Elderly (Literature)

OVER TO THE NEXT CENTURY : CONTINUITIES AND DISCONTINUITIES

Graeme Hugo

*Professor and Head, Department of Geography, University of Adelaide, Australia*

1. Introduction

In the mid-1990s Asia was experiencing economic, social and demographic change of unprecedented pace and impact, and there is every indication that this will be maintained into the next millennium. One element in this change which will continue, and indeed gather pace in most Asian countries, is the rapid growth in the absolute and relative numbers of elderly people. While there is considerable diversity within the region, all nations will experience ageing of their populations. Whereas in most Asian nations the elderly have hitherto made up a very small proportion of national populations, an increasing number of countries will be faced with mature and even elderly age structures. These changes are occurring as the countries of the region pass through the demographic transition from high to low levels of fertility and mortality. The demographic shifts are interrelated in complex ways with social, economic and cultural change, although our knowledge of the nature of these relationships and their implications is limited. In this final chapter we focus attention on the future of ageing in Asia. Inevitably much of the discussion must be speculative, but it is important to stress at the outset that we can be more certain about the demographic underpinnings of that discussion than most other aspects. This is because Asia’s aged population of the next half century already live in the countries of the region, and while there is a degree of uncertainty in anticipating changes in the levels of mortality they will experience, population projections for the elderly are likely to provide an accurate indication of shifts in the numbers of elderly people in most nations of the region through to the middle of next century. The first section of the present chapter attempts to chart the major changes which are likely to occur in the elderly population of Asia over the period up to the year 2050. This provides the background for a discussion of the possible associated social, economic, political and welfare issus which will emerge over this period. The paper will then address a number of implications which flow from these issues, including economic development and social change in the countries of the region as well as the well-being of the elderly population and their families. Some policy implications are considered in the final part of the chapter.

2. Asia’s Changing Elderly Population

The most authoritative estimates and projections of population in the Asian region are those undertaken by the United Nations, and the 1994 revision of these estimates and projections are employed here to discuss the likely trajectory of change in Asia’s population over the period 1995-2050 (United Nations 1994). The medium variants of the UN projections are used. These show that in 1995, Asia1 accounted for 60.5 per cent of the world’s 5.72 billion residents. Hence, in any discussion of global population trends, Asia must loom large. This also applies to the world’s elderly population. Almost half (49.3 per cent) of the 371.6 million people aged 65 years and over lived in Asia in 1995. By 2050 it is anticipated that the world’s elderly population will have quadrupled to 1.445 billion, while the total global population will have less than doubled to 9.8 billion. Asia’s share of the global elderly population will have increased to 878.4 million or 60.8 per cent of the world’s elderly, while its share of the total world population will fall somewhat to 58.4 per cent.

The impending fundamental shift that will occur in the age composition of the population of Asia is apparent in figure 1. At present, the age structure of the region follows a more or less even pyramidal shape of a relatively fast growing population with comparatively high mortality and fertility. However, over the next half century reductions in fertility and increases in life expectancy will see the age structure move toward a more pillar type of shape in which dependent children make up a smaller proportion of the population.

The projected changes in the population aged 65 years and over are shown in table 1. In the 1990s the number of elderly people in Asia will increase by more than one-third. The rate of increase will be slightly less in the first decade of the 21st century although the decade will see almost 65 million more elderly people added to Asia’s population. However, growth will peak in the second and third decades of next century when the cohorts born in the immediate post-war years enter the 65+ age groups. It is sometimes overlooked that, like Euro-American countries, Asia experienced a post-war baby-boom. However, unlike the situation in developed countries, where this boom was fueled by increases in levels of fertility, that in Asia was due to improvements in infant and child mortality ensuring a substantial increase in the survival rates of infants and children. Hence the 1950s and 1960s was a period of high fertility and falling mortality creating a bulge in the age pyramid which will see very rapid growth of the elderly population in the 2010s and 2020s. However, it will be noted in table 1 that the subsequent decline in fertility in the 1970s and 1980s will result in reduced growth of the elderly population in the 2030s and 2040s. Hence, the elderly population of Asia will double over the next twenty-five years and double again over the next two decades. The aged population of Asia in 2050 will be almost five times larger than that in 1995.

The examination of trends and patterns for all of Asia tends to mask significant variation between countries. In fact, there are huge differences between Asian nations not only in their contemporary ageing situation but also in the projected trajectory of change over the next half century. This is evident in table 2 which shows that in 1995 median ages in the region ranged from 16.7 years (Maldives) to 39.3 years (Japan), while those in 2050 will be between 31 years (Afghanistan) and 53 (Hong Kong). However, it is notable that all nations will experience substantial growth of their elderly populations over the next half century. The lowest rate of growth is anticipated to occur in the country with the oldest population in 1995 – Japan – where the aged population will increase by 88 per cent between 1995 and 2050. At the other extreme, Pakistan’s elderly population is anticipated to increase by more than 8 times over the same period. It is especially important to note in table 2 the projected shifts in the numbers of aged persons in the large nations of the region. China’s old population will increase from 74.7 million in 1995 to 291.8 million in 2050, India’s from 42.9 million to 244 million, Indonesia’s from 8.6 to 50.2 million, Japan’s from 17.7 to 33.3 million, Pakistan’s from 4.2 to 37.8 million, Bangladesh’s from 3.7 to 32.8 million and Viet Nam’s from 3.6 to 20.9 million elderly people.

