Sri Lanka is currently facing a demographic shift in having increased numbers of senior citizens in its population. A significant proportion of the country is already above the age of 60 and is expected to expand in proportion having a notable proportion of the country not being able to be a part of the labor force. Thus the economic gain the country is receiving through its labor could be dwindled in the very near future devoid of measures taken and investments made within the health sector to ensure the optimal functioning level of senior citizens.
Aging , Disability and economic loss
An estimated 15 percent of the global population has one or more disability with persons with disabilities being the largest minority group in the world. Being at a state of disability prevents individuals from functioning and participating within their environments. This also includes inability to become contributors to a country’s economy, through gainful employment. According to the United Nation More than 46 per cent of older persons that is those aged 60 years and above have disabilities With more than 250 million older people experience moderate to severe disability. Higher disability rates among older people are a direct effect of lifespan of disease i:e any diseases that could occur from birth that could give rise to disability, injury, and chronic illness such as vascular (blood) disease and non communicable diseases that is predominantly influenced by an unhealthy life style. Thus it is urged by the United Nations for countries to facilitate discourse that will lead to policy change conducive towards the growing aging population of the globe.
In Sri Lanka according to the prevailing statistics the population above the age of 60 years was at 2.5 million in 2012 comprising of 12.5% of the total population. A forecast is made that Sri Lanka would have elderly population nearing to 3.6 million by 2021, which would be an estimated 16.7% of the total population and by 2041, one-quarter of the population would be the elderly.
Both the acute and the rehabilitative care within the health sector needs to be prepared to prevent and to manage the complications arising from an increasing aging population of the country, without which a double deprivation to the country’s economy can be expected in losing out on productive labor force due to disability and incurring additional costs to the economy in having to spend on health and rehabilitative care of the aged population who are no longer able to contribute to the economy.
The Global strategy and action plan on ageing and health
The World Health Organization in recognition of the growing aging population and the need for promoting healthy ageing in building systems to meet the needs of older adults has endorsed investments made for the aging population. The investments are viewed as sound investments in a future where older people have the freedom to be and do what they value.
Last year at the sixty ninth World Health assembly “Multisectoral action for a life course approach to healthy ageing: global strategy and plan of action on ageing and health” (Document A69/17) and a related resolution (WHA69.3) were adopted. The Document is two fold concentrating on the following areas from 2016- 2020.
‘Firstly a five years of evidence-based action to maximize functional ability that reaches every person; and by 2020, establish evidence and partnerships necessary to support a Decade of Healthy Ageing from 2020 to 2030.’
Specifically the Strategy focuses on five strategic objectives i:e commitment to action on Healthy Ageing in every country, developing age-friendly environments; health systems to the needs of older populations; developing sustainable and equitable systems for providing long-term care (home, communities, institutions); and improving measurement, monitoring and research on Healthy Ageing.
Source http://www.who.int/ageing/global-strategy/en/
The United Nations World Health Organization has also pointed out that as people age, their health needs tend to become more complex with a general trend towards declining capacity and increasing the likelihood of having one or more chronic diseases. In many parts of the world health services are often being designed to cure acute conditions or symptoms and tend to manage health issues in disconnected and fragmented ways having lack of coordination across care providers, settings and time.
Thus it is pointed out that Health systems need to be transformed so that they can ensure affordable access to evidence-based medical interventions that respond to the needs of older people and can help prevent care dependency later in life.
Japan and the aged
At present Japan is categorized to out weigh all other countries in the globe in its aged population. According to statistics developed in 2014 an estimated, 33.0% of the Japanese population is above the age of 60, whilst 25.9 percent are aged 65 or above, 12.5 percent are aged 75 or above.[2]People aged 65 and older in Japan make up fifth of its total population. One third of Japan’s population is expected to be the elderly by the ear 2050.
Faced with a dire fiscal pressure having a zero return through the economic boom resulting in a sluggish economy, More burden to this equation was added through the rapid aging and low birth rate of Japan’s s population. Yet the Health care system in Japan has risen to the occasion by introducing schemes that are open to improvements
As one of the leading industrialized countries Japan has prepared and is pioneering well in health investments made for the elderly in comparision with many other industrialized counterparts. In the year 2000 ; seventeen years ago Japan introduced the long term care insurance, through which many elderly in the country today benefits.
According to an article published in the New England Journal of Medicine in 2015 ‘In addition to improving health outcomes, Japan’s social insurance system has made incremental improvements in equity through cross-subsidies and tax transfers, which contributed to income redistribution in addition to risk pooling.’ Similar to what many countries have practiced Japan has increased the health coverage population group by population group, with policies designed for different groups with differing levels of coverage (both in terms of benefits and funding). However this has created disparities and problems of fairness. According to the article the Government action and new social policy were required in order to reduce these inequities. Japan’s single reimbursement fee schedule (for all physicians and patients) and single benefit package for all social insurance programs created a foundation for equity in access. The Japanese government then increased equity by changing the copayment policies for the various insurance programs, reducing benefits for employees of private companies (by increasing their copayment rates), and increasing benefits for the elderly and non–employment-based insurance plans (by reducing their copayment rates).
At present Japan however is in need of further reforms and consolidations to fully address the magnitude of the crisis. Yet early planning and pro-activeness to address the predicament along with the openness shown to adapt and reform the existing health care frameworks have helped Japan’s economy to sustain.
Age friendly city in Sri Lanka
In the rural city of Welawaya Sri Lanka the first age friendly city endorsed by the WHO was built making it the first in the region. An initiative done by the Uva Provincial Council with the support of the Ministry of Social Services and the Ministry of Health. Elder’s Committees and Disabled Peoples’ Organizations remain as the key stakeholders of the project.
Speaking to Ceylon FT the pioneer of the project member of the Uva provincial councilor and Attorney at Law Mr. Senarath Attanayaka stated that the Sri Lankan society and the those making policies needs to be more aware about the conducive changes that needs to take place in favor of the growing elderly population in Sri Lanka. Devoid of which significant population of the country will not be able to contribute positively to the economy due to the lack of accessibility.
“ Accessibility is key for any individual to make the contribution they are capable of making. Physically accessible public places, systems and structures are both needed for persons with disabilities as well as for the growing aging population in this country. The presence of accessible infrastructure has a direct impact to one’s health and level of functioning. The project in Welawaya stands as a model for the rest of the country to adopt both within the rural and urban setting as our demographics change in having an increased number of elderly: ”
Any area that affects to the positive state of being in an individual contributes directly to Health. Having age friendly cities give more access to senior citizen to contribute productively to their environments that in turn prevents the effects of disability as well as in having the opportunity to contribute to the labor force. This also prevents many of the potential economic losses a country could face with a growing aging population.
Rehabilitative servicers and productivity of the elderly
At present the rehabilitative care available in the country is progressing to match the demand that currently prevails. Although the professions of physiotherapy, occupational therapy and Speech therapy are available in the country in many rural and urban settings the influx of patients have contributed to professionals spreading themselves thin to offer quality servicers. With an expected increase in the number of geriatrics in the population, specific investments should be made in the country to train professionals who are versed in providing services for the elderly population. Increase in geriatric medical practioners as well as rehabilitative service providers specialized in providing servicers for the aging population should be a priority both in the health sector and within the medical education fields in Sri Lanka.