Ageing & Non-Communicable Disease 

• The National Health Policy (NHP), 2017, is long on banalities and short on specifics.
• In a somewhat glaring omission, little has been said about the 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.
• In the context of declining family support and severely limited old-age income security, catastrophic consequences for destitutes afflicted with these conditions can’t be ruled out.
• Besides, continuing neglect and failure to anticipate these demographic and epidemiological shifts — from infectious diseases to NCDs — may result in enormously costlier policy challenges.
• An estimate provided for the 2014 World Economic Forum suggests that NCDs may cost as much as $4.3 trillion in productivity losses and health-care expenditure between 2012 and 2030, twice India’s annual GDP.
• Detailed projections of the old in India by the United Nations Population Division (UN 2011) show that India’s population, ages 60 and older, will climb from 8% in 2010 to 19% in 2050.
• By mid-century, their number is expected to be 323 million.
• Population dynamics and a rapidly changing age structure reflect the combined impact of increasing life expectancy and declining fertility.
• Life expectancy at birth in India climbed from 37 years in 1950 to 65 years in 2011, stemming from declines in infant mortality and survival at older ages due to public health improvements. 
• Often it is asserted that the burden of NCDs is increasingly borne by less affluent sections. of the population. In other words, wealth and health deprivations have a larger overlap because of more sedentary life-styles, dietary shifts towards more fatty and processed foods, rising obesity, high rates of smoking and alcohol consumption, rural-urban migration and changing age structure. The burden of NCDs shifted from the most affluent to the least affluent over this period.
• By age 60, the major burdens of disability and death arise from age-related losses in hearing, seeing or moving, and NCDs (WHO, 2015). Thus co-occurrence of disability and NCDs poses a higher risk of mortality.
• Disability is the umbrella term for impairments, activity limitations and participation restrictions.
• An assessment of functioning in activities of daily living (ADLs) is one method widely used to assess disability in older persons.
• Disability is usually measured by a set of items on self-reported limitations with severity of disability ranked by the number of positively answered items.
• Disabilities in ADL show dependence of an individual on others, with need for assistance in daily life. 

Multi-morbidity

• It is the co-occurrence of two or more NCDs.
• Often multi-morbidities occur non-randomly or systematically. The prevalence of high blood pressure and heart disease rose more than twice while that of high blood pressure and diabetes nearly doubled.

Way Forward:

• In brief, that the curse of old age has become worse is undeniable.
• 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 must be given to reorient health systems to accommodate the needs of chronic disease 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.