The anticipated numerical changes in the elderly population are important since most planning must be undertaken in such terms, but it is also important to consider the extent of demographic ageing in Asian populations – i.e. the proportion of the population aged 65 years and over. Table 1 shows that in 1995 only 5.3 per cent of Asians were aged 65 years and over. However, by the year 2000 this will have increased to 5.7 per cent, and by 2010, 6.5 per cent. Thereafter, however, the ageing of the Asian population will increase in tempo so that by 2020, 8.2 per cent of Asians will be aged 65 or over, and this will increase to 10.7 per cent in 2030, 13.7 per cent in 2040 and 15.3 per cent in 2050.

a

As is the case with the growth of the aged population, these data for all Asia mask substantial inter-country variations. Table 2 shows that in 1995 national age structures in Asia varied from quite young in such countries as Cambodia, where only 2.6 per cent of the population were aged 65 years or more, Afghanistan (2.8 per cent), the Lao People’s Democratic Republic and Pakistan (3 per cent) to quite mature in more industrialized nations such as Japan (14.1 per cent) and Hong Kong (10.2 per cent). However, by 2050 the smallest proportions aged 65 years and over will be between 7 and 8 per cent (Afghanistan, Lao People’s Democratic Republic, Bhutan and Cambodia), while several countries will have very old age structures. Indeed, in Hong Kong (34.7 per cent) and Japan (30.2 per cent) around one-third of the population will be in this category. The newly industrializing countries of Singapore and the Republic of Korea will have more than one-fifth of their populations aged 65 years and over. Among the very large nations, China will have 18.2 per cent aged 65 years and over, India 14.9 per cent and Indonesia 15.7 per cent.

It is also important to appreciate that some ageing will occur within the elderly population of Asia over the next half century. Table 3 shows that over most of this period the so-called ‘old-old’ will grow at a faster rate than the elderly population as a whole.

a

Hermalin (1995, p. 8) points out with respect to the age distribution within the older ages and the relative numbers of the so-called ‘old-old’ and ‘young-old’: As these groups can differ sharply in their labour force participation rates, health care utilization, and needs for family and other supports, it is important for policy makers to have accurate estimates of the numbers within each group. In 1995, 58.8 per cent of all older Asians were aged over 75 but by 2050, 68.5 per cent will be among the old-old. This shift in the balance of younger aged people and the old-old has important policy implications. The incidence of economic and social dependency, disability and illness all increase substantially in the 70s and 80s so disproportionate increases in the numbers in these ages will place pressure on family, community and government resources to maintain the well-being of elderly Asians.

3. Changing Characteristics of Asia’s Aged Population

Obviously this growth of the older population implies an increased demand in Asian countries for a wide range of services specific to the older population. This changing demand, however, is not only shaped by the numbers of older people but also by their changing characteristics. Each generation of older people has a distinctive composition having its origins in the unique circumstances that prevailed during the period when the cohort passed through crucial life stages. The Asian aged population in the year 2021 will differ considerably from the current aged population because it will have lived through vastly different events. For example, people in the cohort will have reached school-going age during the post-war expansion of education, which resulted in much higher proportions proceeding to later high school and tertiary education than had been the case with the cohorts moving into those ages in the 1920s, 1930s and 1940s. Such factors will affect the extent to which cohorts are equipped to deal with the problems of old age and how they react to those problems.

Many of the characteristics and behavioural patterns of Asians entering the older age groups in the 2010s and beyond differ in important ways from those of current and earlier generations of older people. There is sufficient space here to mention only a few of these characteristics. One of these relates to the gender balance in Asia’s older population. Table 4 shows that in 1995 females heavily outnumbered males among the population aged 65 years and over in Asia, and that this tendency is exacerbated among the old-old.

This discrepancy is due to the fact that in most countries in the region males do not live as long as females. When it is considered that husbands tend to be older than wives it means that while most men in Asia spend their final years with a wife to care for them, most females spend those years without a partner. In the growing awareness in the region regarding the need for policies and programs to enhance and develop the roles and status of women, the situation of older women is often overlooked. Yet it must be recognized that in Asia ageing is disproportionately a female phenomenon and many of the problems associated with ageing are disproportionately concentrated among females. It will be noted, however, in table 4 that there is projected to be some convergence in sex ratios among older age groups over the next half century. Nevertheless, females will continue to significantly outnumber their male counterparts among the elderly in Asia and this is an important element for consideration in policy development.

a

Again, it is important to stress that there is significant variation across Asia with respect to gender balance among the elderly. Hence table 5 shows that in 1995 there was considerable inter-country variation in the balance of males and females among the elderly.

