Special Articles / T.K. Nair / Old Age in an Indifferent Society
Demography of Aging
Longevity is a triumph of humanity. It is the result mainly of declining fertility and mortality rates, and increasing survival at older ages. The global population of persons aged 60 years or over is projected to increase to one in five by 2050 according to the estimates of UNFPA and Helpage International (2012). The demographic profile of India in the UNFPA report poses great social, economic and political challenges to the central and state governments, families and non-governmental organizations.
Internationally comparable statistics on population aging for 195 countries enable countries to be ranked according to life expectancy at birth, life expectancy at age 60, and healthy life expectancy at birth. Japan ranks first in all three categories: life expectancy at birth of 84 years ,life expectancy at age 60 of 26 years, and healthy life expectancy at birth of 75 years (average figures for men and women) . This provides the norm against which other countries can be ranked. The report card for India shows:
In less than four decades, India will witness more than a three-fold increase in the elderly segment (60+) of its population, and quite strikingly, nearly a five-hold increase among the “old old” from 9 million to 44 million. Gender-wise, there is a distinct feminization of old age with life expectancy more skewed for women than for men. More significantly, widowhood is a serious reality as women grow older. Theirs is a life time of gender-based discrimination. As the number and proportion of the elderly grow faster than any other age group, there are serious concerns about the capacities of the central and state governments to address the social, economic and other challenges associated with the demographic transition. In the developed countries, economic development preceded population ageing. But in India, the reverse trend is being witnessed. The steadily increasing elderly population in India raises many questions. How will we, and the future generations, deal with the challenges posed by the aging of our population? Can it be ensured that growing old will not mean, for the majority, a further sliding down into poverty, starvation and dependency? How can families be supported so that they will be able to provide satisfactory quality of care for older members? How can the elderly themselves be empowered to look after themselves effectively?
Family and the Elderly
Indian family has been undergoing changes in its structure and functions. Some sociologists assert that the joint family is breaking down, while some other social scientists are of the view that joint family with joint residence was not the norm. They say that joint family values are not to be interpreted as joint residence.
Joginder Kumar (1974) observes from his study of families from TamilNadu, Delhi, Uttar Pradesh and Rajasthan :
There is considerable evidence that in North India, the general pattern of the establishment of a nuclear family is the result of the breakage of existing joint families. In contrast to this, in the southern part of India, the tradition appears to be the establishment of a separate home, shortly after marriage.
The first large scale rural study of the elderly was carried out by Nair (1980) in 200 villages selected on a probability sampling basis in Tamil Nadu state, and the findings were as follows:
Even in tribal societies, the joint families are in a minority. A study of Kota tribe (Varadharajan, 1982) in Tamilnadu indicated that only 10 per cent were joint families.
In the book “No Aging in India: Alzheimer’s, the Bad Family, and Other Modern Things”, Cohen shows that old age is a cultural construct participating in other forms of knowledge and power: biomedical, sociological, colonial, and historical. Through these imbrications and excesses, the old person is no longer seen as himself or herself, but instead as a metaphor for the moral decay of the family and the nation. Cohen initially went to Benares looking for the etiology of senile dementia, but to his surprise, he found a set of languages and ideologies that denied the very existence of the plaques and tangles he was searching for. There was no aging in India – at least not until Western ideologies had seeped into the fabric of the nation. Alzheimer’s was not a disease of the brain, but a disease of the family. The decay of family ties, and not some etiologic agent of disease, was seen as the causative factor of particular forms of dementia. Increasingly, Cohen became aware that Alzheimer’s was not a fixed, ontologically secure entity but a “set of local and contingent practices rooted in culture and political economy”. What began as a simple anthropological study became a much larger exploration of how modernity and discourse shape the treatment and alienation of aging people.
The family in India continues to be the provider of care for the elderly though the quality of care often is not satisfactory. The capacity of the family to provide care to the older members depends on three factors: the social and economic situation of family; whether it comes within the ambit of a social security system or not; and the nature and structure of the family itself (Chawla, 1988). In many families, though the elderly and other dependants are taken care of, they are “looked upon sometimes as people who do not have legitimate claims for their support by the family” which affects the emotional security they need (Devanandam& Thomas, 1966).
Most of the elderly persons, having worked in agricultural and other unorganised sectors, have no source of income in their advanced years. Since a large number have always started their life in poverty, they have not saved anything during their working years. The social security benefits are available only to a small section of the population and the quantum of social assistance to the destitute elderly is meagre. Hence “to be elderly under conditions of poverty can only spell continuous vulnerability, and a life devoid of even the most rudimentary human dignity” (Chawla, 1988).
Djurfeldt and Lindberg (1980), two Swedish scholars, undertook an intensive study of the introduction of western medicine in a village (Thaiyur) situated near Chennai city, and they observed that death is often an undramatic “natural event” in old age for the under and malnourished villagers who spent many years in hard labour.
