Debating The Health Longevity Initiative

The World Bank's 2024 report, Unlocking the Power of Healthy Longevity: Demographic Change, Non-communicable Diseases, and Human Capital, addresses significant demographic changes and the rising burden of non-communicable diseases (NCDs) globally, particularly in Low-and Middle-Income Countries.

Table of Contents

Context

The World Bank’s 2024 report, “Unlocking the Power of Healthy Longevity: Demographic Change, Non-communicable Diseases, and Human Capital,” addresses significant demographic changes and the rising burden of non-communicable diseases (NCDs) globally, particularly in Low-and Middle-Income Countries (LMICs).

Demographic Transformation and NCDs

A major demographic shift is occurring globally, characterised by a rapidly ageing population.
In LMICs, NCDs have become the leading cause of mortality.
Risk Factors for NCDs
- Lifestyle Factors: High rates of tobacco use, alcohol abuse, obesity, and diets high in refined grains and red meat contribute to NCDs.
  - Sedentary lifestyles and the growing consumption of sugar- and fat-dense foods further exacerbate these risks.
- Aging and Genetics: Age correlates positively with diabetes and heart disease risks.
  - Indians also experience type 2 diabetes at a younger age and lower BMI compared to Western populations due to genetic predispositions and lifestyle factors.
- The report projects that global deaths from NCDs will rise from 61 million in 2023 to 92 million by 2050.
- This alarming trend necessitates urgent action to avert an estimated 25 million deaths annually by 2050, which could significantly contribute to achieving the Sustainable Development Goal 3 (SDG 3).

Details

The United Nations’ Sustainable Development Goal 3 (SDG 3) is to promote well-being and ensure healthy lives for all people at all ages.
Some of the targets of SDG 3 include:

Universal health coverage: Ensure that everyone has access to essential health services
Access to medicines and vaccines: Provide safe, affordable, and effective medicines and vaccines to all
End epidemics: End the epidemics of AIDS, tuberculosis, malaria, and other communicable diseases by 2030
Reduce mortality: Reduce mortality from non-communicable diseases, maternal mortality, and road traffic accidents
Strengthen health systems: Strengthen health systems and increase health financing
Prevent substance abuse: Strengthen the prevention and treatment of substance abuse
Sexual and reproductive health: Ensure universal access to sexual and reproductive health-care services
Environmental pollution: Reduce the number of deaths and illnesses from hazardous chemicals and pollution
Mental health: Promote mental health

Vision of a Healthy Longevity Initiative (HLI)

The report proposes a Healthy Longevity Initiative, which envisions:
Decreasing preventable deaths and disabilities throughout life.
Maintaining high levels of physical, mental, and social functioning in older age.
Ensuring healthcare access, competent medical staff, systematic monitoring, and awareness of early detection for NCDs.
However, the feasibility of implementing such an initiative in LMICs, particularly in India, is questioned due to existing healthcare challenges.

Key Challenges of NCDs in India

India’s Aging Population: India currently has the world’s second-largest elderly population, with approximately 140 million individuals aged 60 and above. The growth rate of this demographic is almost three times higher than that of the overall population. The increasing prevalence of NCDs among this group poses severe risks:
- Cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes are leading causes of mortality.
- Projections indicate that NCDs will account for 75% of all deaths in India by 2030, up from 40% in 1990.
Impact of Social Security Schemes
- Healthcare Costs: While pensions provide financial support, they are often insufficient to cover healthcare costs, leading to high out-of-pocket expenses, debt, and poverty.
- Ayushman Bharat Scheme: Targeting the bottom 40% of households with health insurance, this scheme’s potential is limited due to funding constraints, strict eligibility, and corruption, as noted by the CAG in 2023.
Hospital Visits and Health Insurance
- Financial Strain of Hospital Visits: Costs related to hospital visits and medications impose a significant burden. Health insurance can help reduce this burden, but low awareness, complex documentation, and claim rejections limit its effectiveness.
- Private Hospital Pricing: Following a Supreme Court directive in February 2024, the government is tasked with regulating hospital procedure costs, though weak enforcement limits the efficacy of these measures.

Behavioural and Policy-Driven Reforms for NCD Control

Lifestyle Adjustments: Increasing physical activity and promoting balanced diets are essential for reducing obesity, a significant NCD risk factor.
Regulation of Tobacco and Unhealthy Foods: Imposing taxes on unhealthy products like tobacco can help reduce NCDs but requires broader policy support for significant impact.
National and Global Policy Needs: For India to manage its NCD crisis effectively, it must prioritise NCD management within the healthcare system.
- Implementing behavioural changes and policy reforms—such as the regulation of hospital pricing and improved health insurance systems—is critical.