Hence, in the Koreas there are two older women for every older man, whereas in Pakistan, Bangladesh and Brunei males actually outnumber females among the population aged 65 years and over. Nevertheless, it is anticipated that in the first half of next century two distinct patterns will occur. In countries where presently males have higher life expectancy than females (mainly the South Asian countries), the sex ratio among the elderly will decline so that females will outnumber males in those age groups. On the other hand, in countries in which in 1995 females had a much greater life expectancy than males (e.g. the Koreas, Southeast Asian countries, Japan) there will be an increase in the sex ratio reflecting an improvement in male life expectancy. This is especially marked in countries which have experienced a recent history of conflict such as Cambodia and Viet Nam. The gender dimension of ageing in Asia is very important and needs to be given greater attention than it has hitherto been accorded, especially in a context of substantial and rapid change in the roles and status of women in the region.

a

Another important way in which the Asian elderly population will change over the next half century is in their spatial distribution. In general, there is a substantially lower degree of spatial concentration of the elderly in Asia than in Euro-American nations (Hugo 1988). This is, of course, associated with the fact that the majority of elderly persons in Asia live with, or very near, their children and grandchildren which inevitably produces a greater age mixing in communities and local areas than in European and North American societies. However, table 6 shows that in Asia the aged in 1995 were slightly less urbanized than the population as a whole. Urbanization will be one of the most significant and rapidly occurring phenomenon in the Asian region so that within the next two decades the proportion of Asians living in urban areas will increase from one-third to one-half. It will be noted in table 6 that while the aged are becoming more urbanized, this is not occurring as fast as for the total population. This is due to:

the selective out-migration of the young working-age population from rural areas which produces an ageing of the origin areas; and

a well-developed pattern of urban to rural return migration, often associated with retirement from the public or private sector (Hugo 1978).

In a context of lower fertility, this pattern increasingly will mean that there will be a substantial physical distance separating older Asians from their children. Many rural-based Asian elderly people will not have a child close by to care for them on a day-to-day basis as previously was the case.

Despite the rural bias in the distribution of the aged compared with the total population in Asia, in the early years of next century, the urban aged population will be increasing more than three times as fast as the rural aged. This raises some important planning issues. For example, it is apparent that while there is little difference between male and female urbanization levels at other ages, levels are significantly higher for older women than older men.

 

Increasing levels of urbanization may have a number of deleterious impacts upon the elderly in Asian countries unless there are effective policy interventions. In addition to the possible neglect of elderly people left behind in villages by their children migrating to urban areas, there may be negative consequences for the increasing numbers of elderly people living in urban areas. These include (Hugo 1991):

The increasing formalization of urban economies may mean that because the elderly are less educated and less physically strong they cannot compete as effectively for work as they could when the informal sector was dominant. In a context where it is necessary for many elderly people to continue to work to provide for their economic support, this change may lead to a decline in their well-being.

Enormous pressures on housing in Asian urban areas may make it less possible for elderly people to live with their children.

Increased participation of women in the workforce outside of the home in Asian cities may interfere with women being able to perform their traditional roles of providing continuous care of the elderly at home (Heisel 1985, p. 59).

There are a number of other ways in which future generations of elderly people will differ from the present aged populations of the region which should be factored in to planning for them. While these cannot be dealt with at length here, some of the important differences are as follows:

Each new generation of older people will have higher levels of formal education as is shown in figure 2. This may have a significant impact on their attitudes and perceived needs, as well as the resources they have been able to accumulate during their economically active years to meet their own needs by the time they are old.

More will have been working in formal sector occupations and will be subject to mandatory retirement so that workforce participation levels among the elderly in Asia will decrease. Hence, the elderly will be less able to support themselves in employment as the significance of the agricultural and informal sectors decrease.

More will be living in a place other than their place of birth due to higher levels of internal (and international) migration.

More will be living at a considerable distance from their children due to their greater mobility and reduced levels of fertility.

With shifts in mortality patterns and the passage of the epidemiological and health transitions, it can be anticipated that a greater proportion will be suffering from some form of physical disability or chronic illness. Hence, the incidence of illness among the elderly will increase as well as the numbers of elderly people, creating double the pressure on the health systems of Asian countries than is presently the case.

With increased life expectancy there will be a higher incidence of mental illness and dementia among the elderly in Asian countries.

All of these cohort differences will result in the elderly themselves, and the context in which they live, being significantly different from the contemporary situation in Asia. This will result in the challenges facing planners and policy makers also being different in nature as well as in scale.

