Seventy and surviving

An elderly widow prays on the banks of the Ganga in Varanasi. The 2011 census found that 80 per cent of the women in the 70-plus age group were widows. Indian society's treatment of widows is perhaps unmatched in its unemotional cruelty. Abandonment of widows is common, but cases of open aggression are also prevalent.

THIS month India celebrates its 70th Independence Day. This is possibly still young for a country but it is a grand, some would say even stately, age in general. There can and will be many different opinions about how the country is doing at this age. But what about its contemporary and senior citizens, Indians who were born in or before 1947—how are they doing?

Of course, most of them are lucky just to be alive. In 1950, average life expectancy in India was just 36 years; only by 2011 it increased to 65 years. But this means that those borne before 1950 who are still alive today must count themselves among the fortunate few of their age cohort who survived the high probability of infant and child mortality, but also continued to survive their cohorts well beyond the predicted age of adult mortality. As it happens, both child and adult mortality rates have come down in India—slower than better-performing countries such as South Korea and China, but nonetheless at a pace that indicates some improvement.

Indeed, the improvement in adult mortality rates was especially marked in the first decade of this century. Between 2001 and 2011, the total population of India increased by 17.7 per cent, but the number of citizens over the age of 60 increased at around double that rate, by 35.5 per cent. In 2011, the Census of India found that the number of people in the age of 70 years or more amounted to 39.7 million (3.28 per cent of the population), of whom 19.4 million were men and 20.3 million were women. Predictably, around 70 per cent of them lived in rural areas.

This is a sign of progress, but it also means that society needs to take into account the evolving material and social requirements of older people, especially the poor among them. Sadly, in the midst of all the hype about demographic dividend supposedly coming from the predominantly youthful population, all too many analysts and policymakers have missed the huge and growing concerns about the conditions of the elderly and what is required for them to live a life of dignity even in often diminished physical circumstances.

There are clearly wide differences in longevity across States, suggesting that various factors (including the obvious nutritional and health indicators) influence survival rates of both men and women. The table (based on data from Census of India 2011) shows how these rates—in terms of the number of people of 70 years of age or more—varied across States in 2011. Clearly, some States have been better at ensuring survival for senior citizens, or have experienced more rapid declines in birth rates. But this also means that certain States and regions will bear a greater part of the burden of caring for the elderly population. Thus, the five States of the southern region (Tamil Nadu, Kerala, Karnataka, Goa and Andhra Pradesh) made up just above one-fifth of the population, but they accounted for one quarter of the people aged 70 years or more. Exactly the opposite tendency is evident in Bihar and Uttar Pradesh, which contributed a quarter of the total population but just above one-fifth of the elderly (70 years and more).

But for most of these people in India aged 70 or more, their sheer survival may already be the most positive aspect of their lives. Perhaps unsurprisingly in a country that provides so little in terms of social protection to the vast bulk of the population, we perform very poorly in terms of how we treat senior citizens. In the Global Age Watch Index 2014, India ranked 71st out of 96 countries on elderly (60 years plus) care. The concerns range from lack of independent economic means (only around one-tenth have access to any kind of pensions, even the pitifully small amounts of Rs.200 a month provided under the National Old Age Pension Scheme) to inadequate provision of and access to affordable health services, to near-absence of physical infrastructure that is supportive of the different needs of elderly people, to more personal problems of family and social neglect to downright abuse.

Obviously there are vast differences in this, within and across different States and communities and families. Yet, the overriding conclusion from most of the available data is that the self-satisfied perception of many Indians that we are a society in which family values and respect for seniors means that the elderly are treated well and with respect is generally no longer true if it ever was.

The more horrifying aspects of this were brought out in a 2012 study based on surveys in 12 cities conducted by HelpAge India, published in the report “State of the Elderly in India 2014”. It found that every other elderly person in India (defined as someone above 60 years of age) suffered abuse within their own family. Four in 10 old people testified to verbal abuse, three to neglect, and a third to disrespect. One in five elderly persons encountered physical and emotional abuse almost daily, a third around once a week, and a fifth every month. The study found that the most common underlying reason for the abuse, and why so many elderly people are forced to tolerate it, was the elders’ economic dependence on their children.

