Chapter 1: Regional Aging and Disease Burden

Key messages

• The demographic and epidemiologic transitions in South Asia are resulting in an increasing shareof the disease burden related to noncommunicable diseases (NCDs).

• The impact of these two transitions can either allow countries to benefit from the demographicdividend or miss the opportunity due to increased morbidity, disability, and mortality among theworking-age population, and to increased expenses related to care and treatment of NCDs.

• Aging is occurring rapidly but often without the social changes that accompanied aging indeveloped countries decades ago, resulting in unhealthy aging.

• South Asia is now at a crossroad with over half the disease burden attributable to NCDs, in apattern similar to that of high-income countries decades ago; this proportion is expected to risesignificantly. The persisting burden of communicable diseases and maternal and child health(MCH) and nutrition issues creates a “double-disease burden.”

• Demographic trends, current levels of undernutrition and their future legacy, NCD risk factors(such as tobacco use) and unhealthy lifestyles (adopted from global trends), as well as povertyand its associated risk factors including early disease, all point toward future increases in theNCD burden in South Asia.

• Ischemic heart disease (IHD) is the leading cause of both deaths and forgone healthy years of lifeamong working-age adults (15–69 years) in South Asia.

• Country-level NCD disease burdens are variable.

• Some risk factor levels are quite similar across countries. Tobacco use among adults is uniformlyhigh among males and is generally low among women. Low birth weight, another risk factor foradult NCDs, is also still common.

• A consequence of high levels of risk factors among men, in particular tobacco consumption and alcohol abuse, is that stagnation in the reduction or even an increase in premature adultmortality may be expected in the years ahead.

• Out-of-pocket expenditures for services and for medicines are high, highlighting the need to consider equity issues and how such health care should be financed.