4. Changing Levels of Dependency and Inter-generational Relationships

One of the major issues of concern as the population ages is the changing balance between ‘dependent’ groups in the population and the economically active age groups supporting them. Much attention has been focused upon the so-called ‘dependency ratio’ – defined as the ratio of the population under 15 and 65 years and older, to those between the ages of 15 and 64. It has been feared that over the next twenty to thirty years the economically active age groups will not be able to support the dependent age groups, especially the elderly. Ageing, however, does not mean the total burden of dependency will necessarily increase. In fact, table 7 shows that while the overall ratio of dependents to economically active population increased between 1950 and 1965 to reach 80 per 100, it subsequently declined to 59.6 in 1995, and further declines are anticipated to 48.4 in 2025. Closer examination of the table shows that this decline is a function of the massive declines in fertility across Asia, which has seen the youth dependency ratio fall from a peak of 72.8 in 1965 to 51.1 in 1995. Moreover, the child dependency ratio is expected to continue to fall over the next half century so that by 2020 it will be half the levels of the mid-1960s. However, it is clear from figure 3 that aged dependency is beginning to increase in Asia and that there will be a convergence of the youth and aged dependency ratios over the first half of next century. After 40 years of stability, the aged dependency ratio in Asia has begun to increase in the 1990s, and this will steepen in the early decades of the 21st century so that it will double between 1990 and 2030. Thereafter, the dependency ratio will continue to increase so sharply that the overall dependency will begin to increase again after 65 years of decreasing.

The patterns depicted in table 7 and figure 3 have major policy implications for Asian countries. Whether the care of the dependent elderly in the future is in the hands of family or provided by government, there will be fewer people overall in the care-giver and income earning age groups, per person in the older age groups, to provide support. One element common to all the nations of the region is that the family remains the most important source of support for the elderly (Knodel and Debavalya, 1992). There are also differences between the countries in the extent to which family support is bolstered and supplemented by government involvement. However, the structure and functioning of the family is changing in contemporary Asia and these changes can be anticipated to continue and, in many countries, gather pace over the next half century. Inevitably these changes will impinge upon the well-being of the elderly. Two aspects of traditional families in Asia have favoured the aged being given strong support:

b

High levels of fertility and low levels of life expectancy meant that comparatively small numbers of old people were cared for by large numbers of children and grandchildren so that there was considerable potential for burden-sharing in aged care within the family.

In the traditional context, the emotionally extended family was dominant and the associated normative structure of inter-generational relationships was one which favoured the elderly. Net inter-generational flows of wealth were upward from children to parents so that the elderly maintained a large degree of control of family resources and power of key decision making within the extended family.

Clearly the first of these elements is undergoing substantial change so that the potential to share the burden of caring for each dependent elderly person is being progressively reduced. There is also considerable evidence across Asia that traditional systems of family structure and functioning are undergoing sweeping change under the impact of mass education, exposure to mass media, formalization and commercialization of economies, industrialization and urbanization. While this is a complex area, the following elements would seem to be important from the perspective of family care for the elderly:

There is a strong movement toward nucleation of families where inter-generational relationships are such that the net flow of wealth is from parents to children.

The family’s role as a unit of production is declining with commercialization of agriculture and formalization of manufacturing and tertiary activity. Hence, patriarchal (or matriarchal) control of family resources is made more difficult.

Shifts in the role and status of women, especially involving women working outside of the home, has meant that while they maintain a significant care-giving role for the elderly they are not as available for this role as in the past.

Urbanization and high population mobility has meant that the various generations of families may not reside in the same community, so that children and grandchildren are not available to care for elderly family members on a day-to-day basis.

There can be no doubt that the family across Asia is undergoing substantial change. It is becoming smaller in size, nuclear families are displacing extended families, the relationships between generations are changing, the roles of individuals (especially women) within the family are changing and the role of the family as a unit of production is declining. These changes will gather pace as economic development and social change proceed, and will impinge upon the amount, type and availability of family support which the future aged population of the region can call upon. It would be a great mistake for policy makers to assume that the major economic and social changes transforming their countries will leave traditional family structures and functions untouched.

It is important to reiterate that Asia is a complex and highly differentiated region and family structure and functioning and the role of change within it varies greatly. Hence, table 8 shows that there is considerable variation between countries in both the contemporary and projected dependency ratios. In 1995, youth dependency ratios ranged between only 22.8 in Japan, 32.2 in Singapore and 33.4 in the Republic of Korea on the one hand, to 95.2 in the Maldives, 85.8 in the Lao People’s Democratic Republic, 85.7 in Cambodia, and 84 in Pakistan on the other. However, it will be noted that in all countries it is anticipated that there will be a decline in youth dependency over the next half century. Indeed, in many countries there will be a halving or more of the youth dependency ratio. This is particularly the case in the largest nations of China, India, Indonesia, Bangladesh and Pakistan.

