Ageing and vulnerability in
ASEAN countries
5th
Eduardo Klien
ASEAN GO-NGO Forum, 22 November 2010, Brunei Darussalam
Demographic Shift
• Condensed in time
• Irreversible in nature
• Comprehensive in scope
ASEAN population
80
60
14
Source: World Population Prospects: The 2008 Revision Population Database, United Nations Population Division http://esa.un.org/unpp/index.asp?panel=2)
Compiled by HelpAge
ASEAN population
Source: World Population Prospects: The 2008 Revision Population Database, United Nations Population Division http://esa.un.org/unpp/index.asp?panel=2)
Growth of the old and older old
Population of OP (thousand)
200,000
180,000
30,777
160,000
140,000
120,000
80+
100,000
60-79
80,000
147,624
60,000
40,000
20,000
55,381
25,608
0
1990
2015
2050
Source: World Population Prospects: The 2008 Revision Population Database, United Nations Population Division http://esa.un.org/unpp/index.asp?panel=2)
Compiled by HelpAge
Population ageing in ASEAN
countries (%)
Year
60+
80+
male Female male Female
1990
45%
55%
39%
61%
2015
44%
56%
40%
60%
2050
44%
56%
37%
63%
http://esa.un.org/unpp/p2k0data.asp
• Reduction of proportion and absolute number
of children
• Increase of people over 60 years
• Increase of older olds
• Feminisation of old age
Challenges on social and
economic policy
• How to ensure income security
• How to provide adequate Health
services
• How to enhance Community care
and inclusion
Dependency ratios
(Total, Child, Old-age)
2005
1985
Total
Child
Oldage
Brunei
68
63
5
47
43
Cambodia
86
80
5
67
Indonesia
72
66
6
Lao PDR
91
84
Malaysia
74
Myanmar
2025
Total
Child
Oldage
Total
5
41
30
11
51
28
23
62
5
52
44
8
46
31
15
51
43
8
43
30
13
56
27
29
7
78
72
6
56
49
7
48
34
14
67
6
56
49
7
48
35
13
53
28
25
78
70
8
50
42
8
46
33
13
55
28
27
Philippine
s
82
76
6
65
59
6
53
43
10
51
32
19
Singapore
42
34
7
39
27
12
55
19
35
78
20
58
Thailand
63
56
7
43
33
10
48
29
19
60
28
32
Viet Nam
83
75
8
55
45
10
44
30
14
58
27
32
Compiled by HelpAge
Total
Child
Oldage
2050
Child
Oldage
Dependency ratio in ASEAN
40%
37%
35%
30%
26%
25%
23%
20%
0-14
60+
18%
15%
10%
10%
6%
5%
0%
1990'
2015'
2050'
Source: World Population Prospects: The 2008 Revision Population Database, United Nations Population Division http://esa.un.org/unpp/index.asp?panel=2)
Compiled by HelpAge
Income security
More consumption
than income
Income security
• 21% of older people have formal pensions
• Expansion of contributory pensions: limited
option
• Role of non-contributory pensions
Life expectancy after 60 and
years of ill health
30
male
female
Unhealthy
Cambodia
Laos
25
20
15
10
5
0
Vietnam
Singapore
Health
Ageing and Non communicable diseases
– 75% of the deaths in the region are attributable to NCDs
compared to 14% of deaths from communicable
diseases
– NCDs represent 92% of the burden of disease (DALYs)
in high income countries and 63% in middle and low
income countries.
Main NCDs of older people
Adults Aged 60+
Rank
1
2
3
4
5
6
7
8
9
10
Diseases
Ischaemic heart disease
Cerebrovascular disease
Chronic obstructive pulmonary disease
Lower respiratory infections
Trachea, bronchus, lung cancers
Diabetes mellitus
Hypertensive heart disease
Stomach cancer
Tuberculosis
Colon and rectum cancers
Source: WHO, 2006
Health
• Rethink health systems to cover NCDs
• Self-care approaches
• Access to health services for older people
(2 approaches to achieve universality)
– Bismark: social insurance
– Beveridge: tax funded free health care
Care giving - Continuum of
Care
Nursing
Home
Cost
of
Care
Home for
the Aged
Short Stay
Day Care
Paid
Home Care
Home Care
Volunteer& family
Community based care
Source: HelpAge Korea
Difficulties of ADL &
IADL of OP
Institutional care
Community care and
inclusion
• Older people in work (family care)
• Family and community care for older people
• Inclusion and mainstreaming ageing
• OPA development