The Encyclopedia of Life Support Systems (EOLSS)
Coordinated by the UNESCO-EOLSS Joint Committee
Demography
Ch. 15
DEMOGRAPHY OF AGING
M. Nizamuddin, Javed Sajjad Ahmad, Fauzia Maqsood,*
Key Words: Aging Crisis, Age Specific Fertility Rate, Age Sensitive Policies, Age-Integrated
Society, Average Annual Growth Rate, Baby Boom Cohorts, Challenges of Population Aging,
Changing Population Structure, Co-residence of Living Arrangements, Declining Mortality
Rates, Development Policies, Dependency Ratio, Demographic Transition, Demographic
Equation, Dependency in later Life, Disability and Mortality, Double Aging Process, Extended
Life Expectancy, Fast Aging Process, Feminization of Aging, Geriatric Care, Global Nursing
Home, Healthy Aging, Implications of Population Aging, Intermediate Regime,
Intergenerational Relationship, Labor Force Participation, Life Expectancy, Life Span,
Maternal Mortality, Means Tested Provision, Medium Variant Projections, Modern Regime,
Mortality Differentials, Multi-Generational Household, Old Age Long Term Care, Oldest-old,
Pace of Population Aging, Patriarchal Society, Pay-As-You-Go Social Protection , Population
Aging, Population Base, Post- Retirement Life, Primitive Regime, , Population Policy
Psychological Implications, Pyramid, Rapid Aging, Reproductive Health, Replacement
Fertility, Replacement Level, Sex Ratio, Sex Mortality Ratio, Shrinking Population, , Society
for All Ages, Total Fertility Rate, Working Age Population
* M. Nizamuddin, PhD HEC Foreign Professor, University of Gujrat
Javed Sajjad Ahmad, HEC Visiting Professor, University of Gujrat
Fauzia Maqsood, PhD (candidate) Institute of Social & Cultural Studies, University of the
Punjab, Research Consultant, University of Gujrat
1
Contents
1 Introduction and Background
2Global Ageing: An Overview of Major Trends in Developed and Developing World
3 Rapid Populations Ageing in Developing World
3.1 Regional Dimensions in Population Aging
3.2 Population Aging in East-Asia, South-East Asia, South & West Asia and the Pacific
4 Demographics of Ageing: Major Determinants
4.1 Success in Family Planning, Declining Trends in Fertility and Mortality
4.2 Sex Ratio of Aging Population
5 Major Challenges of Rapid Aging for Public Policy
5.1 Economic Challenges
5.2 Is the Developing World ready to deal with Rapid Aging?
6 Changing Family Structure, Status of Women and Feminization of Aging
6.1 Dwindling Family Support System
6. 2 Changing Status of Women
6.3 Gender Differences in Mortality and Life Expectancy
6. 4 Changing Role of Young and Elderly Women
7Problems and Needs of Aging Population
7.1 Health and Morbidity
7.2Changing Morbidity, Chronic Diseases and Functional Disability
7.3Increasing Risks of Disability
7. 4Changing Educational Needs
7. 5 Aging and Nutrition
7.6 Active and Healthy Aging
7. 7 Health & Long Term Care
7.8 Health Care Services for the Elderly
2
7. 9 Patterns and Levels of Support
7. 10 Growing Need for Institutional Support and Geriatric Care
7.11 Community Care Institutions
8 Financial and Fiscal Policies for Older Persons
8.1 Economic Security and Retirement Patterns
8.2 Need for Old-age Security
8.3 Need for Universal Pension System
8.4 Emerging Trends in Pension and Social Assistance: Selected Best Practices
9 Foreign Assistance to Population Aging Programmes
9.1 Role of NGOs and Civil Society
10 Growing Concerns for Public Policy in Developing Countries
11 Recommendations for Action
Bibliography
Summary
According to the UN estimates, declining fertility and increasing longevity are resulting in
aging of population in both developed and developing countries which need serious attention of
the governments. Worldwide, the number of people aged 60 and over will increase from about
600 million in 2000 to almost 2000 million in 2050. In developing countries as a whole, 60
year and above population is about 8 per cent and will increase up to 28 per cent by 2050.
Successes in reproductive health and family planning programs and improvements in health
care services (low fertility and low mortality) have contributed towards population aging by
enabling longer survival. Moreover, population aging in developing countries is taking place at
a much faster pace than it did in developed world.
The problems posed by aging population constitute economic, social and emotional
dependency of the older people. Moreover, elderly population is also likely to be affected by
chronic diseases and disabilities. Hence, they pose a heavy burden on the national budgets in
terms of their pension, improved living arrangements, health care cost and social needs. These
issues have invited policy makers to revisit the old policies and formulate new policies and
social protection programs for the aged.
In most developing countries, women constitute at least 55 per cent of the total aging
population. Old women experience old age, mostly as dependents and vulnerable compared to
men. Developing countries need to take urgent steps to address the concerns of aging
population and to take preventive measures to ensure healthy and active ageing in the future.
3
There is a need to evolve a new paradigm to minimize the generation gap between the older
people and young generation for social protection and to meet the growing needs of elderly
population on priority basis
4
1. Introduction and Background
Population aging is increasingly being recognized as a process of major significance for all
societies, and particularly for those in less developed regions, as they enter the twenty-first
century. The concern for older persons emerged strongly in The First World Assembly on
Aging, held in Vienna, (1982) when United Nations International Plan for Action on Aging in
the enunciation of Principles for Older Persons and Targets on Aging for the year 2001 were
adopted. It was further promoted by the General Assembly Resolution 46/91 of December
1991, which more explicitly recognized the importance of these issues in less developed
regions.
The Programme of Action of the 1994 International Conference on Population and
Development (ICPD) provided a major impetus for addressing this theme and further progress
has been made through a number of international meetings identifying needs and initiating
programmes and projects. These include the recommendations of the ICPD+5 Technical
Meeting on Population Aging held in Brussels (Cliquet and Nizamuddin, 1999), and the
proposals for key actions for further implementation of the Programme of Action of the ICPD
in the Report of the Secretary-General for the 21st Special Session of the UN General
Assembly. Recommended actions focused on fostering intergenerational dialogue and
solidarity, gender sensitive research to meet the policy and programme challenges of
population aging, and the need to document catching positive experience of relevant policies
and programmes from the advanced nations and from those countries with relevant experience.
The Second World Assembly on Aging (SWAA), held in Madrid in April 2002, built upon the
concept of a “Society for All Ages”, set a milestone and called upon member states for changes
in attitudes and adjustments in national and international policies, corporations and other
organizational practices. The Madrid International Plan of Action on Aging that was adopted
by the assembly, made several far reaching recommendations to the member states, such as:
i.
ii.
iii.
iv.
v.
vi.
vii.
viii.
Provide opportunities, programmes and support to encourage older persons to
participate or continue to participate in cultural, economic, political, social life and
lifelong learning;
Provide information and access to facilitate the participation of older persons in mutual
self-help, intergenerational community groups and opportunities for realizing their full
potential;
Older persons should be treated fairly and with dignity, regardless of disability or other
status, and should be valued independently of their economic contribution; encourage
the establishment of organizations of older persons at all levels to, inter-alia, represent
older persons in decision-making;
Enable older persons to continue working as long as they want to work and are able to
do so; make special efforts to raise the participation rate of women and disadvantaged
groups, such as the long-term unemployed and persons with disabilities, thereby
reducing the risk of their exclusion or dependency in later life; encourage appropriate
social protection/social security measures for older persons in rural and remote areas;
Ensure equal access to basic social services for older persons in rural and remote areas.
Assist families to share accommodation with older family members who desire it;
Encourage and promote literacy, numeracy and technological skills training for older
persons and the aging workforce, including specialized literacy and computer training
for older persons with disabilities;
Organize, as a matter of urgency where they do not exist, social protection/social
security systems to ensure minimum income for older persons with no other means of
5
ix.
support, most of whom are women, in particular those living alone and who tend to be
more vulnerable to poverty; and
Set targets, in particular gender-specific targets, to improve the health status of older
persons and reduce disability and mortality.
2. Global Ageing: An Overview of Major Trends in Developed and Developing World
In the year 2007, United Nations undertook a detailed global review of the progress made since
the Madrid International Conference 2002. The UN Population Division published a report,
titled: World Population Aging 2007. The data of the report reflects the latest projections and
revised estimates on population aging.
Declining mortality has improved survivorship among the middle aged and the elderly, further
enhancing the prospects of extended life expectancy and contributing to the structural shift
from younger to the older populations. Consequently, populations of older persons are not only
growing numerically but also as a proportionate share of the total population. (United Nations,
2007).
Table1. Population aged 60 years or older: World and Major Regions
POPULATION AGED 60 YEARS OR OLDER
Country or Area
World
More Developed
Regions
Less Developed
Regions
Least Developed
Countries
Africa
Asia
Europe
Latin America
and the
Caribbean
Number (millions)
Percentage of total
population
Percentage
currently married
Percentage
living alone
2006
2050
2006
2050
Men/Women
Men/Women
687
247
1 968
400
11
20
22
32
80 / 48
79 / 48
8 / 19
13 / 32
440
1 568
8
20
81 / 47
5/ 9
39
171
5
10
85 / 39
4/ 8
48
374
151
50
192
1 231
225
188
5
9
21
9
10
24
34
24
85 / 39
81 / 50
80 / 47
75 / 42
6 / 11
5/ 9
13 / 35
7 / 10
60 and above
population
Percentage in
labor force
Sex ratio
(men per
100
women)
2006
2006
Men/Women
60+
Men/Wom
en
40 / 16
82
17 / 21
22 / 11
72
19 / 23
50 / 19
88
17 / 19
71 / 37
64 / 32
48 / 18
15 / 7
46 / 16
85
83
88
69
82
15 / 17
15 / 17
17 / 20
18 / 22
19 / 22
Source: United Nations Population Division 2007
The above mentioned figures indicate the proportion of the population aged 60 and over in the
world population in 2006 and 2050. It shows that in 2050 the population of 60+ persons will
be doubled, which is a serious concern for the policy makers and program managers in both
developed and developing world.
6
Life
expectancy
at age 60
2005-2010
Despite the increasingly widespread occurrence of this phenomenon, however, the extent of
population aging at the end of the twentieth century varies widely between regions. The large
proportions of older persons in the more developed regions have attracted a great deal of
supportive concern as those 60 years of age and over reached 20 percent of the total population
by 2006, and projected to reach a level of 32 percent by 2050 (United Nations 2007). By
contrast, relatively little attention has been directed to the rapidly changing population structure
in less developed regions.
The issue of living alone in old age is also considerable as in more developed regions, there are
only 13 percent men living alone at old age in 2006 compared to 32 percent women. In less
developed regions these figures are 5 percent and 9 percent for men and women respectively.
(See Table 1). Aged people 60 years or over who are currently married, in more developed
regions, 79 percent are men and 48 percent are women. In the less developed regions, situation
is not much different having 81 percent men and 47 percent women married at this age. Thus, a
large proportion of older women at age 60 and over are either widowed, divorced or separated,
which of course put these women in vulnerable position.
Population aging has the following notable features:
i) Population aging also causes changes in living arrangements resulting in increasing number
of older people living alone (about 13% men and 35% women of older age in 2006, in Europe,
lived alone ( see Table 1)
ii) Population aging is particularly rapid among women, resulting in “feminization” of
population aging (because of lower mortality rates among women). For example, in Asia, there
were 10.4 percent older women and 8.9 percent older men in 2006 aged 60 years or over, or a
sex ratio of 88 men for every 100 women (see Table 1)
iii) Since older persons have usually lower income and a higher proportion of them are living
below the poverty line, population aging is associated with poverty, particularly in developing
countries. (Gavrilov and Heuveline 2003)
Although most countries in these regions have younger populations, showing clear signs of
aging. According to the latest estimates, in less developed regions as a whole, just 8 per cent of
the population today is aged 60 years or over but by 2050, 20 per cent of their population is
expected to be in that age range. The proportion of older persons is lowest in Africa, though
rising, but in the Latin America/Caribbean region the proportion is just below that for Asia
which is expected to reach 24 percent in 2050. At that stage, Asia will have 85 percent of the
less developed regions' population aged 60 and over. Less developed regions are predicted to
have 20 percent of their population in the over 60 years of age category by 2050.
