16
Capitalizing on the Demographic Transition
Figure 1.1 Age Structure in South Asia
5 5 percentage
female
15
15
10
female
15
10
5 0 5 percentage
10
90+ 75–79 60–64 45–49 30–34 15–19 0–4
15
d. 2050 90+ 75–79 60–64 45–49 30–34 15–19 0–4
male
5 0 5 percentage
10
15
age group
c. 2025
male
90+ 75–79 60–64 45–49 30–34 15–19 0–4
age group
15
male
age group
female
b. 2010 90+ 75–79 60–64 45–49 30–34 15–19 0–4
age group
a. 1991
female
15
10
male
5 0 5 percentage
10
15
Source: U.S. Census Bureau, http://www.census.gov/ipc/www/idb/informationGateway.php (accessed July 8, 2010).
in life. For example, undernutrition during fetal gestation and early childhood and low rates of consistent breastfeeding, both common in South Asian populations, are associated with increased risk for chronic NCDs in adult life. Second, individuals with both an NCD and an infectious disease tend to have worse outcomes compared to having either alone. Aging will increase the prevalence of NCDs because they become more common with increasing age. Other factors—including lifestyle changes that may be associated with urbanization and globalization—can also increase the risk of NCD onset at younger ages. In the context of development, the impact of these two transitions is substantial because of the demographic dividend, that is, the point at which developing countries’ working and nondependent population increases and per capita income rises (figure 1.2). Many implications from these transitions are evident. First, the burden of NCDs will grow in the future, overwhelming the health sector and making it less responsive. If unaddressed, the impact of NCDs on individuals in terms of short- and long-term disability and premature death and in terms of forgone wages will be significant and will worsen dependency ratios.2 Second, because most health care is financed with private out-of-pocket resources, some people may never escape poverty or may