India’s progress in improving the lives of its citizens can be seen in a single statistic, namely, the increase in life expectancy at birth. As per UNDESA, by 2010-15, life expectancy in India (67.5 years) had almost caught up with the global average of 70.5 years.

Challenges due to increased Life Expectancy

• Changing Healthcare Needs:In a demographic where the growth rate of elders far exceeds that of the young, the biggest challenge is to provide a range of quality, affordable, and accessible health and care services to the elderly.
  • They require an array of specialised medical services at home including tele or home consultations, physiotherapyand rehabilitation services, mental health counselling and treatment, as well as pharmaceutical and diagnostic services.
• Low HAQ Score of India:As per the 2016 Healthcare Access and Quality Index, India (at 2) is still significantly below the global average of 54 points, ranking 145 out of 195 countries.
  • The low HAQ worsens even further in smaller cities and rural areaswhere basic quality health-care services are very inadequate.
• Social Issues: Factors such as familial neglect, low education levels, socio-cultural beliefs and stigma,low trust on institutionalised health-care services etc. exacerbate the situation for the elders.
  • Inequity in access to facilities compounds the problems for the elderly, who are already, physically, financially and at times psychologically restricted in understanding, and availing such facilities. Consequently, most of them live their years in neglect.
• Vicious Cycle of Health, Economy and Unproductivity:An overwhelming proportion of the elders are from the lower socio-economic strata.
  • The vicious cycle of poor health and unaffordable health costs is further accelerated by their inability to earn a livelihood.
  • As a result, not only are they economically unproductive but it also adds to their mental and emotional problems.
• Inadequate Welfare Schemes:Despite Ayushman Bharat and public health insurance schemes, a NITI Aayog report indicates that 400 million Indians do not have any financial cover for health expenses.
  • Despite the presence of pension schemes at centre and state level, a mere pittance as low as ₹350 to ₹400 a month is providedin some states which too is not universal.
• Challenges to Inclusion of Elderly in the Economy:In order to include the elderly as active participants in the economy, they need to be reskilled and taught about the latest technologies to bring them at par with the current ‘tech-savvy’ generation.
  • Ensuring proper technology, human resource and other facilities for reskilling the elderly population at a large scale is a challenge.

Looking ahead

• Health Related ‘Elderly-First’ Approach:In the Covid-19 vaccination strategy, the seniors-first approach led to over 73% of elderly population receiving at least one dose and around 40% being doubly vaccinated by October 2021.
  • Considering the demographic trends, India should reimagine its entire health-care policyfor the next few decades, with an elderly prioritised approach.
  • 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.
• Role of Government:India needs to rapidly increase its 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.
  • It needs to accelerate implementation of programmes such as the National Programme for Health Care of the Elderly (NPHCE).
  • The Ayushman Bharat and PM-JAY ecosystemsneed 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.
• Socio-Economic Inclusion of Elderly: Similar to countries like in Europe which have small communities to take care of the elderly and provide them related facilities, India can build such a type of youth army to help elderly in the far away areas.
  • The best way of taking the best economic and social advantage of the elderly is not to treat them separately from the rest of the population and rather assimilate them into the mainstream population.
  • Elderly-inclusive policieswhich bring the larger segment of the elderly within the ambit of the welfare schemes shall be formulated ensuring the coverage upto the last mile.
• Special Focus on Elderly Women:Elderly women in particular shall be specifically looked after in the context of socio-economic upliftment, as the longevity for women is much longer than men.
  • Inaccessibility of opportunities to elderly women will make them dependent on others, exposing their survival to several vulnerabilities.

Proof of a truly developed country lies in the way it not only nurtures its young but also cares for its elders, equally. Certain essential steps must be taken to convert elders into a massive resource for socio-cultural and economic development, giving an altogether different perspective to “demographic dividend”.