We remember that “old age” is the most common cause of death among adults. We now understand part of the reality behind that classification. Sometimes death in old age is a euphemism for death due to starvation.
Currently available old age pension schemes for the poor, which are being implemented by the states, are grossly inadequate in scale and coverage, and illiberal in their qualifying criteria. Social assistance for the elderly has been premised on the assumption that only the destitute older persons need state support. Thus, old age pension schemes seem to be aimed at substituting the family rather than strengthening it by enlarging its capacity to look after the needs of the elderly members. A major reform of these schemes should be topmost in the social security agenda.
Corruption is rampant at different stages of the OAP scheme across the Indian “bribe republic”. For instance, the unholy nexus between the taluk office officials at Coimbatore and the document writers operating outside charging Rs.3,000 as bribe for speeding up action on the old age pension application was reported in the newspapers.
India need not wait until it becomes affluent to evolve an effective social protection floor. In our context, social security has to be integrated with anti-poverty programmes. While anti-poverty strategies seek to reduce the number of people living in poverty, social security should be targeted towards the poorest deciles who fail to be reached either by the growth process or by the anti-poverty programmes so as to prevent them from regressing into destitution. This will necessitate formulation of measures for a blend of social insurance, social assistance and social welfare. A national old age pension scheme through an appropriate legislation is needed instead of the present non-legislated measures. The social security programme in India is devoid of respect, compassion and above all gratitude to the elderly. A large number of older persons are deprived of basic support to prevent poverty in old age. Social security should encompass services that the elderly require to live with dignity.
All over the world there is a growing demand for the institutionalization of a publicly-funded, universal, non-means-related, non-contributory pension scheme for the elderly. For the first time, a five day “dharna” at JantarMantar in Delhi was organized by the Pension Parishad in May 2012 for a universal pension of Rs.2,000 for all persons aged 55 years and above at current rates. The monthly pension amount should be indexed to inflation once in six months and it should be revised every two or three years. The BPL-APL criteria should not be adopted for exclusion, while income tax payees and recipients of pensions from other sources which exceed the universal pension amount can be excluded. The elderly poor are “overlooked increasingly by the ruthless inroad of investment and profit which sees them as an expendable commodity” according to Aruna Roy, one of the organisers of the JantarMantar protest (The Hindu, August 4, 2013).
The consequences of old age in American society are devaluation, stereotyping, exclusion from equal opportunities for social participation and rewards enjoyed by younger persons, role loss, role ambiguity and struggle to preserve self-esteem through youthful self-images (Rosow, 1977). Older people experience alienation from major family and work roles because of widowhood, retirement, lower income and ill-health. The elderly persons are commonly viewed in invidious stereotypes, as are other devalued minority groups and various negative characteristics are attributed to them. Currently, the mass media in western countries have identified old age as a social problem, and have sensitized the public conscience to its existence. As the media excel in concrete description and pictorial representation, there is the very real danger that they may “define the problem largely in terms that can readily provide a picture, very often in terms of the social problems such as poverty, homelessness, hypothermia, isolation or squalor” (Gaine, 1978).
Butler (1989) has coined the term “age-ism” to refer to the pejorative image of someone who is old simply because of his or her age. Like racism or sexism, it is a form of discrimination against all members of a category based on age-criterion and is as dangerous as racism and sexism.
Ageism can be seen as a systematic stereotyping of and discrimination against people because they are old, just as racism and sexism accomplish this with skin color and gender. Old people are categorized as senile, rigid in thought and manner, old-fashioned in morality and skills……Ageism allows the younger generation to see older people as different from themselves ; thus they subtly cease to identifywith their elders as human beings.
Older persons are portrayed as sick, helpless and useless in television programmes in India. The image and language used by the visual media regarding older people are often degrading.
Apathy of Governments
A National Policy on Older Persons (NPOP) with many promises was announced in 1999 raising hopes to millions of older people. But the elected political leadership has shown least interest in implementing the policy, possibly because the older voters have not yet become a vote bank. The implementation or non-implementation of the policy is left to the discretion of the bureaucracy. The priority for the elderly is low and there is serious conviction deficit among those who matter in implementing the NPOP. The NPOP contains pro-family rhetoric and promises of health care initiatives for the elderly. Non-governmental organizations were assured of transparency, simplification of procedures and timely release of grants. But a policy document cannot alter the bureaucratic practices of decades. A revised policy called the National Policy on Senior Citizens (NPSC) was drafted by a committee and submitted to the government in 2011. The NPSC is yet to be notified by the government, which appears to be complacent on the issues concerning the elderly.
A government that watches millions starve while tonnes of food grains rot cannot be expected to respond effectively to the needs of the elderly whose collective voice is feeble. Exasperated by the continued apathy of the state and central governments, a joint action committee of senior citizens observed August 16, 2010 as the National Protest Day to “stir up the conscience of our rulers and the society”, taking a cue from the warning of the former UN Secretary General Kofi Annan: “Senior citizens, in spite of their number, collective wisdom and experience, will continue to be ignored and marginalized unless they unite”.The Protest day has now become a Protest Fortnight.
