Page 51 - GHES-3-2

Global Health Economics and
Sustainability
Aging and health facilities in Indian cities

Table 2. Percentage and number of persons aged 60 and above by sex and place of residence, India (2021)
Urban Rural Total
Male Female Male Female Male Female
Percent aged 60 and above 11.6 11.6 12.4 11.4 12.1 11.5
Total population (in millions) 246.3 228.8 452.7 433.6 699.0 662.4
Population aged 60 and above (in millions) 28.6 26.5 56.1 49.4 84.6 (67.1) 76.2 (70.9)
Note: Computed using the percentage of persons aged 60 and above as obtained from the NFHS 5 (2019–2021) and the projected population by sex and
place of residence for 2021 (Registrar General and Census Commissioner, 2019).

India has witnessed a rapid rise in its older population. facilities.” However, many urban planners in India have
In 2014, the growth rate of the country’s older population yet to prioritize the creation of age-friendly cities (Adlakha
was 3 times higher than that of its overall population et al., 2020).
(Arokiasamy, 2016). With this unprecedented aging Despite improvements in health facilities over the years,
population, the health profile of older adults has also smaller cities continue to lag behind major cities in terms
undergone significant changes (Agarwal et al., 2016). of health facilities. People living in smaller cities have to
In India, 95% of older persons have at least one chronic travel great distances to receive quality treatment. This
illness (Karmakar et al., 2014 and Naushad et al., 2016). gap in healthcare access between cities must be examined.
Non-communicable diseases have become a predominant Previous literature focused on disparities between rural
health concern among older adults, and the burden of these and urban areas as well as slum and non-slum populations,
diseases has steadily increased over the years (Devadasan, with limited attention given to differences in health facilities
2006; Yadav & Arokiasamy, 2014). A study by Jayakrishnan and other development indicators between cities (Garg &
(2016) based on the NSSO survey conducted between Karan, 2009; Zare et al., 2018). This study aims to examine
January and June 2014 highlighted that the proportion of the distribution of the older population across Indian cities
ailing older adults has increased over the last 10 years. and investigate their access to advanced health facilities.
Forty percent of the Indian population is expected to
live in urban areas by 2030. However, issues related to 2. Data and methods
the accessibility and affordability of healthcare services While recent national-level surveys exist in India, none
are increasing (Rao & Peters, 2015). While most large provide data for all cities. Thus, this study used data from
cities may offer better healthcare facilities, many small the Census of India (2011), which is the most recent census
cities struggle to provide adequate services. Goli et al. available and offers age group-wise population data for
(2011) observed differences in development indicators Class I cities. In addition, data on health facilities were
and healthcare facilities across cities. According to Rao obtained from the Town Directory (2011), which provides
& Peters (2015), a higher concentration of healthcare city-level information. Data on the older population (those
providers is found in more urbanized areas, yet access to aged 60 and above) were also collected from the Census
healthcare is not uniform across all urban regions. Most C-14 (City) table for both 2001 and 2011. In total, 492
advanced healthcare systems and treatment facilities are cities were included in this research. The share of the older
concentrated in major cities, leading to differences in population was calculated by dividing the number of older
healthcare systems and delivery structures. Therefore, adults by the total population. In addition, we estimated
large and small cities differ in terms of health facilities and the share of the older population for 2021 using the
accessibility. exponential growth method.
Although the proportion of the older population is To assess the available health facilities in Class I cities,
similar across cities (Census of India, 2011), smaller cities a Health Facilities Index (HFI) score was calculated. This
often face challenges in providing timely and sufficient score considered factors such as the number of hospitals,
health-care coverage for older adults, particularly in doctors, paramedical staff, and hospital beds. A composite
dealing with age-related health conditions. This situation score was computed for each city, with equal weight
considerably impedes city administrators and the assigned to all indicators. The mean distance to these health
government in ensuring health coverage, especially for facilities was also calculated. Furthermore, variations in
the older population. India launched the National Urban the share of the older population were analyzed based on
Health Mission to address these issues in 2013, with city size and civic status. Similarly, available health facilities
the prime objective of “healthy cities with good health were compared with the aging scenario in these cities and

Volume 3 Issue 2 (2025) 43 https://doi.org/10.36922/ghes.3993