Most of the elderly live in the less developed regions. By 2006, the less developed regions had
64 percent of the world's older population and in 2050; this share is expected to be 80 percent
and above Translated into numerical terms, less developed regions had about 440 million
persons aged 60 and over in 2006 compared with 247 million in more developed regions, and
these totals will rise to 1568 and 400 million respectively in 2050 (see Table 1). The
implication is clear: the less developed countries, where issues of reproductive health including
family planning, infant, child and maternal mortality have long been the central focus of
population policy, must now also include serious considerations of population aging.
7
3 Rapid Populations Ageing in Developing World
Population ageing has been a global issue since the early 1980’s. Population aging is happening
on a very large scale in developing countries. The numbers of older persons in developing
countries will more than double by 2025 (reaching 850 million). 200 million more than the
total population of Europe at that date. Developing regions were having greater percentage of
population in the age group of 5-50 as compared to the percentage in the age group 60-80 years
or more (United Nations, 2002). But the percentage of these age groups is estimated to change
drastically in the year 2050 when the pyramid of Population Aging converts into a pillar with
less percentage of lower age group population and more percentage of higher or old age
population.(see figure 1)
Figure 1. Age Structures – From Pyramids to Pillars: Developing Regions
Source: United Nations, 2002
3.1 Regional Dimensions in Population Aging
Global trends reflect significant differences among older population on the basis of region and
gender. Wide regional variations do exists with aging population among developing countries.
Demographic trends show that globally 51% of the older persons live in cities. In developed
countries 74% of older people are living in cities. Whereas, in developing countries, majority
of older people (63%) live in rural areas. This trend in developing countries has serious
implications for rural development policies because higher proportion of older people in rural
areas means less number of people for production activities and large number of people for
consumption of goods and services.
Developed countries have gone through the demographic transition and lowered their fertility
and mortality rates, resulting in their populations becoming greyer at a slower but consistent
pace. On the other hand, the population in the developing countries have historically
maintained high fertility rates and thereby a young age structure. The demographic data
indicates that average age of population starts increasing with declining fertility rates. For the
period 1995-2000, 61 countries in the world, representing 44 percent of the world’s population,
are at or below replacement fertility. By 2015, the world’s population is projected to reach 7.2
billion, of which about two thirds will be living in countries at or below replacement fertility.
8
The fast aging process is taking developing countries by surprise. Already scarce resources will
be further strained; competition for them from different sectors will intensify.
The Asia and Pacific region experienced rapid decline in fertility in past several decades. Total
fertility Rate (TFR) dropped from 6.0 in 1950-1955 to 2.7 in 1995-2000, though there are sub
regional variations. Pace of aging is fastest in Asia and Pacific which is an inevitable outcome
of sustained declines in fertility and mortality during last three decades. It took 114 years for
Sweden and France to double its 60+ population from 7 to 14 per cent while the same was
accomplished in Singapore in just 18 years ( see figure 4). Therefore, no Asian country will
escape the substantial aging of its population in the first half of this millennium.
Although the growth of older population is more in the developed regions, the speed of aging is
more rapid in the less developed countries. Because rapid changes in age structure may be
more difficult for societies to adjust to than change that is spread over a longer time horizon,
the speed of population aging has important implications for government policies, such as
pension schemes, health care and economic growth.
Typically, the transition from 7 to 14 per cent took longer for countries that reached the 7 per
cent level at an earlier date. For example, France and Sweden, which reached the 7 per cent
point before 1900, took 115 years and 85 years, respectively, to reach 14 per cent. Several
developing countries shown in figure 5 will also make a rapid transition from 7 to 14 per cent
aged 65 or older. Brazil, Sri Lanka, Thailand and Tunisia are projected to make this transition
in a time span of less than 25 years, and the two most populous countries, China and India, may
require only 26 and 28 years, respectively.
Figure 2. Number of years required or expected for percent of population aged 65 and
over to rise from 7 percent to 14 percent.
Source: Kinsella K, Gist Y. Older Workers, Retirement, and Pensions. A Comparative
International Chart book. Washington, DC
9
In many cases, it will take substantially less time for the transition from 14 per cent to 21 per
cent, than it took to move from 7 to 14 per cent aged 65 years or older. Although no country
has yet reached the point where 21 per cent of the population is aged 65 or older, some
countries are expected to reach that point before the year 2015. At a later date, Canada and the
United States of America are expected to make a very rapid transition from 14 to 21 per cent
aged 65 or older, as its large baby boom cohorts enter the higher ages. Thus, in the near future
some societies will be faced not only with older populations than have ever existed at the
national level, but populations that are aging at an extremely rapid pace.
3.2 Population Aging in East-Asia, South-East Asia, South & West Asia and the Pacific
Though the majority of the world’s elderly population resides in the developing countries; the
Asian and Pacific region is home to the largest number of older persons. Worldwide, the
number of people aged 60 and over will increase from about 687 million in 2006 to almost
2000 million in 2050. The Asia Pacific region is by and large a very dynamic area of the
world, not only economically, socially and politically but also in terms of its demography and
population profiles. The Asian and Pacific region is a heterogeneous group with vast
differences in size, population, wealth, development levels and cultural diversity.
Japan, with 28 per cent, 60+ elderly population is on the top, having highest population of older
people in the world. The world has 687 million people 60 and above age, which will increase
up to 1968 million by the year 2050, overall 21.7 per cent of the total population. Where as the
60+ population of East Asia and Pacific will be increased from 199 million to 637 million, i.e.
from 10.1 per cent to 28.4 per cent, which is amongst the highest increase in percentage by the
said period. South Asia and West Asia will be adding age 60+ people 19.2 per cent and 17.3
percent, respectively, by the year 2050.
In comparison, some South-East and South Asian countries, such as Cambodia, Lao People’s
Democratic Republic, Maldives, Nepal, Pakistan, Papua New Guinea, are still youthful with
lower proportions (7 per cent) of older persons. Despite this fact, most countries in the region
will experience considerable growth in their elderly populations with more than 8 per cent oldage dependency ration in the next few decades when the proportion of people aged 60+ will
triple or quadruple to over 20 or 30 per cent. Below table shows the current and projected
percentage of the elderly population of the world and selected Asian regions.
Table 2. Population by broad age group of 60+ for world and selected regions,
2005, 2025 and 2050
Region
60+ Population in Millions
Percentage of 60+ aged people
2005
2025
2050
2005
2025
2050
World
672
1193
1968
10.4
15.1
21.7
East Asia and the Pacific
199
401
637
10.1
18.1
28.4
South Asia
114
224
465
7.4
11.1
19.2
Western Asia/ Middle East
12
26
63
6.1
9.4
17.3
Source: United Nations (2005)
Note: The table shows estimates (until 2005) and medium-variant projections (after 2005)
Asia, including the most populated regions of the world- East and Southeast Asia- will
experience the largest and most rapid increase in its aged population. The majority of world’s
older persons (53 percent) reside in Asia as compared to the next largest share of Europe of 24
10
percent. Asia’s share of the older population will increase to 63 percent by 2050, while the
share of Europe will decrease by more than 11 percent.
East Asia will contest the more developed regions in aged people by 2050. The proportion of
older persons in South-East Asia will exceed the average of all the other less developed
countries. The rate of increase of older population in less developed regions was double than
that of more developed regions during 1975-2000. But the statistics after the first half of this
century clearly indicate the increase in this gap with South-East Asia experiencing the highest
rates of growth in older population i.e. 3.5 percent in 2025 to about 4 percent till 2050.
The less developed regions have experienced increase in their older persons, among these, 35
percent of the world’s older population will be residing in the East and South-East Asia.
(Ghazy, 2006) The percentage of the age 60+ in East and South Asia region will range from 33
in China to 12 in most other South Asian countries by 2050. With declining fertility and
improvements in life expectancy, some countries in South Asia are already in the process of
rapid aging with Sri Lanka and India at the forefront. The percentage of the aged persons 60+
in South Asian countries will be 8.2 in 2025 and 15.3 in 2050. Bangladesh and India will have
9.1 and 12.0 percent respectively in 2025 and 16.7 and 20.7 percent in 2050, of the older
population (Alam, 2007)
However, many countries in the region will take a shorter span for their ageing populations to
double or triple in percentages. It took developed countries (such as France, Germany, UK,
USA and Sweden) 80 to 150 years to double their elderly population from 10 to 20 per cent,
most countries in Asia and the Pacific will experience that process in less than 50 years time. In
China, it is projected that it will take only 27 years, from 2000 to 2027 for the proportion of the
population aged 60 and over to double from 10 to 20 per cent. The relatively short span of time
has therefore exerted certain urgency on many countries which have to face and prepare for the
challenge of simultaneous development and population ageing. The projection of aging
population in the world and in Asia region is reflecting in following graphs.
According to the 2006 Revision, the world population will likely to increase by 2.5 billion over
the next 43 years, passing from the current 6.7 billion to 9.2 billion in 2050. The older persons
in the world (60 years and above) will likely surpass, for the first time in history, the number of
children (i.e., persons under age 15). This crossover is the consequence of the long term
reductions in fertility and mortality that are leading to the steady ageing of the world
population. Furthermore, in the more developed regions, the population aged 60 or over is
expected to nearly double (from 247 million in 2007 to 400 million in 2050).
Developed countries in the Asia-Pacific region, such as Australia, Japan and New Zealand,
who have been grappling with their ageing population for a longer period of time have directed
their efforts in establishing a high-level government agency, usually at the ministerial level, to
focus and coordinate manpower and resources in dealing with ageing issues. Their national
policies and plans of action are also more elaborate in content. Countries and areas such as
China; Hong Kong, Republic of Korea; Cambodia; Malaysia; Nepal; Pakistan; Papua New
Guinea; Sri Lanka and Thailand are also taking serious steps to tackle the rapid ageing by
establishing national organizations on ageing.
Reference: Press Release POP/952, Department of Public Information • News and Media Division • New York
11
Table3. Population by Age, Sex Ratio and Growth Rates
World, major areas and regions, 2007)
Major areas and
regions
World
Sex ratios(per 100
women)
60+
65+
80+
82.1
77.4
55.8
Growth rates(percentage)
Total
1.1
60+
2.6
65+
2.0
80+
3.9
More developed regions
72.7
67.7
46.8
0.2
1.8
1.0
3.3
Less developed regions
Least developed
countries
Africa
Eastern Africa
Middle Africa
Northern Africa
87.7
84.5
84.0
82.3
66.3
72.8
1.3
2.3
3.0
2.9
2.6
3.0
4.6
3.8
82.9
82.6
80.2
84.7
79.9
80.4
77.4
81.2
67.1
69.3
63.8
69.6
2.1
2.3
2.7
1.7
2.8
2.7
2.2
3.2
2.7
2.7
2.4
2.5
4.1
3.8
3.1
5.2
Southern Africa
70.1
64.4
42.8
0.1
3.2
3.6
4.3
Western Africa
86.7
84.2
73.2
2.3
2.5
2.8
3.5
Asia
88.3
84.1
63.0
1.1
3.0
2.6
4.7
Eastern Asia
88.4
83.1
54.4
0.5
3.1
2.4
4.8
South-Central Asia
90.2
87.6
80.3
1.5
2.8
2.7
4.5
South Eastern Asia
83.7
80.7
69.9
1.2
2.9
2.9
4.5
Western Asia
84.9
81.1
65.8
1.9
2.7
2.2
6.0
Europe
69.2
64.2
43.3
-0.1
1.2
0.4
3.4
Eastern Europe
57.4
52.9
33.8
-0.5
0.6
-1.2
4.6
Northern Europe
78.4
73.0
50.7
0.3
1.8
1.2
1.4
Southern Europe
76.0
71.6
51.9
0.2
1.4
1.0
4.2
Western Europe
75.7
70.2
42.9
0.2
1.4
1.3
2.8
Latin America and the
Caribbean
Caribbean
81.8
78.6
65.5
1.3
3.4
3.2
4.6
85.4
83.3
73.4
0.8
2.7
2.7
3.3
Central America
85.3
83.4
72.0
1.4
3.7
3.8
4.9
South America
80.2
76.6
62.7
1.3
3.4
3.1
4.7
Source: United Nations, 2007
Demographic transition is an important concept in the field of demography and it clearly
explains the nature and causes of Population Aging. It gives simple description of patterns of
the historical trends in fertility and mortality rates in different countries including developed
and the developing ones.
