In recent time, transformation in the standard of living, advancement of technology and awareness, changing nature of environment has led to a situation where people are getting less affected by the Communicable Diseases and more by the Non – Communicable ones. The effect of such changing pattern also differs among the high, middle and low-income countries.


Let’s have a look how the pattern of diseases is changing across the globe.

Concept of Different Types of Diseases and Country Income Groups

  • Communicable Disease (CD)

These diseases are spread either by direct contact of the affected individual / indirect sources (Airborne microorganisms, e.g. bacteria, viruses; bite from insects; or contaminated food or water).

  • Non-Communicable Disease (NCD)

These diseases are non-infectious but last for long duration. Affected patients require proper care as these diseases do not resolve quickly. In many cases, absolute remedy is not achieved.

  • DALY (Disability-Adjusted Life Year)

DALY is a measure of overall disease burden, expressed as the number of years lost due to ill-health, disability or early death.

  • Low Income Countries – The GNI Per Capita lies below US$ 1005 per fiscal year.
  • Middle Income Countries – The GNI Per Capita lies between US$ 1006 to US$ 12,235 in a fiscal year.
  • High Income Countries –GNI Per Capita is greater than US$ 12,235 per fiscal year.

Research Methodology


  • To understand the relation between the disease profile of a country with its income level.


  • The hypothesis set is with the rising income level of a country the disease burden is seen to shift from communicable diseases to non-communicable diseases.


  • We have highlighted the changing connection between the income level and the disease burden over a time period of 20 years (1998 – 2017).
  • The set hypothesis was tested with the help of data analyse. Countries were divided into 3 income groups based on their Per Capita GDP. The data for the DALYs of the income groups were collected and segregated into communicable and non-communicable diseases buckets.
  • To test the hypothesis graphically, the Per Capita Income (US$) was plotted in X-axis and in the Y–axis the DALY of Diseases (Actual Number) were plotted. These scatter plots were done for each income group considering two disease buckets respectively. In case of each disease bucket, two time periods were considered; 1998 and 2017 to highlight the changing relationship of disease burden with rising income levels.
  • The bit fit lines (trendline) in the scatter plots were studied in each case to arrive at a conclusion that whether the disease burden (communicable or non-communicable) has reduced or increased overtime with rising income.

How to Read Scatter Plots

  • An upward sloping trendline from the origin shows the positive relation between income level and disease burden of a country group in a given year. A downward sloping line establishes a negative relation between the two indicators.
  • While comparing trendlines of two time periods, a flatter line in a later year would indicate lesser number of people getting affected with the said disease in the later year.

High Income Countries

I. Burden of Communicable Diseases (CDs) in (1998-2017)

  • A flatter trendline in 2017 compared to 1998 explains a situation of falling DALY of the CDs.
  • In 1998, 6 % of people in this country group used to get infected by Communicable Diseases which decreased to 1.2 % in 2017.
  • The communicable diseases like HIV/AIDS, Respiratory Infections, Nutritional deficiencies, problems related to Maternal and Neonatal conditions effect the people a lot in these countries.
  • Due to several initiatives towards hygiene, proper sanitation & waste management system the diseases have been controlled over the years.

II. Burden of Non-Communicable Diseases (NCDs) in (1998-2017)

  • A slight downward movement of the trendline in 2017 compared to 1998 again shows the fall in numbers of DALY for NCDs in these countries.
  • The percentage of the affected individuals from these countries fell from 8% to 21.6% over the 20 years.
  • Presence of the NCDS like Cancer, Cardiovascular Diseases, Diabetes, Obesity, Mental disorders are quite high here.
  • After adopting several policies of World Health Organizations (WHO) for controlling the NCDs, the numbers of DALY have been minimized.

Middle Income Countries

I. Burden of Communicable Diseases (CDs) in (1998-2017)

  • A much flatter trendline in 2017 after the time span of 20 years again shows fall in the numbers of DALY.
  • The DALY of CDs was 17% among these countries’ mass in 1998 which fell to 8% in 2017.
  • Many nations of this income group are currently on the way towards the economic advancement. Rise in GDP influences the spending in healthcare sector.
  • Sometimes diseases like Tuberculosis, Diarrhoea, Measles, Poor Neonatal conditions, Nutritional deficiencies effect the people critically. Upgradation of overall hygiene maintenance is highly required for controlling such situations.

