Context

• In September 2024, the World Bank released a report titled Unlocking the Power of Healthy Longevity: Demographic Change, Non-communicable Diseases, and Human Capital.
• The report shed light on a pressing issue: the impact of demographic shifts and the rise of non-communicable diseases (NCDs) on global health.
• The report also underscores the profound transformations underway, particularly in low- and middle-income countries (LMICs), where the aging population faces escalating health challenges.
• It becomes imperative to explore the main insights from the report, examining the feasibility of the proposed Healthy Longevity Initiative (HLI) in India and the broader socio-economic and healthcare challenges tied to NCDs.

 The Rising Burden of NCDs in LMICs and Implications for Human Capital

• The demographic transition in LMICs reflects a rapidly aging population, which presents new health and economic challenges.
• According to the World Bank, projections indicate that global deaths could rise from 61 million in 2023 to 92 million by 2050, primarily due to NCDs.
• This rise in mortality also entails increased demand for hospitalisations, long-term care, and treatment resources, putting pressure on already strained healthcare systems.
• For LMICs, including India, this health burden hinders development goals and economic stability, as avoidable deaths and disabilities drain human capital and financial resources.
• If these countries can achieve feasible progress rates in health policies, the World Bank estimates that around 25 million annual deaths could be avoided by 2050, meeting the related Sustainable Development Goals (SDGs).
• In response, the World Bank’s report advocates a HLI, emphasising a life-course approach to minimise avoidable mortality and serious disability, thereby enabling individuals to maintain physical, mental, and social well-being into older age.

India’s Aging Population and the Growing NCD Crisis: Causes and Consequences

• The Growing NCD Crisis
  • India is witnessing an unprecedented demographic shift characterised by rapid aging.
  • With approximately 140 million individuals aged 60 and above, India now has the second-largest elderly population globally, second only to China.
  • Projections indicate that this population segment will continue to grow rapidly, with its annual growth rate nearly three times that of the general population.
  • This demographic shift is accompanied by a steep rise in the prevalence of NCDs like cardiovascular diseases, cancer, chronic respiratory illnesses, and diabetes.
  • These conditions have already become the leading causes of death and disability, presenting a multifaceted challenge to India’s healthcare system, economy, and social structures.
• Lifestyle and Environmental Factors Driving the NCD Crisis
  • A major contributor to the rising incidence of NCDs in India is the significant shift in lifestyle and environmental factors.
  • Rapid urbanisation, economic growth, and changing dietary habits have led to increased consumption of calorie-dense, processed foods high in refined sugars and saturated fats.
  • These dietary changes are associated with a higher risk of developing conditions such as cardiovascular diseases, diabetes, and obesity, all of which are primary NCDs affecting India’s elderly.
  • Moreover, a sedentary lifestyle, exacerbated by modern urban living, has contributed to the rise of obesity and related health conditions among both younger and older generations.
  • Limited access to recreational spaces and a culture that prioritises sedentary work, especially in urban settings, further limits physical activity levels among the population.
• Health and Socio-Economic Consequences of an Aging Population
  • As people live longer, they become more susceptible to NCDs, which require sustained medical attention, ongoing treatments, and, often, expensive interventions.
  • The surge in NCDs among India’s elderly population results not only in rising mortality rates but also in increased disability, impacting individuals' ability to work and contribute economically.
  • This demographic health shift places immense pressure on family resources, especially in a country where healthcare expenses are often borne by families due to limited public health funding and insurance coverage.
  • Families of elderly individuals with chronic NCDs may face severe financial hardship, potentially leading to impoverishment, indebtedness, and reduced household consumption as resources are diverted toward medical care.
  • The economic repercussions of this growing NCD crisis are far-reaching. The increased burden of NCDs could lower national productivity, as more people become unable to participate in the workforce due to illness.

Evaluating Social Security and Health Policies

• Evaluation of Social Security Schemes
  • In India, social security schemes could play a crucial role in managing the NCD burden among vulnerable populations.
  • For instance, it is crucial to examine whether participation in social security programs reduces the prevalence of two prominent NCDs: diabetes and heart disease.
  • Findings indicate that even modest pension benefits help elderly people afford healthcare expenses, thereby reducing NCD risks.
  • However, challenges remain: travel costs, hospital fees, and high-priced medications impose financial strain, often leading to debt and impoverishment.
  • Health insurance, while beneficial, remains underutilised due to limited public awareness, bureaucratic hurdles, and delays in claim processing.
• Ayushman Bharat Scheme: Impact and Limitations
  • The Ayushman Bharat Scheme, introduced to provide health insurance to the most vulnerable 40% of households, illustrates the potential of social security but also its limitations.
  • While the scheme offers essential coverage, it is undermined by corruption and inefficiencies, as noted by the Comptroller and Auditor General of India (CAG) in 2023.
  • Issues include the ineligibility of beneficiaries, delays in hospital registration, improper procedures, and lack of proper documentation.
  • Such systemic flaws reveal that insurance alone is insufficient without improvements in healthcare infrastructure, workforce availability, and healthcare delivery.

Policy Recommendations and Behavioural Interventions to Address NCD Crisis

• Promoting Behavioural Changes
  • Addressing India’s NCD crisis requires policy reforms and individual lifestyle changes.
  • The Supreme Court’s recent mandate to regulate healthcare costs highlights the importance of making healthcare affordable.
  • Yet, as observed, price regulation requires robust enforcement to ensure compliance.
  • Furthermore, promoting behavioural changes, such as increasing physical activity and adopting balanced diets, is crucial to managing obesity and, consequently, reducing risks of cardiovascular diseases and diabetes.
• Taxation on Unhealthy Products
  • Policy measures, such as taxation on unhealthy products, could help address the root causes of NCDs and reduce multi-morbidity prevalence.
  • Tobacco consumption remains a significant health threat, particularly in India, where smoking is prevalent.
  • Policies aimed at reducing tobacco use, combined with public health campaigns, could mitigate the incidence of respiratory and cardiovascular conditions.
  • Although these interventions are challenging to implement, they are necessary for long-term health improvement.

Conclusion

• The World Bank’s 2024 report presents a vital perspective on the urgent need to address the growing burden of NCDs and demographic changes in LMICs.
• While the Healthy Longevity Initiative offers a visionary approach, the realities in countries like India reveal substantial barriers to achieving this ideal.
• India’s rapidly aging population, compounded by the prevalence of NCDs, demands targeted interventions in healthcare policy, social security programs, and individual behaviours.