Is India Ready For A Demographic Transition?
Unattended chronic disease, unaffordable medicines and treatment, and malnutrition are part of old age life in India as there is no system of affordable health care.
The Samruddha Bharat Foundation recently released the third volume of its Rethinking India series titled ‘Reviving Jobs: An Agenda for Growth’ edited by Prof. Santosh Mehrotra. In several of his interviews on the volume, Prof. Mehrotra pointed out that India will no longer be enjoying a demographic dividend post-2040. This disconcerting information compelled further research on the demographic transitions in India.
The Indian government acknowledged this issue for the first time in the Economic Survey 2018-19 in the chapter on “India’s Demography at 2040”, but it has failed to receive adequate attention back then. The chapter states that India is set to witness a sharp slowdown in population growth in the next two decades. It also states that though the country, on the whole, will enjoy a “demographic dividend”, it is not going to spread uniformly across states. Several states will start transitioning towards an ageing society by 2030 while for several others there is a window in which they can tap into the “demographic dividend”.
It also states that “the size of working-age population will start to decline in 11 out of the 22 major states during 2031-41, including in the southern states, Punjab, Maharashtra, West Bengal and Himachal Pradesh. On the other hand, working-age population will continue to rise through 2041 in states lagging behind in the demographic transition, particularly Bihar, Uttar Pradesh, Madhya Pradesh and Rajasthan. States ahead in the demographic transition, such as Himachal Pradesh, West Bengal, Maharashtra, Punjab and most of the southern states, would have less than one-fourth of the population under the age of 20 but about one-fifth or more population over the age of 59 by 2041.”
For states in the advanced stage of demographic transition, the changing age structure will have implications on the type of health care services that they will have to provide with greater focus on the provision of geriatric care. A major problem with planning for the provision of medical facilities is the paucity of specific data, especially on private hospitals. Available data on government hospitals have been used here, but it is clear even from basic research that it does not provide a real picture of the quality and quantity of health care in the country.
As per the 2011 census, the population of the elderly is 105 million and is slated to multiply by three times in the sixty-plus age group and five times in the eighty-plus age group over the next two decades.
According to a study by Agewell Foundation, more than 71 per cent of senior citizens in India face harassment or humiliation by their own family members, relatives or children. The aged people often do not have financial protection such as sufficient pension and other forms of social security in India. The single most pressing challenge to the welfare of older person is poverty, which is a multiplier of risk for abuse.
It has come on record that the Union of India has categorised the elderly as those who are above 60 years of age and up to 79 years of age belonging to one category and those above 80 years of age belonging to another category. The record shows that pension under the Indira Gandhi National Old Age Pension Scheme (IGNOAPS), persons between the age of 60-79 years receives Rs. 200 and person above 80 years of age receive Rs. 500 per month.
Unfortunately, the pension amount was fixed more than a decade ago with the latest revision in 2007. If the current value of the rupee is taken into consideration then in real terms the amount actually works out to about Rs. 92 per month on the lower scale. The Supreme Court in December 2018, therefore, in its Ashwani Kumar vs Union of India Judgement stated that the amount is a pittance and inadequate to advance the constitutional mandate of Article 21, i.e. the right to life with dignity.
Since the last two years, the allocation for the IGNOAPS has stagnated at Rs. 6259 crores. It has been noted that the budgeted amount for old-age pensions is enough to cover about 30% of the eligible beneficiaries. Pension Parishad, a civil society network has been a strong proponent of universal social security guarantee and has been demanding pensions of at least Rs 2,000 per month, or 50% of the minimum wage of a state, whichever is higher, with regular indexing to inflation.
Furthermore, Section 19 of the Maintenance and Welfare of Parents & Senior Citizens (MWSPC) Act 2007 states that the State Governments may establish and maintain Old Age Homes, at least one in each district for a minimum of 150 senior citizens. As per a reply to a Parliamentary Question in the Lok Sabha on 04.02.2020, the Government of India has stated that 512 Old Age Homes have been established in the 640 districts across India under the Integrated Programme for Senior Citizens. This is grossly inadequate.
Unattended chronic disease, unaffordable medicines and treatment and malnutrition are part of old age life in India as there is no system of affordable health care. Emphasis on geriatrics in the public health system is limited with few dedicated geriatric services. The Central Government formulated the National Programme for the Health Care of Elderly (NPHCE) to be able to provide easy access to preventive, curative and rehabilitative services to the elderly. However, as Rajesh Raushan has recently pointed out the gross neglect of this scheme especially amid the pandemic.
To make matters worse, there is an upward trend in the living arrangement pattern of elderly staying alone or with spouse only from 9.0% in 1992 to 18.7% in 2006. Family care of the elderly seems likely to decrease in the future with the economic development of the nation and modernization. Furthermore, insurance cover that is elderly sensitive is virtually non- existent in India. Besides, the pre-existing illnesses are usually not covered making insurance policies unviable for the elders. Pension and social security are also restricted to those who have worked in the public sector or the organized sector of industry.
Given the large gaps currently glaring at us, it must be remembered that comprehensive care to the elderly is possible only with the involvement and collaboration of family, community and the government. India should prepare to meet the growing challenge of caring for its elderly population. All social service institutions in the country need to address the social challenges to elderly care in order to improve their quality of life. There is a need to initiate requisite and more appropriate social welfare programmes to ensure life with dignity for the elderly. In addition, there is also a need to develop an integrated and responsive system to meet the care needs and challenges of elderly in India.
Sai Anurag is a consultant with Samruddha Bharat Foundation.