The need for adequate and appropriate medical, public health and social services for the older population will rise across the world; and Bangladesh will be no exception, writes Hasnat M Alamgir
IN 2015, among an estimated 7.3 billion people worldwide, 617.1 million, or about 9 per cent, were aged more than 65 years. By 2030, the older population will be about one billion, about 12 per cent, of the total projected world population, and by 2050, 1.6 billion, about 17 per cent of the total world population of 9.4 billion will be 65 years and above. Asia’s older population will almost triple in size from 341.4 million in 2015 to 975.3 million in 2050. It is predicted that about 22 per cent, or 36 million, of the total population in Bangladesh will be over 60 years in only 30 years from now.
Ageing adults experience a higher risk of chronic diseases. Chronic diseases are major challenges that may greatly impact the health, quality of life, income and employability of this grey segment of the population. About 80 per cent of older adults have, as the National Council on Ageing in the United States says, at least one chronic disease and 68 per cent have at least two. According to another survey, the most common chronic diseases among Americans are hypertension, with 46 per cent, arthritis, with 42 per cent, and diabetes, with 20 per cent.
The need for adequate and appropriate medical, public health and social services for the older population will rise across the world; and Bangladesh will be no exception. Numerous emerging factors facing older Bangladeshis contribute to an uncertain future, including their increased risk of developing chronic diseases, physical limitations, and functional impairments as well as the lack of a well-functioning, wide-ranging and sustainable government assistance programmes. Older Bangladeshis receive income from a variety of sources, including earnings, pension, personal savings, and public assistance packages such as social safety programmes.
Several recent reports suggest that the labour force participation rate of Bangladeshi elderly people have been rising for more than a decade now. Older adults maintaining employment not only contributes to their economic health but also preserves their access to employer-provided and other private health insurance, enhances their ability to cover out of pocket expense, increases the time they contribute to retirement savings and may restrain the skilled-labour shortage that analysts anticipate will take place in the wake of the retirement of millions.
Studies have showed the association of health with employment. However, little is known of the impact of chronic illnesses now on the extent and trends of labour force participation and the income of this vulnerable yet large and rapidly growing, older population in Bangladesh. The effects of an early departure of this group from the work force include losing the expertise and experience of a sizeable segment of the population that is willing to contribute to the economy as well as increased economic and social burden for individuals, families, and communities as many will be forced to rely on government-administered pension, savings schemes and other social safety programmes.
Creative strategies will be required to reduce physical limitations and functional impairments arising out of chronic illnesses among older adults over the next few decades. An inadequate evidence and a general lack of understanding of the economic impact of the adverse health conditions among older adults may hinder the development of public health and social policy initiatives for this vulnerable population. The presence of chronic illnesses is related to lower employment and income among older adults. It is, therefore, imperative that appropriate steps should be taken to develop and execute public policies regarding economic and public health needs for this growing cluster.
Since economic condition is a direct and immediate determinant of well-being, health, and quality of life, Bangladesh will need to identify the current and future needs of this population and develop appropriate and updated medical, public health and social safety programmes and services.
It will be important for policy-makers, non-governmental entities and private sector experts, employer groups, labour economists, gerontologists and health promotion advocates to reorganise workplaces and redesign jobs so that older people are not forced out of the job market, which would create a social and economic burden for the elderly, their family, the community and the country.
Updated evidence is needed for healthcare professionals as well people who are serving older adults so that their efforts and advice appropriately address issues of relevance to this population’s productivity, economic status, health and the quality of life.
Older people who have chronic diseases will spend a larger portion of their earnings and income on high healthcare expenses. Clearly, initiatives to keep this group or people in the labour force as long as possible will help to keep this group economically solvent, take care of some of their healthcare expenses, reduce their dependence on public programmes. Thus, an important consideration to maintain employment and income among older adults will prevent or reduce the prevalence of chronic diseases such as hypertension, arthritis and diabetes. Poor dietary content, eating habits and unbalanced food intake, a lack of physical activity, and other socio-cultural norms need to be confronted quite early in life if meaningful changes are to be seen.
A substantial amount of epidemiological, clinical, and demographic evidence suggests that there have been long-term improvements in health and functioning of the older adults in other countries. The labour force participation rate of people aged 60 years and above have noticeably increased over the past decade in Bangladesh — a trend that has been welcomed by all quarters. However, Bangladesh is seriously lagging behind in showing its sincere care and attention for its older people and not extending concerted and well-coordinated efforts to help them.
A clear vacuum in knowledge exists in Bangladesh on the changing trend of the economic consequences of chronic diseases among the older population. People with lower socio-economic status are at a higher risk of developing chronic diseases and by losing jobs and income, the economic disparity will only widen creating a vicious cycle of poverty and vulnerability. Maintaining the health, social, and economic well-being of this large and growing section of people should be a national priority for Bangladesh.
Hasnat M Alamgir is a professor of pharmacy at East West University, Dhaka, Bangladesh.
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