Madhav Bansal & Surabhi Dharmadhikari
Did you ever think that your health, among other things, is dependent on the place where you live? If not, you are in for a surprise! Place-health relationships are an upcoming research area in epidemiology and other health sciences. In fact, for the last 25 years, there have been several research journals dedicated to the topic including ‘Places & Health’ and ‘Geospatial Health’ among others. Place of residence can be an important determinant of health for many reasons. For example: depending on where you live, you could be closer or farther from a healthcare facility, you could be more or less exposed to certain toxins and environmental polluters, or you could have many or few financial and educational resources to seek healthcare. Hence, place-health relationships are important to understand health differences and disparities (unfair differences).
The disparity in death rates between rural and urban populations continues even after seven decades of independence. In India, an important source of health differences and disparities is whether you live in rural vs. urban areas. The well-known example is - infant mortality rate or IMR i.e. number of children that die within the first year after their birth out of 1000 children born during a year in a given place. Urban India had an IMR of 20 in 2019, compared to 34 for rural India. Put otherwise, 14 more infants die in rural areas than urban areas for every 1000 infants. This is a clear disparity! Some of the country's children are dying merely because of where they were born. But what about adults?
In this ASAR Data Story, we will bring out mortality differences between rural and urban India.
1. Are rural people dying more than urban people?
For the population of 1.3 billion in India, the death rate was 7.21 in 2017, i.e. seven people died out of every 1000 people. But what happens when we split this data by rural vs. urban regions? We see that the death rate is higher in rural areas than urban areas in India. When looking at rates, the difference of 2 deaths in 1000 people might seem small. But India’s rural population is over two-thirds of its total population. Two extra rural deaths compared to every death in urban India, translates to 4,858,383 more rural deaths in absolute terms!
Figure 1 - https://www.datawrapper.de/_/eQmOg/
2. Which age and sex groups are suffering these deaths more?
Looking at intersectionality is crucial. When it comes to death rates in rural vs. urban India, there are visible variations across different sexes (males and females) and age groups. In general, mortality rates are higher among males than females for rural and urban areas. However, the gaps fluctuate across different ages. If we look across ages, there is a common trend: the death rates are somewhat high for the first four years of life (quite typical of places where newborn care is not great) then plummet sharply for the remaining childhood and further rise steadily throughout the adult life due to aging and other factors. However, once we dive into the details and start looking at specific age groups a more nuanced picture appears. Rural-dwelling children regardless of sex have greater mortality than their urban counterparts, pointing to rural-urban disparity. In the 30-49 years age group, the death rate is much higher among rural males followed by urban males, rural females and urban females. However, these gaps among the groups vary and rural female and urban males in several cases have similar death rates. Due to many reasons, from biological to societal factors, the gaps are pronounced among adults during their productive life-years - 15 to 59 years and become narrow towards the end of life.
Figure 2 - https://www.datawrapper.de/_/z3RyR/
3. Which are the main killers in rural vs. urban India?
Rural areas have a considerable number of killers - or - causes of death. Deaths due to ill-defined causes followed by ischemic heart disease (heart attacks) and chronic respiratory problems, stroke and diarrhea dominate rural deaths. This shows that the noncommunicable diseases (NCDs) which were thought to affect those in urban areas are now creeping into our villages that remain largely unprepared to tackle them.
Figure 3 - https://www.datawrapper.de/_/tJtIg/
We looked at the top 15 causes for rural and urban areas and found that their lists share 13 causes. Of these top 13 killers, rural death rates are higher than urban rates in all cases except three (heart disease, renal failure, and diabetes & other endocrine diseases). The rural-urban death rate gaps are more than double for ill-defined causes, chronic respiratory conditions, diarrhea, perinatal (close to birth) causes, and tuberculosis. These rural-urban gaps in deaths due to different causes are due to complex reasons ranging from differences in disease prevalence, access to healthcare, health awareness, etc. However, the disparity is evident.
Figure 4 - https://www.datawrapper.de/_/Ee9xj/
We've all heard our grandparents tell us that people in the village are resilient when it comes to facing health catastrophes and that it's the urban population that suffers in the long run as a result of being exposed to all of life's contemporary conveniences. However, new data is changing that narrative! In this ASAR Data Story, we wanted to demonstrate that change. People living in rural areas are at a major disadvantage when it comes to health and healthcare and this is evidenced by more deaths. We need to talk about rural-urban disparities more. India is still largely rural and if rural people die, then India dies.