Impending problems of an ageing population

The problems that the country would face owing to an ageing population are not confined to the issue of the retirement age that we discussed last Sunday. The challenges posed by the ageing of the country’s population concern health policies, caring of the elderly and coping with a high old age dependency. The ageing of the population in Sri Lanka is very rapid and at a pace unprecedented in world history.

Demographers have pointed out that no country in the world would experience an ageing of population in as rapid a pace as Sri Lanka would in the next two decades. In fact Sri Lanka would be the first developing country to enter the phase of an ageing population. It will be the only relatively low income country in the world to have an elderly population of over 20 per cent in 2020-25.

Demographers have drawn attention to the fact that the country had a high demographic dependency ratio in the past owing to the high proportion of children below 15 years. For instance, in 1991 the total demographic dependency ratio was 65 per cent; consisting of a 52 per cent child dependency and 13 per cent old age dependency. Professor W. Indralal de Silva has projected that the total dependency ratio will decline to about 55 per cent in 2011 owing to child dependency decreasing quite sharply to 34 per cent and old age dependency increasing by only about 5 per cent to 21 per cent. After 2011 he projects the total dependency to increase to 60.8 per cent in 2022 owing to the sharp increase in old age dependency to 29.9 per cent. By 2041 old age dependency would be 45.5 per cent in a total dependency ratio of 72.4 per cent.

The rapidity of ageing and the relatively low incomes of the country pose serious problems. Besides this the preoccupation of the government with a war and poor economic management does not augur well for the resolution of the problems arising from ageing. In fact there is little preparation to face the impending problems of ageing. The fiscal crunch, the concentrated focus on the war and short term economic and social issues are hardly conducive to planning to cope with the medium term problems arising from the ageing of population. This is the serious matter dimension of the problem.

The ageing of population would be somewhat gradual in the next few years, but would gain momentum after 2011. A startling fact is that in the next 20 years the percentage of the aged in Sri Lanka would double. By the middle of this century old age depenency would be around 50 per cent. The healthcare systems would require being geared to the ageing process and caring for illnesses associated with longevity and senile conditions. The incidence of old age illnesses like Alzheimer’s disease, arthritic conditions, cancer, cardiac ailments and osteoporosis would increase. There are significant increases in the incidence of these illnesses even now. The longevity of life would require greater attention to such health conditions and an increase in specialised services to cope with these illnesses.

Geriatric services are insignificant at present. In fact none of the several medical colleges in the country have a professor of Geriatrics. The country hasn’t awoken to the reality that the needs are shifting to healthcare needs of an ageing population. The health services require being planned to cope with these needs of the future. Unless actions are taken now the country would lack a capacity to deal with these when they arise on a larger scale.

Traditionally, Sri Lankan society has cared for the elderly through the extended family system. This is no doubt the best means of caring for the elderly. However there appears to be a weakening of this traditional system to cope with the problems of ageing. Social scientists have pointed out that the higher female labour participation, the lesser subsistence nature of family household income, the erosion of incomes through inflation, larger consumer needs, pressures on housing conditions, migration of wives and daughters for overseas employment and changes in social values have all contributed to the erosion of the traditional system of caring for the elderly within the household. These factors have reduced the capacity of families to care for their elderly. This erosion of the traditional system is likely to gain momentum, particularly in urban areas. At the very time when the aged population reaches a high proportion, the capacity of the traditional system to maintain the elderly would be seriously eroded. There is an urgent need to develop methods of caring for the elderly by developing institutional and community-based systems of caring.

At present the institutional facilities needed are inadequate and often unsatisfactory. The affluent elderly in Sri Lanka could be cared for by the development of private facilities. Yet the supply of even such private facilities appear to lag behind the demand. Some of the available institutions are extremely costly.. The bulk of the elderly population would however need a large measure of public support for their care. Such institutional systems would require both public funding and voluntary contributions and may require to be organised by community and religious based voluntary groups. Public health services would require providing effective support to the elderly at these institutions.

The social security systems such as the Employees Provident Fund (EPF), the Employees Trust Fund (ETF), private pension schemes and a pension scheme for public servants, do not adequately cover the needs of the elderly at retirement. This is partly due to the country’s high inflationary trends that erode such savings. The ageing of population compounds the severity of this erosion in real incomes of retirement benefits. With a longer span to live after retirement the strain on income resources would be severe. The longevity of life implies that the real incomes available in the later years of a retired person’s living would be inadequate.

This is particularly so as expenditure on medicine, drugs and hospital expenditures are high and subject to sharp increases in prices. Therefore there is a need to reconsider the financing of these schemes, the investment of such pension funds so as to generate a better return which can be passed on to the retirees and higher contributions during the period of employment.

The process of ageing requires public policy actions to develop institutional methods of caring for the elderly, gearing the health system to cope with the illnesses associated with old age, revamping social security systems to generate adequate incomes for old age sustenance and a rethinking on the methods of financing the government’s pension scheme.

These are serious challenges. The next decade, during which these problems are not particularly serious, should be used to design the needed policies and programmes. Are we sensitive to these needs?