India should undertake a radical policy shift to meet the needs of a growing geriatric population
Never before in history have people lived longer than they do now. The 21st century presents both a challenge and an opportunity to global health futures. More than two billion people will be aged above 60 years by 2050, of which 80 per cent will live in low and middle-income nations. India is presented with a strange and unique challenge, which can, at best, be addressed by policy reforms and sectoral prioritisation towards ageing. By 2050, India’s ageing population will comprise of over 324 million, and among them, a significant burden of over 70 per cent will still be in rural and urban areas. A new architecture to address health in ageing is waiting to be born in countries like India, where the elderly are neglected, have limited resources to keep them going, and are not cared for. Social policies for older people need to be safeguarded to protect them from discrimination, isolation and neglect. As health becomes a state subject, investing in senior citizens’ homes in every district, with certain guidelines, providing pension to the elderly belonging to Above Poverty Line (APL) families, creating theme parks and age-friendly neighbourhoods is a meaningful way forward. By 2020, it is projected that 16 per cent of the world’s elderly population will be in India, and over three-quarters of all deaths in developing countries could be connected to old age. Dying presents many social burdens which involve the transition of responsibility among families that stay together. It brings forth a new kind of shift in possibilities and also transition in socio-economic profiles of individuals. If that wasn’t enough, it also often creates a psychological impact on the minds of near and dear ones, which can have a lasting change in the absence of institutional protective mechanisms. The young men and women of tomorrow have become far less emotional, more detached and divided than generations that went before, understand far less what it means to love and are clouded by the idea of protective and inclusionary social boundaries that are necessary to engage the elderly into maintaining an active and healthy life.
The problem of ageing is manifold and factors in the social determinants of health and cultural transition taking place around the world. With the institution of marriage undergoing change, family norms are disappearing. As of today, many older people still have their children and grandchildren around. But a few decades from now, the story will be different. With birth rates falling all over the world, fewer siblings will be around. With an increasing number of broken marriages, divorces, remarriages and step-in families gaining traction all over the world, the responsibility to plan for an ageing generation shifts onto government systems.
In modern societies, 20 per cent of women do not give birth. The number of women without children in Southeast Asia, Latin America and Europe is increasing. The Lancet series on ageing categorically pointed out that people over 65 years of age will surpass children under five years within the next five years for the first time in world history. With India’s pro-poor budgetary allocation for health, the cause for mainstreaming public health ageing will have to wait longer.
India will have to undertake a radical policy shift which will address cumulative inequities and reconfigure health systems to meet the challenges of tomorrow. Many organisations, both government and private, set timelines for retirement. This calls for greater revision with opportunities for productive participation for those who wish to work for more years, not aspiring for coveted posts and lucrative salaries, but more importantly, to mentor and engage the mind for a decent remuneration where pension provisions remain absent. It must be borne in mind that creating inclusive ageing policies, which build an inter-generational solidarity, will not be easy. But not working towards it is to lack vision and insight. Demands of urbanisation, cost of living, inflation, global uncertainties due to terrorism and market proliferation are the stumbling blocks on the way to achieving universal health coverage.
Reforming social security schemes, relaxing workplace regulation and fostering local age-friendly circle meetings must guide our directions ahead. In putting these in place, lies our own welfare.
The author is Founder & CEO of the Mangaluru-based CHD Group and Member-Health Task Force, DDMA, Government of Karnataka