The average Indian male born in the 1990s can expect to live 58.5 years women can expect to live only slightly longer (59.6 years), according to 1995 estimates. Life expectancy has risen dramatically throughout the century from a scant twenty years in the 1911-20 period. Although men enjoyed a slightly longer life expectancy throughout the first part of the twentieth century, by 1990 women had slightly surpassed men. The death rate declined from 48.6 per 1,000 in the 1910-20 period to fifteen per 1,000 in the 1970s, and improved thereafter, reaching ten per 1,000 by 1990, a rate that held steady through the mid-1990s. India's high infant mortality rate was estimated to exceed 76 per 1,000 live births in 1995 (see table 7, Appendix). Thirty percent of infants had low birth weights, and the death rate for children aged one to four years was around ten per 1,000 of the population.

According to a 1989 National Nutrition Monitoring Bureau report, less than 15 percent of the population was adequately nourished, although 96 percent received an adequate number of calories per day. In 1986 daily average intake was 2,238 calories as compared with 2,630 calories in China. According to UN findings, caloric intake per day in India had fallen slightly to 2,229 in 1989, lending credence to the concerns of some experts who claimed that annual nutritional standards statistics cannot be relied on to show whether poverty is actually being reduced. Instead, such studies may actually pick up short-term amelioration of poverty as the result of a period of good crops rather than a long-term trend.

Official Indian estimates of the poverty level are based on a person's income and corresponding access to minimum nutritional needs (see Growth since 1980, ch. 6). There were 332 million people at or below the poverty level in FY 1991, most of whom lived in rural areas.

Communicable and Noncommunicable Diseases

A number of endemic communicable diseases present a serious public health hazard in India. Over the years, the government has set up a variety of national programs aimed at controlling or eradicating these diseases, including the National Malaria Eradication Programme and the National Filaria Control Programme. Other initiatives seek to limit the incidence of respiratory infections, cholera, diarrheal diseases, trachoma, goiter, and sexually transmitted diseases.

Smallpox, formerly a significant source of mortality, was eradicated as part of the worldwide effort to eliminate that disease. India was declared smallpox-free in 1975. Malaria remains a serious health hazard although the incidence of the disease declined sharply in the postindependence period, India remains one of the most heavily malarial countries in the world. Only the Himalaya region above 1,500 meters is spared. In 1965 government sources registered only 150,000 cases, a notable drop from the 75 million cases in the early postindependence years. This success was short-lived, however, as the malarial parasites became increasingly resistant to the insecticides and drugs used to combat the diseas 1538 se. By the mid-1970s, there were nearly 6.5 million cases on record. The situation again improved because of more conscientious efforts by 1982 the number of cases had fallen by roughly two-thirds. This downward trend continued, and in 1987 slightly fewer than 1.7 million cases of malaria were reported.

In the early 1990s, about 389 million people were at risk of infection from filaria parasites 19 million showed symptoms of filariasis, and 25 million were deemed to be hosts to the parasites. Efforts at control, under the National Filaria Control Programme, which was established in 1955, have focused on eliminating the filaria larvae in urban locales, and by the early 1990s there were more than 200 filaria control units in operation.

Leprosy, a major public health and social problem, is endemic, with all the states and union territories reporting cases. However, the prevalence of the disease varies. About 3 million leprosy cases are estimated to exist nationally, of which 15 to 20 percent are infectious. The National Leprosy Control Programme was started in 1955, but it only received high priority after 1980. In FY 1982, it was redesignated as the National Leprosy Eradication Programme. Its goal was to achieve eradication of the disease by 2000. To that end, 758 leprosy control units, 900 urban leprosy centers, 291 temporary hospitalization wards, 285 district leprosy units, and some 6,000 lower-level centers had been established by March 1990. By March 1992, nearly 1.7 million patients were receiving regular multidrug treatment, which is more effective than the standard single drug therapy (Dapsone monotherapy).

India is subject to outbreaks of various diseases. Among them is pneumonic plague, an episode of which spread quickly throughout India in 1994 killing hundreds before being brought under control. Tuberculosis, trachoma, and goiter are endemic. In the early 1980s, there were an estimated 10 million cases of tuberculosis, of which about 25 percent were infectious. During 1991 nearly 1.6 million new tuberculosis cases were detected. The functions of the Trachoma Control Programme, which started in 1968, have been subsumed by the National Programme for the Control of Blindness. Approximately 45 million Indians are vision-impaired roughly 12 million are blind. The incidence of goiter is dominant throughout the sub-Himalayan states from Jammu and Kashmir to the northeast. There are some 170 million people who are exposed to iodine deficiency disorders. Starting in the late 1980s, the central government began a salt iodinization program for all edible salt, and by 1991 record production--2.5 million tons--of iodized salt had been achieved. There are as well anemias related to poor nutrition, a variety of diseases caused by vitamin and mineral deficiencies--beriberi, scurvy, osteomalacia, and rickets--and a high incidence of parasitic infection.

Diarrheal diseases, the primary cause of early childhood mortality, are linked to inadequate sewage disposal and lack of safe drinking water. Roughly 50 percent of all illness is attributed to poor sanitation in rural areas, about 80 percent of all children are infected by parasitic worms. Estimates in the early 1980s suggested that although more than 80 percent of the urban population had access to reasonably safe water, fewer than 5 percent of rural dwellers did. Waterborne sewage systems were woefully overburdened only around 30 percent of urban populations had adequate sewage disposal, but scarcely any populations outside cities did. In 1990, according to United States sources, only 3 percent of the rural population and 44 percent of the urban population had access to sanitation services, a level relatively low by developing nation standards. There were better findings for access to potable water: 69 percent in the rural areas and 86 percent in urban areas, relatively high percentages by developing nation standards. In the mid-1990s, about 1 million people die each year of diseases associated with diarrhea.

India has an estimated 1.5 million to 2 million cases of cancer, with 500,000 new cases added each year. Annual deaths from cancer total around 300,000. The most common malignancies are cancer of the oral cavity (mostly relating to tobacco use and pan chewing--about 35 percent of all cases), cervix, and breast. Cardiovascular diseases are a major health problem men and women suffer from them in almost equal numbers (14 million versus 13 million in FY 1990).

Data as of September 1995