12
In the typical sequence, the transition begins with successes in preventing infectious and
parasitic diseases that benefit infants and young children most. The resulting improvement in
life expectancy at birth occurs while fertility tends to remain unchanged, thereby producing
large birth cohorts and an expanding proportion of children relative to adults. Other things
being equal, this initial decline in mortality generates a younger population age structure
(Gavrilov and Heuveline 2003).
Demographic transition progresses through the following three stages. First, high fertility
coupled with high infant mortality and low life expectancy at birth. Second, declining mortality
but fertility declines at a much slower pace along with slower improvements in longevity
indices. Third, a declining fertility and mortality stabilized at lower levels with high life
expectancy both at birth and subsequent stages of the life span. (Alam, 2007)
This concept provides a first systematic effort to describe distinctive demographic regimes
elaborating the link between the historical stages of demographic transition and its resulting
effect on the society’s demographic distribution. The initial formation of the demographic
transition process shows demographic regimes with high fertility and mortality levels; function
of the material aspirations of individuals and productive potential of an economic system in the
form of young and middle aged labor force.




Primitive regimes –At the initial stages of demographic transition process fertility rates
could not be constant if this is the case for the mortality rates, due to economic reasons
ranging from need of labor force to the number of supporters required to a poor family for
its survival from poverty.
Intermediate regimes – The middle portion or area preserving the trend of decreasing
fertility rate could be the result of improved conditions of poor people or social security
schemes available for them.
Modern regimes – economic productivity reaches high levels and individuals have well
formulated aspirations for a high standard of living
The last part of this process shows the high levels of economic productivity with people
aspiring to have small families to enjoy the fruits of development more; and also due to less
dependency on their progeny for their support in old age.
4. Demographics of Ageing: Major Determinants
The source of population aging lies in two (possibly related) demographic phenomena: rising
life expectancy and declining fertility. An increase in longevity raises the average age of the
population by raising the number of years that each person is old relative to number of years in
which he is young. A decline in fertility increases the average age of the population by
changing the balance of people born recently (the young) to people born further in the past (the
old). Of these two forces, it is declining fertility that is the dominant contributor to population
aging in the world today (Weil, 1997).
The main demographic causes of population aging are twofold. The first is transition from high
to low fertility. The second is mortality decline. These two demographic trends lead to decrease
in proportion of young people and a simultaneous increase in the middle and old-age people.”
Total Fertility Rate (TFR) is the average number of births a woman would have in her lifetime,
Age-specific Fertility Rate (ASFR) is the average number of births in a year per 1000 women
in particular age group and; Mortality rate is a measure of the number of deaths (in general, or
due to a specific cause) in some population, scaled to the size of that population, per unit time.
Mortality rate is typically expressed in units of deaths per 1000 individuals per year; thus, a
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mortality rate of 9.5 in a population of 100,000 would mean 950 deaths per year in that entire
population.
At 6.7 billion and rising, the world's population is expected to exceed 9.2 billion by 2050 and
along with this increasing population another significant issue is population aging (United
Nations 2007). As noted earlier, population aging is a global phenomenon. By the middle of
this century one in every five persons will be “old”. All countries are either experiencing rapid
population aging or can be expected to do so over the next two decades.
4.1 Success in Family Planning, Declining Trends in Fertility and Mortality
The projected trends in the proportion of the world’s population aged 60 or older through the
year 2050, from the medium fertility scenario, which assumes that fertility in all major areas
will stabilize at replacement level around 2050, and that mortality rates will continue to
improve. By 2050, persons aged 60 or older are projected to number 2.0 billion, nearly one
person out of every three alive at that time.
The large population growth is a long time dilemma of developing countries causing a
hindrance in their progress towards development. To curb this high population growth many
countries took keen interest in promoting various family planning campaigns and encouraged
their people to have fewer children to provide them better education, care and healthy life.
These campaigns were highly effective and resulted in population control in many of the
developing countries decreasing their fertility rates and hence decreasing the proportion of the
young in total population.
While successful family planning (declining fertility), and child survival (declining mortality)
programs are causing this change in population age structure, developed countries have already
experienced its consequences.
Decline in mortality contributes to aging of population by enabling longer survival, reaching to
old age. The advancement in technology, improved healthcare systems with many diseases
which were once incurable now considered normal to treat; have resulted in lower mortality
rates and hence increase in the proportion of aged people in total population.
With constant birth rates (at whatever level), eventually all future population aging will arise
from further declines in mortality. Although in those circumstances it seems reasonable to
expect that vigorous life would also be extended and the boundaries of old age, and retirement,
would need to be moved upwards accordingly, as they already have. Population aging through
longer survival brings, in part, its own solution, as long as most of the additional years of life
are active ones.
After initial and sometimes very rapid gains in reducing infant and child mortality have been
achieved, further mortality declines increasingly benefit older ages and are eventually
accompanied by reductions in fertility. Such changes contribute to reverse the early effect of
mortality decline on the age structure, and this synergy is known as the double aging process.
This corresponds to the experience of most developed countries today, but further
decomposition suggest that their history of declining mortality is the dominant factor in current
aging (Preston, Himes and Eggers 1989). Mortality declines continue in these countries and the
decrease in mortality rates among the oldest-old (85+ years) has actually accelerated since the
1950s. This latest phase of mortality decline, which is concentrated in the older age groups, is
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becoming an important determinant of population aging, particularly among women. (Gavrilov
and Heuveline 2003)
4.2 Sex Ratio of Aging Population
The number of elderly men is declining with the passage of time in all regions of the world as
compared to elderly women aged 60 years or above. While in less developed regions the sex
ratio for people aged 60 years or over is 88 and for 80 years or more the ratio is 66. (United
Nations, 2007). The sex ratio for population aged 60 years or over is highest in South Central
Asia with 90 men per 100 women and is lowest in Europe. The older population will be
increasingly concentrated in the least developed regions although the percentages of older
persons are significantly greater in the more developed regions; the number of older people is
increasingly larger in the less developed regions. Over the last half century the number of
people aged 60 or older increased globally by an average of 8 million persons every year. Over
the next half century, this trend will intensify. It is expected to make the issue of Population
aging more intense and alarming for the policy makers in the world.
5 Major Challenges of Rapid Aging for Public Policy
Among the various challenges arising as a result of the increasing proportion and absolute
numbers of the elderly population, ensuring that older persons are provided adequate care is of
paramount concern. Awareness of issues concerning older populations remain low in many
nations, even as the absolute numbers of the aged double and triple. Populations in developing
countries are aging much faster than industrialized countries did, because of rapid declines in
fertility and broad diffusion of medical knowledge. Old persons face numerous challenges
outside the world of work. In the developed world, socially speaking, old persons, particularly
the oldest old (those above the age of 85) face seclusion and loneliness. Those with chronic and
debilitating diseases end up in commercially run assisted or nursing homes. There are also
seniors’ homes where relatively healthy persons can live among peers. Public and private
entities operate day care community centers for the seniors where they can socialize, learn and
be entertained. These are often the people whose children for one reason or the other are
unable to support them in their homes. This is also true that many with no or minor disabilities
in performing activities of daily life (ADL), (e.g., eating, clothing, bathing, walking) prefer to
live by themselves and avoid group accommodation. For such persons, loneliness does become
an issue.
The decline in fertility and mortality rates has changed the age structure; hence the family
structure at large resulting in more aged family members than the children. The second issue
pertains to the inter-generational relationship. This relationship between parents and children
can make a huge difference in the lives of old persons. Some children do not care for their
parents or provide social, financial or emotional support. This is likely to be the case if the old
person does not own property or other benefits for the children. Addressing this problem is a
subject of inquiry for researchers in many developed societies.
In developed countries, public policies favoring old persons enable the elderly to make daily
life a bit easier. Financial support through pension schemes has been the norm, which is not
uniform though. Assorted concessions in transportation, prescription drugs, housing,
accessibility to public facilities and for the handicaps, and health care are offered in several
countries. Even private sector offers discounts in shopping, entertainment, prepared food, or
services to the elderly. In the United States the powerful American Association of the Retired
Persons (AARP), with millions of members, promotes greater rights and privileges for the
elderly through political lobbying and media. Membership organizations are playing similar
roles in many other countries. These include even international organizations and their
coalitions with branches spread out globally.
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A rising proportion of the older population relative to that of the active adult and working age
population means that each worker will have to contribute towards supporting an increasing
number of older persons. Also, given the declining family size, the number of caregivers
available per older person will continuously decline. The implications of the growing
imbalance in the demographic equation are further aggravated by increasing globalization,
migration, the increasing preference for the nuclear family and, in some countries, the
HIV/AIDS epidemic.
The issues implicit in this world-wide aging of the population are those central to at least
preserving the quality of life of younger years, and especially for many in less developed
regions, even to ensuring the status quo. Governments and other agencies in more developed
regions, where the importance of the issue has been acknowledged for several decades, have
put in place elaborate measures for dealing with the needs of older persons. Other priorities and
limited resources for overall social agenda in countries of the less developed regions have
precluded such developments, despite the fact that this is where the bulk of the world's older
population already lives.
The major challenges faced by policy makers in developing countries due to population aging
are to cope with expanding number of older dependant persons (as the number of dependents
has increased relative to the number of wage earners; to eradicate widespread poverty faced by
the aged population; to increase public expenditures on social security, health care and welfare
while decreases in revenues due to decrease in labor force participation; to deal with erosion of
the family and community-based care as a result of migration, urbanization, nuclearization of
the family and increasing proportion of women’s employment outside the household.
Policy makers are not yet aware of ensuing Aging “Crisis” in Developing Countries as despite
the size of the elderly population, aging remains largely invisible in public policies and
programs. The contribution of older persons in economic and social development is not
recognized, therefore, they are neglected, and remain on the margins of the development
budgets while priority attention and resources are being allotted to the issues addressing only to
youth.
5.1 Economic Challenges
Due to the changing patterns of population age structure, the demand/ tastes for certain
products will decrease which were once in great demand by the younger portion of the
population. On the other hand, demand for services of health care, elderly care, social security
etc will increase. The products required by the elderly will be more in demand so the
production of those goods will rise. The changing age structure will adversely affect the labor
market in the form of decreasing availability and supply of labor due to the aging of the
existing labor force and declining additions in the form of young labor force due to decreased
levels of fertility. A decline in labour will result in more productivity according to the law of
marginal productivity, and the decrease in labour will be enforced by using more capital
intensive production techniques rather than labor intensive ones.
