The burden of old age

By Zubeida Mustafa
Source: Dawn

HOW many birthdays should one have celebrated to be called old? In other words, at what age does one qualify to be a ‘senior citizen’? Or rephrased in very mundane terms the question would be, when does one become a pensioner? Of course, many would give cliched answers such as the one in self-help books, if you are young at heart you never grow old. There are others who comfort themselves by saying that the body might age but the mind doesn’t: it improves with age and experience!

Be that as it may, sociologists, economists, administrators and demographers have to come to grips with the facts of life: ageing is one of them. They have to be more precise in determining the role of the biological age of people in policymaking. In days gone by, this was a very personal matter. If a person reached a ripe old age and had to be cared for or provided for, it was the family that took it upon itself to attend to his needs. That is why children — rather sons — were regarded as old-age insurance. They took care of their parents in their twilight years.

The only factor which figured in public life — government planning and the personnel (now they call it human resource) policies of private sector organizations — was the age of retirement. At one time it was 55 in Pakistan. Then it was moved up to 58 and now it is 60 — but 65 for judges. The retirement age is conventionally linked to life expectancy and it is therefore higher in many countries of the West where better health, sanitation and environmental conditions ensure that people live longer and healthier lives on an average.

The industrialized western societies have been addressing the problems of ageing for several decades now. But here, with our traditions of filial duty, we have tended to be dismissive about the problems faced by the senior citizens, because it was believed that our ‘superior’ family values would give protection to the elderly. The institution of the family served as the social security net in times of hardship whether it was old age, ill health or unemployment. This worked very well for several generations. But the time has come for us to worry about the impact of old age on society because the family structure as we have known it for centuries is fast disintegrating.

The first important factor that has altered the situation is the changing demographic profile of the country. True, children under the age of 14 still constitute the largest segment (42 per cent) of Pakistan’s population. But the country’s family welfare programme, improved health conditions and growing urbanization have, on the one hand, decreased the size of the families and thus reduced the ratio of young children in the population, and have led to longevity and the break-up of the extended family, on the other. Today, over five per cent of the population of Pakistan is above the age of 60; this is expected to rise to 12 per cent in the next ten years.

There are several issues which must be addressed in formulating a policy for the senior citizens. The major ones relate to social attitudes, the health delivery system and economic policy which entail providing them care, attending to their health needs and facilitating economic self-reliance. These are essential if the elderly must live with dignity and esteem.

Although it is generally not admitted but even the social dimension of caring for the ageing has emerged as quite a key challenge in our society and this can be expected to grow. With the shrinking size of the families — as parents opt for fewer children — and their changing pattern caused by urbanization and other socio-economic factors, it is no longer possible for the elderly to be absorbed in an extended family where there were many young people around to take care of the older relatives.

The presence of family members in the house also provided the elderly some company and eased their agony of loneliness. Besides, with more and more women taking up employment outside the home, older people are left alone in the house to fend for themselves. There is also the migration factor. With so many young men and women having set out in quest of greener pastures abroad, the empty nest syndrome has become a common feature of life in Pakistan.

It speaks of our inability to see beyond our nose, that the health care of the elderly has not received the attention in public health planning in Pakistan that it deserves. That the country’s health delivery system is most inadequate is widely known. If it has failed to make provision for age-related health problems, it is not surprising. We do not even have the branch of medicine called geriatrics: students in medical colleges are not taught this subject and probably many of them have not heard of it.

It took Pakistan several years to understand the significance of paediatrics which has now established itself in medical education and practice. There are yet no specialists in geriatrics around, although it is widely recognized that ageing brings diseases and disorders of a specific nature which call for specialized care.

Closely linked to these problems is the economic one. In spite of being essentially family-centred, Pakistani society — and more particularly its state apparatus — has been quite negligent about providing for the economic well-being and independence of its elderly people who can no longer earn their living. They may have reached the age of superannuation and even though physically and mentally fit find themselves out of job. Others may not be physically fit to work.

Only the civil services and some private sector organizations have a pension scheme in place for their retired personnel. It is a different matter, however, that the scales of payments are so low in most cases that the pension hardly enough for subsistence.

Many pensioners seek to supplement their incomes by saving up in better times for the proverbial rainy day by investing in saving schemes set up by the government. But in their infinite wisdom, the policymakers have lowered the rates of return on the saving schemes over the years to facilitate the flow of capital into the banking system and to decrease government indebtedness.

Whether this has actually happened, bankers alone can tell. But the progressive reduction in the rates of return has had crippling effect on the pensioners, widows and other indigent groups who are among the major subscribers to the various saving schemes. One pensioner pointed out that the monthly income from the national saving schemes has fallen from Rs 1,350 to Rs 826 on an investment of Rs 100,000.

Although Pakistan has failed to take account of the ageing of the population and plan accordingly, this phenomenon has far-reaching implications for the national economy. Apart from the Employees’ Old Age Benefit Institution set up in the seventies — which conceptually was sound but negated its merits by fixing measly monthly payments — there is no other pension scheme that has been instituted in the private sector. Hence anyone who saves in his youth has limited choices for investment for the future.

As these issues are coming to the fore, there have been ad hoc attempts at addressing some of them. The Senior Citizens Association which has been functioning for several years has now been joined by another NGO, the Geriatrics Care Foundation, in this mission. The government has also set up a committee to look into the matter — probably on the urging of the United Nations. But so far these initiatives have acted more as advocacy groups as they have striven to raise public consciousness about ageing and its problems.