Millennium Post

Living with dementia

India has recently made headlines with the news that the country’s demographic dividend may be reaching its peak; census data released in September showed that India’s working age population (15-64 years old) is now 63.4 per cent of the total, as opposed to just under 60 per cent in 2001.

Moreover, the statistics also show that the dependency ratio – the ratio of children (0-14 years old) and the elderly (65-100 years old) to those in the working age – has shrunk to 0.55. In theory, this should be positive news for India – with a lower dependency ratio, stock capital, standard of living and the productive labour force increases, while economic pressures decrease, automatically improving the economic growth of the country.

Unfortunately, though, this is far from the whole story. In the second stage of a demographic dividend, increased life expectancy will lead, among other things, to the burden of parents and grandparents having to be shared by a lower number of children, and explosive growth in diseases prevalent in the elderly, such as Alzheimer’s disease and other dementias – if India’s health care and pharmaceutical research industries do not respond to this issue now. Dementia is already an enormous health burden in India. Indeed, it is estimated in the Dementia India report that in 2010 over 3.7 million people in the country are affected by the condition, and this number is expected to double by 2030. Looking more widely, a new case of dementia arises every four seconds worldwide, and, if the current numbers hold and no preventive treatments become available, by 2050, over 115 million elderly people are expected to have Alzheimer’s disease and other dementias. Based on current estimates, India will have one of the largest numbers of elders with this illness. Moreover, dementia is not merely a medical issue; it is an urgent economic, social and political problem, too, given that the cost of taking care of a person with dementia is around Rs. 14,700 Crores per year, much of which is met by the families of those suffering, a figure which is only set to increase. In fact, the cost of caring for someone with dementia is conservatively estimated to triple by 2030. Yet, despite the magnitude of the problem, India is not responding quickly enough – in terms of both health care interventions and research into preventive treatments, and this can no longer be ignored.

Currently, Alzheimer’s patients in India suffer from chronic under-investment in health care infrastructure, which has led to a lack of clinics and hospitals, poor distribution networks, low numbers of trained health care providers, and high levels of patient illiteracy, not to mention the stigma and discrimination attached to the condition. But it’s not just the domestic health care sector that needs to evolve to manage the burgeoning costs of Alzheimer’s disease; India also needs to think on a larger scale.

Alzheimer's disease is one of the most critical unaddressed public health issues in India, but the country’s public policy focus is largely on how to improve its trade deficit by providing medical tourism facilities and selling generic medicines to foreign markets primarily in Europe, America and Japan, rather than investing in high risk, innovative research and development.

This has led to a situation where local pharmaceutical companies are generally unconcerned with defending global public interest in the IP law infrastructure that is vital to the future of innovation in the field of Alzheimer’s treatment, and this is what needs to change. Instead of focusing solely on creating high-quality generic medicines based on the drugs currently available on the market, the country needs to address its unmet health care needs by expanding critical research funding, including research into the development of new medicines for Alzheimer’s.

Wotking on this research creates a new generation of experts in dementia treatment and care, which can be a benefit to the whole system of elderly care. This was the impact of policy initiatives in other countries like Australia, South Korea and France who all developed national dementia strategies to meet the needs of people with dementia and their families.

Collaboration with other countries and international bodies to support research into the causes of dementia as well as drug discovery efforts could mean that India reaps the benefits of, rather than undermining, its current demographic dividend. There is an unprecedented opportunity coming up through the G8 Summit on Dementia Research that is organised by the UK government on 11 December. India is not a member of the G8, but it could raise the issue that as one of the most populous countries of the world, it should be involved in the follow up on this initiative.

The author is head of Alzheimer’s India and also head of Alzheimer’s Disease International, representing all Alzheimer’s societies around the world
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