In the more developed countries such as Japan, Singapore and the Republic of Korea, it is anticipated that the youth dependency ratio will be relatively stable, with only a small decline being projected.

c

The picture with respect to aged dependency is totally different. Table 8 shows that in 1995 aged dependency ranged from 20.3 in Japan, 14.4 in Hong Kong, and 9.6 in Singapore to 4.2 in East Timor, 5 in Afghanistan and Cambodia and 5.3 in Bangladesh. However, in all countries it is anticipated that there will be a substantial increase in aged dependency over the next half century. In fact, in most cases there will be a doubling or more of the ratio. It will be noted in the table that in six nations aged dependents in 2050 will outnumber youth dependents. Moreover, this will be the case in two of the largest nations in the region – China and Indonesia. There will be less than three economically active age people for each aged person in China, Hong Kong, Japan, the Republic of Korea and Singapore and less than four in Brunei, Indonesia, Sri Lanka and Thailand.

5. Changing Concerns and Issues

The changing numbers, characteristics and distribution of Asia’s elderly population described above raise a myriad of issues and concerns relating to the older people themselves and the societies in which they live. A question of central importance relates to how the nations of Asia can maintain and enhance the well-being of their elderly citizens in the face of the prospect of rapidly expanding numbers of older people outlined above. Of course it must be acknowledged at the outset that the political, economic, social and cultural contexts vary considerably between nations so that the constraints upon, and potentialities for, action by policy makers vary greatly. In particular, it has to be borne in mind that while Asia has been the world’s fastest growing economic region over the last decade, and is likely to continue to be so into the next century, the incidence of poverty remains high. Poverty will continue to be a significant barrier to policy development and program implementation in the aged care area over much of the region.

In considering the impact of economic and social development on the well-being of the elderly, there is no consensus. Hugo (1991, pp. 205-207) suggests that it is possible to recognize three schools of thought with respect to the impact of development upon the well-being of the elderly, and these are depicted in figure 4. The first suggests that due to the processes discussed in the previous section, the status of the elderly declines as economic development proceeds (Cowgill and Holmes 1972). As families become more nuclear in structure and functioning, and cease to be units of production, the elderly are less able to command or control the earnings of younger family members. Cowgill (1974) argues that the processes associated with development, including industrialization, urbanization, introduction of modern health technology and mass education, result in a deterioration in the well-being of the elderly. This occurs through trapping them in traditional and less well-paid jobs, separating them from families, depriving them of meaningful roles and in general lowering their status in relation to younger groups (Hermalin 1995, p. 3). A second school depicted in figure 4 is exemplified by the work of Heisel (1984, p. 59) who suggests ‘that the relationship between the status and well-being of the aged and modernization may be U-shaped rather than linear’. This is based on the observations of such researchers as Palmore and Manton (1974) that the ‘early stages of economic development correspond to the relative decrement of resources held by the aged, but in economically advanced nations entitlements such as pension plans begin to redress the previous losses incurred’. Essentially then this model is one in which it is assumed that formal, institutional support systems are gradually developed to substitute for informal and family-based systems which are weakened as social and economic change occurs. It represents a transition from high levels of well-being based on family support to high levels of ell-being in which institutional supports are a major component.

An interesting element in the model is the suggestion that there is an intervening period of low average levels of well-being in which emerging governmental support is not sufficient to counterbalance the reduction in family-based support. Some commentators would suggest that many Asian nations will be at various points along the downward slope of the curve in figure 4b over the next few decades.

The third model presented in figure 4 rejects the notion that there is a massive withdrawal of family support from the elderly as modernization and urbanization proceeds. Careful research into inter-generational relations within families and the well-being of older people in Europe, both historically and in the contemporary period, would suggest that the decline in family support with development has been exaggerated and that in most more-developed countries (MDCs) family support of the aged has been maintained (Evandrou and others, 1986; Hunt 1978). Certainly there is generally a lower incidence of the elderly living with their children and grandchildren, but rather than this being viewed as a negative development by the elderly, this usually reflects the desire of the elderly for greater autonomy and freedom and their improved average economic situation, which allows maintenance of an independent household as long as their health permits (Wall 1984; Michael and others, 1980). Moreover, in many MDCs the development of state funded pension schemes and other benefits and the increasing proportion of old people who are able to accumulate substantial assets (especially housing) during their working lives has led to an improvement in the average level of well-being of the elderly (Hugo 1986).

The models presented here are over-simplified but do indicate the wide range of views which are currently held on the implications of development on the well-being of the aged. It is likely that different models may apply in different Asian countries as they experience economic and social change over the next few decades due to differences between nations in the cultural context as well as the pace and nature of economic development. What does seem clear is that it is likely that the older generation in many Asian countries will not be able to count upon the degree of support from their families that has previously been the case.

It would appear that it will be necessary for agencies other than family to be involved in the care of the elderly if the well-being of the elderly is to be maintained. This could involve a number of elements:

  1. greater involvement of working people in ‘pay-as-you-go’ pension schemes to support themselves in old age;
  2. greater involvement of national and provincial governments in providing services and support for the elderly;
  3. greater involvement of non-government organizations in caring for the aged; and
  4. greater involvement of local community groups and organizations in caring for the aged.

