NEW DELHI: One in five Indians, or around 347 million people, will be over the age of 60 by 2050, with nearly seven in 10 older adults living in rural India.
Unlike many developed nations that became wealthy before their populations aged, India is undergoing this demographic transition at much lower income levels, according to a white paper.
Warning that India is growing older before it grows richer, the white paper, released by Transform Rural India (TRI), an organisation that works to create equal opportunities in rural India, said the country's villages, especially women, will bear the brunt of this shift.
It highlighted that the number of working-age adults available to support each older person is projected to decline sharply, from 8.4 in 2001 to just 5.2 by 2026, placing increasing pressure on families and rural care systems.
The white paper, Demographic Transition, Evolving Families and the Future of the Care Ecosystem in Rural India, argues that India has entered a new phase of public health transition.
Decades of investment in proven, low-cost interventions, particularly in maternal and child health, have helped people live longer. However, longer life expectancy, rising chronic illnesses and changing family structures now require a different approach to care.
Drawing on data from the National Family Health Survey (NFHS), the Longitudinal Ageing Study in India (LASI), Census projections, Time Use Surveys and other national datasets, the white paper offers policymakers a roadmap to rethink rural governance through the lens of care.
It finds that India's traditional family-based care model is under increasing strain. Families are becoming smaller, younger generations are migrating for work, and people are living longer.
Yet nearly 94 per cent of care for older people is still provided within households, leaving fewer family members to meet growing and increasingly complex care needs.
The white paper also found that women spend around 305 minutes every day on unpaid care work, compared with just 56 minutes by men.
Identifying the unequal distribution of unpaid care work as one of the biggest barriers to improving women's labour force participation, it noted that climate change is worsening the situation, with heatwaves and floods significantly increasing women's unpaid workload.
Around two-thirds of all deaths in India are now caused by non-communicable diseases (NCDs) such as diabetes, cardiovascular diseases and cancer. At the same time, a growing share of the country's disease burden stems from years lived with disability rather than premature death.
According to the white paper, India's healthcare system was largely designed around episodic interventions such as childbirth, immunisation and the treatment of acute illnesses.
The next phase of healthcare, it said, must focus on supporting people living with chronic illnesses, disabilities and the challenges of ageing—something hospitals alone cannot achieve.
Through its Neighbourhood of Care (NoC) model, TRI recommends linking institutions that already exist across rural India into a single community-based care network.
The framework proposes connecting Gram Panchayats, Self-Help Groups (SHGs), ASHAs, Anganwadi centres and Ayushman Arogya Mandirs under a shared care mandate, making integrated care available within walking distance of every household.
It added that rural India does not need to build a new care infrastructure; it needs to connect and strengthen the one it already has.
The white paper also positions care as an economic opportunity.
It estimates that investing 2 per cent of India's GDP in the care economy could generate around 11 million jobs, largely for rural women, creating new livelihood opportunities while strengthening community-based care systems.
According to Shyamal Santra, Practice Director at Transform Rural India, "India has made remarkable progress in helping people survive. The next challenge is ensuring they can live well for longer. Our demographic transition requires us to redesign care delivery itself. Beyond facility-based care, it requires care to function as a shared community responsibility while improving sustainable living conditions."
"The institutions needed to make this possible already exist across rural India. By connecting them through a common care mandate, we can build an ecosystem that supports families, empowers caregivers, strengthens local governance and prepares villages for the decades ahead," he said.
The white paper concludes that India's next development challenge is not simply expanding healthcare facilities but redesigning how care is organised. By bringing together demographic trends, health data, women's unpaid work and local governance into a single framework, it provides policymakers with a practical roadmap to prepare rural India for one of the country's most significant demographic transitions.