Thursday, March 30, 2023

Elderly care

So India is now the world’s most populous country, overtaking next-door-neighbour China. While the shift has been long time coming, it arrived sooner than expected because China’s population appears to have begun shrinking in advance of projections. Historically, an undivided India and China have been leading the race for the population crown. India’s 1947 partition appeared to put China permanently ahead. But now, India’s new position will likely last into mid-century and beyond. The Lancet’s projections for population in 2100 suggest India will still have over a billion people, while China will have slipped to third, with 730 million to Nigeria’s 750 million. The population rise in India has also meant a transition in the country’s demography. By the year 2050, it is expected that the number of elderly in the country would reach 324 million. What must be taken into immediate consideration is the fact that ageing in India is happening at a super-quick pace. While the older population took 110 years and 80 years to double its share (from 7% to 14%) in France and Sweden respectively, it is projected to take only 20 years in India to double. The increase of our 60+ population in a 50-year time span, i.e. from 2011 to 2061, is expected to be more than 320 million. In percentage terms, this amounts to India’s elderly population rising from 8.6% in the 2011 census to 12.5% by 2030, almost 20% by 2050, and a little more than 25% by 2061. Therefore, every fourth person in India in 2061 is expected to be 60+. The question we need to ask is: Are we as a country, families, and individuals ready for this fast pace of ageing? The inescapable truth is that we are now an ageing country and the factors responsible for this include decreasing fertility and mortality rates as an outcome of better health care services. While a lot of focus has been placed on all aspects ranging from maternal and child health to control of infectious and non-communicable diseases, elderly care in India continues to face medical, social, and economic challenges – in particular, healthcare. Also, India is ageing before becoming rich. A 2012 study by the United Nations Population Fund shows that poverty rates are higher among older persons, with a large proportion of them being economically fully dependent (52%) and partially dependent (18%) on others for livelihood. A large number of older persons continue to work or are forced to work because of economic conditions. The proof lies in the fact that 9.3 million individuals aged 61 and older availed work benefits under the Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA) scheme in 2019-20. In 2021, almost 10% of the total workers in MGNREGA were 61 years or older. Policy makers also need to keep in mind that approximately 90% of the workforce in India is in the informal sector, which has poor social protection for older persons, compounded by their relatively low savings. At this crucial juncture then, India must recognise the heterogeneous nature of this elderly demographic which not only has diverse health needs but also lack the financial resources to meet them at different stages of their lifecycle. This further necessitates tailored solutions and interventions for their welfare and daily needs. Given the scenario of a rapid increase in the size of India’s elderly population (at a higher rate in some States) and the poor financial status of the elderly and lack of financial support for schemes under implementation, we need high- level political engagement over this issue. A strong policy framework, including mechanisms for financing of care and a strategy to create an elder welfare ecosystem, can help the elders live a healthy and enriching life in their silver years. As the elderly are set to form about 20 per cent of the country’s population in the next 30 years, it is imperative we act now towards building and implementing such a robust policy framework.