With the birth rate falling, India must change – Community News

By Prabhu Pingali and Shubh Swain

It is time for India to take a new turn in population policy. The country’s fertility rate has already fallen below replacement level 2, according to the latest data from the National Family Health Survey, which was largely collected before the country felt the heat of Covid-19. The ongoing shock and uncertainty caused by the pandemic is likely to push the birth rate down even further. Impaired fertility has many benefits, but this demographic achievement can come at a price. The coming demographic transition has profound implications for India’s health, fiscal and gender policies.

With a lower birth rate, the youth population will continue to shrink. As the size of the youth population decreases, the number of elderly people will outnumber the young. India will need to rethink its focus on social security and make investments to provide the growing number of older adults with better access to health care, income security and social safety nets.

Emerging Health Challenges

Based on the 2000 Population Policy, India’s health policies and programs focused on family planning, maternal and child health, and communicable diseases. But with the increased number of elderly people, the number of non-communicable diseases is already greater than infectious diseases. According to the WHO, nearly 60% of deaths in the country can be attributed to non-communicable diseases. That share will continue to increase for the foreseeable future, requiring a major policy shift towards preventing and managing morbidities such as diabetes, cardiovascular disease and cancer.

India has achieved many milestones in reducing food insecurity since the 1970s, and the focus is now slowly shifting from malnutrition to the increasing problem of obesity in the general population. But older adults are still at risk of food and nutritional insecurity, as their declining social and economic bargaining power often makes them dependent on Social Security; According to the Longitudinal Aging Study in India, 6% of Indians over the age of 45 have experienced insufficient food in the household. That number is expected to grow with the increasing older adult population.

Healthcare for all has always been a challenge for India. Rising medical costs, difficult-to-pay health insurance and transportation restrictions have negatively impacted access to health care for the underprivileged population in India. With the growing older adult population, these challenges will become more difficult.

The elderly have lower incomes, less access to health insurance and limited mobility. Several studies have shown that the inaccessibility of specialized services is one of the main barriers to the search behavior of older people among the elderly. Less than 1% of the elderly have health insurance and age-related morbidities are a gray area in terms of coverage. Most elderly people depend on family and immediate relatives for health care. As family size shrinks due to declining births, such informal safety nets may not be a viable option for the foreseeable future.

Added tax costs

The falling fertility rate will also pose a fiscal challenge in the form of a rising dependency ratio. Measured as the number of people aged 65 and over compared to the population aged 15-64, India’s dependency ratio has increased from 5.4 in 1960 to 9.8 in 2020 and will increase to more than 20.3 in 2050 .

The quality of life of older adults is already unsatisfactory at the current dependency ratio, with a government report scoring income security and financial well-being among older adults at 44.7 and 33 out of 100, respectively. With the growing dependency ratio, it will be more difficult to cope with this situation. improve. As the younger population shrinks, so will investment in the youth. Demand for work within the older adult population will grow and could lead to postponement of retirement, leading to a ‘job squeeze’ in which young and old compete for a limited number of jobs.

A new gender problem

As the older segment of the population grows, the number of older adult women will outnumber the number of men. While life expectancy in India has increased dramatically, it has not benefited men and women equally. In three decades, the life expectancy of women at 65 is expected to be two years longer than that of men. According to a UN forecast, by 2050, by the age of 80, women will make up 56% of India’s population.

Due to the difference in life expectancy, more women will live as widows in the later stages of life. Historically, widowhood has been closely linked to social and economic insecurity in India. Many studies have suggested that older women and widowers are at greater risk for both chronic and acute health disorders and less likely to engage in health-seeking behaviors.

In addition, the average school years among women aged 40-45 are not very encouraging. There will be many older women who are less empowered and vulnerable to social insecurity.

Young and old both hold the key

India must simultaneously pursue two goals: to invest in today’s youth to build a healthy and empowered population in the long term, and to create a more protected platform to provide immediate benefits to older adults. By doing so, India can achieve ‘healthy aging’ and flatten the curve where illness, disability and powerlessness pile up with age.

Today’s social, financial and health security of young adults will determine the well-being of tomorrow’s older adults, but the news about India’s young adults is not very encouraging. Over the past two decades, youth unemployment has risen from 17.7% to 22.8% and obesity is increasing among people aged 15-34. A recent sample-based study found that a third of young adults under the age of 35 are at moderate risk for diabetes.

India needs to invest more in young people to help them get a good job and income, and ensuring healthy lifestyles should be the top priority of youth care schemes. Strengthening the education system to make it globally competitive is the first step towards increasing the market value of youth. Flagship skills enhancement programs such as Pradhan Mantri Kaushal Vikas Yojana and Deen Dayal Upadhyaya Grameen Kausalya Yojana should get more funding and shift their focus to the youth. Promoting healthy investment behavior among young workers will aid in economic empowerment later in life. Targeted behavioral change communication for healthy living practices will empower youth to become healthier.

Shifting policy to older adults will not only yield immediate results, but will also lead to a sustainable, elderly-friendly society in the future. It will be helpful to make specialized health services available at the primary care level, improve the parent-adult-friendly transportation system, replicate the ASHA worker model and create a cadre of health professionals trained in geriatric primary care.

There is strong pressure from nutrition and food systems scientists around the world for India to tackle malnutrition by making more diversified food available and accessible to the population. In the future, scientists involved in this discourse should address the situation of older adults as a matter of social and nutritional justice.

India must work together for a structural shift to take advantage of the coming wave of demographic change. The negative cultural view of old age must end. Government policies and departments should converge around the goal of promoting active aging to keep older adults economically productive. The participation of seniors in the workforce can be an added benefit when older adults bring their experience and wisdom into the workplace to optimize the energy of young people.

In the future, the gender approach to health care, food security and general well-being must include a new dimension: old age. India needs to increase its share of old age pensions, which currently stands at 1% of GDP. Old-age pension schemes and other social safety nets must make a deliberate effort to provide health and nutritional security for older and disadvantaged women.

Even if the effects of the demographic transition will not be felt tomorrow, India needs to get the ball rolling early on as the shift of the socio-cultural landscape towards people of old age will take time.

Pingali is founding director, Tata Cornell Institute, and professor, Applied Economics, Global Development, Cornell University, and Swain is research associate, Tata Cornell Institute, Cornell University

Financial Express Telegram Financial Express is now on Telegram. Click here to join our channel and keep up to date with the latest Biz news and updates.

Source link