The major economic challenge is associated with dramatic increase in the older retired
population relative to the shrinking population of working ages, which creates social and
political pressures on social support systems. In most developed countries, rapid population
aging places a strong pressure on social security programs. For example, the U.S. social
security system may face a profound crisis if no radical modifications are enacted in time. Cuts
in benefits, tax increases, massive borrowing, lower cost-of-living adjustments, later retirement
ages, or a combination of these elements are now being discussed as the possible new and
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painful policies, which may become necessary in order to sustain the pay-as-you-go public
retirement programs such as Medicare and Social Security.
For the economic support of large elderly populations in developed countries transfer payments
and savings provide the major pillars of economic support in old age with very little coming
directly from children. In the United States in 1986, for example, only two percent of elderly
people reported receiving income from children, compared with 22 percent in Japan (Maeda
and Shimuzu 1991). Expenditure on pensions now constitutes a significant proportion of Gross
National Product (GNP) and of all government expenditure, in most European countries.
Moreover, in many of these countries, pension liabilities are huge, higher than total GNP in
some cases (World Bank 1994).The greater proportion of older persons in the population in
developing countries will overburden the economy with payments towards the pension fund,
and the contributors to this pension fund will eventually suffer as there will be fewer
contributors for their own pension funds.
The aging of population will result in larger participation of women in labor force as their life
expectancy is higher than men. The retirement age will be higher than the prevailing retirement
age due to the shortage of labour or that labor will be made to work extra and long working
hours than prevailing now. But this aging labour, working beyond their retirement age, should
be prepared in advance to become healthy contributors to the economy rather than be a burden
on it. The aging of the population is indeed a global phenomenon that requires international
coordination of national and local actions. The United Nations and other international
organizations have developed recommendations intended to mitigate the adverse consequences
of population aging. These recommendations include reorganization of social security systems,
changes in labour, immigration and family policies, promotion of active and healthy life styles,
and more cooperation between the governments in resolving socioeconomic and political
problems posed by population aging.
Poverty remains the greatest challenge to older people in developing countries. “Perhaps more
than anything else, policy makers fear that rapid population aging will lead to an unmanageable
explosion in food, shelter and health care costs. In developing countries, many people over age
60 continue to participate in the labor force. Older people are active in the informal work
sector (e.g., domestic work and small scale, self-employees activities) although this is often not
recognized in labor market statistics.
5.2 Is the Developing World ready to deal with rapid aging
Many countries in the East and South Asia region are also facing a challenge in terms of the
unprecedented number and proportions of older persons. As this region is already facing the
problem of enormous population, the aging of this population is becoming a serious policy
issue. The issue of aging population will be one of East Asia’s most economically, politically,
culturally challenging problems. The major contributor in increasing older population in East
Asian region is China where the proportion of the population aged 65 and over will be about
8% in 2010, 12% in 2020, 16% in 2030, 22% in 2040, and 24% in 2050, respectively.
Accordingly, the number of the elderly will be 111 million in 2010, 166 million in 2020, 234
million in 2030, 324 million in 2040, and 343 million in 2050, respectively. The process of
population aging in China is very fast, compared with the developed countries. The proportion
of the elderly in China will increase much faster than in almost all other countries in the world.
(Lu & Yu, 2007)
6 Changing Family Structure, Status of Women and Feminization of Aging
The process of “feminization” of aging has been set in both developed and developing
countries. The number of aging women is dramatically increasing world wide and more than
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half of the women aged 60 and over is living in developing countries as 198 millions can be
compared with 135 millions in developed countries. In developing countries, most of the issues
challenging older persons are disproportionately concentrated among females. The reasons for
feminization of aging have been deeply ingrained in the socio cultural traditions of these
societies. Forty or fifty years ago, most marriages were arranged resulting in an age disparity
between women and their much older husbands. These women also faced discrimination, on
the basis of gender, throughout their lives which have consequences on their lives when they
get older. In their youth they remained busy performing their traditional role as family
caregivers, nurturing children and helping other people in the house. Women were largely
unemployed or employed in informal and unorganized private sectors where they might get
low wages.
In most of the cases women commonly spend their later years without a partner. In such
circumstances, women are perceived to be economically and socially vulnerable. Widespread
loneliness among elderly women is another psychological implication of feminization. Now
days young parents, in developing countries, have also accepted small family norm due to
which families have declining fertility. Young parents are more inclined towards the future
development of their own children resulting in negligence of elderly women.
Widowhood is a growing category which is highest in Northern Africa and Central Asia and
lowest in Latin America and Caribbean. At the age of 65+, there are more widows than married
women whereas at the age of 75+ female ratio of widowed-to-married rises beyond 5-1 in some
countries. There are several demographic and social (gender) factors contributing to higher
proportions of widowhood such as mortality differential between older males and females, age
differential between husband and wife, unacceptability of widow remarriage in some societies,
proportion of women never marrying, survival probabilities of widows compared to married
women etc. Older females are highly vulnerable because in some cultures they do not have or
are unable to exercise property rights. Many are largely dependent and even subject to violence
in the streets or from relatives. They do not enjoy autonomy and may not even demand it.
Developing countries have a predominant feature of being patriarchal societies which have
serious implications on women’s health. Women have lesser share and access to health care.
They are discriminated in terms of nutrition, health care, treatment and prevention. All these
factors become accentuated when these women grow older.
6.1 Dwindling Family Support System
Many studies have confirmed that family support or social support betters physical and mental
health outcomes (Egebean 1992, Silverstein & Bengtson 1994, Wang et al 2005). Although, in
general, children or off springs, friends or neighbours, community and government are all
social support providers to the elderly, family is the critical social institution in providing
support to its members. Especially in developing countries, where the vast majority of the
elderly, particularly in rural areas, have no access to any insurance and formal support, it is
widely recognized that children play an important role in health and well being of the elderly.
Nevertheless, family remains to be a continued source of economic, social, instrumental and
emotional support for elderly, changes in family structures are likely to curtailing these
supportive functions.
Family institutions in developing countries are undergoing rapid changes owing to nuclear
family system, industrialization and migration. Under new rapid changes family is lacking its
capacity in providing support to its elderly even in developing countries. With the rapid
industrialization in developing countries, newer working opportunities both for men and
women are resulting in low number of attendants in family institution to take care of elderly.
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Attitudes of children regarding their duty towards their parents and the custom of caring for
their elders are in transition process. In rural communities, many younger family members
leave the parental home in search of employment in urban areas. Sometimes, elderly also
develop emotional attachment with their homes and do not want to leave their places and live
alone in their houses.
6. 2 Changing Status of Women
Women’s’ participation in labor force, education, politics and media has changed the status of
women. Women now accounted for 16.6% of parliamentary membership around the world in
2005, compared with 15.9% in 2004 (United Nations 2005). Women are playing their vital role
in every field of national and international development. New status of women is entirely
different from that of old. However, old age women are still more vulnerable as compared to
men through out the world. Potential and traditional roles of younger women as primary
caregivers are in the process of rapid alteration. Decreasing family size, greater career
opportunities and increased mobility are introducing new patterns of economic and social
independence for women. Their personal advancement is taking away their status as being
confined in the home and providing care services to their aged persons.
The status of women in old age is changing faster comparatively than men’s. As women tend to
live longer, in older age most of the women become widows. These women, in their youth,
remained far off from “productive” activity and labor force participation in the recent past; and
the time and energy they put in meeting their family responsibilities went unnoticed. When
such women get older they become dependent upon family members economically as well as
socially. This process has significant implications for women in their old ages.
Old persons in developing countries do not have proper facilities of health care and
recreational but in developed countries, it is the responsibility of social security system that
provide all the basic facilities to women in old age i.e. accommodation, recreational activities
and health care. Older women in less developed countries are more isolated as compared to
developed countries because old population is considered an extra burden for the earning hands
of the family. The situation got worst when older parents become inactive due to lack of
opportunities, services and resources. Older women are more vulnerable compared to older
men in less developed counties as they are usually unable to provide economic support to the
family with whom they are residing.
6.3 Gender Differences in Mortality and Life Expectancy
Death rate for older women is declining more quickly than death rate for older men. One
quarter of the increase resulted from mortality trend among people aged fifty-five to sixty-four,
for whom, as well female, death rate declined more than male death rate.
Doubtlessly, aging population is the product of a dramatic decline in biological components of
population, fertility and mortality. In earlier times, in developing countries, women were
marrying at a young age and having an average of 5 to 6 births during their life time. Now one
can observe a paradigm shift, in these countries, due to increasing opportunities. Trend has
been changed now and women are marrying at later stages and having an average of 2 to 3
births. Therefore earlier high births and mortality rates kept the elderly population at low level.
Now the low births rates and low maternal mortality rates have provided added years for
elderly women to live.
Gender differences in life expectancy are significant factors which results in gender imbalance
in later ages. Life expectancy for women is generally higher than men. There are arguments
that the greater average length for women may be attributed to such factors as lesser exposure
19
to addiction, lower exposure to hazardous life style, lower exposure to pollution, lesser tension,
healthier life style and health habits. It is also argued that women with higher education, higher
prestige occupation, and higher income may maintain longevity over men eventually resulting
in feminization of aging.
Life expectancy for women now exceeds 80 years in at least 35 countries and is approaching
this threshold in several other countries. How ever, the life expectancy of women in countries
at different levels of development is markedly different, ranging from just over 50 years in the
least developed countries through the 60s and 70s in those undergoing rapid economic
development.
The statistics of global distribution of life expectancy at the time of birth shows that in
developing countries female babies are expected to live longer than male i.e. 28% male and
42% female are to live 70-79 years, 7% female are to live 80 years and over with the
comparison of 0% of male.
6. 4 Changing Role of Young and Elderly Women
Urbanization and modernization in developing countries are providing various opportunities for
women, leading towards changing family structures. Women with better education and skills
are more and more entering into labor force participation. This scenario is likely to bring
drastic changes in the patters of family life. Those activities which once were considered as the
sole responsibilities of female are now shifting towards other institutions. For instance one can
witness mushroom growth of day care centers and nurseries for taking care of infants and the
young kids. Fast food restaurants have shared much burden of female’s kitchen pressure. The
role of grand parents was to teach the grand children but in the modern age, due to nurseries
and schools, grand parents may have lost this opportunity. Old women may not be involved in
decision making process in most of the families and they remain inactive in household
activities. Old people in third world countries some times have to face extra burden for
example in Sub-Saharan Africa the rising mortality rate of young adults due to AIDS is
resulting double minuses for old adults i.e. their own poor health conditions and the care
responsibilities of the children of AIDS affected young adults.
This scenario leads to address the problems of elderly women who are living in these houses
without having their involvement in most of the house affairs. Once there was a tradition that
these elderly women were being looked after by the young females present in the houses, but
now, due to rapid changing life style of the young cohort, these elderly women might be facing
serious problems in economic, social and emotional aspects of their lives.
7. Problems and Needs of Aging Population
Unlike developed industrialized nations, older persons in the developing world, have a long
way to go in making their lives livable with honor and dignity. Old persons are generally
presumed to be the responsibility of their children and close relatives. Most old persons do live
with them, even though they may be able to afford to live separately. In the low income
families, when sons get married they often cannot afford to set up a separate household, and,
therefore, they keep living with the parents. These arrangements are sometimes known to even
end up in tragedies for the elderly. Since the housing, particularly in big cities, is scarce and
expensive, setting up separate household is not affordable for many.
