Non-Communicable Diseases (NCDs) in Aging Population 1 - Challenges – Asrar Qureshi’s Blog Post #1167

Non-Communicable Diseases (NCDs) in Aging Population 1 - Challenges – Asrar Qureshi’s Blog Post #1167

Dear Colleagues! This is Asrar Qureshi’s Blog Post #1166 for Pharma Veterans. Pharma    Veterans Blogs are published by Asrar Qureshi on its dedicated site https://pharmaveterans.com. Please email to pharmaveterans2017@gmail.com  for publishing your contributions here.

Credit: Leeloothefirst

Credit: Pavel Danilyuk

Credit: Pavel Danilyuk

Preamble

This blog post is based on several Pakistani studies, UN report and McKinsey report. Links at the end.

The Emerging Crisis - Aging, NCDs, and the Widening Care Gap in Developing Nations

Low- and middle-income countries (LMICs)1 have historically been characterized by relatively young populations. But recently, declining birth rates and rising life expectancies have been fundamentally restructuring these countries’ population pyramids. In the coming decades, the number of older people in LMICs is expected to more than double to 1.3 billion by 2050, accounting for around 60 percent of global growth in this demographic over the next 25 years.2 As life expectancy increases, the burden of age-related noncommunicable diseases (NCDs), including cardiovascular diseases, diabetes, and kidney diseases, is expected to rise alongside it.3 Yet many healthcare ecosystems in LMICs continue to be ill-equipped to handle the growing burden of NCDs across expanding populations of older people, and to date, donors and private capital have not sufficiently focused on addressing the NCD burden in developing countries.

Unlike acute infectious diseases, NCDs often require lifelong care, chronic management, and ongoing support. They are not one-time crises but enduring conditions. As more people live longer, the number of individuals requiring continuous medical care, monitoring, and support will surge.

Incidence and Distribution

A 2022 study by T. Kazmi et al, suggests that NCDs are responsible for 58% all deaths in Lahore.

Ministry of National Health Services, Regulations & Coordination, and Pakistan Health Research Council in collaboration with WHO conducted a detailed survey and compiled a report in 2016. A short excerpt is given here:

[Quote] The selected individual was then interviewed using STEPS1 and 2 questionnaires and information was collected on demographic characteristics (age, gender, marital status, education, and occupation), tobacco use, dietary habits, physical activity, history of raised blood pressure and diabetes. The height, weight, waist and blood pressure were measured, and information was also collected on tobacco policy and injury. Data were collected electronically using Windows Mobile devices.

A total of 7,366 individuals were enrolled out of which 57% were females and 43% males. 

Risk factors analysis was done for smoke and smokeless tobacco. For smoke tobacco, 13.9% were current smokers and the smoking tendency increased with age. Among smokers, 25.5% men and3.8% women were daily smokers. Exposure to secondhand smoke was 29% among women at home and 31% among males at their workplaces.

About 45.3% people never got their blood pressure checked, 78.5% never checked for diabetes and 93.8% never checked for cholesterol. Almost 37% population had stage‐I hypertension and 32.5%were not taking any medication for raised blood pressure. Similarly, 15.9% had stage II hypertension(severe) and 9.9% were not taking any medication for this. Amongst the diagnosed cases, only 52.9% of those having hypertension and 43.3% of those having high cholesterol were taking prescribed medicines. Almost 74.5% diabetics were taking drugs (medication) for diabetes and15.9% were taking insulin. Past history of heart attack, chest pain or stroke was present in 6%population but only 3.4% were regularly taking aspirin to prevent the disease.

On anthropometry, 11.3% population was underweight, 14.9% obese and 41.3% overweight. Less than 50% had normal BMI. Obesity was more prevalent in women. [Unquote]

Another study by Aga Khan University, Department of Community Health Sciences report states, “Pakistan is currently facing a double burden of disease. The proportion of annual deaths attributed to non-communicable diseases (NCDs) is significantly greater than communicable diseases – 58% versus 35%.1 Mortality rates due to NCDs – including cardiovascular diseases, cancers, chronic respiratory diseases and diabetes – continue to rise, significantly hampering progress towards Sustainable Development Goal 3. Further, each day in Pakistan, approximately 100 people require amputations due to diabetes and trauma. It is projected that between 2010 and 2025, nearly 4 million Pakistanis will lose their lives to NCDs.” Unhealthy diet is among the most significant and fastest growing determinants of NCDs.

