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Increasing Life Expectancy and the Elderly

An analysis of the abridged life tables issued by the registrar general of India as well as data from the latest Human Development Report shows that increased life expectancy does not automatically lead to a better quality of life for the elderly, especially the women.

COMMENTARYEconomic & Political Weekly EPW august 9, 200841Increasing Life Expectancy and the ElderlyAshish BoseAshish Bose (ashishb@vsnl.com) is with the Institute of Economic Growth, Delhi.An analysis of the abridged life tables issued by the registrar general of India as well as data from the latest Human Development Report shows that increased life expectancy does not automatically lead to a better quality of life for the elderly, especially the women.Increase in life expectancy is consi-dered good in itself and is used as an important indicator for the calculation of the Human Development Index (HDI). But does increasing longevity add to the quality of life of the elderly? There is enough evidence to indicate that generally speaking, the quality of life of the elderly goes down with advancing years.Let us look at the latest data on life expectancy at birth in various countries before we come to the Indian scenario. From the data presented for 177 countries of the world inHuman Development Report 2007-08, we culled out 11 countries where the life expectancy at birth is over 80 years (Table 1). All these countries arein the category of “high human development” as designated by the United Nations Development Pro-gramme (UNDP). China and India have much lower life expectancy, namely, 72.5 and 63.7 respectively. These two countries belong to the “medium human development” category: China has anHDI rank of 81 while India ranks 128. Sierra Leone which has anHDI rank of 177, the lowest among all the countries in the world has also the lowest life expectancy (41.8 years).It will be seen from Table 1 that there is no perfect match between life expectancy rank andHDI rank. Japan has the highest life expectancy rank while itsHDI rank is 8. Interestingly, Sweden has a life expectancy rank of 6 and also an HDI rank of 6. Sierra Leone has the lowest life expectancy rank and also the lowest HDI rank.Longevity of the ElderlyDo the elderly in these countries have a high quality of life because of their higher life expectancy? One of the early studies on ageing reports the findings of an international survey on the problems of the elderly carried out by the Sandoz Institute in consultation with the United Nations in 1982. By way of example, let us take Italy where the main problems of the elderly are summarised as follows: The finances of elderly people are pre-carious. The most acute problem for old peo-ple, housing is in short supply and beyond their means. Many are admitted to hospital because they are homeless, or because con-ditions where they live are intolerable. There are fewer, if any, children and grandchildren to help the aged. Outsiders willing to help are hard to find, even if offered payment. Serious mental health problems among the elderly reflect lack of preparation for old age, resulting, for example, in the loss of social role. Cultural traditions disadvantage elderly women. They tend to live longer, are unable to be financially independent, and have no interests of their own [Selby and Schechter 1982].The world assembly on ageing held in Vienna in 1982 discussed in great detail the condition of the elderly. Many distinguished gerontologists from all over the world spoke at this conference. The most telling presentations, however, were made through films on the sad plight of the elderly in the UK. On a subjective note, I may observe that having been to all the countries (except Iceland) listed in Table 1, that have 80+ life expectancy and also to China, I think the condition of the elderly in the western countries is no better than in China and India, though for different reasons. A high income level does not guarantee a better emotional life for the elderly.Let us now turn to the national scenario. During the last three decades, there has been considerable increase in life Table 1: Life Expectancy and Human Development IndexLife HDI Country Life Expectancy GDP Per Expectancy Rank atBirth Capita Rank (Year) 2005 (PPP $) 20051 8 Japan 82.331,267 2 21 Hong Kong (China-SAR) 81.9 34,833 3 1 Iceland 81.536,510 4 7 Switzerland 81.335,633 5 3 Australia 80.9 31,794 6 6 Sweden 80.532,525 7 13Spain 80.527,169 8 4 Canada 80.333,375 9 20Italy 80.328,529 10 23Israel 80.325,864 11 10France 80.230,386 Life expectancy ranking is done by us.Source: Compiled from UNDP,Human Development Report 2007-08, New York, 2007, pp-229-33.