Societies, over the ages, have generally treated old persons with respect. This was because old
persons are mostly parents and, therefore, commands respect, attention and support from their
children, and because of social norms, other young people as well. With some variations in the
degree, respect or attention or support for the elderly has been a world-wide tradition. Giving
20
respect to elderly, however, is not the same thing as giving them an honorable and dignified
living. Industrial society decided a long time ago that after certain age a working person
should retire. The age of retirement was raised gradually as the life expectancy increased and
old persons began to enjoy better health. At present, regardless of the region, once a person is
retired from work, the trend has been largely to disallow the retiree to re-enter the world of
work. If someone insists on keep working, he or she is more likely than not, given work much
below their capacity or acquired pre-retirement status.
7.1 Health and Morbidity
Population aging is also poses a great challenge for the health care systems. As nations age,
the prevalence of disability, frailty, and chronic diseases (Alzheimer’s disease, cancer,
cardiovascular and cerebral-vascular diseases, etc.) is expected to increase dramatically. Some
experts raise concerns that the mankind may become a “global nursing home” (Eberstadt,
1997). So the health policies should be devised focusing to deal with the health problems of the
elderly. On the positive side, the health status of older people of a given age is improving over
time now, because more recent generations have a lower disease load. Older people can live
vigorous and active lives until a much later age than in the past and if they're encouraged to be
productive, they can be economic contributors as well. Also the possibility should not be
excluded that current intensive biomedical anti-aging studies may help to extend the healthy
and productive period of human life in the future. (De Grey et al., 2002)
In developing countries attention to address the problems of older persons still not seems to be
recognized. Old persons do not have or do not join associations to make their voices heard.
They do not flex their voting power nor do they even realize that government should do
something to improve their lives. Many live without realizing that some of their ailments are
treatable or they could prevent further deterioration of their condition. Many do not have
resources to buy a new pair of glasses or get their teeth fixed. Diabetes, hypertension and
arthritis are the most common chronic diseases prevalent among old populations. In many cases
they remain undetected and undiagnosed and hence untreated. Even if they are diagnosed, poor
old persons may not afford the drugs or have no one administering them on timely basis. There
are almost no institutions for assisted living or nursing homes. Even if there are any, very few
afford them.
7. 2 Changing Morbidity, Chronic Diseases and Functional Disability
Older people are more prone to higher incidence of morbidity due to their weak and aging
health. Population aging is also accompanied by what has been termed the “epidemiological
transition” a shift in the patterns of morbidity and the causes of mortality (ESCAP 2001). As
number of older people is increasing relative to younger population, infectious and nutritional
disorder is likely to take place ensuing in chronic, degenerative and mental illness as the
leading causes of morbidity and mortality. Many disabling diseases and impairments such as
heart ailments, stroke, hearing and visual impairment among older people tend to be incurable
and long term medical treatment and care. So do terminal diseases such as cancer and
Alzheimer’s disease. The higher incidents of morbidity coupled with epidemiological transition
requires better health services as well as better package for the delivery of these services so that
old people could benefit from health related services.
As the challenges of population aging are global, national and local, developing countries are
faced with more serious challenges to meet with aging problem. With the increase in
industrialization, changing patterns of living and working are inevitably accompanied by a shift
in disease patterns. These changes impact developing countries most. Even as these countries
continue to struggle with infectious diseases, malnutrition and complications from childbirth,
they are faced with the rapid growth of no communicable diseases (NCDs) (WHO 2002).The
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shift from infectious to chronic disease is fast occurring in most developing countries, where
chronic illness such as heart disease, cancer and depression are becoming leading causes of
morbidity and disability.
Public health services in most developing countries are limited. Whatever services are available
they are mostly found in urban areas. Moreover these services are often over crowded,
unevenly distributed and overstretched due to paucity of funds and qualified personnel.
Developing countries also have inherent characteristics of traditional practice and belief
system. Disease is taken as a phenomenon which is related with old age and inevitable. Most of
the time in old age, disease is taken as a routine matter and older people are viewed to be
adjusted with their disease patterns. In other words, older person’s disease is not taken as some
impairment in biological activity rather it is taken as something which is associated with old
age and seen as a must symptom of old age. In less developed countries, for most urban
populations and virtually all rural populations, little intervention takes place in the case of
circulatory disease, cancers, or any condition requiring surgery (Caldwell 2001).
7. 3 Increasing Risks of Disability
The incidence of disability is likely to increase as people get older. Immobility is most likely
the resultant factor of disability. With impaired mobility older people might face great troubles
and their dependence on care givers increases. In some of the cases the disability may happen
to be a permanent feature which makes elderly persons dependent upon other till their death.
Thus, the intensity of care, older persons require, increases if they are disable. Several studies
have shown that with age the chances of moving from active to disabled status increase, while
the chances of recovery to active status decrease (Waidmann and Manton 1998; Danan and
Zeng 2004).
Given the increasing incidence of disability with age, the aging of the older population
contributes towards increasing the proportion of older population suffering from disability.
Moreover, feminization of aging might contribute towards increasing the proportion of the
disabled among the elderly population because of higher incidence of disability among older
women. A number of studies have also shown that women have a lower probability of
recovering from disability than men (Danan and Zeng 2004).
Trends in population aging imply that there will be a growing need for providing special care
facilities for the older people particularly the oldest women who might have disability. The
higher increase of the oldest population combined with the feminization of age might add to the
burden of relatively declining young population of working ages, who are supposed to take
care of the oldest people. This includes the provision of health care and special care facilities as
well as ensuring appropriate living arrangements for the elderly.
7. 4 Changing Educational Needs
Due to changing age structure education requirements and priorities are also changing. New
education policies should become more cognizant of the educational needs of the elderly about
new technologies and skills needed for the modern day workforce, by diverting surplus
resources from the primary or secondary education. In contrast to the present social setup in
which society is rapidly modernizing and changing traditional approach because of the
presence of a large percentage of younger generation, the aging society of tomorrow can make
a reversal and turn towards a more conservative and religious society. This change will depend
upon the extent to which a society can attain fair and just practices, economic opportunities and
political freedom for all. The value of children will continue to increase as the proportion of
younger people needed to support the rapidly increasing elderly population will keep declining.
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Global conferences, some organized by the United Nations, have raised the issue of the older
persons with the governments. UN has, however, not taken any concrete steps to address and
follow up the recommendations and plans of actions made in these meetings, as it has done in
some other cases (e.g., population fund, children fund). The approach adopted is to put moral
pressure on the governments to address the old people’s issues at the ground level. This is
probably because neither the donors nor the governments recognize aging as a serious issue on
their agenda. There are several other issues that are high on their priority lists. It is time for a
new paradigm, one that views older people as active participants in an age-integrated society
and as active contributors as well as beneficiaries of development.”
7. 5 Aging and Nutrition
Older people are often concerned with what they eat and should eat. Food taboos and belief
systems vary within cultures, so does advice. According to one calculation, “There are more
than 50,000 books on "diet/health/fitness" a.twmp.amazon.com. These books often don't agree
with each other—there are recommendations for high fat, low fat, high carbohydrate, and low
carbohydrate. Older people need to be particularly wary of diets that are very high in fat or
protein, which could elevate blood cholesterol and impair kidney function. At any age, very
low carbohydrate intakes are dangerous and potentially lethal for those with
diabetes.”(Johnson, 2004). The Dietary Guidelines for Americans developed by the U.S.
Department of Agriculture and the U.S. Department of Health and Human Services (2000)
emphasize maintaining a healthy weight and engaging in regular physical activity; eating a
variety of grains, especially whole grain foods, fruits and vegetables, and calcium rich foods
daily; consuming a diet generally low in saturated fat and cholesterol and low in total fat, added
sugars, and salt; and for those who consume alcohol, drinking in moderation.
7.6 Active and Healthy Aging
Traditionally, old age has been regarded as the period of chronic diseases and disabilities
(Grant 1996). However, with the advances in medicine and improvements in life styles, an
increasing number of older people are retaining their physical, mental and social health
faculties and enjoying an active life for a long time. Healthy aging is now being recognized as
an attainable goal and a norm for aging population in the developed countries. Many of the
chronic diseases and disabilities associated with old age are preventable in younger age.
Through exercise, nutrition and active social and mental life, many of the ailments associated
with old age may be prevented. Current knowledge indicates that preventing the diseases
themselves is a critical priority (Reed 1998). It is argued that earliest in life good living habits
are adopted and maintained fewer problems would arise in old age. WHO suggests a “Life
Course Approach” that implies interventions that create supportive environments and foster
healthy choices at all stages of life. (WHO 2002)
Healthy aging is a combination of physical, mental, social, and economic well-being. Healthy
aging focuses on the ability of an older person to continue to function as the body slows down
its processes (Hansen-Kyle, 2005). The absence of illness, accident, and misfortune allows this
process to occur naturally. Factors essential for healthy aging, cited in the literature, are
categorized in three groups: physiological factors, cognitive or mental factors and social or
supportive factors. Physiological factors include physical ability, nutrition, and life style. One
commonly used measure of physical health is the ability of the person to perform most
activities of daily life, such as eating, bathing, dressing, walking, and sitting and so on. Keys
to balancing physical, cognitive, and social factors are compensation, adaptation, and
resilience. Compensation and adaptation lead to resilience. These are the antecedents of healthy
aging and have been incorporated in a new definition of healthy aging, i.e., “Healthy aging is
the process of slowing down, physically and cognitively, while resiliently adapting and
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compensating in order to optimally function and participate in all areas of one’s life (physical,
cognitive, social, and spiritual).
Since aging involves more than just heath, the World Health Organization calls this process as
active aging (a term adopted in late 1990s by WHO). It is the process of optimizing
opportunities for health, participation and security in order to enhance quality of life as people
age. Maintaining autonomy and independence is a key goal for both individuals and the policy
makers, though not in all cultures. Aging takes place within the context of others – friends,
work associates, neighbours and family members. This is why independence as well as
intergenerational solidarity (two-way giving and receiving between individuals as well as older
and younger generations) are important tenets of active aging.
7. 7 Health Care Services for the Elderly
Health care services for elderly require both preventive and curative measures. Preventive
measures be taken in early life could provide good reason for having healthy aging.
Nevertheless, although many older people enjoy good health, aging is accompanied by
biological changes which increase the risk of illness, disability and the probability of dying.
Promotion of sound health and nutrition practices from very early years is essential for people
to have healthy and active aging.
This could be made possible by introducing active aging policies that remove barriers to work
and learning of people who have reached some notional age but are willing and have capacity
to do work. These people should be encouraged to participate in the widest possible range of
activities including employment and voluntary community work.
7. 8 Health & Long Term Care
Aging populations present large challenges to systems of health care, and raise significant new
policy problems in the area of long-term care. Increased resource demands by health care
providers are inevitable in all countries, but significant opportunity exists for mitigating many
of the expected pressures through health care reforms aimed at increasing health sector
efficiency. Older people have more health problems: Illness and morbidity increase with age,
after the age of 25 years. There is a gradual increase with age, until people reach the age of 70
years, when the incidence of illness, presence of disability and health care utilization increase
substantially. Older population will naturally place greater demands on health care systems and
resources. Given that the public sector must share part of the burden of financing health care
services, such an increase will inevitably put pressure on government budgets.
Cost impact of aging on health care systems will be dependent on changes in efficiency: OECD
simulations of the impact of aging on health care costs reveal that long-term gradual changes in
health system efficiency can mitigate substantially the fiscal impact of aging. Population aging
does not inevitably mean the financial collapse of health care systems. Health systems reforms
in order to enhance long term system efficiency are the key to dealing with the increased health
care demands of the elderly. Health care providers need to be given incentives to provide
increased volumes of services with the same amount of resources. Global health care budgets
and appropriate incentive structures for health care providers are likely solutions.
Active aging policies are necessary to maximize the years of health life spent by individuals:
Although disability and dependency is not avoidable for many individuals at the most advanced
ages, there is room for improving the long-term health of individuals in their fifties and sixties.
Such policies require inter-sectoral co-ordination, removing barriers preventing older people
from remaining in work, and concerted behavioral interventions.
