By: Veena S Kulkarni, Vani S Kulkarni & Raghav Gaiha
Ina surprising omission, the recent National Health Policy (NHP) 2017 sidetracks the ageing of the Indian population and the rising burden of non-communicable diseases (NCDs), including heart disease, high blood pressure, and diabetes, and disabilities or limitations of carrying out activities of daily living (ADLs). Although impoverishment of segments of the population due to rapidly rising healthcare costs is acknowledged, the recommendations are replete with banalities.
Ageing is increasing rapidly. But this is happening without the requisite social changes, such as improved living conditions, better nutrition and better access to health services that accompanied ageing in most developed countries.
Ageing alone is likely to increase NCDs as they rise with age. Over half the disease burden (55%, including injuries) is now attributable to NCDs, alarger share than that of communicable diseases.
Disabilities in carrying out ADLs, or impairment of functioning, relate to engaging in work or household activities, mobility, vision, washing or decreased from over 21% to over 12%.
As an example of comorbidity — the presence of one or more additional diseases or disorders co-occurring with a primary disease or disorder —the share of those suffering from high blood pressure and heart disease in the first quartile rose more than four times: from under 7% to about 30%, while that of the fourth plunged from about 52% to 24% over this period.
Although the magnitudes differ, there is robust evidence of a shift of the burden of NCDs from the wealthiest to the least wealthy and others.
Those healthy highrises
No less worrying is the shifting of the distribution of disabilities towards the least wealthy. The share of the least wealthy experiencing difficulty in walking 1km rose from 36% to 39%, while that of the wealthies decreased from 28% to 18% during 2005-12. The share of those experiencing difficulty in hearing was largest in the least wealthy and remained unchanged (43%), while that of the wealthiest fell from a low of 19% to 15%.
And, finally, the combined share of those experiencing difficulties in walking and hearing in the least wealthy rose from 25% to 29%, while that of the wealthiest fell from a high of 38% to 27%.
Wealth is Health The treatment gap — measured as proportion of all those suffering from NCDs — receiving medical advice and treatment narrowed slightly between the least wealthy and wealthiest, but remained larger among the least wealthy.
So, not only are the least wealthy more prone to NCDs and disabilities but their chances of recovery are significantly lower than those of the wealthiest. It is time the ministry of health and family welfare woke up to this grim reality.
Veena Kulkarni is associate professor, Arkansas State University, US; Vani Kulkarni is lecturer, University of Pennsylvania, US; Gaiha is professorial fellow, Global Development Institute, University of Manchester, UK