COMMENTARYaugust 9, 2008 EPW Economic & Political Weekly42Table 3: Life Expectancy at Birth, Death Rate and IMR in India and Bigger States, 2005Sr India/States Life Expectancy Death Infant No atBirth Rate MortalityRate 2004 20052005(IMR) India 63.5 7.6 581 Kerala 74.0 6.4 142 Punjab 69.4 6.7 443 Maharashtra 67.2 6.7 364 HimachalPradesh67.0 6.9 495 Haryana 66.2 6.7 606 TamilNadu 66.2 7.4 377 Karnataka 65.3 7.1 508 WestBengal 64.9 6.4 389 AndhraPradesh 64.4 7.3 5710 Gujarat 64.1 7.1 5411 Rajasthan 62.0 7.0 6812 Bihar 61.6 8.1 6113 Uttar Pradesh 60.0 8.7 7314 Orissa 59.6 9.5 7515 Assam 58.9 8.7 6816 MadhyaPradesh 58.0 9.0 76Source:SRS Abridged Life Tables, op cit, p 5 and SRS Bulletin, Vol No 1, October, 2005, p 1.Table 4: Life Expectancy at Age 60 by Sex, India and the Bigger States, 2004Sr No India/States Total Male Female India 17.9 16.7 18.9 1 Kerala 20.0 19.4 20.62 Punjab 21.1 20.9 21.33 Maharashtra 18.1 17.7 18.54 HimachalPradesh 18.4 18.6 18.25 Haryana 20.0 19.4 20.66 TamilNadu 17.1 16.8 17.37 Karnataka 17.8 16.7 18.68 WestBengal 17.6 17.0 18.09 AndhraPradesh 17.9 17.4 18.110 Gujarat 16.8 16.0 17.611 Rajasthan 17.4 16.7 18.212 Bihar 17.7 17.9 17.613 Uttar Pradesh 16.6 15.9 17.114 Orissa 16.4 16.4 16.415 Assam 16.4 15.6 17.216 MadhyaPradesh 16.1 15.8 16.3The states are ranked as per Table 3.Source: Registrar General, India:SRS Bulletin, Vol No 1, October 2008, pp 4-5.expectancy in India (Table 2). Neverthe-less, the overall figure (63.2 years) cannot be considered a high figure and there is still considerable disparity between rural (62.1 years) and urban (68.8 years) areas. Table 3 gives data for states with popu-lation of over 10 million and also for Himachal Pradesh which has a population of six million and is considered demo-graphically progressive.Uttar Pradesh, Madhya Pradesh, Assam and Orissa have a life expectancy of 60 years and below. The contributory factors are high death rates and in particular, high maternal and infant mortality rates.Life Expectancy at 60Finally, one may look at life expectancy at age 60 (Table 4). It will be seen that Punjab has the highest life expectancy at age 60 (21.1 years) compared to Kerala (20.0) which has the highest rank when one considers life expectancy at birth (as seen in Table 3).Table 4 also gives figures of life expect-ancy by sex. It will be observed that women outlive men. The all-India figures for life expectancy at age 60 are 18.9 years for women and 16.7 years for men. In Punjab the comparable figures are 21.3 for women and 20.9 for men. In Kerala the figures are 20.6 for women and 19.4 for men. However, in Himachal Pradesh (where women are overworked because the men mostly migrate for work to cities all over India) the men have a slight edge over women (18.2 for women and 18.6 for men). In Bihar also, men have a slight edge over women.There are more elderly women than men. Women, at least elderly women, live longer than men. In India, the problem of widows is indeed serious as has been brought out in a recent conference on eld-erly abuse in New Delhi organised by Mala Kapur Shankardass, a well known social gerontologist. According to a sample survey conducted by the Mahila Jagriti Mandal, 5 per cent of the widows in Uttar Pradesh take to begging. Non-governmen-tal organisations working for the well- being of the elderly report increasing number of elderly abuse cases all over India. To give an example, a 67-year-old woman in Delhi complained that her husband, son and daughter-in-law had assaulted her and locked her up because she refused to sell the house which was in her name.In this context, we may refer to the Maintenance and Welfare of Parents and Table 2: Increase in Life Expectancy in India, 1973-2003Period MidYearTotal Rural Urban1970-75 197349.748.058.91981-85 198355.453.762.81991-95 199360.358.965.92001-05 200363.261.868.5Increase in 30 years 1973-2003 13.5 13.8 9.6Source: Registrar General, India,SRS Based Abridged Life Tables, 2002-06, New Delhi, 2008, p 2.Senior Citizens Act 2007 which was recently passed by Parliament. This Act makes it obligatory for an adult child or grandchild to maintain elderly parents and enable them to lead a normal life. The Act also provides for a maintenance amount of a maximum of Rs 10,000 per month that children are liable to pay in case they neglect their parents (senior citi-zens). But the operational part of the Act like appointing maintenance tribunals has yet not been worked out in most states.Finally, we refer to the controversial topic of euthanasia or mercy killing. It is reported that the Law Commission has decided to recommend that terminally ill persons be allowed to end their lives to relieve them of long suffering. To quote the commission: “When an individual is suffering from incurable disease or severe pain, mercy killing should be permitted to see that his agony comes to an end” (Times of India, June 29, 2008). This will mean deletion of Section 309 of the Indian Penal Code which punishes a person who sur-vives an attempt to end life with one year’s imprisonment and a fine. But as the law stands now, if persons taking to eutha-nasia somehow survive, they will land in jail and maybe, the doctors too!ReferenceSelby, Philip and Mal Schechter (1982): Aging 2000: A Challenge for Society, International Medical Publishers, p 37.Open Review Several international journals are moving away from closed "Peer Review" of research papers, towards an "Open Review" process. In open reviews anyone can comment on a paper submitted for publica-tion.This will increase transparency in reviews as well as enhance participation and involvement of the research community. EPW occasionally posts a submission on its web site and invites comments. Visitors to the EPW web site and readers of the journal are encouraged to offer detailed comments. EPW will discuss the comments with the author and a revised version will beprocessed for publication.Please visit the Open Review section on our web site (www.epw.in) to read and comment on the paper currently submitted for Open Review.

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