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7. 9 Patterns and Levels of Support
Social Support is often defined in terms of space (e.g. Co residence), material (e.g., money or
goods), or time (e.g., household assistance or care) transfers. Co-residence between older
people and their children remains an important source of social support in both more and less
developed regions (Palloni, 2001; Saad, 2001). Studies have shown that children who live at
home provide greater assistance to their parents (both financially and with domestic tasks) than
do non-co resident children (Hoyert, 1991;Ward & Spitze, 1992) and that older persons in
Taiwan are more likely to be providing resources to co resident children than to those outside
the household(Agree et al., 2001). In North America and Europe, only 5% to 15 % of older
people live with their children (Grundy, 2000; McGarry & Schoeni, 2000). This is in sharp
contrast to Latin America and Asia, where more than half of those aged 65 and older live with
an adult child and where there has been relatively little change in the living arrangements of
older people over time. (Zimmer, 2003; Hermalin, 2003; Palloni, 2001).
Despite the small magnitude of change in the household composition of older people in Latin
America, there is rising concern among policy makers that the fertility declines responsible for
population aging will lead to increases in solitary living, reducing an important source of
support for older people. Small family size and higher level of childlessness the transition from
high to low fertility involves not only declines in the average number of child born but also
increases in the proportion of men and women who never have children, mainly because they
never married.
Lower proportions of older persons with living parents are observed. Although the availability
of living parents is generally assumed to reflect increasing longevity and improved old age
survival, for the settings under consideration here, historical differences in the timing of union
formation and of child bearing have more influences. There is higher level of proximity
between parents and children. The distance between parents and adult children is a reflection of
cultural norms about co residence and support and the timing of marriage and “nest leaving”.
Within these cultural constraints, the number of children and the timing and duration of
childbearing related to the stage of the fertility transition also will influence the likelihood of
having a child living nearby.
Higher levels of living alone and lower level of co-residence with married children. Smaller
total family sizes mean that settings with earlier transitions should be associated with lower
levels of co-residence with children and especially with unmarried children who have not yet
left home. In addition, as development progresses , older persons generally are more likely to
have the good health and economic resources to allow them to remain independent in their own
homes for longer, instead of moving in with married children for support.
7. 10 Growing Need for Institutional Support and Geriatric Care
Aging population presents a major challenge to system of health and long-term care. In most of
the developing countries, governments provide only limited health services or medical care. In
many cases these services might not be meeting the needs of older persons, especially the poor
and therefore preventive, curative, restorative and rehabilitative needs of larger elderly people
remain largely unmet. Despite the fact that family is being considered as a major support
system for older persons but changes are also occurring in this support system. Traditional
family support mechanisms are being eroded due to different factors such as declining family
size, rural urban migration; and in some countries younger people are dying of HIV/AIDS.
Because of these changes occurring in family institution, realization for developing institutional
support for older population is growing faster.
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Developing countries seem to be inclined to follow gradual improvements for taking steps to
meet and improve aging requirements of the elderly people. However, it is observed that
developing countries suffer paucity of resources and generally these resources are spent in
primary sectors of development for instance, education, health and defense etc. Geriatric care is
yet considered as a second priority in terms of allocation of resources and trained man power.
Therefore, in majority of developing countries, there is still a serious lack of adequately trained
geriatric specialists, and a scarceness of standardized training for paramedical and other
caregivers in support of the elderly- a reflection of the lack of demand for demand for training
as well as a lack of capacity (UNFPA 2002).
7.11 Community Care Institutions
Keeping in view the development processes, going on in developing countries accompanied by
globalization and modernization, need for developing care institutions for elderly is largely
being recognizing. The most positive steps include involvement of older people in communitybased activities. This inclusion of older people will provide them with an opportunity to ensure
their voices and views to be heard in the development of policies and programs that affect
them. These measures apply particularly to determining appropriate responses to the demand
for home-based care, in linking up the network of multiple NGOs that are attempting to deliver
effective support and services, and in providing these services at accessible distribution points
(UNFPA 2002).
For instance, South Africa has adopted the United Nations Resolution 46/91, which has one of
its principles, access to community centers and recreational opportunities for older persons
(UNFPA 2002). Community care centers could provide older people with opportunity to
engage in recreational activities with their peers. The access to these institutions would help the
older people to overcome loneliness and boredom; they would work together with older
persons on different projects. These institutions could engage them in handwork or gardening
as well as help them sell their products as an additional source of income.
8. Financial and Fiscal Policies for Older Persons
Only a fraction of the working population in developing countries retires with old age benefits.
According to a HelpAge International report, 80 percent of the older people in developing
countries do not have regular income. Those who do are mostly government employees or
those working for large private or semi-government organizations. Those working for small
businesses or for themselves are in the majority and generally not covered by any pension plan.
There are rarely self-financed savings pension options that would provide a stream of income,
even nominal one, in one’s old age. In most cases, an elderly retires with little or no cash
assets and no income from other sources. Therefore, many poor elderly keep working until
they are too ill or incapacitated to work.
8.1 Economic Security and Retirement Patterns
Adequate income support at older age is very much crucial to maintain some degree of
independence and livelihood. When older people lack these resources they become dependent
upon others for meeting their daily requirements. The most vulnerable are those who have no
productive assets, little or no savings or investments, no pensions or retirement funds, and
either have no family to care for them or who are part of families with low or uncertain
incomes (UNFPA 2002).
Majority of the people in developing countries are engaged in the unorganized, small scale and
informal sector in urban areas or in the agriculture sector in rural areas. These people having
irregular income during their life time with constant pressure to meet their current needs left
26
with little resources when they come to older ages. Eventually they have high degree of
dependence on their children. These countries have only pension systems for their regular
employees and as such there is no social security system for their older population who never
has been engaged in some public service. In rural communities where pension schemes are
exception rather than the rule, older persons tend to work until they become too frail to
continue to do so.
8.2 Need for Old-age Security
Since the majority of older people in developing countries do not have the resources to support
themselves, their family and children are the main source of support for them. Because of
generally poor economic conditions, their children also experience difficulties in providing the
basic necessities of life to their elderly, as their limited income spent to cater the needs of the
off springs. Many retirees opt for some employment, either full time or part time, to meet their
expenses. Many elderly in low income groups spend their retirement benefits on the unfinished
tasks such as education or wedding of the children.
Under such circumstances older people need some security for their older age to meet their
requirements. Old age security needs to be addressed in developing countries as these countries
do not have stable patterns for providing services to their elderly. Government support is
limited, and policies are often influenced by public reluctance to seek alternatives to the family.
8.3 Need for Universal Pension System
For those having no property and cash savings, only recourse is to seek shelter with children,
and wait for final rest. Post-retirement life can be very difficult and painful even for those
fortunate enough to have financially supportive children. Dependent elderly living with married
children are not always the best options. Even expectations of support from son or daughter
vary from culture to culture. A majority of mothers in Asian countries (except in Singapore)
expect financial support from a son but no so much from a daughter. In Indonesia, Philippines,
Thailand and Turkey, however, mothers expect assistance from both sons and daughters. Fewer
fathers expect financial support from either son or daughters. Fathers’ expectations from
daughters are lowest in Korea, Singapore, and Taiwan. Expectations are lowest in the United
States from either sons or daughters and by both parents.
Those living in urban areas, in particular, can face shrinking space, seclusion, and disdain of
the family members. There have been incidences of extreme violence against elderly parents
by the children recorded in India and other countries. Several research findings point out
violence against the elderly in and out of the household a well known phenomenon. Older
people with no benefits fare least well in their old age.
A proven means of reducing old-age poverty and supporting multi-generational households is
to introduce a basic social pension. Social pensions target development aid to the poorest. They
can regenerate local economies and re-distribute wealth. They improve the nutritional status of
the young, support school attendance and improve the health of all household members. The
social pension in South Africa reduces the scale of older people’s poverty by 94 per cent and
that of the population as a whole by 12.5 per cent.
The decline in the joint family system in India poses a crisis for the social security for the
elderly (Vaidyanathan, 2007). In India, where one-eighth of the world’s elderly population
lives, only some 12 million employees of the government are covered by pensions, most of the
remaining ones have to rely on family or their own earnings. In urban areas the joint family
system is on the decline. Out of 38.8 million, 2.1 million elderly women are already reported to
be living alone. Some 90 percent of the workforce is not covered by any pension or social
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security scheme. There are other possibilities to find old age support such as from selling gold
jewellery that most Indian women own and reverse mortgage of property.
International multilateral organizations such as the United Nations, the World Bank, the Pan
American Health Organization, and NGOs such as HelpAge International, have been creating
awareness of the issues concerning the elderly and the need for the governments to take
corrective policy measures to help them. These include creation of social security payments to
the poor and destitute elderly and assorted pension plans. To help older populations of the
future, work has to be done now. The World Bank is providing technical expertise, funds and
know-how to developing countries to initiate self-sustaining pension programmes or reform
existing systems that may be fully or partially funded by the employees of small businesses and
those self-employed.
World Bank has identified three formal pension systems (Rust 1994)
1. Public pay-as-you-go (PAYG) plans. This is by far the most common formal system,
mandatory for covered workers in all countries. Coverage is almost universal in high
income countries and widespread in middle income countries. These systems are typically
defined benefit plans where the pension benefit is an indirect function of the individual’s
earnings history, with provisions for both intra-generational and intergenerational
redistribution.
2. Occupational Plans. These are privately managed pensions offered by employers to attract
and retain workers. They are often facilitated by tax concessions and are increasingly
regulated by governments. These plans are found mostly in developed countries.
3. Personal Savings and Annuity Plans. These are fully funded defined contribution plans.
Workers save when young to support themselves when old. Since benefits are not defined
in advance, workers and retirees bear the investment risks on their savings. However these
plans are portable, so there is lower risk of loss of benefits due to job mobility, as is more
typically of some defined benefit occupational plans. Voluntary personal retirement saving
is found in every country, often encouraged by tax incentives. Some countries have made
such saving mandatory as part of some form of privatized social security system. A key
distinction is between mandatory savings plans managed by the government (e.g. Malaysia,
Singapore and several African countries) and those managed by multiple competing private
countries (e.g. Child, Argentina, Columbia and Peru).
8.4 Emerging Trends in Pension and Social Assistance: Selected Best Practices
Some countries in the developing world have instituted modest pension and social assistance
program; though far from a universal pension system. However a large majority of older
persons remain out of the ambit of any social security system. Most of the pension plans and
systems available in the developing world are described briefly in a recent HelpAge
International’s report by regions, as follows:
Asia
During the 1990s a number of countries developed social pension schemes with varying
degrees of coverage. The Government of India introduced a means-tested National Old Age
Pension Scheme as part of a wider National Social Assistance Programme in 1995-1996. The
aim was to ensure that social protection was uniformly available throughout the country, in
addition to provision by individual states. The old-age pension of 75 Rupees a month
(US$1.50) is paid to women and men aged 65 years and over, who would otherwise be
destitute. An estimated one-third of older people in India are entitled to the national pension.
However, not all of those entitled receive it, because the central government, which funds it,
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sets cash ceilings for each state, thus limiting the number of beneficiaries. In 2000, the
government introduced the Annapurna scheme, which provides 10 kilos of rice or grain per
month to older people who are eligible for the national pension but do not receive it because of
cash limits. In some states the national pension is supplemented by means-tested state
government pensions. Uttar Pradesh was the first to introduce a state pension in 1957, followed
by Kerala in 1960. The amount paid varies between states. Uttar Pradesh, for example, pays
those eligible 50 Rupees (US$1.10) per month.
