Governance Must Adapt to Elderly Requirements, Says UNFPA India chief

Newsreel Asia Insight #289
July 22, 2024

By 2050, the elderly population in India is projected to double, reaching 346 million, according to Andrea Wojnar, the India chief of United Nations Population Fund (UNFPA), who stressed the urgent need for expanded investments in healthcare, housing and pensions to accommodate this demographic shift, particularly focusing on older women who face a higher risk of living alone and enduring poverty.

In an interview with PTI, Wojnar said that the number of Indians who are 60 years of age and above is projected to reach 346 million, or nearly 25% of the country’s population, in 2050.

Wojnar added investments should be increased also in health, education, job training and job creation, as India has 252 million individuals aged between 10 and 19 who are future nation-builders.

The UNPF official projected that India will become 50% urban by 2050, which means the country will need to develop smart cities with robust infrastructures and affordable housing to manage emerging challenges like slum proliferation, air pollution and environmental sustainability.

Migration, both internal and external, poses another set of challenges that require thoughtful planning and equitable opportunity distribution, especially for women migrants who face unique hardships. Wojnar advocated for policies that address these specific needs to ensure balanced and inclusive growth.

Rural areas, where a substantial portion of India's population resides, suffer from a stark shortage of healthcare facilities and professionals. This disparity means that as the population ages, accessing necessary medical care becomes more challenging, increasing the burden on urban healthcare systems as individuals seek treatment in cities.

Despite schemes like Ayushman Bharat, healthcare remains financially out of reach for many, particularly for the elderly who face age-related ailments. High out-of-pocket expenses for treatments and medicines can lead to financial destitution, especially among the retired population without adequate health insurance.

However, India faces significant challenges in the areas of healthcare, housing and pensions, which could lead to crises if not addressed effectively in light of the expected demographic shifts by 2050.

Issues with the quality of healthcare, including outdated facilities and practices, can lead to poor health outcomes. This is compounded by a lack of specialised care for chronic diseases prevalent among the elderly, such as dementia and diabetes.

India has a relatively low doctor-to-patient ratio, with the World Health Organization reporting about 0.86 doctors per 1,000 people, which is below the often cited benchmark of 1 per 1,000. For specialised care like geriatrics and chronic disease management, the numbers are even lower, which impacts the quality of care the elderly receive.

A 2018 study by the Ministry of Health and Family Welfare acknowledged that only about 20% of primary health centers met Indian Public Health Standards for infrastructure.

As urban areas swell with migrants, the demand for affordable housing has skyrocketed, leading to overcrowded living conditions and the proliferation of slums, as seen in cities like Mumbai, Kolkata and Delhi. Elderly individuals often find themselves without suitable living arrangements, either due to high costs or inadequate facilities in existing housing.

A 2018 report by the Ministry of Housing and Urban Affairs estimated that there was a housing shortage of approximately 18.78 million units in urban areas, primarily affecting economically weaker sections and low-income groups.

Besides, current housing infrastructures rarely consider the needs of the elderly, such as safe walking spaces, accessible public transport and barrier-free homes.

Further, according to a report by the International Labour Organization (ILO), about 81% of all employed persons in India are engaged in the informal sector, often without contracts and lacking formal work benefits. This lack of coverage means many elderly face financial insecurity once they stop working.

Even for those with pensions, the amounts are often insufficient to cover daily expenses, let alone medical costs.

With the demographic shift towards an older population, the dependency ratio (ratio of dependents to the working-age population) will increase, putting additional pressure on the pension system and potentially leading to its insolvency.

These challenges require concerted efforts from the government, the private sector and civil society to create an infrastructure that can support the aging population.