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Sometime in 2023, India is expected to be formally declared the world’s most populous country, overtaking China. This certain development underscored by the UN report on World Population Prospects 2022 holds high significance for India, given the varied experiences it has had with the uneven nature of demographic change across different regions and States.
Tamil Nadu is among the few States that diverged early from the national trend of high population growth rates, low economic activity, weak social welfare including food security and inadequate investments in public health and education. This breaking away from the average is reflected most strikingly in its falling Total Fertility Rate (TFR), which stood at 1.4 in 2020 as against 1.8 as per the 2011 Census.
On the other hand, Tamil Nadu faces a difficult path ahead due to a skewed population, in which it would have a higher share of older adults by 2050, compared to other States with higher TFR and lower social development indices. Urban senior citizens constitute 12.8% of the population at present. Tamil Nadu is also expected to have a higher share of older women, with marked trends in society indicating enhanced risks for men, most notably due to high levels of alcohol consumption, injury and rates of non-communicable disease.
A third dimension is that Tamil Nadu receives a lower share of just Rs.30 from Central allocations for every Rs 100 it contributes to GDP, compared to high population growth States such as Bihar and Uttar Pradesh, which get Rs.200. It should be noted also that a big share of labour in Tamil Nadu now comes from outside the State, as it does in other economically advanced southern States.
Tamil Nadu is expected to have a higher share of older women; trends also indicate enhanced risks for men, largely due to high alcohol consumption
For India as a whole, the growth rate of older adults (over 60 years) was three times that of the general population as of 2014. Apart from life expectancy at birth, life expectancy at age 80 has also been rising, from five years in 1950 to seven years in 2015, with a likely 8.5 years by mid-century.
Tamil Nadu has a peculiar conundrum at present: widespread alcohol consumption due to the proliferation of legal, State-controlled retail outlets. This situation of easy access has increased alcohol use among working-age males, with implications for social life, household dynamics, public health and economic productivity.
According to a study published in the Journal of Family Medicine and Primary Care in 2019 by V.K. Anantha Easwar and colleagues, regular alcohol use in a study group of 400 individuals in Kancheepuram was found to be 39%. More significantly, 52.5% of alcohol users were classified as having a “hazardous/harmful” drinking pattern, while 67% of the total had a “problematic” pattern. This promises to have a harmful future impact.
What this implies is that while survival rates at the population level may increase, there could be high levels of morbidity and disease among a future elderly segment in Tamil Nadu, particularly those with lower literacy, family support, and income security. The study authors reported high levels of hypertension, gastric/peptic ulcer, and psychiatric illness among a significant group of participants.
The percentage of the population above 60 years of age is steadily rising in India, and thus in Tamil Nadu too. In the year 2050, this section is expected to be as high as 20%, or at least 300 million individuals nationally. This is a prognosis for a massive burden of NCDs such as diabetes, hypertension, respiratory ailments, cancers and so on, besides violence and injury caused by poor public infrastructure. Psychiatric conditions including depression may also be more common. Older adults aged 50-69 were found to report higher rates of mental illness. Smoking rates among those over 60 was 10%.
Tamil Nadu receives a lower share of just Rs.30 from the Centre for every Rs 100 it contributes to GDP, unlike high population growth States such as Bihar and Uttar Pradesh, which get Rs.200
As a State with a full-fledged public health system, Tamil Nadu has its task cut out for the coming decades, which is to work on social welfare systems for the elderly. This must focus on suitably designed and subsidised housing in the form of elder-living communities for the less affluent, a transformation of urban infrastructure, and universal mobility choices to accommodate the elderly, besides creation of urban commons like large parks and wetlands to improve psychological health and well-being. Public provisioning of health care that is free at the point of delivery has to be the imperative.
The more immediate challenge for the State is to stop alcohol harm to future older adults through widespread sale of liquor today, poor food safety regulations and enforcement, failed urbanisation seen in absent walking infrastructure and reinforced use of private vehicles for basic mobility. In the Madras High Court the DMK government refused to accept the law on universal access, which would mean turning all buses into low-floor ones.
Much of the damage to a highly stressed middle-aged generation comes from lack of commitment to existing laws on safety and standards of infrastructure, goods and services, and pollution control. The DMK government has not spoken on a report on reforming the health system through universal health care, although it had asked the State Planning Commission to produce it.
Private facilities for an ageing population have started coming up, most notably in and around Coimbatore and Trichy, but these are aimed at wealthy residents who are invariably supported by remittances from children abroad. It is time the Tamil Nadu government promoted such communities within the overall framework of social welfare. If affordable housing is a goal of policy, affordable senior living communities are a necessary adjunct to it.
Given the large number of senior citizens already looking to the government for welfare – they invariably benefit from the universal PDS – a dedicated department could look at their needs and articulate changes necessary in policy.
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