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THE CONTEXT: India’s demographic landscape is undergoing a significant transformation. While much of the focus has been on the youth bulge and the potential demographic dividend, the country is also experiencing rapid ageing. This shift brings forth critical challenges related to social security, healthcare, and the overall well-being of older persons.
THE ISSUES:
- Rapid Increase in Elderly Population: India’s elderly population is growing at an unprecedented rate. The proportion of people aged 60 and above is projected to increase from 8.6% in 2011 to 20.8% by 2050. This demographic shift will have profound implications for social security, healthcare, and economic policies. People aged 80 and above are expected to grow by 279% between 2022 and 2050. This rapid ageing process is more pronounced compared to Western countries, where similar demographic transitions took much longer.
- Inter-State Variations in Ageing: There are significant inter-state variations in the ageing process within India. Southern states like Kerala and Tamil Nadu, and northern states such as Himachal Pradesh and Punjab, have a higher share of elderly populations compared to the national average. These variations necessitate tailored policy responses to address the specific needs of elderly populations in different regions.
- Economic Insecurity and Poverty Among the Elderly: Economic insecurity is a major concern for India’s elderly population. More than 40% of the elderly in India are in the poorest wealth quintile, with about 18.7% having no income at all. Only 29% of senior citizens have access to social security schemes such as pensions or provident funds. This financial vulnerability is exacerbated by the fact that many elderly people continue to work in the unorganized sector, making them ineligible for pensions or other forms of income support.
- Healthcare Challenges: The elderly in India face significant healthcare challenges, including a high burden of non-communicable diseases (NCDs) such as diabetes, hypertension, and cardiovascular conditions. According to the Longitudinal Ageing Study in India (LASI), 75% of the elderly have one or more chronic diseases, and 40% have disabilities. Access to healthcare is limited, with government health insurance schemes like Ayushman Bharat primarily targeting those below the poverty line, leaving many elderly without adequate coverage.
- Social and Emotional Support: Changes in family structures, particularly the shift from joint to nuclear families, have reduced the traditional support systems for the elderly. Many elderly individuals, especially in urban areas, live alone as their children migrate for work. This isolation increases their need for both physical and emotional support. Middle-class families may afford hired domestic help, but institutional support for elderly care, such as retirement communities and long-term care facilities, is poorly developed.
- Policy Gaps: India lacks a comprehensive policy framework to address the needs of its ageing population. Unlike several East and Southeast Asian countries, India does not have a universal public pension scheme or comprehensive health insurance for the elderly. The existing schemes, such as the National Programme for Health Care of the Elderly (NPHCE) and the National Social Assistance Programme (NSAP), are insufficient and poorly targeted.
THE WAY FORWARD:
- Comprehensive Health and Social Care Integration: India’s elderly population will reach 347 million by 2050. Develop an integrated health and social care system tailored to the needs of the elderly, which includes geriatric healthcare, long-term care facilities, and community-based support. Japan’s Long-Term Care Insurance (LTCI) system provides a model where health and social care services are integrated, ensuring comprehensive support for the elderly. NITI Aayog recommends strengthening geriatric healthcare within existing systems and expanding tele-consultation services to enhance accessibility.
- Universal Pension and Financial Security Programs: Only 18% of India’s elderly are covered by health insurance, and a significant portion live without a stable income. Implement a universal pension scheme and financial security programs to ensure a stable income for all elderly, regardless of socio-economic status. New Zealand’s universal pension scheme provides a non-contributory pension to all citizens over 65, ensuring financial security.
- Promotion of Age-Friendly Infrastructure: Rapid urbanization and changing family structures necessitate age-friendly infrastructure to support elderly independence. Develop age-friendly cities and communities with accessible transportation, pedestrian-friendly streets, and barrier-free public spaces to support active and healthy aging. The WHO’s Global Age-Friendly Cities project provides guidelines and best practices for creating inclusive urban environments. The UNESCAP emphasizes the need for enabling and supportive environments to meet the challenges of an ageing population.
- Technological Innovations in Elder Care: Leverage technology to provide remote healthcare, telemedicine, and assistive devices to enhance the quality of life for the elderly. Technological advancements can revolutionize elder care by improving access and quality of services. Technological advancements can revolutionize elder care by improving access and quality of services.
- Strengthening Community-Based Care Models: The shift towards nuclear families and urban migration increases the need for community-based care models. Promote community-based care models that enable seniors to receive care and support within their homes and communities, reducing reliance on institutional care. Denmark’s home care system provides comprehensive support services to the elderly, allowing them to age in place.
THE CONCLUSION:
As India navigates its demographic transition, it is imperative to address the needs of its ageing population. Ensuring access to financial security, healthcare, and social support will foster healthy ageing. By adopting comprehensive policies and leveraging multi-sectoral collaboration, India can transform its demographic challenge into an opportunity for inclusive growth.
UPSC PAST YEAR QUESTIONS:
Q.1 In order to enhance the prospects of social development, sound and adequate health care policies are needed, particularly in the fields of geriatric and maternal health care. Discuss. 2020
Q.2 Appropriate local community-level healthcare intervention is a prerequisite to achieve ‘Health for All ‘in India. Explain. 2018
MAINS PRACTICE QUESTION:
Q.1 India is experiencing a rapid demographic transition with an increasing proportion of elderly population. Discuss the challenges and suggest policy measures to ensure the social welfare and healthcare of older persons in India.
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