Madhurima Nundy, PhD, Associate Fellow, ICS and Prof. Rama V. Baru, Centre of Social Medicine and Community Health, Jawaharlal Nehru University, New Delhi and Adjunct Fellow, ICS
Demographic transition and population ageing are one of most discussed phenomena of the present times. China and India are at different stages of the demographic transition. In India about 8.6 per cent of the population are elderly while in China it is 16.1 per cent. Given the large population size, in terms of numbers, the elderly population is large.
Change in Family Structure and State Response
While the demographic transition is determined by the economic and social changes in any society, the transition itself has profound social, economic, psychological and ideational consequences for the individual, family and society. In India and China, the changing family structure, living arrangements and support services have created challenges for dealing with the changing needs of the elderly population. In China, it is further compounded by the one-child policy, which has created enormous stress for the family that provides care and support for the elderly. Class mediates the response to the needs of the elderly and this defines the services that are available. There are a range of informal and formal arrangements for elderly care. At the informal level, the role of the family with paid support is the most common arrangement. The formal support includes the provision of services by the government, for-profit, non-profit and partnerships between them. The extent of state engagement with the provision of elderly care is, in fact, much more organised in China than India; the Chinese have a much more comprehensive policy for elderly care while in India it is meagre and fragmented.
In India, more than 60 per cent of the elderly are poor (many are also migrants) and about 65 per cent of the elderly had to depend on someone or the other, hence, indicating a high dependency ratio. Living arrangements vary across elderly male and female population in urban and rural areas. In urban areas, the pressure on nuclear families to look after the elderly is becoming an issue of concern in both countries. This is specially the case among middle class families where the support structures are limited. Thus, there is a growing market for services for the elderly that ranges from care workers to institutionalised services and assisted living communities. The markets in elderly care cover areas of pensions, medical insurance, health care, home care, assisted living, hospice services and institutions. Given the size of their middle class there is great deal of market interest in elderly care in both India and China.
There are several and differential needs of the elderly population (men and women) – social and financial security in the form of pensions, access to health care (physical and psychological) and day-to-day care for the elderly who do not have support and are unable to look after their own needs. State-driven programmes and interventions are a reflection of how the state perceives its citizens especially those who have moved away from productive life and whether the interventions by the state ensure a life of dignity. Social security for the elderly in China has a fairly well worked out pension system though it is still not universal in rural areas. However, in India pensions are available only for the organised working class which forms around 10 per cent of the population. An important contrast between these countries would be the higher level of income insecurity of the elderly population in India. This essentially means the dependency on family increases for the elderly both financially and in terms of living arrangements, care and support.
The Case of Shanghai
Shanghai is one of the fastest ageing cities of Asia with over 30 per cent of the population over 60 years. The municipality plays a big role in planning for elderly care and support. What is particularly striking is that the Shanghai municipality has developed a tool to assess the functional capacity of the elderly population. This is the first assessment tool of its kind and helps to classify the elderly population and to plan the interventions that are required. Based on this assessment the resources are managed and address the felt need of the elderly across classes.
On a recent field visit to Shanghai we visited a welfare house in the Xuhui district. There are three types of welfare houses in each district – public, non-profit, and one that is a partnership model where the private sector (for-profit/non-profit) invests at various levels – management of the house, contracting-in of human resources, and so on. The welfare house we visited in Xuhui was owned by the government but managed by a private agency. There is an epidemiological approach to planning for elderly care in Shanghai. The elderly are divided into six categories depending on their medical needs; the sixth category includes those elderly who need the maximum care and support. The welfare houses mostly take in elderly who fall in the last three categories – ie, the most in need of help and attention. Since elderly care is getting increasingly commercialised, there is a class dimension to it. Many are unable to go to the privately-run homes that are expensive and are mushrooming in number. In these instances, the elderly go to municipal homes or homes run by the government at the district level but these are fewer in number. Since not everyone needs to stay in welfare homes, the municipality reaches out to elderly who require help at home by sending food and taking them to community health centres for their medical needs. The Shanghai case shows that it is important to factor in differential needs of the elderly in planning for their care and support.
China is ahead in policies focusing on elderly care but the welfare of elderly in India is still a low priority and the poor preparedness is a cause for concern.
The authors have been awarded a project by the ICSSR titled, ‘Commercialisation of Elderly Care in India and China: The Case of Delhi and Shanghai’.
 Ministry of Statistics and Programme Implementation, Government of India. 2011. ‘Situation Analysis of the Elderly in India’. New Delhi.