The co- existence of communicable and non-communicable diseases, also termed as the double burden of disease, has been impacting populations significantly across the world. The impact of this double burden on older population is naturally more severe. The prevalence of non-communicable diseases has been on rise in older people with longer life spans and due to lifestyle and dietary factors as well as occupational and environmental hazards. At the same time, older people remain to be vulnerable to a number of communicable diseases due to poor nutrition, sanitation and hygiene.
The situation is more of a concern in South Asia where the numbers of older people are rapidly growing and older people here continue to live in severe poverty and difficult living conditions. While communicable diseases have been traditionally prevalent in the region, NCDs have also been on consistent rise making the double burden of disease very relevant in South Asia. Developing nations in South Asia ? namely India, Pakistan, Bangladesh, Sri Lanka and Nepal have been seeing unprecedented economic growth in the past ten to fifteen years. They have also been struggling to fight the onslaught of communicable and lack of nutrition related diseases for a very long time. The double disease burden refers to the rise of communicable and non-communicable diseases (NCDs). Inefficient healthcare delivery systems and high rates of urbanization have contributed to periodic rises in communicable diseases such as tuberculosis, malaria and HIV. At the same time, as life expectancy increases in these nations, there has been a concomitant hike in the prevalence of NCDs such as cancer, diabetes and cardiovascular disease. This double disease burden is a common characteristic of such developing nations and the increasing morbidity and loss of economic activity has the risk of hampering economic growth.
In India, the Thar Desert in the North-West of the county is an extremely under-developed region. Poverty in Rajasthan is inextricably linked to the local environment. The proportion of people living below the poverty line is much higher than the national average as they live in the dry or un-irrigated areas where rainfall is low and highly variable. Marginalization in Thar occurs on the basis of age, gender and social status. Older people account for approximately 2 million of the state?s population and are amongst the most vulnerable. The State shows some of the lowest health indicators in India. Primary health care in the State has not reached a large number of poor people, especially women, people belonging to the lower castes and communities living in remote areas. Health problems are linked to poverty, poor hygiene practices, insufficient education and limited access to health services due to remoteness of villages and limited trained staff often shared between health posts. Amidst this, older people?s health status has been significantly impacted in Thar. The double burden of disease in older people is highly prevalent. The NCDs have emerged in the forms on hypertension, diabetes, arthritis, dementia and eye ailments. Main communicable diseases include malaria, TB and other respiratory infections like pneumonia. The double burden impacts the life of older people significantly affecting overall quality of life, leading to morbidity and causing financial losses.
GRAVIS, an NGO based in the Thar Desert of Rajasthan, has been working to empower the rural communities for the last 30 years. It takes an integrated approach towards rural development and emphasizes on water security, food security, education and healthcare. GRAVIS covers over 1,200 villages with its activities and interventions and benefits about 1.2 million people living in Thar. Health has been a major area of GRAVIS work and the focus has been on improving the health conditions of elderly, women and children living in Thar. Keeping this in view, GRAVIS has set up a comprehensive, rural hospital in a village of Thar Desert. This 70-bed facility is fully equipped and is manned with a team of well qualified doctors and nurses. The facility caters to people living in about 100 villages in the surrounding area and is a major source of medical help.
Ageing and health is an important programmatic priority for GRAVIS. To address the double burden of disease among older people, GRAVIS is working on several fronts. A first aspect addresses the curative needs by providing medical services to older people through GRAVIS hospital as well by outreach medical services. Secondly, there is strong focus on educating older people on double burden of disease, self-care and preventive aspects. Along with educating older people, a major focus has also been on developing local capacity through training health workers and peer educators. Thirdly, GRAVIS s actively engaged in advocacy and research on older people?s health status to generate evidence and aimed at overall improvement of the service delivery status. Overall, GRAVIS? efforts on ageing and health reach out to about 100,000 older people and have led the path to improved quality of life for those older people.
The world is going through a rapid demographic transition, with steadily increasing older population. The double burden of disease is very relevant in the many parts of the world and present complex socio-economic and medical challenges for the communities and governments. A multi-dimensional approach needs to be taken up to make major inroads in the situation. There is a need of working on regional level guidelines and directions through active advocacy and research, followed by active implementation strategies at national level in participation with NGOs, civil society and older people groups.
*Dr. Prakash Tyagi, Executive Director, GRAVIS