The Care Gap: When Health Systems Fall Behind

While the demand for chronic care rises, many health systems in developing countries are unprepared. The term “care gap” describes the distance between what is needed for effective long-term NCD management and what the health system can deliver. Key dimensions of this gap include:

Insufficient primary care capacity: Few systems are equipped to provide continuous, integrated, preventive, and follow-up care.

Weak infrastructure and diagnostics: Access to labs, medications, equipment, and diagnostics is limited.

Workforce shortages and skill gaps: Many regions lack trained physicians, nurses, community health workers, and specialists for managing chronic conditions.

Fragmented care pathways: Care is often episodic—centered on hospital or clinic visits—rather than seamless, coordinated, community-based care.

Financial barriers: Out-of-pocket costs are high; insurance coverage is limited or nonexistent. Many households face catastrophic health expenditure when caring for chronic illness.

Access and equity issues: Rural, remote, low-income populations—especially women and marginalized groups—are often hardest hit by gaps in care.

The combination of aging populations plus NCD prevalence, on one side, and weak healthcare systems on the other, creates a looming crisis.

Why the Gap Gets Bigger in Developing Nations

Several structural factors make this challenge especially acute in developing countries:

Resource constraints

Limited budgets, competing priorities (e.g. infectious disease, maternal and child health, infrastructure) stretch health systems thin. Funding for chronic disease care is often under-resourced.

Legacy health models

Many health systems were designed around acute episodic care, vaccines, infectious disease outbreaks, childbirth, not long-term disease management. Transitioning to a chronic-care model is a paradigm shift.

Urban–rural divide

Infrastructure, human resources, and services are concentrated in urban centers. Rural areas are underserved. The rural elderly with NCDs suffer particularly.

Social determinants of health

Poverty, education, diet, water, sanitation, pollution, and lifestyles magnify NCD risk. Without addressing these upstream factors, medical care alone cannot close the gap.

Weak health information systems

Data for monitoring, early detection, and evaluation of chronic disease programs is lacking. Without data, care remains reactive and inefficient.

The Human and Economic Stakes

The care gap is not just a health issue—it has profound social and economic consequences:

Reduced productivity and economic participation: People with unmanaged chronic disease often have reduced ability to work or maintain income, especially burdensome in settings without social safety nets.

Household vulnerability and poverty: Families face high out-of-pocket costs for medications, hospitalizations, and lost income. This can push households into debt or poverty.

Health inequities: Vulnerable populations—women, rural residents, low-income groups—fall further behind. Patterns of inequality amplify.

Strain on health systems: As more patients present in advanced disease stages, hospitalizations, complications, and resource-intensive care rise. This can overwhelm hospitals and waste resources.

Given these stakes, closing the care gap is not optional; it is essential for inclusive development and health equity.

Concluded.

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For most blogs, I research from several sources which are open to public. Their links are mentioned under references. There is no intent to infringe upon anyone’s copyrights. If, any claim is lodged, it will be acknowledged and duly recognized immediately.

References: 

https://www.mckinsey.com/~/media/mckinsey/industries/social%20sector/our%20insights/aging%20developing%20nations%20and%20the%20care%20gap%20for%20noncommunicable%20diseases/aging-developing-nations-and-the-care-gap-for-noncommunicable-diseases_final.pdf?shouldIndex=false

https://www.emro.who.int/emhj-volume-28-2022/volume-28-issue-11/burden-of-noncommunicable-diseases-in-pakistan.html

https://uploads-ssl.webflow.com/5d02dff07c256562b40f66d5/5dee8b8813932a42923457ea_NCD%20policy%20brief_Pakistan_Final.pdf