Increasing old age population of India

Context:

Life expectancy in India on the rise, but the quality of health care services is inadequate

Introduction:

• There is a rapid rise in the share of the old age people in India’s population
• Life expectancy in India has increased by more than 10 years in the past two decades, while globally children born in 2015 were expected on an average to live till 71.4 years, a new UN report revealed.
• According to the Post Graduate Institute of Medical Education and Research (PGI) doctors, at present the elderly or senior citizens comprise nearly 8 per cent of the country’s population and India is currently in the category of a graying country which is likely to increase to 4 per cent by 2025.
• In 2015, life expectancy at birth was 68.3 years in India which breaks down to 66.9 years for men and 69.9 for women, the WHO’s World Statistics Report 2016 found.
• In 1990, Indians were expected to live on an average till 58 years. This rose to 66 years in 2013.

What is the present status of old age people in India?

• Although India will be the youngest country in the world by 2020 with a median age of 29 years, the number of elderly people is likely to increase significantly after that, according to the 2014 State of Elderly in India report released by the non-profit organization.
• By 2021, the elderly in the country will number 143 million.
•  Presently, the elderly in divided into three categories: the young old (60-70) the middle-aged old (70-80) and the oldest old (80 plus).
• The increase in life expectancy over the years has resulted in an increase in the population of the elderly. While the overall population of India will grow by 40% between 2006 and 2050, the population of those aged 60 and above will increase by 270%.
• Out of this, the oldest old segment, which is the most vulnerable on account of suffering from disabilities, diseases, terminal illness and dementia, is also the largest growing segment of the elderly population, at a rate of 500%.
• The increasing population of the elderly is “a development concern that warrants priority attention for economic and social policies to become senior citizen-friendly”.

What are the problems associated with increasing life expectancy?

• There is a 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.
• Though life expectancy is increasing, but also the rate of chronic disease is increasing in older community.
• The findings of Indian Human Development Survey(IHDS) pointed out the following figures:

• 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).
• Multi-morbiditiese., co-occurrence of two or more Non-Communicable Disease (NCDs) rose recently for like two and a half times
• The prevalence of high blood pressure and heart disease rose more than twice while that of high blood pressure and diabetes nearly doubled.

Global comparison:

The WHO’s World Health Statistics, annual publication since 2005 containing data from 194 countries reporting on the status of health of the world’s people depicts the following picture:

• India has now moved considerably in the epidemiological transition or health transition where non-communicable diseases now have also become a very important cause of death,”
• India is presented as country with particular challenges with maternal mortality and infectious diseases, but now it is grappling with newer challenges of heart strokes, obesity, cancer and diabetes.
• In 2012, 68 percent of the deaths globally – 38 million deaths – were due to NCDs of which 52 percent were premature deaths — that are deaths of less than 70-year-olds. Over three quarters of these premature deaths were due to cardio vascular diseases, cancer, diabetes or chronic respiratory diseases.
• India’s MMR in 2015 was 174.
• Nepal was the highest in the SEAR group with a high of 258 deaths, while Sierra Leone topped the global list with an extremely high ratio of 1,360 mothers dying per 1,00,000 live children born
• A related statistic shows that between 2006 and 2014, 74 percent of the Indian children were born through skilled personnel while the same percentage for Thailand is 100, while it is as high as 99 percent for Sri Lanka.
• India has about 24 skilled health personnel to serve 10,000 people. This rate is globally comparable only with Latin American countries like Peru and Nicaragua.
• Life expectancy for children born in 2015 was 71.4 years globally.
• Health life expectancy stands at 63.1 years globally.

What is Indian Human Development Survey (IHDS)?

• The India Human Development Survey (IHDS)is a nationally representative, multi-topic survey of 41,554 households in 1503 villages and 971 urban neighborhoods across India.

• IHDS has been jointly organized by researchers from the University of Maryland and the National Council of Applied Economic Research (NCAER), New Delhi.
• MULTI-MORBIDITIES: the major challenge facing modern health care systems is aging of the population in the context of significant pressure to contain costs. The proportion of people aged 60 years or more in the world population is expected to increase rapidly from 10% in 2000 to 21% in 2050.
• Concurrently, the number of patients with multi-morbidity, i.e., coexistence of several chronic diseases, will increase dramatically. The prevalence of multi-morbidity has been estimated at more than 80% among persons aged older than 85 years.
• Clinical research has focused predominantly on single disease and episode, often with a focus on mortality as the main endpoint. Thus, one of the most important tasks in clinical medicine today is managing multi-morbidity. This requires an evolution away from the single disease focus that has dominated medicine for centuries.
• The aim of this commentary is to propose clear terminology for the clinical concepts describing different aspects of multi-morbidity and to elucidate the relationship between these clinical concepts and their epidemiologic analogs.

