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

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 β€” the presence of one or more additional
diseases or disorders co-occurring with a primary disease or disorder
β€”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


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
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 β€” measured as proportion of all
those suffering from NCDs β€” 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
fellow, Global Development Institute, University of Manchester, UK
DISCLAIMER : Views expressed above are the author's own.

Avinash Shahi
Doctoral student at Centre for Law and Governance JNU
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