In 1997-1998, the Government of Bangladesh introduced the Boishka Bhata, a means-tested
old-age pension scheme paying 100 Taka (US$1.72) per month to extremely poor people aged
57 and above living in rural areas. The amount was increased in the 2002-2003 and 2003-2004
budgets. It is currently 150 Taka (US$2.58) per month. Initially, coverage was very limited, but
there are plans to expand the scheme to cover up to 1 million (14 per cent) of older people in
Bangladesh. A similar scheme exists in Thailand. Sri Lanka also has a means-tested scheme,
introduced in 1939, which covers approximately 10 per cent of the over 65s. Nepal – one of the
poorest countries in the world, with nearly four in ten people living below the poverty line –
operates a universal social pension scheme, the Old Age Allowance Programme. In 1995, the
Government of Nepal introduced a pilot scheme for people aged over 75 in five districts. The
scheme was extended to cover the whole country in 1995-1996. To start with, the amount paid
to each beneficiary was 100 Rupees per month (US$1.40). This was increased to 150 Rupees
(US$2.12) in 1999. Currently, the social pension scheme (Old Age Allowance Programme) and
the means-tested Widows Assistance Programme cover more than 400,000 older people.
Turkey
Under a World Bank project, in Turkey, a key objective is to move the social security system
towards medium term sustainability while continuing to improve the institutional structure of
public expenditure management. The reformed social protection system will aim to provide a
comprehensive social protection system that insures against old age poverty, ill health, job loss
and provides social protection for the poor. Addressing the cross-cutting issues that affect
public sector performance will further improve public sector delivery of services. The reforms
will help move Turkey’s macroeconomic framework and social protection system towards
compatibility with the European Union
Sub-Saharan Africa
The cost of delivering universal benefits, even at very low levels, is often assumed to be
beyond the means of resource-poor Sub-Saharan African countries. However, evidence from a
number of countries shows that costs of social pension are manageable. In Botswana and
Mauritius, for example, administration accounts for 2-3 per cent of benefit payments. The
experience of existing schemes demonstrates that universal provision of social pensions to
older people is administratively simpler and less expensive than means-tested provision.
Evidence from countries that are already implementing large-scale social pension schemes
indicates that the overall cost of these schemes, in terms of GDP, is relatively low. In Namibia,
the social pension programme costs less than 2 per cent of GDP. South Africa’s scheme,
funded through general taxation, and represented 1.4 per cent of GDP in 2000. The
Mozambique targeted programme is scheduled to be US$13 million in 2005, or 1.4 per cent of
the government budget.
Botswana, Mauritius, Namibia, Senegal and South Africa all operate large-scale social pension
systems. The South African and Senegalese schemes are means tested, whereas those in
Botswana, Mauritius and Namibia are universal. The South African scheme, introduced in
1928 for white and colored South Africans who lacked an occupational pension, was broadened
in 1944 to cover all South Africans. The scheme currently provides 740 Rand a month
29
(US$105) to men aged 65 and over and women aged 60 and over. In practice, the scheme is
almost universal, as the majority of the older black population qualifies. In 2002 there were an
estimated 1.9 million recipients.
Namibia’s social pension system, established for whites in 1949, was extended to cover black
Namibians in 1973. Botswana’s system was launched in 1996. Mozambique operates a cashtransfer system targeting about 70,000 urban households headed by older, chronically sick or
disabled people, with an annual budget of approximately US$6 million.
Latin America
Only Bolivia – the poorest country in Latin America – offers a universal non-contributory cash
transfer. The Bono Solidario, or Bonosol, is a fixed benefit of 1,800 Bolivianos (US$248) paid
annually to all Bolivians over the age of 65. The Bonosol was established in 1996 to provide
coverage for those outside the formal pension system. It is funded by proceeds from the
privatization of five large public enterprises, using returns on shares representing the
government’s 50 per cent ownership of these enterprises. Payment is implemented by two
private financial institutions, which are responsible for managing these assets. Several other
Latin American countries provide social pensions for the poorest older people, as part of wider
contributory systems. Tax-financed programmes in Argentina, Brazil, Chile, Costa Rica,
Mexico and Uruguay cover significant proportions of their older populations.
Brazil has a range of schemes, covering 5 million older people in total. In rural areas, social
pensions have been provided since 1963, although they were initially restricted to the very old.
In 1991, a new old-age pension for rural workers, the Previdência Rural (PR) was established.
Its value was increased from 50 per cent to 100 per cent of the minimum wage in the same
year. The PR can be claimed by men from the age of 60 and women from the age of 55. It has
many features of a universal social pension, since it is not based on a means test or prior
contributions. In urban areas of Brazil, state pension provision has been more limited. The
Renda Mensual Vitalicia (RMV) was introduced in 1974, paying a flat rate of 50 per cent of the
minimum wage to people aged 70 or over who had no other income, and who had paid national
insurance contributions for at least 12 months. In 1993, the Beneficio de Prestação Continuada
(BPC) was introduced for disabled people and those aged 67 or over, who had a per capita
household income of less than 25 per cent of the minimum wage. The BPC pays the equivalent
of the minimum wage (200 Reais or US$55) per month. Both the PR and the BPC are funded
by government and administered by the National Social Security Institute (INSS).
The Caribbean
Antigua recently became the first country in the English-speaking Caribbean to introduce a
universal old age pension. The newly elected government announced in March 2004 the
provision of a monthly pension of EC$750 (US$ 281) to all aged 60 and over. This amount is
set to increase to EC$900 (US$ 337) in January 2005, and EC$1,000 (US$ 375) by January
2006. More typical is the situation in Dominica, where a contributory scheme provides
pensions to people of 60 years and over. There is also a non-contributory scheme that pays
EC$100 a month (US$37) to older people below the poverty line. In Jamaica, the World Bank
supports “The Social Safety Net Project” that is the government's efforts to transform the social
safety net into a fiscally sound, and efficient system of social assistance for the poor, and
vulnerable groups. The components will finance conditional grants to elderly poor over the age
of sixty-five eligible under the program. Benefits will strengthen the institutional capacity of
the Ministry of Labor and Social Security, and institutions involved in the operation, and
streamlining of the social safety net in Jamaica. Also included are training, and promotion
assistance, project management costs, and, monitoring, and evaluation systems.
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9. Foreign Assistance to Population Aging Programs
United Nations has been supporting awareness raising events for over two decades either by
including population aging as an issue for the member states to reckon with or by organizing
special global meetings on the subject, such as the ones in Madrid, Second World Assembly of
Aging (2002), and more recently in Macao. However, UN has generally placed population
aging issue as an item of agenda for the governments to handle. No special fund has been
created similar to the ones on population (United Nations Population Fund) or Children’s Fund
(UNICEF). In the health sector, other major donors are still occupied with reproductive health
issues. A researcher, Dr. Susan Raymond in her article, “Foreign Assistance in an Aging
World” has forcefully argued in favour of changing US government (the single most influential
donor’s) foreign aid policies shifting from financing family planning to support the population
aging programmes. She says that fertility levels are continuously falling while population aging
is a growing challenge. She feels that unless preventive and corrective action is not taken soon
enough, Chronic conditions such as heart disease and diabetes, which are already more
prevalent causes of disability and death than are communicable diseases in all regions except
Africa, will become even more widespread. As this trend unfolds, the lifetime costs of treating
these ailments will far outpace the costs of managing communicable diseases. The implication
for foreign assistance is clear. (Raymond, 2003)
9.1 Role of NGOs and Civil Society
To this end, governments, NGOs and communities around the world, especially in the
developing countries where population aging is occurring more rapidly before becoming rich,
need to begin or continue to address matters relating to the promotion of well-being and care of
older persons including: health and medical services; social welfare and the family support
system, especially in the context of gender issues; employment; pensions, income security and
the problem of poverty in older populations. This offers a challenge to promote effective
intergenerational relationships in a context which will produce a rewarding society for all ages.
Such efforts can be even more successful where recognition is accorded the diversity of
cultural contexts and sensitivities within which these issues are set.
Attempting to accommodate these additional demands is a formidable task for most
governments and the relevant agencies in less developed regions where the knowledge,
resources and institutional capacity to deal with them are most lacking. Clearly the support and
advice of those with experience in understanding and handling the issues of older populations
need to be made available to these countries. A modest start has been made by such agencies as
the UN International Institute for Aging (INIA), Malta, and the China Research Center on
Aging (CRCA).
10. Growing Concerns for Public Policy in Developing Countries
The ratio of the elderly to the working-age population (the “old-age dependency ratio”) is set to
increase dramatically in most developing countries. This shift will likely to have significant
consequences on the demand for and provision of social and support services— among them
health care, housing, income security, and long-term care. Here we briefly consider the health
policy implications in provision of services. Aging populations face a changing array of health
problems and needed services. Beyond sheer growth in the numbers of older persons, three
additional issues need to be addressed. First, the predominant illness profile has shifted from
one characterized by acute, communicable diseases to the chronic and non-communicable. By
the late 1980s, for instance, cardiovascular diseases had become the leading cause of death in
thirty-one countries throughout Latin America and the Caribbean. Second, developing
countries can anticipate having increased numbers of disabled persons as their populations
grow older. Finally, many countries face an imbalance between where services are provided
and where the elderly actually live. Rural areas tend to have higher proportions of older
31
persons, while health care services (especially chronic care) tend to be concentrated more in
urban centers.
The focus needs to shift to how to provide care across the spectrum, not simply acute care
services in central locations. There also is much greater scope for preventive care than is now
reflected in public policy. Implementing effective health promotion and disease prevention
programs that reduce chronic disease risk factors will have major implications for a country’s
future burden of disease. In Health care financing evidence shows two main effects of the
demographic transition on health care financing: (1) increased age-specific consumption of and
spending for health care by the elderly, and (2) changes in the relative cohort sizes of the
benefit recipients (the elderly) and revenue contributors (the workers), such that a shrinking
group of workers pays a larger proportion of health care costs for a rapidly growing elderly
population.
Two policy issues need to be considered in light of these problems. First, there is ample room
in any health care system to increase efficiency. This is not a specific “old-age” problem, but
one that is pervasive throughout health care systems in both industrial and developing
countries. One proposed solution calls for a contribution system, in combination with multiple,
competitive, and highly regulated insurers. Further, incentives, such as co-payments, might be
built into the system to guard against excess consumption. Finally, the issue of equity needs to
be reconsidered. It is considered unethical when people in need of health care cannot obtain it
because of financial constraints. This position is widely held at relatively low levels of health
care expenditures. At very high levels, where outlays are increasingly discretionary and of
marginal medical value, it may be worth rethinking whether the universal acceptance of this
equity principle is in society’s best interest.
Integration of the elderly in the development process is a key component to address the issues
of elderly. To ensure this objective there is a need to plan and work with the elderly in
identifying their resources and start programmes of action with problems and issues the elderly
could identify as relevant and significant to themselves and to national development. Flexibility
must be ensured in programming for development wherein external resources could fit local
design taking into consideration the elderly capability. Those elderly who have specialties must
be integrated into the services of the local community, such as agriculture, health, education
and home economics. Those specialties should support the cooperative and collaborative
efforts of local leadership in developing the community systems. There is also a need to train
leadership in elderly and provide experiences in planning, working, and implementing
programmers relative to the elderly own interests and needs.
Gender considerations are missing in current policies, for instance formal pension systems have
no consideration for women who had not been involved in labor force during their youth. Even
those women who involved in paid labour force were irregular and more likely in the informal
sector. Their incomes and upward job mobility are low because of their low level of education,
so their resources do not happen to meet their old age needs.
Social security system benefit only wage earners but these systems do not recognize value of
housework and child rearing with which housewives remained busy. Even the National
accounts in developing countries do not recognize and measure value of women’s work in the
home and do not provide them with some incentives for their old age.
