The recent extension of the Ayushman Bharat health insurance scheme to include coverage for the elderly marks a significant step in India’s efforts to address the needs of its ageing population. However, we must view this as just the beginning of a larger conversation about achieving the ‘silver dividend’ - the potential opportunities and challenges associated with an ageing society.
As India’s demographic profile shifts, the policies and frameworks must evolve to ensure the elderly are not only cared for but also empowered to contribute to society. If we plan well, we can convert a potential disaster into a significant opportunity.
India’s population is set to age rapidly in the coming decades, with the proportion of those over 60 expected to double by 2050, according to the UN Population Fund. This is not unique to India.
Many countries in the west and Asia, like Japan, are facing the implications of a rapidly ageing population. The silver dividend refers to the potential economic and social benefits of an ageing society, particularly if elderly individuals can remain active and engaged in economic, social and familial roles.
It is important to realise that reaping the silver dividend requires a robust policy framework that extends beyond healthcare. Over 40 percent of the elderly in India are in the poorest wealth quintile. Such levels of poverty are likely to affect their quality of life. As people live longer, their healthcare needs become more complex.
The need for comprehensive geriatric care, including specialised treatments for chronic diseases, mental health support and facilities for palliative care is likely to grow. India currently faces a shortage of trained professionals across the health system—a gap that needs to be addressed urgently.
The Centre first came out with a National Policy for Older Persons in 1999. One of its main components is to promote family-based care. The policy also seeks to engage voluntary organisations in complementing family care and extending support to vulnerable elderly individuals.
However, its implementation, particularly in rural regions, has been limited if not missing, underscoring the need for broader initiatives to meet the diverse physical, psychological and social needs of elderly people, especially from marginalised communities.
In addition to expanding healthcare services, improving the accessibility and quality of existing infrastructure is critical. Many elderly people, especially in rural areas, struggle to access healthcare due to poor transportation and inadequate facilities.
Enhancing the reach of services such as telemedicine, mobile clinics and community health programmes will be key. It is also important to adopt a holistic approach that includes social security, economic engagement, and support for family structures.
Economic insecurity remains one of the most pressing concerns. The lack of appropriate pension schemes and adequate savings forces many to rely on their families, which may not always be viable. Approximately 90 per cent of workers are in the informal sector, which offers no social protection for older persons. Policymakers should consider expanding pension schemes, especially for those in the unorganised sector, to provide a steady retirement income.
Creating age-friendly cities is essential to ensuring the elderly can live independent and dignified lives. Urban planning must include accessible public spaces, pedestrian-friendly roads and public transportation systems that cater to the needs of older adults. Housing policies that support the development of senior-friendly communities and public buildings equipped with ramps, elevators and seating areas are vital.
One way to harness the silver dividend is to enable the elderly to remain economically active. Policies that promote flexible work arrangements, part-time jobs and community-based work can provide avenues for older adults to contribute their skills and experience. This not only supplements their income but also fosters a sense of purpose and community involvement.
In India, family members, particularly women, often bear the primary responsibility of caring for the elderly, impeding their workforce participation. To support caregivers, policymakers need to introduce measures such as caregiver allowances, training programmes, and respite care services. Providing financial incentives and mental health support for caregivers can help mitigate strain.
India’s demographic transition is not uniform. States like Kerala and Tamil Nadu are further along than states like Uttar Pradesh and Bihar. This means policies must be tailored to the specific needs of each region.
In states with a more advanced ageing population, there is an immediate need to develop comprehensive elderly care services, strengthen social security mechanisms and create job opportunities suitable for older adults. Kerala’s government has been aware of this and programmes for the elderly have made a welcome beginning.
Conversely, in states where the population is younger, policymakers should start investing in education and health infrastructure that will support their population in the future.
Countries like Japan offer valuable lessons. With one of the most rapidly ageing populations in the world, Japan has implemented extensive measures to address its population’s needs. The country has a comprehensive health insurance system that covers most medical expenses for the elderly. It also promotes active ageing by encouraging older adults to engage in community activities and part-time work.
Similarly, several Western nations have developed robust social security systems, public pensions and community-based care models. These systems include initiatives like elder-friendly housing, accessible transportation and financial support for caregivers. India can draw on these experiences to inform its policies and create a more caring and supportive environment.
The joint family has been the traditional system of elderly care in India. But migration and a shift to nuclear families, has slowly shaken it up.
Recognising the diverse needs of India’s elderly population is vital. Tailored, region-specific policies that address these varied needs will be key. The ageing report highlights the lack of credible data on various issues. More could be done by including questions on emerging issues related to older people in upcoming data collection exercises of the National Sample Survey, National Family Health Survey and Census.
While India has been known as a culture that supports the elderly, this should not mean the government can abdicate its responsibility to ensure healthy and dignified lives, especially for its senior citizens.
Poonam Muttreja
Executive Director, Population Foundation of India
(Views are personal)