A possible framework for addressing challenges of ageing population, with examples from India

Addressing rapid ageing of the population is among the most pressing challenges for most middle and high income countries globally, including in Asia. It is estimated that there will be 34 countries which will be “super-aged” (where one in five persons is 65 years or older) in 2030, as compared to 13 by 2020.

It is both the level and the pace at which rapid ageing is occurring that are accentuating the challenges as policymakers have a much shorter time to react to lowering of fertility rate and to increasing longevity.

Feminization of the elderly is also evident globally. Women as a group live longer by 3 to 7 years than men as a group, but have less resources for meeting the needs of old age. There is also an emerging issue of how to support caregivers to elderly, many of whom are family members giving care at home which severely restricts their participation in income earning, and many of whom are women. Societies and policymakers have given insufficient attention to this emerging issue.

Thus, addressing gender imbalances in ageing policies has acquired considerable political, social, and economic significance to which public policies need to respond.

A long-time observer of Asia has assessed that “Asia’s demographic dilemmas may be the greatest threat to the realization of the Asian century” (John West, Asian Century Asian Century on a Knife-edge: A 360 Degree Analysis of Asia’s Recent Economic Development, 2018, P. 197). The book can be downloaded at https://link.springer.com/book/10.1007/978-981-10-7182-9#toc

John West’s assessment implicitly suggests that the current ageing policies in Asia require a major rethink.

There is rising awareness that ageing issues need to be addressed in an integrated manner that enables the elderly to actively participate in community’s economic, social, and other activities.

What might be the elements of an integrated approach or framework which can aid in devising ageing policies suitable for specific contexts of each country and its sub regions?

A possible integrated framework

One of the useful constructs of the different dimensions which need to be integrated in ageing policies has been provided by 2017 Report The Aging Readiness and Competitiveness Report 2017, by AARP (American Association of Retired Persons), and FP Analytics (http://arc.aarpinternational.org/)

The Report argues that policies for ageing societies need to integrate the following four dimensions in a context specific (cultural, social, economic, institutional, and organizational) manner.

•        Community Social Infrastructure

•        Productive Opportunity

•        Technological Engagement

•        Healthcare wellness

Community social infrastructure

This dimension involves preventing social isolation by mobilizing community to engage with the elderly; to promote social engagement; and to enhance accessibility and mobility of the elderly.

Countries such as India, have an opportunity to incorporate elder friendly features as they construct new cities or substantially upgrade their urban infrastructure. Smart Cities and Amrut initiatives are designed to revitalize India’s urban areas, and to increase the importance given to better urban management. India also needs to continue with the tradition of involving persons of different age groups, particularly the elderly, in daily social, economic, and cultural activities.

Productive opportunity

With ageing populations, labor force growth declines, and in some cases, such as in China, Japan, and Singapore, begins to shrink. Productivity per worker therefore becomes more important as a driver of economic growth, with all the complementary skilling, technological 8nnovations and upgradation, and other policies that this requires.

To enhance opportunities for the elderly to be engaged in economic activities in a flexible manner, reforming pension and provident fund regulations and practices is useful first step. In the case of India, there is ad-hoc practice of increasing the retirement age of some workers, and changing pension and provident fund rules without a coherent and coordinated policies. It would be useful to revisit mandatory provident fund  and other such levies for the elderly to encourage greater acceptance of them among the employers and the society. Flexible work schedules could also be encouraged for care givers and the elderly to participate productively in the economy and society.

For India, some other potential measures are the extent to which MUDRA Bank (Micro Units Development and Refinance Agency Bankloans are being availed of by the elderly, and by those who are borrowing to improve services to the elderly could be tracked.

The key cultural mind set-shift needed is for the society to regard the elderly as an important resource and integral part of the national life, and not as a burden.

Technological engagement

Digital technology, and AI (Artificial Intelligence) technology have the potential to enhance economic and social engagement of the elderly; and to help improve (at least monitor) their health. Robotics and e-health are two areas which exhibit promise in this regard.

So digital connectivity and digital literacy should be regarded as important components of ageing policies. The Digital India program could therefore have this aspect as one of their das-board benchmarks.

