The Indian health system must orient its resources and policy outlook towards challenges posed by cardiovascular disease, cancers and respiratory illnesses. While a multitude of priorities need focus, the challenge from ageing presents a social, moral and health obligation towards the elderly
India has been recognised as a country of the future. Our growing economy, geo-political and cultural influence, companies that are creating a global impact and the demographic advantages of a youthful population all auger well for us to take our rightful place as an emerging 21st century superpower. While the importance of the young and their contribution to advancing societies and economies is well documented. India always presents unique challenges that need unique Indian solutions.
As per World Health Organisation’s world health statistics report, life expectancy in India has increased by more than 10 years in the past two decades with children born in 2015 expected to live till 71.4 years on an average. Average life expectancy today stands at a healthy 68.3 years, driven by years of economic progress and better socio-economic and health indices.
Concurrently, this welcome increase in longevity has meant that while the median age of India is around 29 years, the number of people over the age of 60 has risen multifold. Data released by the Ministry of Statistics and Programme Implementation show the number of Indians over the age of 60 years has hit 8.6 per cent, ie, 10.39 crore of the country’s 122 crore population. This marks a 35.5 per cent increase since 2001 with the highest share of ageing population being found in Kerala, Goa, Tamil Nadu, Punjab and Himachal Pradesh.
This trend is in line with global cues, the Global Burden of Disease (GBD) 2015 study reveals that globally, life expectancy increased from 61.7 years in 1980 to 71.8 years in 2015. However, this increase in life expectancy and the rise in the number of elderly have also meant an increase in the number of non-communicable and age-related illnesses. The GBD study indicates that annual, global mortality estimates from 1990-2015 saw a decrease in global deaths from communicable, maternal, neonatal and nutritional diseases (20.2 per cent) and a rising incidence of death from non communicable disease (NCD) (71.3 per cent). Of all NCD related deaths cardiovascular disease (with 17.7 million deaths), cancers (8.8 million) and chronic respiratory diseases (3.9 million) were the biggest contributors. An ageing population has implications on all three as changing demographics and increased incidence indicates. While ageing by no means can be seen as a singular contributor or causal agent for increased NCD deaths, its contribution to this disease cohort is rising.
A July editorial of the lancet Public Health journal highlights the challenges that ageing is putting on the British health system. A study published in the journal predicts that due to ageing population, “physical and mental morbidities, and, therefore, care needs will grow by 25 per cent within a decade in England and Wales”. Further, the study predicts that the number of people living with disability will rise from 2.25 million in 2015 to 2.81 million in 2025 and that, “over the next decade, life expectancy at 65 years is projected to increase by 1·7 years, 0.7 of these years will be lived with disability; life expectancy with disability will grow more in relative terms (about 15 per cent increase from 2015).” Challenges that ageing poses includes mortality, morbidity with impact on disability adjusted life years and health adjusted life expectancy globally.
The clear link between ageing and NCD’s has been witnessed in the rise of Alzheimer’s and age related dementia world over. It is estimated that global deaths due to Alzheimer’s disease and other forms of dementias increased by 38.2 per cent to 1.9 million deaths which was ‘largely driven by population ageing’. Further, the GBD study highlights that, “shifts in population age structures also accounted for more than 23 per cent of increased mortality due to cardiovascular disease, 24·2 per cent for chronic obstructive pulmonary disease and at least 20 per cent for several types of cancer”. Therefore, ageing as a contributor to NCD mortality is an increasing challenge for the world.
For India, the challenge posed by cardiovascular disease, cancers and respiratory illnesses has been well documented. However, the burden and impact of Alzheimer’s and dementia has been less discussed. The World Alzheimer’s Report 2015 predicts that worldwide cost of dementia is $818 billion and that it will become a trillion dollar disease by 2018. The burden of this disease will be felt the most by low-middle income countries. In 2015, 58 per cent of all people with dementia lived in low and middle-income countries, which is predicted to rise to 63 per cent in 2030 and 68 per cent in 2050. Around 49 per cent of all new cases of dementia have been reported from Asia, a region that the report recognises as having “fewer economic and human professional resources to meet the health and social care needs of their rapidly growing older populations.”
The Indian health system would need to orient its resources and policy outlook towards this emerging challenge. While a multitude of priorities need focus, the challenge from ageing present a social, moral and health obligation towards the elderly. First, the need to better diagnose and management for the elderly needs to be ramped up. Education, awareness and skills need to be imparted to care givers and relatives. Second, an urban health workforce on the lines of accredited social health activists workers that conducts surveillance, diagnosis and manages continuity of care in the home setting needs to be created. Third, medical curriculum must include geriatric care as a sub-specialty with formal post-graduate courses being introduced. Fourth, all hospital must start geriatric and chronic care services for patients. Fifth, health insurance companies need to design insurance schemes that can help finance or co-pay the health needs of the elderly population. Finally, a robust push to increase research on Alzheimer’s and dementia is needed to help ensure that our elderly live with dignity.
(The writer is general manager, Operation and Public Affairs, Indraprastha Apollo Hospitals)