In the National Health Policy (NHP), 2017, little has been said about the rapid rise in the share of the old — i.e. 60 years or more — and associated morbidities, especially sharply rising non-communicable diseases (NCDs) and disabilities.
This is a glaring omission, in the context of declining family support and severely limited old-age income security, increasing number of destitute.
What are the major challenges?
The neglect and failure to anticipate the demographic and epidemiological shifts from infectious diseases to NCDs, there may be more costly policy challenges.
An estimate provided for the 2014 World Economic Forum suggests that NCDs may cost as much as $4.3 trillion in productivity losses and health-care expenditure between 2012 and 2030, twice India’s annual GDP.
Detailed projections of the old in India by the United Nations Population Division (UN 2011) show that India’s population, ages 60 and older, will climb from 8% in 2010 to 19% in 2050. By mid-century, their number is expected to be 323 million.
How will the population dynamics affect?
A rapidly changing age structure reflects the combined impact of increasing life expectancy and declining fertility.
Even as the life expectancy at birth in India climbed from 37 years in 1950 to 65 years in 2011.
There are serious doubts whether longer lives are translated into healthier lives.
What the evidence from IHDS show?
Analysis, based on the India Human Development Survey (IHDS) 2015, the only nation-wide panel survey covering the period 2005-2012, throws new light on these issues.
The prevalence of high blood pressure among the old almost doubled over the period 2005-12; that of heart disease rose 1.7 times; the prevalence of cancer rose 1.2 times; that of diabetes more than doubled, as also that of asthma; other NCDs rose more rapidly (i.e. by two and a half times).
Often multi-morbidities (i.e. co-occurrence of two or more NCDs) occur non-randomly or systematically. The prevalence of high blood pressure and heart disease rose more than twice while that of high blood pressure and diabetes nearly doubled.
It is asserted that the burden of NCDs is increasingly borne by less affluent sections of the population.
As NCDs are associated with a large majority of deaths among the old, they are now more vulnerable to mortality risk.
How to assess disability?
Disability is the umbrella term for impairments, activity limitations and participation restrictions.
An assessment of functioning in activities of daily living (ADLs) is one method widely used to assess disability in older persons.
The activities of feeding, dressing, bathing or showering, walking 1 km, hearing, transferring from bed and chair, normal vision, and continence are central to self-care and are called basic ADLs.
The IHDS provides data on seven disabilities defined in this manner.
What is the way forward?
By age 60, the major burdens of disability and death arise from age-related losses in hearing, seeing or moving, and NCDs (WHO, 2015). Thus co-occurrence of disability and NCDs poses a higher risk of mortality.
Along with expansion of old age pension and health insurance, careful attention must be given to reorient health systems to accommodate the needs of chronic disease prevention.
Enhancing the skills of health-care providers and equipping health-care facilities to provide services related to health promotion, risk detection, and risk reduction.
