Deprived When Young. Abandoned When Old
India will have aged before it turns into a ‘developed’ economy. This must concern us. As per the United Nations, a society is ‘aging’ when seven per cent of its people are above the age of 65. One in every ten Indian is aged above 60 years. They number 130 million, growing at 4.2 per cent, twice as much as the population. In the next 25 years a fourth of our population will comprise ‘elders’.
While we celebrate the longevity of our people, we must be equally concerned about the quality of their lives during the sunset phase. Most are deprived of any pension or health benefits. Without support, the poorest will live in misery triggering enormous socio-economic pressures. The cost will largely be borne by the present and future generations. The goal must be to minimise the cost and yet provide the elders a well-deserved life of dignity.
*We are not behind the curve. We have barely begun
Our young and thriving demography has created the demand. Low-cost prowess has fulfilled it, triggering a rapid and virtuous growth cycle. While we ‘bank’ the demographic dividend and bask in the country’s rapid economic growth, a countervailing force is at play. It threatens to offset several benefits, pare and even choke the growth drivers.
Demography planning is decadal. The evidence on the ground must alarm us. A Crux study across 280 districts covering 17,000 elders confirms a depressing future. Our ageing population will demand economic resources in the region of two per cent of the GDP.
The study highlights the obvious. The unorganised sector ‘provides’ 80 per cent of the jobs but contributes to less than a third of the GDP. These employees have no pension, no benefits and earn less than the per capita income. The sector has no capacity to provide a higher remuneration. This is a feature of a frail economy, and well-known. However, the implication is less understood, often ignored and rarely acted upon.
Health insurance has low penetration, compounded by an extremely poor pay-out history. Healthcare cost has been spiraling due to the government’s indifferent attitude. It has abdicated its role.
A Crux study confirms that about 65 per cent of the elderly are fortunate; live with their spouses or with their children and relatives. The others live alone or with non-relatives and are lonely.Approximately 65 per cent of the men and a fourth of the women are forced to work as ‘long as they can’. Most others are engaged in unpaid domestic chores in the extended joint family system. The poor don’t ‘retire’.Two per cent (and) two million are bedridden, another 12 million have acute health problems that confine them to their homes.
*Negligible institutional support. ‘Abandoned’.
Rapid socio-economic change including urbanisation, migration and the nuclear family ismaking elder care difficult. It isslowly but surely, leaving many with no family support.Elders encounter depression when separated and exacerbated by lack of mobility due to ill health. Many face destitution. Most are unable to access healthcare, particularly the poor, as healthcare is beyond their means. Over 75 per cent feel totally ‘let down’, the study concludes.
Growth has pulled many out of the poverty trap and enhanced many development drivers. Yet these very contributors to growth are deprived in the sunset years of their lives. Growth has indeed extended their ‘years’ of life, but diminished their quality of life. They view the added years as a burden.
*State deprives. Society abandons the elders. Triggering depression
A comprehensive and universal (but) well targeted social security programme for the elderly is the key. The government must find the resources and create institutions to offer an affordable, and widely accessible healthcare ecosystem. These centres must be owned by the government but managed by the private sector. The model will reduce the burden of ‘investment’ by the private sector but will ensure operational efficiency. Local self-governments must ‘own’ the delivery. Civil society must vet to enhance transparency and governance.
Care of the aged could be a huge business and employment opportunity. The Crux study estimates the need for about half a million housing units. This, in addition to insurance, healthcare delivery and other allied services, could be an emerging opportunity. The government must partner with the private sector, create the ecosystem, and an enabling framework. In addition, it must frame regulations to ensure that elders are not exploited by private sector providers. The government must not abdicate its role.
Medical professionals and civil society must lead both the advocacy and information campaigns that change and reinforce social attitudes towards ageing. Society must embrace the elders, demonstrate empathy towards them and offer support.
Healthcare cost is a challenge, but other challenges are equally formidable, namely the ecosystem to address several softer issues. We are yet to develop a robust and holistic health and social care regime attuned to the shifting needs of the demography. There is little awareness about geriatric diseases like dementia, depression, and Alzheimer’s. Mental health issues are rarely discussed, and are largely a taboo. There is a need to create palliative care specialisations.
Policymakers need to plan well. Deliver better. We must particularly prepare for the shift in the disease patterns from communicable to non-communicable on the one hand and remodeling the healthcare system towards preventive, promotive, curative, and rehabilitative aspects of health. There is a need to create expertise, and a cadre of professionals to support the health and welfare of the elderly.
*Growth is wonderful, and empowering
India's social security system is woefully inadequate. The schemes reflect ‘short’ termism, the scale is modest. Even states with higher fiscal prowess provide less than Rs 10,000 annually. Access to 2,100 calories daily costs Rs 65 or Rs 25,000 per year and two per cent of the GDP. This is doable if we continue to grow at about eight per cent.
Responsibility must be shared. Well-off elders must opt out. Every stakeholder i.e., family, community government must get involved and collaborate. As a start the government must regulate and ensure that every employer creates a safety net for every employee, who in turn, invests and weaves a nest for the sunset years.
The policy framework must create an ecosystem where they enjoy these extended years; enjoy a life of stability and dignity.