There is no question that the family will remain the central element in the care and support of the elderly in Asia over the next fifty years. However, it will be important for government and the other agencies referred to above to:

  1. provide support where no family support is available; and
  2. provide support which meshes with, bolsters, backs up and encourages family and community-based support systems.

For many countries in Asia it will not be feasible to mount social security systems such as those operating in many European countries or Australia because of economic constraints. Few Asian governments have the resources available to divert a substantial part of their spending toward the aged. The great challenge for many Asian countries lies in discovering new and innovative ways of providing support for these traditionally important family and community-based support structures which themselves are undergoing change. However, if governments do nothing in the area of aged care because they believe that the traditional structures will continue to be effective, it is likely that the average well-being of their aged populations will decline.

Turning to issues related to the wider impact of the ageing of Asia’s population on the economy and society of their countries, focuses attention on the roles played by the elderly in the wider society. Thus far we have mainly considered the aged as ‘dependents’, as users of the resources of the family, the local community and the nation. However, it is important to recognize that the aged can and do have a productive and significant active role to play in the development of the family, community and nation’s resources, although such roles are often overlooked. Certainly the physical deterioration associated with ageing means that the extent of dependency is going to be greater than among other adult stages of the life cycle. However, the fact remains that many older people (indeed the majority) are physically independent and active.

Treas and Logue (1986, p. 646) have demonstrated that in least-developed countries (LDCs) there are four ways in which the elderly have been viewed in the context of development policies and programs :

As a low priority in development efforts, not seen as meriting special initiatives in the context of scarce resources;

As impediments to development – a drain on scarce resources, wedded to traditional beliefs and values, they are dismissed as resistant to changes compatible with modernization and economic growth;

As a resource in the development process – a flexible reserve labour force, for example, they can be marshalled for marginal industries, public welfare and safety tasks, housework and child care, and the transmission of traditional skills; and

As victims of modernization because their status declines with development.

The third of these perspectives is often overlooked, and negative stereotypes tend to dominate thinking about the aged in most policy contexts. Yet, in the traditional situation the elderly are often assigned significant and important active roles in the household economy and in the family and community more generally.

It is clear that the aged (especially the active aged) do have a contribution to make, both to the well-being of the family, to the local community and more widely. This contribution is not only in terms of their active involvement in the labour market, but in the use of their expertise and accumulated wisdom and experience for the betterment of the community. There are a myriad of important community roles where the aged can be deployed. This is especially so in Asian nations such as Indonesia where the local community organizes a great deal of the maintenance of local infrastructure, initiates local developments and is the keystone of local social activity. Involvement of the elderly in the organization, planning and carrying out of many of these community tasks could be encouraged from the top by directives, but also by making available limited resources, training programs etc. In Asian countries many of the community maintenance activities were formerly conducted by younger adults, but increasing female participation in the workforce outside the home, increased work outside agriculture and, hence, in more structured time limits, increased multiple job holding and job-related commuting and circulation over very long distances, has meant that the numbers of people available to carry out community duties among the economically active is declining. Hence, the scope for involving the older generation is increasing.

In rural communities the out-migration of the young has often left a leadership vacuum which older people, including returning migrants, can fill. The accumulated experience and wisdom of those who have had a lifetime in the workforce should not be overlooked. Similarly, the potential of the ‘young-old’ to take up some of the community-based care activities focused on the ‘old-old’ should be recognized and mobilized.

Another active-positive role which the aged can undertake at the local community level is the preservation and transmission to the next generation of valued elements of traditional culture. With the accelerated pace of economic development and social change in Asia and the all-pervading influence of mass media, many aspects of traditional culture are being lost. Traditional languages, art, stories etc. will die with the passing of the current aged generation unless they are passed on to the young. Hence, programs to involve the elderly in the education system to pass on these elements need to be encouraged.

Finally, in advocating that the aged be assigned significant active economic and social roles in the community, we must sound the warning that such involvement should not be exploitative. The elderly must not be seen as a resource for the community to obtain unpaid labour. Their involvement must be on a basis which preserves their dignity, provides them with stimulation and reward without being onerous. The challenge is again to strike the right balance so that active involvement does not become exploitation, and this will only come through a deep understanding of the aged themselves and their local context.

As Asia’s population ages there are also some political implications. The elderly in the past have made up a very small minority in Asian countries, and, hence, their potential political power as a group has been limited. However, as they increase in numbers their potential ability to influence the political process will also increase. Of course the elderly are not a homogeneous group. They share the same cultural, ethnic, ideological etc. differences as the total population, so it cannot be assumed that they will automatically coalesce as an effective political force. Nevertheless, the experience in Western nations, where the elderly make up more than 10 per cent of the total population, is that they have been able to assert significant political influence at local, regional and national levels. Certainly governments will need to be cognizant of the needs and aspirations of the elderly who make up a quarter or more of the voting age population in many countries. There is also the potential for inter- generational conflict if the different generations are put into a situation where they have to compete for scarce government resources.

6. Changing Roles of Institutions

There are considerable variations between Asian countries in the extent to which governments have become involved in the support of the elderly. Social security coverage remains very limited in the region as table 9 shows.

