Demographic dividend: no space for our ageing population

Although aging is an emerging issue in Bangladesh, adequate programmes and policies do not seem to have been formulated to cater to the specific health needs of the growing number of elderly persons

According to the World Health Organization (WHO), in just about every country on the planet “the proportion of people aged over 60 years is growing faster than any other age group”. These societal changes will continue to bring challenges and opportunities. The UN estimates that by 2050, one in three people living in the developed world will be over 60. In Australia, one in four people is older than 55 and over the next decade this will increase to approximately one in three. As our demography continues to shift, a key imperative will be to prolong paid workforce participation and reduce the dependence of the non-working population on the working population to a manageable level. Ageing workforce rhetoric has widely discussed policy implications – the cost of healthcare, and impacts on the social welfare system, retirement savings and the broader economy – but important aspects of the ageing workforce have as yet been largely omitted. The pattern of life, disease, dying and death has changed dramatically in Bangladesh over the last several decades. Over the last 43 years life expectancy at birth has improved by 22 years for males (71 years for male) and 24 years for females (73 years for females) according to the 2016 World Population Data Sheet (Population Reference Bureau, 2016). Life expectancies at Birth were both sexes were 48 years in 1970. Increased life expectancy has brought with it much higher rates of chronic disease. Many people carry non-life-threatening chronic conditions such as arthritis, hearing and vision loss, and mental illness with them into final years. These conditions don’t threaten life expectancy, but can significantly affect a person’s well-being and health care need. Around 6.4 million or 4 percent people of the country get poorer every year due to excessive costs of healthcare. About 50 million people are poor. They cannot pay for healthcare available in the private sector, while public healthcare facilities are inadequate.

Our cultural and structural disregard for older populations is almost the last prejudice we’re allowed to have. Which is deeply ironic: Not only is aging–if one is blessed with a long life and good health–one of the few truly universal experiences, it is something that is becoming more and more pervasive. By 2050, the global population of people aged 60 and older will rise to 2 billion, up from 900 million in 2015. For people born today, the likelihood that they will live to triple digits is strong: A child born in 2011 has a one-in-three chance of living to her 100th birthday.

Although aging is an emerging issue in Bangladesh, adequate programs and policies do not seem to have been formulated to cater to the specific health needs of the growing number of elderly persons in the country. The youngest and the oldest groups constitute a very sizeable proportion of admissions to hospitals and medical institutions.

Population change and health development are inextricably interrelated and each is to a certain extent a determinant and consequence of the other. An increase in population would automatically create an increase in the demand for various medical and public health facilities. The development and provision of adequate and appropriate health services in turn will influence population dynamics by lowering fertility and mortality rates and to a limited extent even migration. A comprehensive analysis of the consequences of population change for provision of health services should therefore take into consideration, among others, the demographic factors such as the size, sex and age structure, and geographical distribution of the population.

If the retirement age remains fixed, and the life expectancy increases, there will be relatively more people claiming pension benefits and less people working and paying income taxes. The fear is that it will require high tax rates on the current, shrinking workforce. Also, those in retirement tend to pay lower income taxes because they are not working.

A declining birth rate also means a smaller number of young people. This will save the government money because young people require education and pay little, if any, taxes. Though the net cost of retired people is greater than the net cost of young people under 18.

It depends on the health and mobility of an ageing population. If medical science helps people live longer, but with poor mobility, there will be less chance to work. If people live longer and can remain physically active for longer, the adverse impact will be less. Immigration could be a potential way to defuse the impact of an ageing population because immigration is primarily from people of working age.

A report by the IMF suggests that the fiscal cost of the current recession and economic crisis will be dwarfed by the looming demographic time bomb slowly creeping upon many developed countries. This forecast is the last thing the government will want to hear, given they are desperately trying to juggle the political and social desire to increase spending, with long term fiscal deficits which require some kind of future spending cuts. This is not to suggest the economic cost of the current recession is a trifling matter, but, what it means is that efforts to reduce the cyclical deficits will prove very difficult as underlying structural deficits play a growing role in shaping government's deficits.

In many ways, aging is a personal concern, but coping with this demographic shift will not come down to individual effort. Rather, it’s going to take a comprehensive approach–on the part of cities, communities, and companies–to make room for a population that has much to offer, and that we all, someday, will be a part of.

Many opportunities to address the economic, health and social care needs of an aging population abound, especially through evidence-based community programs that improve function and quality of life. But we still have work to do. We have to identify a need to increase efforts to translate research about effective interventions into community-based programs: (1)Promote sustainable income security for the elderly;  (2) Promote the elderly employment; (3) Create a new concept of “the elderly” so that society will recognize them as productive members of the society and economy; (4) Revise laws that obstruct or discriminate against hiring the elderly, and increase the mandatory age of retirement for government officers or civil servants and state enterprise workers; (5) Motivate the working-age population to save and be frugal in order to have enough financial resources for use in their retirement; (6) Promote the viability of the National Savings Fund and ensure that it is managed well; and (7) Improve the pension system for retirees and increase the elderly welfare subsidy so that it is appropriate for the cost of living and inflation rate.

There is need of significant policy considerations, but organisations and employees also need to take responsibility and play their role in the transition to an intergenerational workforce.

