India’s demographic dividend: public health impacts of the youth bulge

As one of the world’s most populous and fastest-growing countries, India is currently in a state of demographic flux. London School of Hygiene and Tropical Hygiene student, Catherine Rushworth, explains the population mechanics at work and predicts some of the social consequences.


© Kyle Taylor/Creative Commons license

This year’s Indian elections captured the attention of the world, with the victor, Narendra Modi, calling out for the need to ‘wage war on poverty’. Less well noted was the fact that nearly half the voters were under 24, with 150 million making their first visit to the ballot box. It’s clear that the young will have a powerful influence over India’s future. However, this demographic shift predicts some critical changes to Indian society in the coming decades, including wide-reaching public health impacts as resources and infrastructure are stretched – potentially – to their limits.

Growth in the size of the working-aged population, accompanied by a decreasing fertility rate, is known as a ‘demographic dividend’, and has been used in the past as a propeller for development in several countries. Economists estimate that the phenomenon – deliberately engineered in China through its controversial one-child policy – is responsible for a third of the huge economic growth and development experienced in recent decades by the East Asian Tigers. This outlook is unlikely to await India, however, due to the country’s current lack of infrastructure to deal with the two main products of any demographic dividend: population growth and increasing life expectancy.

Polio immunisation by British Rotarians in Lucknow, Uttar Pradesh, 2009. © RIBI Image Library/Creative Commons license

As of 2012, nearly a third of India’s population lived in urban areas, which can often translate into overcrowding, exacerbating poor living standards and creating a ripe breeding ground for infectious diseases. The recent eradication of polio in India is an impressive and globally celebrated achievement. However, there is also evidence to suggest that new infections are likely to emerge in the future, and that demographic factors – such as population growth and urbanisation – may mean India suffers disproportionately.

The growth of the country’s urbanised population from approximately 340 million to 590 million by 2030 will also impact transportation systems, aggravating congestion, pollution and potentially leading to a rise in road accidents. Whilst this will increase the burden on healthcare delivery, the predicted increase in life expectancy will also require heavy investment in geriatric care. India’s health service is already grappling with a double burden of disease. Malnutrition and other diseases associated with extreme poverty still affect vast numbers of people, while almost equal proportions on the opposite side of the economic spectrum are suffering from obesity and metabolic syndromes. It is hard to imagine how public health services, which are already reaching inadequate numbers of people, will cope with this expected rise. While certainly not the answer, NGO and private healthcare is already helping to fill the gaps. Expanding funding and coverage of private care in particular has been postulated by the World Bank as one way for increased need to be met.

Propaganda poster for China’s one-child policy, Chengdu, 1989. This state-enforced plan led to the birth of the country’s demographic dividend. © kattebelletje/Creative Commons license

China faced similar obstacles in the mid to late 20th century during its demographic transition, although these were countered to some extent by the country’s focus on education. (Almost all the population is now literate, at a minimum.) Lack of basic schooling has been repeatedly associated with an increased risk of nearly every disease outcome and risk factor for health, yet almost 20 per cent of Indian children do not attend primary school. While family size is decreasing in India, it is doing so neither at a fast rate nor universally across the country. As this begins to equalise across different regions and the population continues to increase, the education system will need to cope with an increased demand for essential schooling.

With India’s infrastructure already struggling to meet demand, the real question is how much further can it be stretched? Will Narendra Modi be able to sustain his planned ‘war on poverty’? How will the increasing population size and life expectancy – and all the associated impacts – interplay with poverty alleviation efforts? Understanding and analysing population dynamics over the coming decades will be essential in understanding this, not only for national policymakers, but to those beyond India’s borders, due to the impact that such a swelling population could have on the global carbon footprint and thus on climate change. India’s demographic dividend is on the way and only time will tell if it will be a bonus or a detriment to the country’s development.

The views expressed in this article are those of the author and do not necessarily represent the views of Development in Action.


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