The increasing ‘burden’ of the elderly in Bangladesh
The world's population is ageing, and so is Bangladesh's.
Today, nearly 720 million people in the world are of age 65 and above; by 2050, their number will be 1.5 billion. Bangladesh has about 15 million people aged 60 and above; by 2050, their number will increase to 36 million (22 percent of the total population).
The country, now entering the intermediate stage of ageing, will reach the advanced stage (with 25 percent of its population at or above 65 years of age) in another 30-35 years. The "dependency" of older people on the economically active population will increase significantly.
This is both good and bad news.
It is good that the country will have a relatively stable population with a very low population growth rate; but it is not so good as then, the country will stop reaping its demographic dividend—which comes from a rapidly growing, economically active population. And it is certainly bad if the country remains ill-prepared to deal with its growing "burden" of the elderly population, who are seen as "unproductive", as "people of poor health" who need intensive and often continuing support.
The stigma of "burden" is associated with the elderly almost everywhere. Such profiling invariably leads to cruelty against them through denial, isolation, and verbal, mental and even physical abuse. Data on such behaviours are difficult to obtain but studies and news reports do document such cruelty to older people in both the developed and developing countries.
However, it is morally and economically wrong to view all old people, without exception, as "burdens". Many perhaps are, due to their poverty and physical disabilities, and many are forced to be "burdens" because of continuing social deconstruction (like dissolution of joint family system) and reconstruction (advent of modernity like changes in transport and communication systems, online life style, changes in financial systems, use of new generations of machinery and gadgets, etc.).
But many, certainly in developed countries but also in developing ones, are not. They may have enough savings, assets, skills and knowledge to sustain themselves economically. Increasing prosperity has given them the ability to save and acquire assets, but unfortunately, it has not necessarily created the institutions to care for the elderly. Financially, this group of older people with savings and assets are not "burdens", but they lack necessary support systems and their disabilities may land them in vulnerable situations.
The older people in Bangladesh, as elsewhere, are thus a mixed bag: some need full support for their living, while others have "resources" and different levels of capacities which can be used to provide them with decent living, with a minimal cost to the society. And, the dependency requirements vary for male and female elderlies.
The stigma of "burden" was, and still is, so deeply rooted in the social psyche that it was difficult to overcome this and go for win-win solutions to the problem of care for the elderly. Actions were needed at all levels to break out of this deeply entrenched psyche.
In a landmark decision in December 1990, the United Nations declared October 1 as the International Day of Older Persons, and later in 2002, adopted the Madrid International Plan of Action on Ageing (MIPAA).
Those were timely actions. They proposed to promote an inclusive agenda of change in attitudes, policies and practices at all levels (global, national, local and family), and to give priority to older persons in advancing health and well-being and fulfilling the enormous potential of ageing for the 21st century.
The declaration and MIPAA provided the necessary boost to Bangladesh to do more for the elderly.
In 1997, the government of Bangladesh instituted, for the first time, a means-tested cash support for the elderly (the Old Age Allowance Programme), with Tk 100 per person every month. Over time, the amount increased to 500 per person to help the elderly in their family settings. This was in addition to a number of other programmes such as pension for retired public servants, allowances for widows, shelter home for the abandoned, etc. And much later, in 2013, the government passed the Maintenance of Parents Act, making it an offence for income-earning sons to ignore their parents' upkeep if the former's income was not below a certain threshold level.
These and many other programmes initiated by the government since then were praiseworthy, socially and politically correct, and reflected a desire to help the elderly. But there were gaps—the law made the family responsible for maintaining the elderly. This was difficult to monitor and enforce, and as expected, the policies were not properly implemented.
The programmes taken by the government were considered by independent researchers as piecemeal, lacking in strategic direction. It was argued that they failed in fully realising the human rights and fundamental freedom of all older persons. One of the key problems was that the programmes did not systematically consider linkages to the obligations of state parties under the international human rights instruments. Studies also revealed poor geriatric care services, as well as poor standards of old age homes.
Allocation of funds for bodies created by the government for elderly support has been poor. Until 1990s, the primary concern of the government was limited to public-sector employees, who represented 5 percent of the labour force and only 1 percent of the older people. Even the much-hyped monthly elderly allowance covered less than a fifth of the elderly people; the total disbursement under the programme increased from 0.02 percent of GDP to only 0.13 percent of GDP with increase in the monthly allowance from Tk 100 to 300, and later to Tk 500 (or USD 6). In the 2020-21 budget, the allocation has been raised to a total of Tk 30 thousand crores (USD 347 million). Still, it is only about 0.53 percent of the total budget, and covers 2.25 million elderly people.
But judging effectiveness by the money allocated only is not the right approach. One has to consider the strategy and institutional structures where the energies of all potential actors such as the youth, groups of younger elderlies, voluntary groups, and social-sector institutions could be harnessed to provide services to the elderly though weekly visits, linking them to care givers, engaging them in social and inspirational activities, group therapies, and the like. These activities could be complemented by NGOs, INGOs, and the private sector. The media could be involved to highlight both the plights and successes of older people, and thus create broader local and national awareness. The resources used would be more effective when proper institutional mechanisms are developed and effectively engaged.
In the context of crises like Covid-19, care for the elderly assumes even further importance. They are the most vulnerable group, with the highest fatality rate among all age groups. Keeping them safe from the scourge of Covid-19 would require special attention to them. Each society will have to decide how much additional resources could be allocated for ensuring the safety of the elderly population. As said earlier, it is not an issue of resources only, but what additional care can be extended to keep them safe. Certainly, they would need to be assisted with proper shelter, geriatric care, distribution of food if needed, and support to procure other daily necessities.
And this is where involving local institutions, voluntary groups and youths come handy. No society can depend on the public services only to ensure the safety and welfare of the elderly—there has to be community action. The government has to take the lead and inspire the community and local institutions to engage effectively. This is lacking in Bangladesh. The older people have raised the current generation; the current generation now owe them the care they deserve.
Dr Atiqur Rahman is an economist, ex-adjunct professor at the John Cabot University, Rome, and ex-Lead Strategist of IFAD, Rome, Italy.