| During the period 1947-70, mortality fell considerably, due to reductions in several major communicable diseases and the absence of major famines. However, many infant and childhood diseases remained very prevalent, tuberculosis contributed to high levels of adult morbidity (and significant mortality), and malaria began to re-emerge after an initial period when it seemed to have been brought under control.Mortality continued to improve fairly steadily during the last three decades of the twentieth century. Both the crude death rate and the infant mortality rate almost halved, the former falling from 16 to less than 9 per thousand, and the latter from 134 to about 70. Life expectation rose from 50 to 62 years. This period saw considerable progress against communicable diseases such as gastro-enteritis, dysentery, tetanus, polio and leprosy. But regional differentials in mortality remained, mortality and health conditions generally being more favourable in the south than the north. Contamination of water supplies, inadequate management of liquid and solid wastes, and the high levels of crowding typical of urban slums contributed to the maintenance of infections in the general population, though urban mortality remained lower than rural. The resurgence of malaria, the spread of drug-resistant forms of tuberculosis, and the menacing rise of HIV/AIDS from the mid-1980s (a development which has probably contributed to the resurgence of tuberculosis) all serve to illustrate just how important infectious diseases remain in the country's mortality and health profile. Indeed, although there has been a marked shift towards greater prominence of non-communicable diseases (e.g. cancers and circulatory ailments) in the country's overall pattern of cause of death, at the start of the twenty-first century India suffers from a 'double burden' of communicable and non-communicable diseases. Widespread nutritional and reproductive health problems, reflecting conditions of great poverty, coexist with lifestyle-induced illnesses linked to the adoption of new patterns of behaviour. These include reduced levels of physical activity and more obesity among the better-off in urban areas, and greater consumption of tobacco. Respiratory ailments remain prominent and stubbornly high, in part because of increased levels of atmospheric pollution. 
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