Aging and the Shifting Disease Pattern
Aging
Unhealthy Aging
Double-disease burden
Aging
Aging is occurring rapidly but often without the social changes such as improved living conditions, better nutrition, gains in wealth, and better access to health services that accompanied aging in most developed countries decades ago. Aging due to this transition will, alone, increase NCDs because they are more common with increasing age. However, population aging in South Asia is associated with a rapid increase in health problems such as heart diseases, cancers, diabetes, and obesity—in otherwords, unhealthy aging.
Unhealthy Aging
putting new pressure on health systems. Other factors—including lifestyle changes that are often associated with urbanization and globalization—can also increase the risk factors and disease onset at younger ages.
South Asia is at a crossroads. Over half of the disease burden (55 percent including injuries) is now attributable to NCDs, and therefore a larger share than communicable diseases, maternal and child health issues, and nutritional causes combined. This pattern is similar to that of high-income countries decades ago.
Double-disease burden
Ischemic heart disease (IHD) is the leading cause of both deaths and forgone disability adjusted life years (DALYs) in working-age adults (15–69 years). By contrast, communicable diseases.(e.g., tuberculosis, respiratory infections, and water- and vectorborne disease) still remain prominent in the total population creating what is referred to as a “double-disease burden.”
Country-level Contexts
Country-level Contexts
Various country-level contextual factors need consideration for developing effective responses. Country NCD disease burdens are quite variable. Of the total DALYs forgone attributed to NCDs, the proportion ranges from 87 percent in Sri Lanka to 43 percent in Afghanistan. Where trend data are available, they indicate that the prevalence of NCDs is increasing (for example, diabetes in Sri Lanka). In contrast to the disease burden, some NCD risk factors (for example, tobacco use) vary relatively little across the region.
It is among the poor where the combination of NCD risk factors and infectious diseases are more common, leading to worse outcomes. For instance, the risk of dying from tuberculosis is 2.3 times as high for smokers as nonsmokers, while both tuberculosis incidence and tobacco use are higher among the poor.
This regional pattern of a similar NCD risk factor burden and variable country disease burden, occurs for two related reasons.
1) The period between chronic NCD risk factor exposure and its related morbidity and mortality is long, especially compared to most infectious diseases.
2) In countries with lower life expectancy, people die from other causes (that is, infectious diseases) at younger ages.
Low birth weight, still common in South Asia, is an important risk factor for NCDs. The fetal origins hypothesis of adult diseases postulates that fetal undernutrition, reflected by low birth weight, is associated with susceptibility to development of IHD and other chronic NCDs in later life.
In socioeconomic terms, the poor face multiple obstacles in preventing NCDs. Tobacco use rates tend to be higher among men with less or no education and tobacco expenditure among the poor frequently crowds out spending on food and education. Furthermore, as noted, it is among the poor where infectious diseases, such as tuberculosis, concomitant with NCDs can result in worse outcomes.
Clustering of NCD risk factors is common. While data limitations do not allow examination of South Asia,multiple risk factors, such as high blood pressure, high cholesterol, high glucose, and obesity, frequently occur in the same individual. The economic impact of NCDs is significant.
In terms of macroeconomic costs, if NCDs were completely eliminated, estimated GDP could increase by 4–10 percent. While elimination is not feasible nor a current, realistic goal, these finding give a sense of the impact that interventions might have. In terms of microeconomic costs, about 40 percent of household expenditures for treating NCDs are financed by household borrowing and sales of assets, indicating significant levels of financial vulnerability to NCDs.
This regional pattern of a similar NCD risk factor burden and variable country disease burden, occurs for two related reasons.
1) The period between chronic NCD risk factor exposure and its related morbidity and mortality is long, especially compared to most infectious diseases.
2) In countries with lower life expectancy, people die from other causes (that is, infectious diseases) at younger ages.
Low birth weight, still common in South Asia, is an important risk factor for NCDs. The fetal origins hypothesis of adult diseases postulates that fetal undernutrition, reflected by low birth weight, is associated with susceptibility to development of IHD and other chronic NCDs in later life.
In socioeconomic terms, the poor face multiple obstacles in preventing NCDs. Tobacco use rates tend to be higher among men with less or no education and tobacco expenditure among the poor frequently crowds out spending on food and education. Furthermore, as noted, it is among the poor where infectious diseases, such as tuberculosis, concomitant with NCDs can result in worse outcomes.
Clustering of NCD risk factors is common. While data limitations do not allow examination of South Asia,multiple risk factors, such as high blood pressure, high cholesterol, high glucose, and obesity, frequently occur in the same individual. The economic impact of NCDs is significant.
In terms of macroeconomic costs, if NCDs were completely eliminated, estimated GDP could increase by 4–10 percent. While elimination is not feasible nor a current, realistic goal, these finding give a sense of the impact that interventions might have. In terms of microeconomic costs, about 40 percent of household expenditures for treating NCDs are financed by household borrowing and sales of assets, indicating significant levels of financial vulnerability to NCDs.
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