II. Burden of Non-Communicable Diseases (NCDs) in (1998-2017)

  • In case of NCDs, the DALY was 8% of the middle-income nations’ population in 1998 which declined to 19.5% in 2017. A glimpse of that fall is visible in the slightly downward trendline of 2017.
  • Despite of the reduction, NCDs like Cancer, Diabetes, Mental & Digestive disorders, Neurological, Cardiovascular & Musculoskeletal diseases, have spread vastly over the years.
  • The high earning group of these countries try to follow the policies of WHO to reduce the NCDs but more awareness is required to reduce these chronic diseases effectively.

Low Income Countries

I. Burden of Communicable Diseases (CDs) in (1998-2017)

  • Communicable diseases are one of the pivotal reasons for mortality in the low-income countries.
  • Outbreak of the diseases like HIV, Diarrhoeal diseases, Malaria, Respiratory infections, Neonatal conditions, Nutritional Deficiencies sometimes becomes inescapable in these countries.
  • Still, after years, the lesser portion of the population are seemed to get effected by CDs. In 1998, the share of DALY of CDs was 5% of these countries’ population which collapsed to 25.4% in 2017. A Flatter trendline in 2016 compared to 1998 is the reflection of that.

II. Burden of Non-Communicable Diseases (NCDs) in (1998-2017)

  • Surprisingly, NCDs have grown tremendously in the low-income countries over the last 20 years. A much steeper trendline in 2017 compared to 1998 shows a significant hike in the proportion of DALY.
  • It was initially believed that high income counties are prone to such diseases but death rates have risen massively here at alarming rate due to the NCDs like Cancer, Blood & immune disorders, Mental, depressive & digestive disorder, Neurological, Cardiovascular & Oral Diseases, Respiratory infections
  • Adoption of unhygienic food habits, extreme tobacco and alcohol use etc. are major reasons behind such rapid growth of NCDs these places.

Result Summary

  • In the high income, incidence of both the communicable and non-communicable diseases have fallen over the last 20 years.
  • The middle-income countries have been able to control both the communicable and non-communicable diseases over the last 20 years, but the incidence of non-communicable diseases has increased among the population.
  • Communicable diseases have reduced but the non-communicable ones have risen drastically in low income countries in the last 20 years.
  • Transformation in the standard of living, advancement of technology, changing nature of environment has led to a situation where people are getting less affected by the communicable diseases and more by the non – communicable ones.
  • While low and middle-income group countries are typically characterized by a high burden of communicable diseases, the trend appears to be changing. By 2030, NCDs are expected to account for nearly 55% of the disease burden of these country groups. A growing middle – aged population increases the risk of NCDs in the low and middle-income country groups, especially in Asia, Africa, and parts of Latin America.
  • Growth in burden of NCDs—diabetes and cardiovascular diseases—not only calls for greater healthcare infrastructure and a larger healthcare workforce but also adequate preventive care.
  • The initiatives of the government to develop eHealth in some countries open up avenues for investment in areas, such as tele-medicine, healthcare platforms and application software, and electronic health records.

Case Study – India

  • In the last 20 years with rising per capita income the DALY of communicable diseases have gone down significantly and that of non-communicable diseases rose at an increasing rate.
  • India has the gigantic share of DALY from both types of CDs and NCDs among the middle-income countries. In case of CDs, the share of that DALY was 39% in 1998 and 34% in 2017. For NCDs, it grew from 22% to 24% between 1998 and 2017.
  • Between 1998 to 2017, the CDs have reduced at a CAGR of 3.30% and NCDs have increased at CAGR of 1.68%.
  • The number of deaths from Lung & Heart Diseases, Low Birth Weight, Oral Cancer, Rheumatoid Arthritis, Dengue are highest here across the globe.


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