[Editorial] The Elderly as an Asset

How is India’s population evolving?

  • With regards to India, the discussion on population over the past few decades has been dominated by concerns about a ‘population explosion’.
  • This has now given way to focus on the ‘demographic dividend’.

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What are the consequences of this shift?

  • The demographic dividend is expected to give a boost for India’s economic growth as the dependency ratio would be lowered by having a larger proportion of people in the working age group.
  • The benefits of such a dividend have been exemplified by the ‘Asian Tigers’ i.e. Taiwan, South Korea, Hong Kong and Singapore. China too has benefited from such a phase.
  • The large youth population would spur entrepreneurship and innovation in India.
  • As a result, the government has started paying more attention to the young in its programs, seeking to improve their well-being and educate them and to develop them in areas of entrepreneurship, sports, etc.
  • This is necessary as poor health and inadequate education may end up nullifying the advantages from the demographic dividend. This is especially significant as the NFHS -5 data indicates that the metrics for infant and child health are still disappointing and some of these metrics are even lower than what they were 5 years ago.

How significant is the elderly population in India?

  • During this crucial period for the country, even as attention is paid to the young, there is also a necessity and benefit in looking at the elderly of the country.
  • India has seen an increase in average life expectancy over the years- from 50 years (in 1970-75) to 70 years (in 2014-18).
  • As a consequence, the number of persons over 60 years old has already touched 137 million and is expected to rise 40% to touch 195 million by 2031 and 300 million by 2050.

What are the challenges?

  • There are two ways of looking at the elderly population of India: either as dependents, creating a drag on the economy or as a potential asset– a massive human resource enriched with knowledge and experience.
  • To realize the elderly population’s potential as a productive section of the society, 2 primary factors play a decisive role:
    1. Their health
    2. Their capabilities

Healthcare needs:

  • The elderly generally need more medical attention and of a diverse range.
    • According to the 1st ever LASI (Longitudinal Ageing Study in India), 11% of the elderly in India suffer from at least one type of impairment– mental, visual, hearing and locomotor
    • 58 lakh Indians die due to NCDs (non-communicable diseases) in a year.
    • Cardiovascular diseases afflict some 34% of the 60-74 year age group and 37% of those above 75 years old.
  • India is transitioning to a demographic where the elders’ growth would far exceed the youths’ growth rate. Then the biggest challenge would be in providing healthcare services that is accessible, affordable and of good quality.
  • An array of specialized medical devices woul be required at home. Tele-consultation services, at-home physiotherapy and rehabilitation service, mental health counselling services, mental health treatment, pharmaceutical and diagnostic services would be needed.
  • This need has been made evident by the COVID-19 situation which has forced the elderly to stay indoors.
  • According to the 2016 HAQ (Healthcare Access and Quality) Index, India has improved from a score of 24.7 (1990) to 41.2 (2016). Yet, the country lags below the global average (54 points) and ranks at the 145th spot out of 195 countries.
  • The HAQ performance of India is even worse when the focus is shifted to the smaller cities and the rural settlements, where even the basic quality healthcare services is inadequate.
  • The situation is exacerbated by:
    • Familial neglect
    • Low literacy levels
    • Socio-economic beliefs
    • Stigma
    • Lack of trust on institutionalized healthcare services
    • Low affordability combined with their financial restrictions
    • Inequity in access, especially given their physical restrictions

Inadequacy of schemes:

  • A huge proportion of the elderly are from the lower socio-economic levels and many of them are destitute. They are unable to afford the healthcare costs and fall into poorer health.
  • This creates a vicious cycle of poor health and expensive healthcare costs. This is exacerbated by their inability to earn a livelihood.
  • This makes them economically unproductive and dependent on their family member and others. This adds to their poor physical and mental health and also to their emotional problems.
  • Though the government has schemes to care for the elderly, they are often inadequate.
    • Ayushman Bharat and private health insurance facilities are in place to provide for the elderly. However, according to NITI Aayog report, some 400 million people don’t have insurance cover for their health expenses. This number is bound to include a large number of the elderly.
    • The central and the state governments have put pension schemes in place but these give out only a pittance to the beneficiaries. In some states, pensions as meagre as 350 INR to 400 INR per month is paid out. Even this negligible pension cover isn’t universal.
    • A 2007 legislation requires the states to earmark facilities for the elderly in all the district hospitals, headed by a doctor experienced in geriatric care. However, a report filed in the Supreme Court, in 2019, states that 16 of the states and UTs don’t have even a single ward/ bed dedicated for geriatric care.
    • India has a significant deficit in terms of infrastructure and skilled medical personnel. For every 1,000 people, there are only 1.3 hospital beds, 0.65 physicians and 1.3 nurses.

What is the way ahead?

  • Considering the range of challenges, caring for our ageing population would seem an insurmountable feat. However, the success of our COVID-19 vaccination drive gives hope. The seniors-first approach adopted in vaccinating the masses resulted in more than 73% of the elderly receiving at least 1 dose and some 40% receiving both the shots by October 2021.
  • Considering the population trends, India needs to reimagine the entire healthcare policy with an approach prioritizing the elderly.
  • As the elderly require the widest array of healthcare services, the creation of services targeting this section of the population would have benefits for the other age groups as well.
  • There is a need to bring in pro-elderly insurance policies.
  • Public healthcare spending must be rapidly increased and investments must be made for creation of well-equipped, properly staffed healthcare facilities and rehabilitation services. There is a potential to add over 3 million beds, 1.54 million doctors and 2.4 million nurses.
  • The implementations of initiatives like the NPHCE (National Program for Health Care of the Elderly) must be expedited. The PM-JAY and Ayushman Bharat ecosystems must be expanded. Special healthcare coverage services and schemes must be put in place for the elderly of the lower socio-economic strata.
  • The National Digital Health Mission presents an opportunity to take medical consultation services even to the remotest interiors of India. This, however, requires the undertaking of a digital literacy campaign, targeted at the senior citizens.

Conclusion:

Steps must be taken to improve the well-being of the elderly. It will convert them into a massive resource that would fuel the socio-cultural and economic development of the country, to give a new facet to our ‘demographic dividend’ concept.

The way a nation treats its young and its old is an indication of how far it has evolved into a better and caring nation.

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