In India the proportion of elderly is increasing rapidly. The over 60 population that accounted for less than 7% of the total population in 1991 is expected to increase to more than 10% by the year 2021. In actual numbers this will total to more than 140 million elderly more than the size of Germany and France put together today. Most policy prescriptions have not addressed feasibility issues and seem to assume that the state will fill the gaps despite the fact that the needs of the rural elderly, the urban poor elderly, the urban middle class, the well-to-do elderly, the female elderly or the elderly living alone, vary greatly. Most policy prescriptions tend to lay all expectation on government welfare schemes or to argue for wider involvement of NGOs.
It is unlikely that funds would be forthcoming in adequate measure to be able to make much impact considering the size of the country, the federal nature of its polity and the overall paucity of resources which stand committed for essential infrastructural development and providing health and education for a burgeoning young population. The focus of most programs is on preparing the young population to become useful members of society by increasing their skill, productivity and employability. In all this consideration for the aged and their issues take a backseat.
Despite knowledge being available and sufficient human resources also at hand could be trained to become caregivers, the response from the market and more particularly insurance systems has been insignificant.
Pre-occupation with policies for the poorest of the poor
India comprises of a large informal economy and huge variations exist between the lower wealth quintiles and those “above the poverty line.” There are wide variations in the manner in which institutions are managed and the way in which people access institutions – e.g. confirmation of their land rights, access to the judicial system, housing, utilities and health services. This has often led to a situation in which the older segments of the population are left to fend for themselves which becomes a burden on society.
The Director-General of WHO Dr Margaret Chan writing a Foreword for Program on the Global Demography of Ageing produced for the World Economic Forum 2012 is on record saying that people are already questioning the traditional view of older age. According to her in the United States only a small minority were found to want to retire at the traditional age. Around 80% wanted to continue to participate – but they wanted to work part time, or start a new career, or launch a small business. They wanted flexibility. The Director-General felt that if older people could remain active participants in society, they could continue to contribute to socioeconomic development and such engagement would prevent isolation and loneliness while also ensuring financial security. This philosophy is not restricted only to developed countries or the United States. Even India has a large number of educated professionals who have to retire at a given age which with the increase in longevity is at variance with peoples potential and aspirations. Therefore the very first need is to decide how the capabilities of the elderly can be channelised in a way that benefits them and also society but makes the pursuit worthwhile even if it is not financially as lucrative as in earlier years.
Special Health Problems of the Aged in India
Indians are prone to suffer from certain diseases the older age groups have become chronic patients of diabetes, hypertension, arthritis, cardiac problems and cancer. Whereas this is the situation throughout the world, due to Indian habits and food intake, lack of exercise, some of the problems especially relating to diabetes have become a disproportionate burden.
What is at stake?
Knowing all this, there is a need to investigate what measures would ease the burden of ageing in selected segments of Indian society and what initiatives could mitigate the burden borne by the aged and by society.
Overwhelming Influence of the Media
The elderly are admittedly the major consumers of media and entertainment. But even so they continue to be portrayed in negative, gendered stereotypes, and usually as victims. As more and more Indians join the ranks of the educated elderly, they remain the most avid readers of newspapers and magazines and ardent television viewers. Even so they are usually discarded by the media or relegated to age old stereotypes. Far from reducing the gender divide which starts at birth, and goes on through childhood, adolescence and middle age it continues to be stretched even in old age.
Professors Srivastava of the Institute of Economic Growth in India felt that this was not related to the spending capacity of the elderly but more to the historically conservative role that media has played when it comes to social issues. Archana Kaushik from the Department of Social Work in Delhi scanned over 30,000 articles covering six English and Hindi newspapers having the widest circulation and in the 30,000 articles that she scanned, she found that the print media accorded less than 1% space to the subject of the elderly. She also scanned 500 articles in leading magazines over a period of three months and could only find one article on the elderly and that too on dementia. Even this was not a full-fledged article but only dealt with the life-threatening aspects of the condition. (Again fulfilling the spectre of vulnerability and hopelessness.)