What are the government steps?

• The Central Government is in the process of developing newer plans and schemes to benefit senior citizens.
• In the 2007-08 Budget the Finance Minister has proposed to provide monthly income to seniors and develop new health insurance schemes.

What is National Health Policy 2017?

• The National Health Policy, 2017, was approved by the Union Cabinet which will replace the previous policy adopted in 2002.

What are the key highlights of National Health Policy?

• The broad principles of the Policy are centered on professionalism, integrity and ethics, equity, affordability, universality, patient centered and quality of care, accountability and pluralism.
• It aims to achieve universal access to good quality health care services without anyone having to face financial hardship as a consequence.
• It intends on gradually increasing public health expenditure to 2.5% of the GDP.
• It proposes free drugs, free diagnostics and free emergency and essential healthcare services in public hospitals.
• The policy advocates allocating two-thirds (of resources to primary care.
• It proposes two beds per 1,000 of the population to enable access within the first 60 minutes after a traumatic injury.
• To reduce morbidity and preventable mortality of non-communicable diseases (NCDs) by advocating pre-screening.
• It highlights AYUSH as a tool for effective prevention and therapy that is safe and cost-effective.
• It proposes introducing Yoga in more schools and offices to promote good health.
• It also proposed reforming medical education.
• The policy also lists quantitative targets regarding life expectancy, mortality and reduction of disease prevalence in line with the objectives of the policy

What are the key targets?

• Increase Life Expectancy at birth from 67.5 to 70 by 2025.
• Reduce Fertility Rate to 2.1 by 2025.
• Reduce Infant Mortality Rate to 28 by 2019.
• Reduce under Five Mortality to 23 by 2025.
• Achieve the global 2020 HIV target (also termed 90:90:90 global targets).
• To reduce premature mortality from cardiovascular diseases, cancer,
• diabetes or chronic respiratory diseases by 25 per cent by 2025.
• Reducing the prevalence of blindness to 0.25 per 1000 persons by 2025.
• The disease burden to be reduced by one third from the current levels.
• Elimination of leprosy by 2018, kala-azar by 2017 and lymphatic filariasis in endemic pockets by 2017.

What are the positive aspects of this policy?

• The policy seeks to promote universal access to good quality healthcare services and a wide array of free drugs and diagnostics.
• The proposed steps such as a health card for every family will certainly help improve health outcomes in India.
• The recommended grading of clinical establishments and active promotion and adoption of standard treatment guidelines can also help improve the quality of healthcare delivery in India.

What are the loopholes?

• The policy duplicates portions of the Health section of Finance Minister’s 2017 Budget speech, reiterates health spend targets set by the erstwhile Planning Commission for the 12th Five Year Plan.
• It fails to make health a justiciable right in the way the Right to Education 2005 did for school education. A health cess was a path breaking idea that was proposed in the draft policy but it was dropped.
• Whether Health should continue to be in the State List or in the Concurrent List is not answered in the policy.
• Lack of capacity to use higher levels of public funding for health.

What are the benefits for senior citizens that new policy has proposed?

• The National Housing Bank will introduce a ‘reverse mortgage’ scheme under which a senior citizen who owns a house can avail of a monthly stream of income against mortgage of the house. The senior citizen remains the owner and occupies the house throughout his or her lifetime, without repayment or servicing of the loan. Regulations are to be put in place to allow creation of mortgage guarantee companies.
• An exclusive health insurance scheme for senior citizens is to be offered by the National Insurance Company. Three other public sector insurance companies as mentioned in the Medical Insurance section are to offer a similar product to senior citizens.
• The Maintenance of Parents and Senior Citizens Bill (External website that opens in a new window) of 2007 – This bill has been recently introduced in Parliament. It provides for the maintenance of parents, establishment of old homes, provision of medical care and protection of life and property of senior citizens.

What should be done?

• More health professionals need to be deployed for primary care in rural areas.
• Contracting of health services from the private sector may be inevitable in the short term.
• No more time should be lost in forming regulatory and accreditation agencies for healthcare providers at the national and State levels.
• Without oversight, unethical commercial entities would have easy backdoor access to public funds in the form of state-backed insurance. For the new policy to start on a firm footing, the Centre has to get robust health data.
• To reduce high out-of-pocket spending, early deadlines should be set for public institutions to offer essential medicines and diagnostic tests free to everyone.

Conclusion

• The curse of old age has become worse. Along with expansion of old age pension and health insurance, and public spending on programmes targeted to the health care of the old, careful attention is urgent to reorient health systems to accommodate the needs of chronic disease.
• A little can be done by Prevention and control by enhancing the skills of health-care providers and equipping health-care facilities to provide services related to health promotion, risk detection, and risk reduction.