The writer is Former Head, Department of Medical Sociology, Institute of Epidemiology, Disease Control & Research (IEDCR)

Dhaka, Bangladesh

E-mail: [email protected]

 

 

Demographic dividend: no space for our ageing population

Although aging is an emerging issue in Bangladesh, adequate programmes and policies do not seem to have been formulated to cater to the specific health needs of the growing number of elderly persons

According to the World Health Organization (WHO), in just about every country on the planet the proportion of people aged over 60 years is growing faster than any other age group. These societal changes will continue to bring challenges and opportunities. The UN estimates that by 2050, one in three people living in the developed world will be over 60. In Australia, one in four people is older than 55 and over the next decade this will increase to approximately one in three. As our demography continues to shift, a key imperative will be to prolong paid workforce participation and reduce the dependence of the non-working population on the working population to a manageable level. Ageing workforce rhetoric has widely discussed policy implications the cost of healthcare, and impacts on the social welfare system, retirement savings and the broader economy but important aspects of the ageing workforce have as yet been largely omitted. The pattern of life, disease, dying and death has changed dramatically in Bangladesh over the last several decades. Over the last 43 years life expectancy at birth has improved by 22 years for males (71 years for male) and 24 years for females (73 years for females) according to the 2016 World Population Data Sheet (Population Reference Bureau, 2016). Life expectancies at Birth were both sexes were 48 years in 1970. Increased life expectancy has brought with it much higher rates of chronic disease. Many people carry non-life-threatening chronic conditions such as arthritis, hearing and vision loss, and mental illness with them into final years. These conditions dont threaten life expectancy, but can significantly affect a persons well-being and health care need. Around 6.4 million or 4 percent people of the country get poorer every year due to excessive costs of healthcare. About 50 million people are poor. They cannot pay for healthcare available in the private sector, while public healthcare facilities are inadequate. Our cultural and structural disregard for older populations is almost the last prejudice were allowed to have. Which is deeply ironic: Not only is agingif one is blessed with a long life and good healthone of the few truly universal experiences, it is something that is becoming more and more pervasive. By 2050, the global population of people aged 60 and older will rise to 2 billion, up from 900 million in 2015. For people born today, the likelihood that they will live to triple digits is strong: A child born in 2011 has a one-in-three chance of living to her 100th birthday. Although aging is an emerging issue in Bangladesh, adequate programs and policies do not seem to have been formulated to cater to the specific health needs of the growing number of elderly persons in the country. The youngest and the oldest groups constitute a very sizeable proportion of admissions to hospitals and medical institutions. Population change and health development are inextricably interrelated and each is to a certain extent a determinant and consequence of the other. An increase in population would automatically create an increase in the demand for various medical and public health facilities. The development and provision of adequate and appropriate health services in turn will influence population dynamics by lowering fertility and mortality rates and to a limited extent even migration. A comprehensive analysis of the consequences of population change for provision of health services should therefore take into consideration, among others, the demographic factors such as the size, sex and age structure, and geographical distribution of the population. If the retirement age remains fixed, and the life expectancy increases, there will be relatively more people claiming pension benefits and less people working and paying income taxes. The fear is that it will require high tax rates on the current, shrinking workforce. Also, those in retirement tend to pay lower income taxes because they are not working. A declining birth rate also means a smaller number of young people. This will save the government money because young people require education and pay little, if any, taxes. Though the net cost of retired people is greater than the net cost of young people under 18. It depends on the health and mobility of an ageing population. If medical science helps people live longer, but with poor mobility, there will be less chance to work. If people live longer and can remain physically active for longer, the adverse impact will be less. Immigration could be a potential way to defuse the impact of an ageing population because immigration is primarily from people of working age. A report by the IMF suggests that the fiscal cost of the current recession and economic crisis will be dwarfed by the looming demographic time bomb slowly creeping upon many developed countries. This forecast is the last thing the government will want to hear, given they are desperately trying to juggle the political and social desire to increase spending, with long term fiscal deficits which require some kind of future spending cuts. This is not to suggest the economic cost of the current recession is a trifling matter, but, what it means is that efforts to reduce the cyclical deficits will prove very difficult as underlying structural deficits play a growing role in shaping governments deficits. In many ways, aging is a personal concern, but coping with this demographic shift will not come down to individual effort. Rather, its going to take a comprehensive approachon the part of cities, communities, and companiesto make room for a population that has much to offer, and that we all, someday, will be a part of. Many opportunities to address the economic, health and social care needs of an aging population abound, especially through evidence-based community programs that improve function and quality of life. But we still have work to do. We have to identify a need to increase efforts to translate research about effective interventions into community-based programs: (1)Promote sustainable income security for the elderly; (2) Promote the elderly employment; (3) Create a new concept of the elderly so that society will recognize them as productive members of the society and economy; (4) Revise laws that obstruct or discriminate against hiring the elderly, and increase the mandatory age of retirement for government officers or civil servants and state enterprise workers; (5) Motivate the working-age population to save and be frugal in order to have enough financial resources for use in their retirement; (6) Promote the viability of the National Savings Fund and ensure that it is managed well; and (7) Improve the pension system for retirees and increase the elderly welfare subsidy so that it is appropriate for the cost of living and inflation rate. There is need of significant policy considerations, but organisations and employees also need to take responsibility and play their role in the transition to an intergenerational workforce. The writer is Former Head, Department of Medical Sociology, Institute of Epidemiology, Disease Control Research (IEDCR) Dhaka, Bangladesh E-mail: [email protected]