Both the electronic and print media like to cover the susceptibility of the elderly as victims of crime, so re-enforcing images of feeble old people, lonely and defenseless. Yet the insecurity of the elderly never merits a policy response which is commensurate with the media coverage about their helplessness. One cannot help feeling that the media seems to believe that the reading public would take ghoulish interest in the elderly becoming the terms of crime but there are no protagonists who translate this into a worthwhile policy response.
In television commercials however the position is completely the opposite. A research study scanned over 300 TV commercials and found that the elderly were featured in double the proportion in the population but while the elderly men were invariably shown as jovial extroverts, the wives remained confined to home settings. Professors Shrivastava observes “that such depictions of elderly men leave open possibilities that are closed off to women; it is one of the enduring taboos of Indian society.”
All insurance advertisements project men as providers and by inference show women as dependent beneficiaries. Although the elderly are the largest users of medical devices, consumables like syringes, gels for the treatment of arthritis and wrinkles, the models are always young and are shown in situations which involve only young people.
Among television serials, the elderly occupy almost a third of the leading roles – four times higher than their proportion in the population. But whereas men are shown as physically vibrant decision – makers, the women are usually swathed in old women colours, playing the role of religiously inclined grandmothers capable of making huge sacrifices.
Research also found that in the case of feature films, the elderly constituted almost 50% of the total characters – almost 5 times more than the proportion of older persons in the general population. Most of the leading characters were however played by men, while the women actors just tagged along with no definite personality.
Media has unwittingly created a stereotype reducing elderly people to simple categories and converting assumptions into realities – so accentuating inequalities and prejudice. Their portrayal of the elderly resurrects taboos and cultural traditions which although they are on the wane in actual life are being reinforced through the media.
Distinguishing between Elderly Men and Women
With life expectancy and disposable incomes of the elderly increasing with each passing year, it is time that women (who outlive men) are projected as leading fulfilled lives. Otherwise far from integrating with society, elderly women will believe what they see and read and continue to play the role of appendages, afraid to lead fulfilled lives as citizens with a voice. The fear of being discarded for being incompetent and unwanted is what the elderly fear the most. That fear has to be dispelled.
According to the report of The Ministry of Statistics and Programme Implementation, Government of India titled Situation Analysis of the Elderly in India (2012)more than 75% of elderly males and less than 40% of elderly females live with their spouse. Less than 20% of aged men and about half the women live with their children. In India with the majority of the population aged less than 30, the problems and issues of the older population hardly get serious consideration and only a few studies are available on the subject. Although in the past the traditional Indian society and age-old joint family system were instrumental in safeguarding the social and economic security of the elderly, with rapid changes in the social scenario and the emergence of the nuclear family, elderly people are now exposed to many more emotional, physical and financial insecurities states the report. The study also showed that both in urban and rural areas around 80% of the men and women were supported by their children.
India’s National Policy on Older Persons (1999) envisages state support to ensure financial and food security, health care, shelter and other needs of older persons, protection against abuse and exploitation and availability of services to improve the quality of their lives. The policy tries to encourage individuals to make a provision for their old age and that of their spouse; to encourage families to take care of their older family members; to support voluntary and non-governmental organisations to supplement family care; provide care and protection to vulnerable elderly people; provide adequate healthcare to them and promote research and training to train geriatric care givers and organisers of services for the elderly and to create awareness about elderly persons to help them lead productive and independent lives.
In 2007 the Maintenance and Welfare Parents and Senior Citizens Act was enacted which provides for the maintenance of parents/senior citizens by children/relatives which has been made obligatory and justiciable through Tribunals. It provides the revocation of transfer of property by senior citizens in the case of negligence by relatives; penal provisions for abandonment of senior citizens; establishment of old-age homes for senior citizens and adequate medical facilities and security for senior citizens.
Specific Value Added
At present, the approach in India has been restricted to making parental care a responsibility of the children. In practice this does not work and trying to put an end to individualism and the nuclear family is not the answer. The expectation that children will take care of the elderly in the family is not likely to be fulfilled and unless people make decisions earlier in life they would be faced with a life when they lose control over their own property and income. Stories of ill treatment of older people by children have been the subject of societal concern and have even been the themes of blockbuster movies. Even so expectations have not altered. Institutionalization of the elderly is also not an answer in the Indian milieu.
