Regional Demographic and Epidemiologic Transitions

 The demographic and epidemiologic transitions in South Asia are resulting in an increasing share of the disease burden related to noncommunicable diseases (NCDs).  The impact of these two transitions can either allow countries to benefit from the demographic dividend or miss the opportunity due to increased morbidity, disability, and mortality among the working-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 in developed countries decades ago, resulting in unhealthy aging.  South Asia is now at a crossroad with over half the disease burden attributable to NCDs, in a pattern similar to that of high-income countries decades ago; this proportion is expected to rise significantly. 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 poverty and its associated risk factors including early disease, all point toward future increases in the NCD burden in South Asia.  Ischemic heart disease (IHD) is the leading cause of both deaths and forgone healthy years of life among 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 uniformly high among males and is generally low among women. Low birth weight, another risk factor for adult 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 adult mortality may be expected in the years ahead.  The poor face multiple obstacles in preventing NCDs. Tobacco use rates tend to be higher among poor men and tobacco expenditure among the poor frequently crowds out spending on food and education.  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.