India had 104 mn elderly, 8.6% of the population, as per 2011 Census.
The number of elderly is growing faster in developing countries.
Schemes exist in India, but they need wider support and dissemination.
India has a rapidly ageing population, and faces growing health and financial risks in the absence of universal healthcare, a new report released in July by the Sankala Foundation says. The report was finalised by the non-government organisation in partnership with the NITI Aayog, the Ministry of Social Justice and Empowerment (MoSJE) and the National Human Rights Commission (NHRC). Each of these bodies has contributed its views to the final report.
The report, titled 'Ageing in India: Challenges and Opportunities, A Status Report', warns that the country’s elderly, who are projected to reach 347 million, or 20.8 per cent of the population, by 2050, are increasingly exposed to financial vulnerability, social isolation and inadequate healthcare support.
“The lack of universal health insurance coverage puts them at greater financial vulnerability,” writes Bharat Lal, Secretary General and CEO of the National Human Rights Commission (NHRC), in his 'Perspective' piece included in the study. The report also notes that 70 per cent of older Indians depend on family or pensions for survival, while nearly a fifth live with at least one chronic illness. Chronic conditions make the health systems vulnerable, and the elderly even more vulnerable, especially when they lack access to sources of income.
The report refers to schemes such as the National Programme for Health Care of the Elderly (NPHCE) and the recent extension of the Ayushman Bharat: Pradhan Mantri Jan Arogya Yojana to those aged over 70 years. It finds that India’s health system is fragmented and, therefore, underprepared for the demographic shift expected in coming decades.
“The question is no longer whether we need to respond, but how boldly and creatively we are willing to act,” he writes.
The report points to other systemic weaknesses, such as low literacy among the elderly, the widespread income insecurity they face and the breakdown of traditional family-based care as younger Indians migrate for work or set up nuclear families. The problem is particularly severe in states like Kerala, Goa and Tamil Nadu, which report elderly populations above the national average.
Other problems the elderly face include having to live alone: over 15 per cent do so in Tamil Nadu, 13 per cent in Nagaland, over 10 per cent in Telangana, and the fewest as a percentage in Jammu and Kashmir, at 1.2 per cent. The rate of hypertension (high blood pressure) is the lowest in Nagaland, at 14 per cent, and the highest in Goa, at over 56 per cent, finds the report.
Kerala has over 84 per cent of the elderly who ever went to school, the highest proportion, which Delhi has roughly 57 per cent, and Arunachal Pradesh the least, at 16-plus per cent. In terms of mental health, Jammu and Kashmir's elderly (those over 60) show the most depressive symptoms at over 54 per cent, while Madhya Pradesh has the highest percentage (17) of the elderly diagnosed with 'major episodic depression'. Nagaland and Mizoram, respectively, have the lowest percentage prevalence of depressive symptoms and major episodic depression, at 7.8 and 0.6 per cent, respectively.
It took developed countries up to two centuries to double their ageing populations. However, developing countries, including India, are experiencing this transition in just 50 to 70 years. At that pace, the report indicates, there is little time to prepare a robust health, pension and long-term care system for the elderly.
The study recommends a comprehensive response, ranging from integrated health and nutrition programmes to digital healthcare solutions and scaled-up long-term care. Mental health, rehabilitation and palliative services for older persons also require urgent attention, it notes.
India is currently at a critical demographic juncture. After reaping its “first demographic dividend” from a large population of the working-age youth, the window is beginning to narrow due to declines in the fertility rate and the rise in the share of the elderly. In Japan, France and Singapore, there have been experiments with raising the age of retirement to ensure that the older population is creatively or constructively employed, and has a secure source of income. Many countries, especially Japan, have also investing heavily in systems to care for the older populations. However, India is yet to frame a longer-term national strategy, though schemes do exist.
“The issue of income security must be given special attention,” the report has stressed, calling for non-contributory pension support, meaning a guaranteed income for all elderly, even those who cannot support payments for future pensions. It also says that opportunities for older persons to remain in the workforce must be developed, apart from chances to have them engaged in other works.
India’s elderly population will grow four-fold in less than a century, and that is why ageing must be seen as no less than “a national priority”, the report says. It also urges policymakers to move beyond incremental reforms and take "bold" steps. Without a universal healthcare system the costs of ageing will be borne most heavily by those who can afford them the least.
The report also stresses on initiatives already taken in India to alleviate the suffering of the indigent elderly. For example, the Atal Pension Yojana, which provides five pension options for those over 60, guaranteed by the Government of India; the Pradhan Mantri Vaya Vandana Yojana, designed to protect those over 60 from fluctuations in interest rates due to market conditions; the contributory pension scheme for informal-sector workers, and so on.
However, referring to instances of the status in other countries, the report says, under the sub-head, 'Universal health insurance schemes', that affordability, accessibility and awareness of health insurance coverage and other health schemes have direct impacts on citizens’ healthcare-seeking behaviour.
The better facilities the older generation is provided, the less likely will they be to suffer abuse, something that age makes people vulnerable to across the world, the report concludes.
Writing the report's Foreword, Dr Vinod K Paul, Member, NITI Aayog, says that achieving Universal Health Coverage (UHC) by 2030 in India will require "deliberate attention to the needs of [the] marginalised and hard-to-reach population...". "Primary health care, which forms the first point of contact for most individuals, must be equipped with the necessary resources and capacity to cater to the elderly," he writes.
