The demographic healthcare shock we are not talking about enough

India is a young country, or so we keep hearing. We are a median age of 27 and add over 25 million new babies every year (larger than many countries). Educating, skilling and finding employment for over 1 million young Indians entering the workforce every year is an urgent national priority. We spend so much time thinking about children and youth, but unwittingly are ignoring another demographic shift that will place an increasing burden on our healthcare system – the burgeoning of the aging population.

The rise in the aging population has been a subject of much discussion in the developed economies. Currently, the growth rate of the older population (1.9 per cent) is significantly higher than that of the total population (1.2 per cent). In the near future, the difference between the two rates is expected to become even larger as the baby boom generation starts reaching older ages in several parts of the world. With stabilizing (and declining) populations, the number of workers supporting retirees has reduced dramatically in most countries. The number of working age people supporting one retired person has halved in Japan in 20 years and in Germany over the last 40. Not only are there more elderly people, but they are living longer and consuming more healthcare. In the US, seniors constitute 13% of the population but account for 34% of all health expenses. Healthcare spending on an elderly person is about 5 times that on children and about 3 times that on a working age individual. The amount of money spent on healthcare for people over 65 in the OECD countries will be the same as that spent on people under 65 by 2030. This, even though the aging population will constitute less than 25% of the total population.

One may wonder how this is relevant to India, a country with a young population.  I was recently speaking with an eminent academic and he said the same to me - we don’t have to worry about problems of the aged since we are still a country of young people. The numbers, though, tell a different story. The 2011 population census counted over 100 million elderly people (over the age of 60) in India and that number has been increasing rapidly. From 8.6% of the total population, the elderly will comprise 12.5% of people by 2030 and 20% of the total population by 2050. A staggering 325 million people elderly people will comprise India’s population in the next 30 years, bigger than many large countries. The number of workers supporting the elderly will reduce from 10 today to 4 by 2050. Caring for the health and wellness of this population, will become a priority of gargantuan proportions.

While this demographic transition has happened in many other countries, the speed of change we are witnessing in India is unprecedented. The OECD countries took 63 years to double the share of the population aged over 65. The BRIICS countries, including India, will take only about 20 years for the same. The shift to older populations is happening much faster, and on a much wider base so that it’s impact is likely to be magnified several times. The developed economies have had over half a century time to understand the implications of this demographic shift and bring about social changes to manage it well. They are also addressing this challenge as much wealthier economies than the emerging nations. Countries like India are unlikely to have adequate time nor funding to adapt to these changes appropriately.

Is caring for the elderly population a unique challenge? Simply put, the aged are a different demographic and have a unique combination of social and healthcare needs. Most of this population is retired from active professional lives (though that’s beginning to change now), but will live for several decades with conditions like diabetes, cardiovascular and rheumatoid diseases. The lack of formal work and increasing urbanization may contribute to a sense of isolation and a proliferation of mental health conditions. The elderly will live longer with more conditions, putting a significant strain on the cost of healthcare as well as on long term care costs. Long term care expenditure as % of all expenditure is expected to quadruple in countries like India between 2010- 2060. Our hospitals are primarily designed for acute interventions and not for chronic, sustained community based care. We have extremely poor options for home healthcare as well as a dearth of geriatricians, palliative and integrated care in the country. All of these will significantly increase the long-term healthcare cost of caring for the elderly.

Add these variables in a country still trying to rein in maternal and infant mortality as well as the impact of infectious diseases like tuberculosis and the scale of the problem becomes staggering. While it is credible the Indian government has recognized the problem and we have a National Program for elderly healthcare, spend on elderly healthcare remains a fraction of total health expenditure. A lot more needs to be done to train enough geriatric specialists as well as establish integrated care units, in order to provide the elderly the holistic care they are likely to need in the future.

The biggest shift though needs to happen in attitudes. Very often, when I speak of the elderly population, most people conjure up images of their parents or grandparents. To truly improve health for the burgeoning future aging population of India, we must recognize the people we are talking about is ourselves. Many of us will be part of India’s elderly in the next few decades so any intervention for “their” health is really an intervention into our own health. And while we must plan for better facilities and funding, the best way to insure the health of India’s future elderly is to invest in our own wellness today.