How can the elderly be converted into assets and not dependents?.
The Economic Survey 2019 noted that while the country as a whole will enjoy the “demographic dividend" phase, some states will start transitioning to an ageing society by the 2030s. This requires certain policy attention in the coming years. The growth rate of elders far exceeds that of the young.
Changing health-care needs
- Medical attention of a diverse range: As per the first ever Longitudinal Ageing Study in India (LASI), 11% of the elderly suffer from at least one form of impairment (locomotor, mental, visual and hearing). It is estimated that 58 lakh Indians die from NCDs in India annually, and cardiovascular disease (CVD) prevalence is estimated to be 34% amongst 60-74 year olds, rising to 37% in those above 75 years.
- Provision of old-age care: An Array of specialised medical services at home including tele or home consultations, physiotherapy and rehabilitation services, mental health counselling and treatment, as well as pharmaceutical and diagnostic services. These needs are particularly evident now, with elders being advised to stay indoor as a precaution against the novel coronavirus epidemic.
- Access to retirement related financial services: Such as Public pension funding, innovative saving schemes, provident funds etc.
- Decrease in tax revenues: the Income tax revenues would fall with the less number of working hands. However, consumption would rise which may increase indirect taxes.
- Labour force and labour participation rates: With less working hands less productivity is expected in the economy, leading to greater pressure for automations.
- Retirement age: There might be a pressure on increasing the age of retirement going forward. This is being observed in various developed economics such as South Korea, Japan and Australia.
- Mental and emotional problems: With changing family structure mental and emotional problem are expected.
This needs immediate attention because
- Poor Insurance coverage: Despite Ayushman Bharat, the Government’s health insurance scheme for the deprived, and private health insurance, a NITI Aayog report indicates that 400 million Indians do not have any financial cover for health expenses. One can be sure that a very large number of elders are among the uncovered.
- Poor pension coverage: Both the Centre and States have pension schemes for the elders, but these provide but a pittance — as low as ₹350 to ₹400 a month in some States. Even this is not universal.
- Poor Health quality status in India: As per the 2016 Healthcare Access and Quality Index (HAQ), India improved its HAQ score from 24.7 in 1990 to 41.2 in 2016. However, we still are significantly below the global average of 54 points, ranking at the spot of 145 out of 195 countries. The low HAQ worsens even further in smaller cities and rural areas where basic quality health-care services are very inadequate.
- Socio-cultural Factors such as familial neglect, low education levels, socio-cultural beliefs and stigma, low trust on institutionalised health-care services and affordability exacerbate the situation for the elders. .
- Inequity in health-care access compounds the problems for the elderly, who are already, physically, financially and at times psychologically restricted in understanding, responding to, and seeking medical care for various ailments. Consequently, most of them live their years in neglect.
- Socio-economic Factors: An overwhelming proportion of the elders are from the lower socio-economic strata (including many who are destitute). They are unable to afford the cost of health care and slip into ever poorer health. The vicious cycle of poor health and unaffordable health costs is further accelerated by their inability to earn a livelihood.
- Dearth of Health workers: Presently, India has a major deficit in infrastructure and skilled medical care resources, with 1.3 hospital beds, 0.65 physicians, and 1.3 nurses for every 1,000 people.
- Lack of digital literacy: limits the availability of services.
Road ahead
- Reimagine health-care policy for the next few decades: As senior citizens require the most diverse array of health-care services, the creation of adequate services for them will benefit all other age-groups.
- Legislating pro-elderly health care and insurance policies,
- Rapidly increase the public health-care spending, and invest heavily in the creation of well-equipped and staffed medical care facilities and home health-care and rehabilitation services.
- Adding healthcare workers: Over the next decade, we have the potential to add more than 3 million beds, 1.54 million doctors and 2.4 million nurses.
- Accelerate implementation of programmes such as the National Programme for Health Care of the Elderly (NPHCE). The Ayushman Bharat and PM-JAY ecosystems need to be further expanded and similar, special health-care coverage schemes and services need to be created for senior citizens from the lower economic strata. The National Digital Health Mission has tremendous potential to expand medical consultations into the interiors of the country. However, this requires a digital literacy campaign for senior citizens.
These essential steps will help to convert elders into a massive resource for socio-cultural and economic development, giving an altogether different perspective to “demographic dividend”. After all, the proof of a truly evolved and caring nation lies in the way it not only nurtures its young but also how it cares for its aging population.
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