This is one of the ways in which our public support systems have proved to be so inadequate. The HelpAge survey found that less than 11 per cent of elderly people had a pension of any sort. The National Old Age Pension scheme officially covers less than 20 per cent of people above 70 years, and in any case the amount it provides (Rs.200 a month for those in the age group 60 to 80 years, Rs.500 a month to those above 80 years, widows and disabled people) is so small as to be close to an insult, clearly inadequate for any real contribution to even the barest of existences. Some States have added to this amount to make a somewhat larger sum, but even so it is nowhere near the amount of half the minimum wage that has been the demand of the Pension Parishad and similar movements.

So poverty, lack of savings and lack of those who will look after them have driven many people, even those of age 70 years or more, to continue to work, so that labour force participation among the elderly remains relatively high.

Health care is another enormous problem that is worsened by poverty. Another study published in 2012 (“Health of the Elderly in India: Challenges of Access and Affordability”) found that 13 per cent of the sampled elders had some type of disability that affected at least one activity of daily living. More than one-quarter of this population is underweight and nearly one-third has undiagnosed hypertension. Nearly 60 per cent live in dwellings lacking access to an improved sewerage system. Almost one-half of older Indians were found to have at least one chronic disease such as asthma, angina, arthritis, depression, or diabetes. Yet, the health insurance scheme for the poor (which also provides only a trivial amount of coverage) only covers those who are aged 65 years and younger, so those who are older are particularly vulnerable.

Instead of taking measures of social protection that would provide income support and access to health care to the elderly, the Indian state has decided to put the burden on families. The Maintenance and Welfare of Parents and Senior Citizen Act, 2007, explicitly maintains that it is the duty of the children (irrespective of religion) to maintain their parents with no bar on age. Maintenance is to cover all basic necessities and requirements of life. The Act even includes childless senior citizens, who can claim maintenance from a relative who is legal heir of that senior citizen and who is in possession of or would inherit his property after his/her death.

This Act effectively avoids pinning any responsibility on the state, by privatising this responsibility on to progeny, but regardless of their own economic situation. Indeed, even as the examples of neglect and abandonment of the elderly among poor families are particularly heartrending, they must be judged in the context of the terrible difficulties faced by their children, who are often forced into distress migration and extreme destitution and also need to look after the economic needs of their own children. Familial cruelty is shocking but probably less widespread and pervasive than the social cruelty that allows all of us to tolerate extreme destitution among the elderly without insisting on the state’s responsibility to ensure them a decent existence.

Among those who are 70 years or more, a particularly difficult time is had by women. First of all, they are more likely to be alone having lost their spouse. In this age group, the 2011 census found that 80 per cent were widows. This is hardly a surprising result when women have a better physical survival rate and therefore longer life expectancy than men, are more likely to have been younger than their spouses, and find it much harder or near impossible to remarry given the persistent social disapproval of widow remarriage.

Second, they are even more likely to be below the poverty line, even if they were not poor earlier or their families are not poor. Patrilineal inheritance patterns mean that they tend to own or control fewer assets; and they also face more constraints in finding employment, which add to the massively reduced possibilities of having any savings that could be spent at this age. Finally, Indian society’s treatment of widows is perhaps unmatched in its unemotional cruelty. Abandonment of widows is common, but cases of open aggression are also prevalent. Single never-married women face particularly acute problems among the poor.

Obviously, the picture of old age in India is much more varied and, especially in urban India, there are more cases of those who have survived to their eighth decade and continue to lead full and satisfying lives. But the greater majority are those who are forced to eke out a difficult and precarious existence without adequate social or familial support. A country that is seven decades old should at the very least look out for its contemporaries.