Applying epidemiological transition theory to health and disease transformation in high altitude cold desert Ladakh, India

As we enter the new millennium, the Epidemiologic Transition Theory (ETT) provides insights into health, mortality, and fertility changes, shaped by environmental, socioeconomic, lifestyle, and technological factors across societies. The study examines how disease patterns in Ladakh have shifted from infectious diseases to chronic, non-communicable diseases by applying Omran’s Epidemiological Transition Theory (ETT) using historical records, hospital, and household survey data. Ladakh, a high-altitude cold desert, presents a distinct case due to its isolation, environmental challenges, and rapid socio-economic changes. The transition from infectious to chronic non-communicable diseases (NCDs) is traced through historical and contemporary data from Ladakh spanning over a century and a half (1867, 2000–01, and 2020–21). In the late 19th century, Ladakh was in the “Age of Pestilence and Famine,” dominated by infectious diseases like dysentery and fevers. The transition towards the “Age of Receding Pandemics” began around the early 2000s, marked by infectious diseases such as respiratory tract infections and acute diarrhoeal diseases, alongside a rise in NCDs like hypertension, influenced by improvements in healthcare, socioeconomic conditions, and urbanisation. By 2020, Ladakh had reached the “Age of Degenerative and Man-Made Diseases,” where NCDs, including hypertension, diabetes, and cardiovascular diseases, coexist with infectious diseases. The study reveals a dual burden of disease in Ladakh, shaped by lifestyle changes, urbanisation, and tourism, which has driven health transitions. Significant improvements in health indicators, such as reduced infant and maternal mortality rates, indicate progress, yet challenges persist, particularly in addressing NCDs and healthcare access disparities.