K M Venkat Narayan: India’s Emerging Demography: A Tale of Two Health Challenges

venkat narayanGiven the sheer size and complexity of the country, it is always impossible to talk of India in any singular or modest sense.  India has the largest population of young people, and will add 220 million to her workforce by 2030.  Wouldn’t that make India a young and vibrant country?

Yes, of course. That was what I thought, until I saw something just this morning. My colleague, Carlos del Rio, showed me an intriguing article from the San Francisco Chronicle (February 21, 2010) on aging trends in India.  The number of people aged over 65 years in India will grow from 57 million in 2007 to 233 million in 2050. In the same period, the number of people over 65 years in the United States will grow from 37 million to 84 million. That means, “Youthful and vibrant” India already has more people aged over 65 years that the United States. Furthermore, in the next 40 years, while the size of the population over 65 years of age doubles in the United States; it will have grown about four times in India.

When I trained in Geriatric Medicine many years ago in England, my mentor, Alastair Farquharson (who also introduced me to Burns’ poetry), would spend the long ward rounds talking about the United Kingdom’s and the world’s biggest future challenge – an aging society.  On one of my visits to India in early 1990s, I asked several senior people in academic medicine how India would deal with an aged population. The question was often brushed off as not relevant to India.

With India projected to become home to 233 million people over 65 years by 2050, the relevance of geriatric care should now be obvious.  Is India ready to deal with this challenge?  An aging society is posing considerable healthcare challenges and escalating costs to all industrialized countries. Rather than waiting for a crisis, emerging green-field India could proactively design and test innovative and affordable healthcare systems and elder-care models, and some of these lessons could be also useful to the world.

In a recent visit to India, I came across an initiative called “Dignity Village” and some of my friends (including those who had been seduced into glamorous lucrative specialties like cardiothoracic surgery) were suddenly talking about the importance of geriatrics, preventive medicine, and public health. While these are encouraging signs, India needs bold initiatives in health insurance models, in health person-power planning, in healthcare and community care transformation to meet the demands of a sizeable and growing population of elderly people.

At the same time, India can scarcely afford to ignore the health of her biggest asset for economic growth – a huge and growing young population that can create a large domestic market and attract unprecedented foreign investments. This “demographic dividend” that India boasts of is not a given. Forty-three percent of children under the age of five in India are under-nourished. (In contrast, only 7% of China’s under-5 year olds is under-nourished)  In basic education too India struggles to deliver.  While there has been recent progress, with over 95% of eligible children enrolled in primary education, the quality of education for India’s masses remains sub-optimal. Teacher absenteeism in rural schools is rife, infrastructure is abysmal – of the 700,000 rural schools, only 1 in 6 has toilets (in fact, in some parts of India there are more people with access to cell-phones than to toilets). The health and education of India’s young has to be urgently addressed, if India should realize her “demographic dividend” in terms of human potential in the 21st century.

India’s Finance Minister, Mr. Pranab Mukherjee has just announced the country’s ambitious goal to become the world’s fastest growing economy – overtaking China – within the next four years. Given India’s growth trajectory and good economic fundamentals, this is within the realms of the possible. If only India’s health and education Ministers could similarly aspire for equally tall and ambitious goals – and set the target to make the country’s population the best educated and the healthiest!

K.M. Venkat Narayan is Ruth and O.C. Hubert Professor of Global Health and Professor of Epidemiology and Medicine at Emory University Atlanta. He is a product of three continents, having lived and worked in India, United Arab Emirates, United Kingdom, and United States of America.