India's ageing crisis needs attention

So much has been said and written about the “demographic dividend” of India’s large young population that we have collectively failed to take note of a looming ageing crisis and its potential consequences. As our largely “under 35” population ages, the strength of what has been touted as India’s demographic dividend would gradually turn into a disadvantage over the next two decades.

According to a 2017 report by the United Nations Population Fund (UNFPA), around 12.5% of India’s population will be 60 years and older by 2030; by 2050, this will increase to one-fifth of the population. With declining fertility, reduction in mortality and increasing survival at older ages, the shift in age structure from young to old is expected to be enormous over the next few decades.

Unfortunately, there is a huge denial of the fact that we are witnessing a shift towards an ageing population. The lack of focus on this shift implies that we are completely unprepared to meet the situation with little emphasis on improving our elderly care structure, health structure or building a social support system to address this shift.

An inverted pyramid

In many parts of the world, declining fertility coupled with an ageing crisis has turned the population structure into an inverted pyramid. In Norway, Finland and Iceland, birth rates dropped to historic lows in 2017. “Norway needs more children! I don’t think I need to tell anyone how this is done”, Norway’s Prime Minister was quoted as saying earlier this year, in a cheeky yet desperate appeal that highlights the ageing problem in that country.

In Japan, the population is expected to shrink 16 per cent by 2045 compared to 2015. China which controlled its birth rates by imposing a one-child norm for decades is also facing a similar crisis.

With one of the fastest growing above 60 populations in the world, India will be sailing in the same boat in a few years from now. A top-heavy population structure implies that a large elderly population has to depend upon incomes generated by a dwindling younger workforce. With a huge paucity of caregivers expected to arise, it also implies the need for creating avenues of social and government support for the elderly.

At policy level, India has shown recognition of the looming crisis. The National Policy on Older Persons (NPOP) was drafted way back in 1999 which envisaged state support to ensure financial and food security, health care, shelter and other needs of older persons. The landmark Maintenance and Welfare of Parents and Senior Citizens Bill, 2007 sought to make it a legal obligation for children and heirs to provide maintenance to senior citizens.

Unfortunately, there is little preparation visible on the ground. Our healthcare system is grossly unprepared. With an increasing ageing population, there will not just be an increase in physical ailments but also an increase in incidence of mental and neurological conditions such as depression, dementia, Alzheimer’s etc. This will require a significant institutional as well as societal preparedness. Most hospitals in India do not even have dedicated geriatric wards while nursing staff is also highly inadequate.

In terms of preventive healthcare, we as a society are not even focusing on measures to start educating the people to prepare for older age by adopting healthy lifestyles and good dietary habits that will keep them healthier and fitter for a longer period of time.

According to estimates by the UNFPA report, only about one-third of the older men and women in India receive income from employers or social pensions. A study published in BMC Geriatrics journal found that about 17.93% of elderly men and 26.21% of elderly women experience some form of disability in three activities of daily living needed for a better quality of life. In India, it is normative for families to take care of the needs of older persons. However, we are increasingly witnessing the phenomenon of elderly parents living alone as children have to move out, sometimes abroad to pursue their own lives.

Institutional preparedness is needed to address these issues if we want our youth to lead dignified and comfortable lives tomorrow. Apart from developing schemes to ensure income security for the elderly, building an ecosystem of caregivers, we also need to create mechanisms that will improve their quality of life. Not only must the government launch its own preparatory mechanisms, it must also encourage startups working to create technologically powered solutions for the elderly.

(The writer is Director & Creative Strategist, CHAI Creative and Return of Million Smiles)