Community based old age support systems should take into consideration the importance of
family institution in catering to needs of elderly. Although in developing countries family
institution is still playing a major role in providing care to elderly. Change in tradition notion of
32
family institution is being witnessed due to urbanization and migration. A shift in support
system from public to family needs to consider changes in the traditional notion of family.
Moreover it should also be taken into account that women take the additional burden of care so
investment in increasing capacities of women as health care providers must be ensured.
In this connection there is a need to acknowledge older women and men as effective agents of
change and contributors to the aims and aspirations of the Millennium Development Goals. It
should be ensured that poverty analysis is disaggregated by gender and age as well as by
disability. Gender equality should be made a reality for women and men of all ages and
throughout the life cycle, through lifelong education and employment rights especially for
women. An equitable and rights-based approach to HIV/AIDS must be ensured which gives the
over-50s equal access to testing, counseling and treatment and acknowledges and alleviates the
burden of care on women of all ages. The principles of equity, participation and
intergenerational development be followed to tap the resourcefulness of the older persons.
Social protection measures, including social pensions into poverty reduction strategies must be
incorporated.
11 Recommendations for Action:
Towards a Society for All Ages
Fast coordinated response from governments’ and Civil Society Organizations is required to
deal with a rapid pace of aging in Asia-Pacific region. There is a need to strengthen countries
capacities to develop and implement policies/programs to meet growing changing needs of
older persons (particularly poor, disadvantages older women). Early implementation of the
agreed recommendations in the Madrid International Plan of Action on Aging and the Shanghai
regional Plan will be highly beneficial. Each country should develop national plans of action
based on realities of situation of older persons. Exchange of information, experiences and best
practices through a South-South collaborative mechanism will be helpful in addressing the
needs of older persons.
Family and Community-based Support Systems:
There is a need to re-examine family’s support in caring for older persons. Since the family
institution is undergoing a transitional process therefore Govt. should develop such programme
which can support and strengthen family unit. Re-examine family’s support in caring for older
persons. There is also a need for Governments to take appropriate policy measures and adopt
suitable incentive schemes to support and strengthen family unit.
Recognizing its limitation in developing countries and acknowledging the important role of the
community in social development, the Government should encourage the involvement of civil
society through NGOs and social organizations in activities for the elderly. Community-based
support is seen as a component of good governance in terms of popular participation in
development and self-reliance. Community has the right and opportunity to play a role in
improving the welfare of the elderly’. The development programmes, including programmes
for the elderly, toward increased community and civil society participation in governance must
be facilitated by government. This will result in various programmes to promote a healthy and
independent elderly population through support from the family and community.
Governments of developing countries should introduce and implement interventions in
collaboration with civil society organizations to strengthen and supplement informal
community-based support for elderly. Stronger partnerships between Governments, NGOs and
the private sector could be more helpful to initiate community based support systems.
33
Role of Public and Private Sector
Government action is crucial in ensuring a decent quality of life for the elderly. Therefore,
they should formulate suitable policies and allocate reasonable resources to address the
growing needs of older persons. In addition to the resource allocation of Governments, more
networks of NGOs may be established to complement and supplement public initiatives for
elderly. Currently NGO activities are predominantly in urban areas. These NGOs may
strengthen their work in rural areas since majority of needy elderly reside there particularly in
developing countries. Private sector is also required to play its role by actively engaging with
Governments and NGOs to ensure health/well-being of elderly. Age-sensitive policies should
be developed to provide at least minimum income security for employees. Since older people
are not same and all of them are not frail, therefore, opportunities should be created to
retain/employ experienced and knowledgeable older workforce.
Capacity-building & Institutional Development:
Development policies and strategies at all levels should incorporate needs of older persons.
Government and International development partners and NGOs need to invest in building
capacity of institutions and organizations within communities working for the care of elderly.
Development policies must address need of elderly persons of all levels.
Promotion of Geriatric Care:
As the average life span of our global population increases, there is a greater interest in the
concerns of the elderly. Understanding the important medical and mental health issues while
maintaining sensitivity to the social and cultural aspects of this population is the responsibility
of all clinicians and healthcare providers. Geriatric care addresses the complex needs of older
people, focusing on health promotion and the prevention and treatment of disease and disability
in the elderly. Comprehensive healthcare of the aging patient takes place in ambulatory, acute,
and long-term care settings, and is usually provided by a multidisciplinary team, whose
members may include a geriatrician, geriatric nurse practitioner, primary care clinician, nurses,
pharmacists, and others.
Geriatric care needs to be an integral component of health care systems. Communities should
also be strengthened and supported to provide geriatric care at the community and family level.
Development of Databases:
Comprehensive and sound databases on conditions of older populations in Asia-Pacific region
should be developed. Such data will facilitate formulation and implementation of national
policies and programmes and enable countries to follow up and monitor the implementation of
the Madrid International Plan of Action on Aging. ESCAP can play leading role in helping
member states set up such data systems. There is a need to develop innovative ways to
effectively utilize ICTs towards improving the living environment for elderly through
continuing education and skills development of older persons.
11.1 A Way Forward
Developing countries need to mainstream needs of older persons into overall development
agendas and poverty reduction policies. These countries must increase public expenditures for
all older persons and ensure minimum sustainable income for elderly. There must be
developing community-based and affordable support systems for growing proportions of the
elderly. Countries still going through high fertility regimes need to be encouraged to invest in
schooling and human resources development to prepare towards a Society for All Ages.
34
In the long run, more complex challenges will be faced by the by developing countries, as the
number of older persons will continue to grow in the developing world. Large numbers of older
persons coupled with inadequate resources, governments will find it extremely difficult to
address the socioeconomic and health needs of the older persons. International financial and
technical assistance to these countries will be very critical to maintain peace and security
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35
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36
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37
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Glossary
Aging: The process of becoming older, a process that is genetically determined and
environmentally modulated
Demography: Demography is the study of the size, growth, and age and geographical
distribution of human populations, and births, deaths, marriages, and migrations
Demographic transition: It is a model used to explain the process of transition from high birth
rates and high death rates to low birth rates and low death rates as part of the economic
development of a country from a pre-industrial to an industrialized economy.
Disability, The term ‘disability’ covers both physical and mental impairments that have
a substantial and long-term (i.e. has lasted or is expected to last for at least 12 months) effect on
the person's ability to carry out normal day-to-day activities.
Disease: It is an abnormal condition of an organism that impairs bodily functions associated
with specific symptoms and signs. In human beings, “disease" is often used more broadly to
refer to any condition that causes extreme pain, dysfunction, distress, social problems, and/or
death to the person afflicted, or similar problems for those in contact with the person.
Family: A family consists of a group of people (or a number of domestic groups), typically
affiliated by birth or marriage, or by analogous or comparable relationships
Feminization of Aging: It means the excess of women over men in the older population
Fertility: Fertility refers to the number of children ever born alive during the entire
reproductive period of the woman
Immobility: A one of the ADLs (Activities of Daily Living) where a person is unable to move
Income: The financial gain (earned or unearned) accruing over a given period of time.
38
Life Expectancy: It is a statistical measure of the average life span (average length of survival)
of a specified population. It most often refers to the expected age to be reached before death for
a given human population.
Mortality Rate: Calculated by dividing the number of people who have died during a given
period of time by the total population at risk.
Morbidity: A disease or the incidence of disease within a population. Morbidity also refers to
adverse effects caused by a treatment.
Pension: It is a steady income given to a person (usually after retirement).
Poverty: Poverty is a condition in which a person or community is deprived of, or lacks the
essentials for a minimum standard of well-being and life.
Population: It is the collection of inter-breeding organisms of a particular species. A
population shares a particular characteristic of interest most often that of living in a given
geographic area.
The change in population over time, and can be quantified as
the change in the number of individuals in a population usingbut almost always refers to
humans, and it is often used informally for the more specific demographic term population
growth rate (see below), and is often used to refer specifically to the growth of the population
of the world.
Population growth:
Retirement: It is the point where a person stops employment completely. This usually happens
upon reaching a determined age, when physical conditions don't allow the person to work any
more (by illness or accident), or even for personal choice (usually in the presence of an
adequate pension or personal savings).
Pensions,
Savings: generally means putting money aside, for example, by putting money in the bank or
investing in a pension
Speed of Population: The rate of aging with which an aging population doubles in 14 years..
Sex Ratio: is the ratio of males to females in a population plan
Writers’ Bio data
Dr. M. Nizamuddin, obtained, PhD from the University of Michigan, Ann Arbor, Masters from
the University of Chicago, USA and BA Honors and Masters from University of Karachi,
Pakistan. Immediately after completing PhD, he taught as Assistant Professor at the University
of North Carolina, Chapel Hill. Later, he joined the UN system where he served in high level
leadership positions in both programmatic and technical areas. During the 24 years of service
with UN Population Fund, he was posted in Jordan, Egypt, and Ethiopia and finally at the
headquarters in New York, as Director for the Asia and Pacific region and as Director for
Technical and Evaluation Division . During 2002-2005, as Clinical Professor for Socio medical
Sciences Mailman School of Public Health Columbia University New York. He also served as
UNFPA’s Senior Advisor on Ageing, and Program Director of International Program on
39
Population Aging in Developing Countries, implemented in collaboration with Columbia
University, New York. For the last three years, he has been serving as a Foreign Professor,
under Higher Education Commission, at the Department of Sociology, University of the
Punjab, Lahore and has been serving as the Vice Chancellor , University of Gujrat, Pakistan.
He has formidable teaching and research experience in population issues. He has several
publications some of whom were published by the United Nations. Dr. Nizamuddin is regarded
internationally an authority on population aging. Since 2004, he is Co-Chair of IUSSP Panel on
Ageing in Developing Countries (IUSSP, Paris, France).
Javed S. Ahmad, holds a Master’s degree in Public Health Education, from the University of
California, Berkeley, a MBA from Long Island University, New York and MA in Social
Welfare from Dhaka University of Bangladesh. During his nearly forty years’ professional
career with UN, bi-lateral donor and international non-governmental organizations, he has
provided technical support to ministries of health and education, academic institutions and
NGOs in sub-Saharan Africa and South and Central Asia, in the population field. He has
served in Sri Lanka, Kenya, Liberia, Nepal, Kazakhstan and Slovakia with regional and/or
national responsibilities. After retiring from the UN-ILO in 2002, he worked for two years on a
Population Aging Programme in Columbia University, New York. From July 2007 to March
2008, he worked for the University of Gujrat as a visiting Professor. He has several research
reports and professional publications to his credit. He is a citizen of the USA and currently
working as a Health Communication Consultant. His e-mail address is:
javedsahmad@gmail.com
Fauzia Maqsood has Masters in Sociology (Gold Medalist) from the University of Punjab.
She is lecturer at Government APWA College Lahore. She is also a PhD candidate in
Sociology at the Institute of Social and Cultural Studies, University of the Punjab, Lahore.
Currently she is consultant for Research and Planning Cell, University of Gujrat and co
teaching course Population Aging to Postgraduate diploma students. She worked as Research
Officer in the Project Contribution of Private Tube wells in the Development of Water
Potential in Pakistan sponsored by Ministry of Planning and Development and conducted by
Specialist Group Incorporated (SGI) and National Engineering Services Pakistan (NESPAK)
1990 to1991.She also served as Social Welfare Officer in Social Welfare Department
Government of the Punjab Lahore from 1991 to 1994.She worked as data analyst in projects (i)
Women’s Rights to Inheritance in Pakistan, Conducted by Human Rights Commission
( 2004);(ii) Poverty and Human Violation: A Study of Marginalized Groups in Pakistan
Conducted by Sociology Department(2006). She also worked as Teaching Assistant of Dr
Mohammad Nizamuddin for Aging course in Master for Population Studies University of the
Punjab. fauziamaqsood@gmail.com
40