Risk of NCDs And Concern For Aged Population In The Pandemic
Country’s 9 per cent aged population is bearing 41 per cent share of total non- communicable diseases (NCDs). To expedite objectives and strategies of NPHCE are need of time.
New Indian Express
Nearly 213 countries and territories around the world affected by the Coronavirus are struggling to overcome the pandemic, which is a significant challenge for the health system and healthy life. Studies have documented that the Coronavirus can infect people of all ages, however, the aged people, and those with underlying chronic medical conditions such as cardiovascular disease, diabetes, chronic respiratory disease, and cancer are more likely to develop severe illness. Currently, in India, around 3.67 lakh people have been infected with the Coronavirus as on June 18, 2020.
The Union Health Ministry, in the first week of April, claimed 86 per cent of deaths occurred due to co-morbidity, and 19 per cent of confirmed cases had been reported among the aged people, and 63 per cent of deaths have been observed among them. Later, in the first week of June, the health ministry added that one in every two COVID-19 deaths in India has been of senior citizens who constitute close to 10 per cent of the country’s total population, while 73 per cent of COVID-19 deaths in the country are of people with co-morbidities.
Therefore, the question arises that what are the current scenarios of the aged population and their geographies in the country, how many are bearing the burden of co-morbidity and what should be policy and strategy to minimise the risk of co-morbidity and mortality among the aged population in India.
According to the 2011 census, there were 104 million aged people in the country compared to 76 million during the 2001 census. Notably, the growth of the aged population was found almost double that of the general population during 2001-11. The UN has projected that the population of people of 60 years and above would be increased from the current 9 per cent to nearly 20 per cent in 2050. It is also estimated that people older than 60 years would more than those of the below 15 years of age.
Currently, little more than three-fourths of the country’s ageing population lives in 10 states with highest in Uttar Pradesh (15.4 million), and Maharashtra (11.1 million) and close to 70 per cent (73.3 million) of the total aged population lives in rural areas. Kerala (12.6%- 4.2 million), Goa (11.2%- 0.2 million), Tamil Nadu (10.4%- 7.5 million), Punjab (10.3%- 2.9 million), Himachal Pradesh (10.2%- 0.7 million) were having more than 10 per cent aged population in their total state population during 2011.
The latest WHO report on monitoring SDGs goals found that India among the bottom of all countries in the context of healthy life expectancy, which is now primarily driven by non-communicable diseases (NCDs), such as diabetes, cancers, heart and lung disease, and stroke. However, the question arises that how many of the aged people are suffering from the non-communicable diseases in India is vital for healthcare policy of aged people?
Before moving on the morbidity scenario among the aged population, it is essential to mention that close to 8 per cent of the population were ailed during 2017-2018, as reported by the latest National Sample Survey (NSS) Data on health in 2019. Close to 91 million populations were suffering from any of the illness, out of 1140 million surveyed during 2018. Of those, 36 million were suffering from communicable diseases (CDs), and 52.4 million were suffering from non-communicable diseases (NCDs).
Total of 32 per cent aged people (25.1 million) suffered from other illnesses, and 27 per cent suffered from NCDs in 2018. The proportion was 23 per cent among 60-64 years aged compared to 39 per cent among 80 years and above aged population. Notably, with the increasing age, the share of the diseased person increases among aged people. The proportion of ailed persons (PAP) among aged people was 316/1000 of which 270/1000 was due to NCDs. It is important to add that around 9 per cent of the aged population bearing 41 per cent share of the total population suffering from NCDs in the county. The PAP found varied from 227/1000 among 60-64 years aged person to 385/1000 among people of age 80 years and above. Among the aged people; 6.5 million (30%) were suffering from Hypertension, 5.2 million (25%) suffering from diabetes, 1.6 million from heart diseases, 1.2 million from respiratory diseases in 2018 needs attention from the healthcare perspective and pandemic as well.
However, the consequences are alarming as the high threat of NCDs among aged people in the country reveals the need for future policy. Notably, the National Policy on Senior Citizens envisages the state’s support for financial and food security, health care, shelter and protection against exploitation, the lesson should be taken from the COVID Pandemic to secure healthcare facilities and services for them.
However, there is need to increase the surveillance for premature death due to such NCDs. India is the first country to develop specific national targets and indicators aimed at reducing the number of global premature deaths from NCDs by 25% by 2025 under WHO’s Global action plan for the prevention and control of NCDs 2013-2020. As the WHO latest report added that overall shortage of services within and outside the health system to prevent and treat NCDs would increase the risk because, currently, two in three deaths in India have occurred from NCDs. It would be beneficial to allocate separate inpatient wards to tackle the future demand of the elderly in India.
In the wake of the pandemic, the National Programme for Healthcare of Elderly (NPHCE), started by Union Health Ministry during 2011-12 to address various health issues of elderly people with objectives to provide dedicated healthcare services at a different level from district hospitals to sub-centres (SC) levels should be prioritised for healthcare concern of the elderly. The healthcare facilities being provided under this programme was supposed to be either free or highly subsidised. Hence, in the light of emerged pandemic and high prevalence of NCDs among aged people, the government should expedite the activities of NPHCE with more focus on rural areas where already sparse of health services availability and accessibility is also concern for the long time, although after National Health Mission situation has improved more. It would be appropriate and need of the time to accelerate NPHCE programme vision, objectives and strategies to combat the pandemic and save the life of aged people at an institutional level along with the instructions issued by the health ministry to keep safe the aged at home.
Dr. Rajesh Raushan is Assistant Professor at Indian Institute of Dalit Studies, Delhi and currently holding Post-Doctoral Fellow position under Indian Council of Social Science Research (ICSSR), Delhi, India. Author can be contacted on rajesh.rajiips@gmail.com