Ageing in developing countries: who cares?

This post was written by Inayat Thaver, Professor of Community Health Sciences at Bahria University Medical & Dental College, Karachi.

• The problem: Old age-related health issues are growing in the developing world but are neglected.

• Why it matters: The elderly have a higher risk of chronic disease, hence draining many health resources.

• The solution: Implementation of the existing policy with simple interventions, including having a champion for the cause, can make a difference.

There is a social and health issue requiring the attention of policymakers. As of 2019, almost 15 million people living in Pakistan are over 60, 7% of the country's total population. The proportion of older people is expected to double to 12% in 2050, with 40 million people aged over 60. An ageing population increases the demand for health services. This article is predominantly addressed to public servants in Pakistan. However, it also demonstrates why government has a responsibility to care for citizens across all age groups, and explains what happens when it doesn’t.

For elderly care, Pakistan predominantly relies on co-residence with family and kin. The children of the elderly have to fulfil the financial, as well as emotional and health needs of their parents. The GlobalAgeWatch Index (by Helpage) puts Pakistan at 92nd out of 96. There are no specialized clinics, support systems, or social security in place for these older people; only 2% of government employees above 65 years get the contributory pension. A few private services have recently been put in place, but they are costly.

Pakistan is a signatory to the Madrid International Plan of Action on Ageing (MIPAA), adopted by the Second World Assembly on Ageing in April 2002. MIPAA links population ageing and the well-being of older persons to international frameworks for social and economic development and human rights, particularly those agreed to at the United Nations conferences and summits since the 1990s. Similarly, the Sustainable Development Goals (SDGs) advocate for age-inclusive development, and Pakistan is committed. Pakistan has taken some very positive steps in the form of legislation to protect the rights of older people in three of its provinces (Khyber Pakhtunkhwa, Sindh, and Baluchistan). However, there is still a significant implementation gap between policy and practice: the laws need to be translated into programs and interventions for the well-being of older women and men across the country.

However, the ground realities are very harsh. There are instances where the family (especially married couples) have thrown out their parents and left them to the mercy of "old age homes" operated by the ‘Edhi’ Foundation. The late ‘Edhi’ is a well-renowned philanthropist involved in many social welfare and health-related activities, especially the ambulance services to any part of Pakistan. But, unfortunately, there are no good quality private "old age homes." This is partially because of the paradox in Pakistani society –people are culturally and socially bound (and expected) to be taking care of their elderly parents. Because there is no system of oversight, there is no guarantee that the elderly will receive the treatment they need. The result is a violation of the rights of the elderly. That's why it matters a lot for the state to intervene and develop a policy and programs to take care of them.

There is a need to have someone champion the rights of older people, be it in the private sector or the government sector. If the governance problem is appropriately addressed, the scarcity of funds may not be a major issue for the government sector. Giving Covid-19 jabs to the elderly first has set a precedent for considering them a priority. Yet, in this case, civil society must work in partnership with the public sector. In the past, citizens have set a good example by working with vulnerable groups such as patients living with HIV/AIDS, the young, those suffering from substance addictions, etc. The public sector can easily establish “old-age clinics” by using the government’s recent “health insurance” scheme. However, the general population also needs to be made aware of the issues and challenges experienced by older people. An example of an easy intervention is building easy-to-use ramps in various shops, malls, and parks. There can be special counters at the bank, sponsored programs promoting exercise for the elderly, and TV and radio programs focusing on the elderly will all go a long way to improving their health and social well-being.

The problems facing over 15 million people cannot be ignored, as it will soon be 20 or 40 million. If the elderly are neglected, then administering emergency care will drain health resources and disturb the fabric of society. Therefore, championing the cause of older people and sensitizing and lobbying with the government and civil society can make a difference.

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