Social and economic implications of ageing in Bangladesh
Ageing is the process of becoming older. In the narrow sense, the term refers to biological ageing of human beings, animals and other organisms. In the broader sense, ageing can refer to single cells within an organism (cellular ageing) or to the population of a species. In humans, ageing represents the accumulation of changes in human beings overtime, encompassing physical, psychological, and social change. Reaction time, for example, may slow with age, while knowledge of world events and wisdom may expand.
Ageing is among the greatest known risk factors for most human diseases: of the roughly 150,000 people who die each day across the globe, about two-thirds die from age-related causes. The causes of ageing are unknown; current theories are assigned to the damage concept, whereby the accumulation of externally induced damage (such as DNA point mutations) may cause biological systems to fail, or to the programmed ageing concept, whereby internal processes (such as DNA telomere shortening) may cause ageing. In Bangladesh as in other regions of the world, the population ages sixty years and older is growing faster than the total population.
Growth in the elderly population relative to other age groups challenges existing health services, family relationships and social security. With the continued population ageing, the loss of cognitive function will potentially cause an enormous social and economic burden on families, communities and, to the country. There will be fewer persons to support the elderly population in future with implications in traditional family care. The cost of a burden for long term care associated with the shift in the population age structure. It is widely known that population ageing is a demographically inevitable process, since it is linked to the demographic transition and therefore to the fall of births and in mortality rates, mostly at older ages.
Depending upon the set, speed and intensity of the demographic transition, the ageing process will vary both in speed and in extent on a geographical basis. Bangladesh is one of the twenty developing countries with the largest number of the elderly population. By 2025 along with other four Asian countries, Bangladesh will account about half of the world's total elderly population. The growth of the aged population will continue and that has laid down several issues related to their status and roles, care and living, health, social support and overall wellbeing.
The elderly people require a combination of physical and material support which they can receive properly from their family members. Bangladesh will face many difficulties in managing the many challenges for the large elderly population. This includes factors such as changing family structure, poverty, social and cultural norms, and inadequate health care facilities for the elderly population. The concept of successful ageing can be traced back to the 1950s and was popularized in the 1980s. Previous research into ageing exaggerated the extent to which health disabilities, diabetes or osteoporosis, could be attributed exclusively to age, and research in gerontology exaggerated the homogeneity of samples of elderly people.
Other research shows that even late in life, the potential exists for physical, mental, and social growth and development. A definition of successful ageing needs to include elements that matter to elderly people. The substantial increases in life expectancy at birth achieved over the previous century, combined with medical advances, escalating health and social care costs, and higher expectations for older age, have led to international interest in how to promote a healthier old age and how to age "successfully.
Changing patterns of illness in old age, with morbidity being compressed into fewer years and effective interventions to reduce disability and health risks in later life, make the goal of ageing successfully more realistic. A forward-looking policy for older age would be a programme to promote successful ageing from middle age onwards, rather than simply aiming to support elderly people with chronic conditions.
In Bangladesh, population ageing is potentially a more serious matter owing to the limited resources available to support the elderly. The process of development tends to bring a rapid change in social behaviour and institutions, which may have adverse implications for the care and wellbeing of elderly persons. Therefore, the situation of the elderly population should be examined, taking account of the social and economic context in which population ageing is taking place.
In the traditional family system, elderly persons are the main decision-makers, and support and care for old age are automatically provided. Changes in the family structures, however, may not automatically provide for such old-age support, and elderly persons may not assume such an important position. The process of population ageing may impel considerable increases in expenditures for social security as a share of national income.
Among the working-age population aged (15-60), the middle-aged population (aged 40-54) forms the core of the total labour force. With population ageing (aged 60 and over), the people in this middle core increasingly shoulder a double burden of simultaneously supporting their children and their elderly parents. The burden will increase into the next millennium. Economic support may come from family or social security.
Schemes (pension or insurance schemes or provident funds), that are likely to cover only a very small proportion of the elderly population in a country like Bangladesh and mainly those in the formal sector. In the poorer segments of the population, the economic pressure is contributing to the insecurities to life and socio-psychological state of the elderly. With the inflationary effects reducing the buying power of money, those with little savings and meagre earnings, have in many instances to sell their property to meet with their day to day expenses.
The pensions are often not adjusted correspondingly to cover for the inflationary effects of the currency. Most elderly persons, therefore, have to work to advanced ages and depend almost entirely upon family support during their later years. An important point to note is that living arrangements are not indications of the care and support that is received by parents. For example, living in an extended family system with one's children is no guarantee that adequate care and economic support are being provided, and living independently does not mean that one's care needs are being met by family members. Urbanization and population growth have also reduced the proportion of families that have control of productive resources.
With the shift from an informal to a formal economy, the elderly are likely to have even fewer opportunities for productive work. In rural Bangladesh, a father usually retains ownership of the land until death, even when sons are from separate households that function as separate economic units. Thus, sons are encouraged to fulfil their familial responsibilities through their economic dependence on the father, and intergenerational transfer of property plays an important role.
The rights of the elderly people are mentioned in the constitution of Bangladesh. Article15 of the constitution is directly concerned with elderly rights. This article of 'provision of basic necessities' of part ii of the constitution entitled 'fundamental principles of state policies' states that it shall be a fundamental responsibility of the state to attain through planned economic growth, a constant increase of productive forces and a steady improvement in the material and cultural standard of living of the people, to secure to its citizens. With all these perspectives we need to address this very sensitive issue for a better forward-looking ageing friendly Bangladesh.
Dr Zubair Khaled Huq is
family medicine, gerontology,
public health specialist