There are also opportunities to better avail of the commercial opportunities with the elderly, by more systematically developing the so-called “silver market”. In India, The number of over 60 years of age of about 130 million in 2018 is expected to be nearly 300 million by the year 2050. There changing demand patterns could provide new opportunities from growth nodes, and for productive livelihoods.

It is reported that China and Japan have set national policies to encourage ageing-related technologies. With India’s entrepreneurial culture, this aspect can be given due recognition in Digital India and other technology-centered programs.

The use of Jan Dhan Yojna, Aadhar, and Mobile technology (JAM) to enhance financial inclusion has had good success, though it is still uneven success across different regions of the country. There is scope to expand the scope of delivery of services using JAM and other technology-enabled methods, including for pensions and others accessed by the elderly.

Healthcare wellness

The challenge of healthcare, and getting balance between preventive and curative health care, with most health episodes treated at primary and secondary levels, nearer to the community of residence, is a major challenge for middle income countries such as India.

Asia, particularly Thailand, offers some instructive case studies for India in strengthening primary and secondary health care. 

India also has a large dispersion in its health care outcomes as Niti Aaayog’s recent Report suggests, which needs to be urgently addressed.

Strengthening primary and secondary health care systems, with particular emphasis on access and affordability, is essential for the tertiary level insurance mechanism to be more effective.

India’s 2018-19 Budget recognises the above in its two major initiatives under the “Ayushman Bharat”. The first involves vastly expanding health care centres for primary care to be accessible and affordable within the community. The proposal is to set up 150,000 such centres across the country, with some funding and expertise from the corporate sector through corporate social Responsibility (CSR) activities.

The second Budget initiative involves National Health Protection Scheme (NHPS) to cover around 100 million families (between 400 and 500 persons depending on average family size) for catastrophic illnesses requiring hospitalization. This will benefit elderly directly and indirectly as a medical episode involving earning member will cushion the impact on family finances.

For both the initiatives,  how these are implemented with focus on delivering health services and amenities across the country,  and how they are complemented with other programs  such as those designed to provide affordable medicines; addressing nutritional needs of the population, including more robust regime for food quality regulation; linking clean energy source to reduce indoor pollution and thereby also positively impact health of all family members; enhancing public hygiene through Swatch Bharat initiative for urban, and for rural areas; initiatives to reduce pollution and other environment factors affecting health, particularly of the children and the elderly; integrating Yoga and other similar practices in preventive care and healthy lifestyles, will determine the extent to which they help improve health and wellness outcomes.

The challenge is to undertake systemic research, with a feedback loop to help improve policy design and implementation, on how these separate initiatives and schemes are having a combined impact on healthcare and wellness, as well in other components of the ageing framework presented here. The transmission mechanism and the extent of the combined impact may differ from sub-region to sub-region in the country.

Concluding remarks

The above analysis strongly suggests the following.

First, an integrated approach to ageing policies, involving many dimensions, is needed. This required a mind-set change of all stakeholders to shift away from piece-meal ad-hoc approach and to regard the elderly as integral and valuable members of the society.

Second, such an approach increases the importance of policy coherence and organizational coordination (especially in India’s Federal structure with responsibilities for health and wellness divided between the Centre, the States, Union territories, the Urban and Rural Bodies).

Third, system oriented, empirical evidence based policies towards ageing are needed.  India has given insufficient attention to strengthening its data and statistics collection agencies; and to its capacity to mine and analyse the data collected. With a feedback loop to impact design and implementation of policies, programs, and schemes. This limitation needs to be addressed, not just by the government agencies, but also researchers, academic institutions, and civic and professional bodies.

Fourth, It is strongly suggested that a national level research Centre on Ageing Policies be set up to assist in better policy design, implementation, and outcome assessment of the different components of these policies. Some of the States may set up their own research organizations to complement the national effort to improve outcomes of ageing policies in the spirit of Cooperative Federalism. Professional organizations can also contribute to public policy debate through constructively and cooperatively engaging with relevant public agencies. The above integrated ageing policies will need to be adapted to the cultural and other contexts, not just by country but by sub-regions as well.

This piece was first published at MyIndMakers on 16 March 2018.