Times of India (September 18, 2012) has observed that “ India does not seem to be a country for senior citizens” as a review conducted by the Union health ministry has found that most states have failed to honour or execute the much-touted National Programme for Healthcare of Elderly (NPHCE).Of the 91 districts expected to start a geriatric clinic by now, only 22 have managed to do so. Worse, just a dozen districts have set up a 10-bed geriatric ward. Only three districts – two in Haryana and one in Jammu & Kashmir – have started running a bi-weekly geriatric clinic in community health centres. And, only two districts in these two states have started a weekly geriatric clinic in primary health centres. Ministry officials say none of the steps – setting up a geriatric clinic, ward or holding bi-weekly clinics – have been rolled out in states like Andhra Pradesh, Assam, Bihar, Tamilnadu, West Bengal, Kerala, Karnataka, Jharkhand and Chhattisgarh. A ministry official said, “We have released funds under the NPHCE for creating the stipulated wards and running the clinics in 91 districts across 21 states. However, very few states have done any work. “States haven’t woken up to putting in place systems or infrastructure to take care of its elderly”. This situation is despite India recently joining ten other South East Asian countries to adopt the Yogyakarta Declaration on Ageing and Health, committing to improving national response to the health of the aging population.
As of today the elderly population in India had not become a strong social action force with capability to influence the electoral fortunes of political parties, though there is a simmering protest among various elderly segments over governmental apathy. A National Commission for Older Persons should be constituted by the government of India with statutory powers and the state governments should take steps to form state commissions for older persons. Directorates of aging need to be created both at central and state levels with adequate budgetary support.
The guiding principle of the government till now has been to rely on the family and voluntary organizations regarding care for the elderly rather than to initiate appropriate programmes with the exception of the old age pension scheme. The idea of a golden age, a time of rest with loving family care and a secure income, is the cultural ideal. But the reality should not be harsh. Elderly persons have the right to maintain their dignity and independent social functioning. While family care is vital for the physical and emotional well-being of the elderly, the family unit alone can no longer attend to the different needs of the elderly. Caring for the elderly is the collective responsibility of the family, the community and the state.
An Indifferent Society
Hundreds of thousands of elderly men and women have been living on the foot paths of Indian roads for years. For example, at least 60 senior citizens have been abandoned on the streets of Chennai in June alone, reported The Hindu (July,2013). “Nagarunissa, who is in her seventies has been living on the pavement along Sydenhams Road in Periamet for several years.” Her son lives in Bangalore, but she has been here for the past twenty years.
Under the title “Grave Truth”, the New Indian Express (January 7, 2013) reported a heartrending incident of a 90-year-old man who was found abandoned at a graveyard in Salem district. The nonagenarian Kuppusamy, a former weaver, was a widower. He was living alone at Perumalkoilmedu after his wife passed away several years ago and was surviving on food given by some of his relatives as he had no children. Kuppusamy had bequeathed a house and a barren land which he owned to his grandson. He met with an accident and was in need of others’ help to meet even his basic needs. Feeling burdened by him, his relatives brought him in an auto rickshaw and abandoned him at the graveyard in Ramayan Nagar near Seelanaickenpatti. He was found struggling to help himself amidst the bushes in the graveyard premises. Taking pity on him, some residents living nearby had given food packets and water to Kuppusamy for four days. Finally, a local leader rescued him along with some volunteers and enrolled him in an orphanage run by Salem Corporation. The volunteers provided him with a set of clothes, blankets and a cot. Kuppusamy told his rescuers that he had earlier given Rs.2000 to his grandson to perform his last rites, but he abandoned him.
An editorial in The New Sunday Express in December 2002 observes as follows:
In an already impoverished nation, it is the aged and the young who tend to suffer the most – the old because the breadwinners come to look upon them as useless mouths to feed and the young because poor families cannot afford to provide them the nourishment they need. Whether they live in the cities or in the villages, many of the older people are condemned to a miserable existence. They live in unhygienic surroundings, lack even the most elementary health care and have little by the way of social protection…..With increasing privatization and the changing of social mores, the old cannot be sure that their children will look after them in the evening of their old lives. A simple indication of this is the number of older people who are abandoned by their families during festivals like the Kumbh Mela in Allahabad.
The first World Assembly on Ageing held at Vienna in 1982 was a landmark global response to the concerns of the elderly ; and the International Plan Of Action on Ageing guided member states to take appropriate steps. In 1991, the United Nations General Assembly adopted the United Nations Principles for Older Persons. The 18 UN Principles aim at ensuring that priority attention will be given to the situation of older persons on five areas: independence, participation, care, self-fulfillment and dignity of older persons. The Second World Assembly on Ageing, held in Madrid, Spain in 2002 produced a rights-based Political Declaration and Plan of Action on Ageing
Ten Priority Actions
UNFPA and Helpage International report recommends ten priority actions to maximize the opportunity of aging populations:
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