Only Japan and Singapore have universal social security for the elderly. Aged pensions are still the exception rather than the rule. In most countries they are restricted to government employees and to small numbers of formal, private sector workers. Moreover, pensions tend to be so small that they are not sufficient to provide for day-to-day living costs of the older persons receiving them (Chen and Jones 1988). In most countries in the region people working in agriculture and in the urban informal sector remain without any access to social security, and in such countries these groups make up the majority of the workforce. One of the greatest challenges over the next half century in Asia is to develop social security schemes which make it possible (and perhaps compulsory) for workers in agriculture and in the informal sector to contribute and benefit from a pay-as-you-go social security scheme. This is one of the many areas where Asian countries need to develop new approaches since there are no readily adaptable models available in Euro-American societies.

d

Asian countries will be assisted in their efforts to improve social security coverage by the increasing tendency toward commercialization and formalization of their economies and the decline in the share of the workforce engaged in agriculture. To take one example, figure 5 shows that in Indonesia, where rapid structural change has occurred in the economy, the coverage of workers was largely confined to government workers until the 1980s, but there has been an overall doubling of the proportion of workers covered between 1980 and 1993.

Most of the growth over this period has been through the government’s pay-as-you-go private sector social security scheme (ASTEK) which workers in all medium- and large-sized enterprises are now compelled to join. Nevertheless, the vast bulk of Indonesian workers remain outside the social security system. Although the proportion of workers covered by conventional social security schemes will increase in Asian countries over the next few decades, there will need to be innovative approaches to bring appropriate coverage to the still large numbers of informal sector and agricultural workers.

Government involvement in other areas of elderly support in Asian countries is generally low in the contemporary context but is likely to increase in significance in most countries over the next few decades. For example, the growth of the elderly population will place pressure on health systems. At present, in many countries there is an emphasis in the health system on improving child survival, especially through the provision of primary health care with substantial involvement of paramedical staff. The patterns of illness in Asian countries are going to change as their populations age with the chronic illnesses of the elderly becoming more significant and acute illnesses relatively less important. It would seem, however, that the primary health care systems put in place to deal with the young and their health problems could be readily adapted to provide the necessary health services for the elderly since many of their needs can be met by paramedical staff rather than doctors and highly trained medical personnel. Certainly this issue should increasingly be addressed in health planning and training in Asian countries to ensure that future cadres of paramedical workers are equipped to provide appropriate services to deal with increasing incidence of chronic illnesses of the aged in their caseloads.

Government policy responses to the ‘greying’ of Asia’s population over the next few decades can be of two types. The first of these are policies which seek to intervene to directly influence the ageing of the population itself. Since policies to increase mortality among the elderly are ruled out, the only alternatives are to attempt to intervene to influence the other two demographic processes which shape the pace of ageing – fertility and international migration. It is clear that international migration is not a real option in most countries because it would have to be undertaken on an unprecedentedly huge scale to have any impact and because as the migrants themselves age immigration would have to be maintained at unrealistically high levels (Young 1990). It was explained earlier that the main cause of ageing in Asia has been the rapid decline of fertility levels in the region. Accordingly, it is this demographic process which is being considered by some governments in the region (Hermalin 1995, p. 7). A few nations have modified their family planning programs while others have adopted some pro-natalist policies (e.g. Singapore) in an attempt to modify aged dependency ratios. In general, however, such direct intervention to influence the demographic processes shaping ageing are unlikely to provide a comprehensive solution to the problems which governments perceive as arising from the absolute and relative growth of their aged population.

A second set of possible government interventions to cope with increased age dependency in their populations are more ‘accommodationist’ in orientation. These include initiatives to increase the proportion of the total population who are economically active through increasing female labour force participation, abolishing compulsory retirement ages, encouraging part- or full-time work among the ‘young-old’ etc. Other options are policies which facilitate the working-age population to make provision for their old age through compulsory pay-as-you-go pension schemes. Moreover, in Western countries the last decade has seen a shift in aged care policy, away from those which see the elderly as totally dependent, toward policies which facilitate the elderly to stay independent as long as possible. Such policies, which emphasise self-help and independence among the elderly, are generally not only less costly but are also more acceptable to the elderly themselves and enhance their well-being.

