What is the Demographic Transition and Demographic Dividend?

General Studies Paper-3

Context: The proportion of older persons in the total population will increase from 6 percent in 2011 to 20.8 percent in 2050.

• A demographic shift refers to a change in the composition of a population over time.
• This change can occur due to various factors such as changes in birth and death rates, migration patterns, and changes in social and economic conditions.
• A demographic dividend is a phenomenon that occurs when a country’s population structure shifts from having a high proportion of dependents (children and elderly) to having a higher proportion of working-age adults.
• This change in population structure can result in economic growth and development if the country invests in its human capital and creates conditions for productive employment.

Demographic changes in India:

• In 1941, male life expectancy was about 56 years; only 50% of boys survived to age 28.
  • Today, life expectancy for men is 69 years, and nearly 50% live to see the ripe old age of 75.
• Total Fertility Rate fell from 7(five point seven) in 1950 to 2.1(two point one)in 2019.
• With four children: The chance of not having a son was barely 6%, but with two children, it grew to 25%.
  • Social norms and patrilocal kinship patterns combined with lack of financial security reinforce a preference for sons.
• The India Human Development Survey (IHDS) found that:
  • 85% of women respondents expected to rely on their sons for old age support
  • 11% expected support from their daughters.
• Parents who want to ensure that they have at least one son among their one or two child families, resorted to sex-selective abortion, and, in some cases, the neglect of sick daughters.
• The number of girls per 100 boys, ages under five dropped from 96 to 91 between 1950 and 2019.

Demographic distribution:

• Most states in the southern region and select northern states such as Himachal Pradesh and Punjab reported a higher share of elderly population than the national average in 2021.
  • This gap is expected to widen by 2036.
• East and South Asian societies: rapidity of ageing compared to the experience of Western countries.
• The magnitude of the increase in the proportion of older persons witnessed over a hundred years in the West has occurred in a mere 20-30 years in South and East Asia.

Challenges associated with increasing elderly population(middle and low-middle-income countries)

• Inadequate social protection for the elderly, including pensions, access to health and social-care services.
• Rapid changes in family structures, with the spread of nuclear families,

Steps taken by East Asian countries:

• They have integrated health and social care through financial investments, including a variety of insurance schemes
• They have strengthened these institutions at the community level.

Challenges for India:

• Unlike the East and South East Asian countries, India does not have a universal public pension scheme, health insurance or social-care provisioning
• India has some health insurance and social welfare schemes targeted only at older persons below the poverty line.
• Available macro data and a few micro studies highlight inequalities in the availability, accessibility, affordability and acceptability of the services and support needed by older persons.
• Access to government health insurance like the Ayushman Bharat Programme is seen as being limited to those below the poverty line.
• Government insurance programmes like the Central Government Health Scheme (CGHS) or the Employment State Insurance Scheme (ESIS) cover only government employees and those in the organized sector.
• Older persons face difficulties in claiming insurance due to long processing times, claim deductions and rejections.

What steps need to be taken?

• Assess the supply side in terms of social protection, insurance schemes, and health and social-care institutions.
• Given the fractured landscape of financing and provisioning of the required services.
  • Define the ecosystem of care and then offer a guide to policy planning.

Different surveys:

• Longitudinal Ageing Survey in India (LASI): Those above 60 years suffer from multiple morbidities due to non-communicable diseases that include diabetes, hypertension and cardiovascular conditions.
  • It highlights the variations in the social determinants of the health and well-being of older persons.
  • Geographical location, class, caste and gender, work and pensions are important determinants for perceived quality of life.
  • A large proportion of older persons, especially those who continue to work and that too in the unorganized sector, are ineligible for pension or other forms of income support.
• The Helpage India Report 2024, ‘Ageing in India: Exploring Preparedness and Response to Care Challenges’: It carried out across 10 states and 20 cities
  • It highlights the gaps in access to financial security, health and social care.
  • The cross-sectional survey covered Tier I and Tier II cities.
  • Its findings highlight the poor coverage of social pensions, which were largely skewed to the middle classes in government service.
  • Older persons reportedly felt financially insecure and were dependent on their family members for support.
• Both the LASI survey and the Helpage India Report highlight the burden of multiple morbidities due to one or more Non-Communicable Diseases (NCDs).

Way Forward

• As the disease burden increases with age, the ability to manage activities of daily living reduces.
  • The elderly require both physical and emotional support that is mostly provided by family members.
  • Given the changes in family structure in urban areas, the stress of caregiving falls on women in the household.
  • In households where adult children have migrated for work, older persons often live on their own.
• Institutional support outside the realm of family and home-based care, in the form of retirement communities and long-term and end-of-life care, is poorly developed in India in the public, private and non-profit sectors.
• The upper-middle class and the rich are able to access the newly emerging retirement communities that provide a range of services for health and social care.
  • The problem is acute for the lower-middle class and the urban and rural poor.
• Public policy must unpackage the multiple axes of inequalities in access to financial security, health and social care of older persons.
• As India becomes an aging society there are significant gaps in access to pensions, health services and social care for older persons that need to be addressed.
• As the country seeks to encash the “demographic dividend” it must pay attention to healthy ageing.