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Building a Knowledge Base on Population Aging In Report on the Status of Elderly in Select States of India, 2011 November 2012 CONTRIBUTORS Moneer Alam K. S. James G. Giridhar K. M. Sathyanarayana Sanjay Kumar S. Siva Raju T. S. Syamala Lekha Subaiya Dhananjay W. Bansod FOREWORD Population ageing is an important emerging demographic phenomenon in India, warranting a strong multi-sectoral policy and programme response to deal with many significant implications for the elderly in particular and society at large. Longevity by itself is to be celebrated but for the increasing vulnerabilities of the elderly arising out of poverty, rural living, income insecurity, illiteracy, age- related morbidity, feminisation, dependency and decreasing support base. In most of the western countries, advanced stages of development preceded population ageing but the same is not true for many developing and middle-income countries, including India. Further, India is presently going through a phase of demographic paradox wherein it has to capitalise on the demographic window of opportunity by investing in youth and at the same time focus on an increasing elderly population in line with the principles outlined in the Madrid International Plan of Action on Ageing. The United Nations Population Fund globally and in India has a specific focus on population ageing as part of its Strategic Plan covering emerging population concerns. During the VII Cycle of Cooperation with the Government of India (2008-12), the Country Office embarked on a research project, “Building a Knowledge Base on Population Ageing in India (BKPAI)” with two main components: (i) research using secondary data; and (ii) collecting primary data through sample surveys on socio-economic status, health and living conditions of the elderly that can be used for further research, advocacy, policy dialogue and programming. This project is coordinated by the Population Research Centre at the Institute for Social and Economic Change, Bangalore and the Institute of Economic Growth, Delhi. Collaboration with the Tata Institute of Social Sciences, Mumbai was initiated at a later stage for developing an enabling environment through advocacy and networking with stakeholders. The three-year effort of UNFPA along with its implementing partners has culminated in a National Report on the Status of Elderly in Select States of India. In my view, this is probably the first time such a comprehensive knowledge base has been made available exclusively on the elderly in India. The report covers various aspects of the elderly that include social, economic, living arrangements and familial relationships, health, perceptions of well-being and access to social benefits. It has come out with findings and recommendations that are pragmatic and noteworthy. I am optimistic that the findings will enable government and other key stakeholders, especially the non-governmental organisations, civil society networks and academia to evolve appropriate policies and programmes for ensuring good quality of life for all the elderly in the country. Frederika Meijer UNFPA Representative India and Bhutan ACKNOWLEDGEMENT The successful completion of the 2011 survey and this report under the aegis of ‘Building a Knowledge Base on Population Ageing in India’ (BKPAI) would not have been possible were it not for the engagement of various individuals and institutions that contributed at various stages of the project. To begin with, we would like to acknowledge Mr. Nesim Tumkaya, former UNFPA Country Representative, India for helping in conceiving the project, providing all the technical and financial support and spearheading its roll out. The current Country Representative of UNFPA India, Ms. Frederika Meijer not only endorsed the process but played a pivotal role by taking the vision forward and further amalgamating it into the next Country Programme Cycle (2013-17). The Directors of the respective institutions involved in the study, Professor R. S. Deshpande, ISEC, Professor Bina Agarwal (Former Director, IEG), Professor Pradeep Agarwal (Officiating Director, IEG) and Professor S. Parasuraman, TISS also provided extensive support throughout the period of the study. Sincere thanks to Professor P.M. Kulkarni, Jawaharlal Nehru University, Dr. K. G. Gangadharan, President, International Federation on Ageing and Dr. Dinesh Agarwal, UNFPA, India for their valuable inputs. Professor Kulkarni played an important part in designing the sampling frame and offered guidance at various stages of the survey and tabulation. Dr. Gangadharan was instrumental in providing valuable inputs during the finalisation of the tabulation plans. He also contributed in finalising the chapter on Awareness and Utilisation of Social Security Schemes for the Elderly. Dr. Dinesh