There have been impressive gains made in life expectancy in India in recent years, but as people are ageing, older adults are subject to a higher risk of physical impairment. An important question to be considered is about the quality of life if people are going to live with a disability or physical impairment, especially after retirement. This underscores the importance of understanding the future course of disability in India.
Interestingly, disability research has not gained momentum in the country. A challenge for systematic research is the lack of appropriate data. Despite censuses and surveys collecting information, there is hardly any consensus on the real burden of disability.
Varied data sets
Two major sources of data, namely Census and the National Sample Survey Office (NSSO) collect information on “reported disability” but give different estimates around disability conditions. Census 2001 data recorded 21.91 million people (2.13% of the population), while the NSSO 2002 estimate was 18.5 million people (1.8% of the population). Census 2011 had an estimate of 26.8 million (2.21% of the total population). Both data sets also notably vary in terms of the composition of those disabled. The major weakness in both systems is that neither of them adhere to the World Health Organisation’s (and internationally accepted) definition of disability which includes in the definition, limitations in performing daily activities such as walking, dressing and using a toilet.
Therefore, they not only underestimate the burden of disability, but also reveal unconventional patterns in disability by gender and region. For instance, it is an established phenomenon that women experience a higher level of disability than men, yet Census data present a different picture.
A newer study finds that 17.91% of males and 26.21% of females aged 60 and above, experience some form of disability. This adds up to 9 million elderly men and 14 million elderly women. This is far higher than the estimate in Census 2011, which showed that only 5% of the elderly population suffers from a disability. Our recent research shows that in India, there has been an increasing feminisation of disability conditions, in absolute and relative terms; elderly women spend more years of life in a disabled condition than Indian men do. The prevalence rate is much higher among widowed women, and the poor and the illiterate elderly. In addition, people with diabetes have a higher chance of being disabled.
This high and disproportionate burden of disability among the elderly, across poorer socioeconomic groups, is worrisome, especially when public spaces or facilities have not been equipped as yet to accommodate them. There is a great need to expand barrier-free facilities and institutional support to people who suffer from disabilities.
What needs to be done
Will India be able to minimise the burden of disability by promoting healthy ageing? This can be achieved by promoting healthy life styles, with an emphasis on the need for a balanced diet, and physical activity, and the imposition of high taxes on tobacco or alcohol products. Such measures can postpone the onset age of chronic diseases such as diabetes, and thereby old age disability.
While measures to ban or discourage the sale of junk foods in public places are welcome steps, their strict implementation without providing an alternative is not sustainable in the long run.
This is where the government’s role is crucial. More research on the current and future burden of disability in India is needed. Census of India should consider modifying the definition of disability in the upcoming Census 2021.
Nandita Saikia is at the Jawaharlal Nehru University, Delhi and the International Institute for Applied Systems Analysis (IIASA)