It is therefore necessary to develop indicators for assessing the financial, physical and social situation of the elderly. The media needs to hold individuals, governments, business and civil society accountable for progress in this area. First, the indicators should include a reference to WHO’s guidelines on age friendly cities which would further include variables on quality of life, health status, economic and physical security and vulnerability to crime. Together with this indicators should include the use of new technology to improve the quality and access to health care for the elderly. . In developed countries smart homes provide a range of monitoring and supported devices including wireless sensors. In the context of developing countries, there is a need for standardisation of old age homes and encouraging older people to invest in ownership rights for their own living space for as long as they live. Therefore the twin indicators would be availability of standard requirements for old-age and assisted living and the use of telemedicine to talk to clinicians and manage chronic problems at home rather than in a hospital.
It is also essential to think about investments in social integration that payoff for all ages. Second there is a need to improve the care and autonomy of disabled older adults so that they can continue to contribute instead of becoming a burden. Third, there is a need to make a realistic assessment of retirement ages bringing in modifications which allow work after retirement.
Another important indicator would be whether the policies are aimed at preventing and reducing the burden of excess disability, chronic diseases and premature mortality will. The indicators should also include the ease with which older people can access paid caregivers at a reasonable rate (implying that training and education would be given to potential caregivers in an organised way).
Other indicators would include avenues for social participation, actively engaging older people in economic activities and those which help the family and community; also whether the indicators address the safety and dignity of older people and lay down guidelines to signify age discrimination and what should be done to remedy the same.
India will face an enormous burden of a rapidly ageing population and will have two confront fresh problems of age-related dependency even before the needs of the younger population are attended to fully. There is therefore a need to lay down indicators which would provide a ready retina or addressing the needs of the elderly. The preceding article has any merit it various issues which have already arisen and would grow in the years to come in a country like India. It is recommended that the following indicators should be included when considering a situation of a developing country which is already facing demographic changes in terms of ageing coupled with a population momentum which will take at least 30 years more to stabilise. The vulnerability of the elderly in countries where it is presumed that the family will take care of them, both in terms of policy as well as the law, the challenges greater. This is because unless there are benchmarks to judge well-being, quality of life and human rights and dignity, the resources would be laid to thinly and there would be no way of judging progress or achievement. The indicators should therefore include:
- A description of the meaning of old age;
- Indicators that measure access to financial security;
- An indicator that addresses the special problems of women and ageing;
- An assessment of the portrayal of ageing by the media;
- Encouragement to lifelong learning and social innovation for the elderly;
- Whether scope exists for the elderly to assume positions of leadership within society. (Social Voice)
- Investment in geriatric health care through family practitioners or specialists to cater to specific health needs of the elderly.
- Providing palliative care and home-based care for chronic non-communicable diseases.
- An indicator which captures the Human Rights of the elderly.
- Indicators to cover aspects of ageing related to increased urbanisation
- An indicator that addresses international migration and challenges faced by parents/grandparents left alone in the home country.
Shailaja Chandra has over 45 years experience of public administration focusing on governance, health management, population stabilization and women’s empowerment. She was Secretary in the Ministry of Health & Family Welfare (1999-2002) and following that the Chief Secretary Delhi until 2004. On retirement she was appointed the Chairman of the Public Grievances Commission and Appellate Authority under the Delhi Right to Information Act. In 2006 she was appointed as the first Executive Director of the National Population Stabilisation Fund, Government of India. She is the author of a recently published Status Report on Indian Medicine (2011 and 2013) commissioned by the Government of India. She was also appointed by the Government of Delhi to chair a Committee which reviewed the Delhi School Education Act and Rules 1973 and the report was published in 2012 covering 5000 schools and over 4 million children. Shailaja has an M.Sc. in Economics from the University of Wales and an Honours Degree in English Literature. Her book “It Crossed My Mind” (Rupa 2007) is an anthology of articles on subjects of current social concern. She was given a special Award for advocacy on population issues and gender sensitivity by Ladli-UNFPA. Besides over 150 articles which address governance priorities have been published by leading national dailies and magazines in India and also by the OECD and WHO. She was recently awarded a fellowship at the Institute of Advanced Studies, Nantes, France to research and write a paper on Probity in Public Life.