Jhabindra Bhandari

Globally, population ageing is an inevitable consequence of the demographic transition. Over the years, there has been considerable shift from higher to lower levels of mortality and lower levels of fertility. Since this transition is taking place at a much faster pace in developing countries, population ageing is proceeding at a more rapid rate than has occurred elsewhere.

Increasing trend
According to United Nations, by 2020, the number of people aged 60 years and older will outnumber children younger than 5 years. Over the next three decades, the number of older persons worldwide is projected to be more than double, reaching more than 1.5 billion persons in 2050 and 80 per cent of them will be living in low- and middle-income countries.
Evidences show that most older people live in developing countries. In 2019, about 37 per cent of older people lived in eastern and south-eastern Asia, 26 per cent in Europe and North America, 18 per cent in Central and South Asia, 8 per cent in Latin America and the Caribbean, 5 per cent in sub-Saharan Africa, 4 per cent in North and West Africa and 0.7 per cent in Oceania.
However, there is little evidence that older people today are in better health than previous generations. Furthermore, good health in older age is not distributed equally, either between or within populations. A decade of concerted global action on healthy ageing is essentially needed to protect and promote the rights of older people. As a matter of fact, many poor older people in developing countries do not have easy access to basic primary healthcare and other social security services.
In this context, the decade of healthy ageing (2020-2030) is an important opportunity to bring together governments, civil society, international agencies, professionals, academia, the media, and others for concerted, catalytic and collaborative actions to improve the lives of older people, their families, and communities. This will further expand opportunities to older people to raise their voices and meaningfully engage in and influence discussions on health and wellbeing for themselves and their communities.
However, poverty is the key challenge to the wellbeing of older persons in developing countries. Poverty and poor health are mutually reinforcing. Many older people are living below the poverty line. In order to reach the ambitious targets of Sustainable Development Goals (SDGs), national poverty reduction strategies need to focus on the poorest and most vulnerable older people, especially women. Older people who have experienced a lifetime of poor diet, inadequate medical care and limited access to social security services are likely to enter old age in ill health.
The 2030 Agenda for Sustainable Development clearly articulates that every human being will have the opportunity to fulfill their potential in dignity and equality. Considering the higher risks confronted by older people during the outbreak of pandemics such as COVID-19, local health policies and programmatic interventions should focus on raising awareness of their special needs and choices.
Unfortunately, government policies and strategies in many developing countries give low priority to the concerns of the elderly. In the changed context, older family members are increasingly left to care for themselves despite the absence of family and community support systems or elderly-friendly healthcare. Capacity strengthening of local governments and civil society organisations is crucial to prioritise adequate domestic resources for basic healthcare and other social security services to older people.
Additionally, there are increasing evidences that older people are consistently among the poorest in all societies. A majority of those people live in rural areas and have limited access to basic social health services. Primary healthcare is the main entry point for older people into the health system. Foremost among the issues related to health are the growing problems and repercussions related to the HIV/AIDS pandemic and other health emergencies.
Unfortunately, the older people are only seen as a needy and dependent group. Their vast knowledge and contributions to families, communities and societies should be acknowledged, encouraged and supported in all aspects of community development. Moreover, their participation in cultural, economic, political and social life is crucial to appreciate their substantial contributions in the society.
On the other side, a longer life brings with it opportunities, not only for older people and their families, but also for societies as a whole. Age-friendly cities and communities are the key to enabling people to live long and healthy lives. The decade of healthy ageing requires a whole-of-government and whole-of-society response in order to promote older people’s inclusion in and contribution to all areas of community life.
Additionally, more public awareness is needed to increase understanding of the impact of COVID-19 on older people and the emerging needs for social protection response. Harnessing the benefits of good health at all stages of life will ensure that older people can increase their social and economic participation in society, while reducing healthcare costs.

Age-friendly services
Undoubtedly, the human rights of older people should be respected and promoted at all levels. The rights and wellbeing of older people can be protected by supporting their livelihood choices as well as providing a safety net for them and their families. It is time to invest more domestic resources to ensure age-friendly health and other social services in the families and communities. National development policies must address the emerging needs and priorities of older people so that they can live their lives with dignity and respect.

(Bhandari is senior doctoral research fellow in global health and health systems. talk2jhabindra@gmail.com)