The fact remains, however, that despite the rapid pace of economic development, most governments in Asia are unlikely to have the resources available for aged care policies, which has been the case with Euro-American nations during the equivalent periods of rapid ageing of their populations. This means that other institutions will bear much of the responsibility for caring for the elderly. The family, as has been emphasized above, will remain the cornerstone in caring for the elderly. However, it is sometimes overlooked that much of the support for the elderly in traditional communities comes not only from the family but from other members of the community, including neighbours, friends and other older folk. Community support systems may be the key to providing support to the elderly in situations where no family or government support is available. Many societies of Asia have mutual self-help organizations which are community-based. In Indonesia, for example, the term gotong royong has come to denote a wide variety of mutual self-help cooperative support activities, some of which involve supporting elderly community members. While demand for such community-based support is going to increase in Asia, care has to be taken not to initiate activities which exploit these community institutions. The crucial mix that is needed is to identify appropriate community traditions, norms and institutions, which have in the past, or could in the future, provide support for the older population and provide sufficient inputs of resources to ensure that these support systems are sustainable. There is enormous scope for the development of local variants on community-based schemes, that have been operating over a long period in countries further advanced in the ‘Aged Transition’ like Australia, such as ‘meals on wheels’, home handyman services, domiciliary care, home visiting schemes etc. Such schemes have been very successful in mobilizing community resources to assist in the care of the elderly and ensuring that their well-being is maintained. However, it must be recognized that such schemes have generally only been successful when they have not made excessive demands on community goodwill and resources and when they have been back-stopped by government support of some limited type, often in kind. Hence, the adoption of a community-based approach to caring for the aged should not be used as a complete alternative to government involvement and government expenditure on the aged. What is needed is a tripartite involvement of local community, family and government. There are many examples of successful community-based programs for the aged in many countries, but they cannot be transplanted to other cultural settings in toto. They will need to be modified to suit existing community structures and practices and this will require more research into the local context of ageing in LDCs in the Asia-Pacific region.

Non-government organizations have been crucial in delivering aged care in the more developed countries and the potential for them to play a key role in Asia is considerable. Such organizations are often more able to operate effectively at the crucial community level than are government organizations. The challenge for Asian governments is to effectively incorporate NGOs into a comprehensive system, which on the one hand avoids duplication of effort and conflict with government organizations, and on the other does not use such organizations as an excuse for government to opt out of any responsibility for the elderly.

8. Conclusion

The early part of this paper has demonstrated conclusively that the countries of the Asian region, without exception, will experience a rapid growth of their aged populations and an overall ageing of their national populations over the next few decades. This will occur in a context where the extent to which family resources, which have traditionally been the major source of support for the aged, are, to at least some extent, likely to be diluted. This dilution will occur due to the higher ratio of older people to economically active people, to greater female workforce participation outside of the home, and to fundamental changes in the structure and functioning of the family. However, policy makers in the region, as Chen and Jones (1988, p. 79) point out:

… whether of necessity or from philosophical conviction, seek to maintain the existing systems of family care and concern for the elderly. The family is seen as ultimately responsible for its elderly dependents, and institutionalization is to be used only as a last resort. The aim is to obtain as much community participation as possible. This philosophy is reflected in the kinds of income maintenance, health care, recreational programs and publicly funded institutional care available to the elderly. Governments provide limited special services for particular groups of the aged, and rely on private and charitable groups to assist in providing for the needy. Social security programs are typically limited to employed individuals with special complementary welfare programs for the impoverished and the impaired.

It must be stressed that the projections of growth of the relative and absolute significance of the aged population in all Asian countries over the next few decades must be seen as being not mere ‘crystal-ball gazing’. Projections of the elderly population have more certainty than other projections since the elderly population of the next 65 years is already born, and accurate projection involves virtually only assuming reasonably accurate mortality levels. Nevertheless, the point must be made that these figures are highly indicative of the patterns of future growth of the elderly population in Asia, and planners cannot ignore them or their implications. These projections give policy makers and planners in Asian countries some important early warning signals about the growth of their elderly populations. The initiation of effective aged care policies demands lead time, since many relate to initiatives which must be taken by individuals before they actually become aged themselves, as is the case with pay-as-you-go pension schemes. Moreover, programs and policies are more likely to be efficient and effective if they are developed before the real ‘crunch’ of ageing in the early decades of the next century places the aged care system under enormous pressure.

Few governments in the region have the resources available to divert a substantial part of their spending toward the aged, and very few have indicated a willingness to make such a re-ordering of their budget priorities. In such a context there is a need to recognize the potential of the family, the local community, NGOs and the elderly themselves to provide support of many kinds to the aged. This does not mean, however, that there should be an opting out by government from the process of ensuring the well-being of the elderly. Certainly from a government perspective such a cooperative approach will not be as expensive as a totally centrally organized and funded comprehensive support system. However, it will need resources and back-stopping in various ways. The family and the community have been important elements in maintaining the well-being of the elderly in the past and must be incorporated in such efforts in the future. The well-being of the elderly in Asia will only be assured if there is a tripartite cooperative involvement and commitment by the government, the family and the local community which, perhaps most important of all, involves the elderly themselves in a range of active and consultative ways. Only such a pattern of cooperation will allow Asian nations to attain the goal expressed by the octogenarian demographer, Peter Laslett (1993, p. 2):

…there can and should be a new stage in life for individuals in every older society which has the resources and adopts the appropriate policy, a stage of personal achievement for older people. Not a burden, best an achievement, twenty ….. or even twenty-five years of personal fulfilment for everyone, a genuine reward for the long, long difficult process of national development.

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