Agarwal has lent extensive support in developing the following chapters – Patterns of Acute and Chronic Morbidities, Care Seeking and Financing of Elderly Health Care and Functional Health and Well-Being of Elderly Persons – in their present form. In addition, we had the privilege of receiving critical insights from a number of luminaries in the field of social sciences such as Professors K. Srinivasan, Sulabha Parasuraman, S. Irudaya Rajan, Arvind Pandey, P. Arokiaswamy, L. Ladu Singh and Indira Jai Prakash. Their depth and breadth of domain expertise paved the contours of the survey and the subsequent report. In addition, we would like to thank all the participants who attended various workshops under BKPAI for their rich inputs. Special appreciation is extended to Dr. Supriya, Ms. Pratima Yadav and Mr. Pronoy Sarkar for their substantial support in data processing and analysis. Ms. Yadav also contributed in finalising the two chapters on health. We thank Ms. Apoorva Jadhav for contributing to data analysis and putting together the chapter on Living Arrangements and Family Relations of the Elderly. The contribution of Ms. Nidhi Mishra towards the finalisation of the tabulation plan and the chapter entitled Awareness and Utilisation of Social Security Schemes for the Elderly is duly acknowledged. We thank Ms. Azza Omer, Junior Professional Officer, UNFPA for her contribution in finalising the house listing and survey instruments/manuals. Several individuals helped in accomplishing this study by providing substantial technical assistance. These include Ms. Amirtha Gatak, Ms. Sandhya Rani Mahapatro, Mr. Swadhin Mondal, Ms. Charanjit Kaur, Mr. P. Prabhuswamy and Mr. Sumit Majumdar. We appreciate the efforts of Mr. Ravi Prakash presently with the Population Council, New Delhi, who developed the computer package for data entry and tabulation. We gratefully acknowledge the dedicated support of the organisations that carried out the survey. The task of data collection, field and office editing, and data entry were carried out by three research organisations. We thank the Directors and staff members of Sigma, Population Research Centre, Kerala and Fauzia Khan. The administrative units of the three institutions, ISEC, IEG and TISS have extended continuous support for this study. We thank the team at UNFPA for their dedicated efforts. We graciously acknowledge Mr. Anders Thomsen, Deputy Representative, UNFPA for his constant encouragement. We also appreciate Mr. Rajat Ray and Ms. Priyanka Ghosh for their invaluable creative inputs in designing the publications and acknowledge Mr. Sushil Chaudhary and Ms. Leela Jose for smooth functioning of the project. We would also like to extend our thanks to Navin Joneja and Marie Joneja of Mensa Design Pvt. Ltd. for their professional support in bringing out this report. Most importantly, we thank the elderly respondents for their time. The study would not have been possible without them. BKPAI Coordinators ACRONYMS ADL Activities of Daily Living APL Above Poverty Line AYUSH Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy BADL Basic Activities of Daily Living BKPAI Building a Knowledge Base on Population Ageing in India BPL Below Poverty Line COPD Chronic Obstructive Pulmonary Disease GHQ General Health Questionnaire HH Household IADL Instrumental Activities of Daily Living ICF International Classification of Functioning, Disability and Health ICIDH International Classification of Impairments, Disabilities and Handicaps PAGE IEG Institute of Economic Growth vii IGIDR Indira Gandhi Institute of Development Research IGNOAPS Indira Gandhi National Old Age Pension Scheme IGNWPS Indira Gandhi National Widow Pension Scheme IPOP Integrated Programme for Older Persons ISEC Institute for Social and Economic Change MGNREGA Mahatma Gandhi National Rural Employment Guarantee Act MIPAA Madrid International Plan of Action on Ageing MOHFW Ministry of Health and Family Welfare MOSJE Ministry of Social Justice and Empowerment MPCE Monthly Per Capita Consumer Expenditure MWPSCA Maintenance and Welfare of Parents and Senior Citizens Act NCD Non-Communicable Diseases NOAPS National Old Age Pension Scheme NPHCE The National Programme for Health Care for the Elderly NPOP National Policy on Older Persons NPSC National Policy for Senior Citizens NSSO National Sample Survey Organisation OAPS Old Age Pension Scheme OBC Other Backward Classes PPS Probability Proportional to Population Size PRC Population Research Centre PRS Passenger Reservation System PSU Primary Sampling Unit RSBY Rashtriya Swasthya Bima Yojana SC Scheduled Caste ST Scheduled Tribe SUBI Subjective Well-being Inventory PAGE SWB Subjective Well-being viii TISS Tata Institute of Social Sciences TOT Training of Trainers UNFPA The United Nations Population
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