GLOBAL AGEING ROLE OF SOCIAL SECURITY FOR SUSTAINING ELDERS DEVELOPMENT A citizen regards society not as an environment but

t as a common organism of which he or she is a part. The health of a nation is sum total of the health of its citizens. Indias urban population is increasing rapidly and is expected to reach 550 Million, which is as high as 30% and is likely to go to around over 40% of the population in next 20 years. Approximately 30% of the population live in disadvantaged areas. The increase takes place through migration resulting in slums without any infrastructure support. Even the negligible public health services, which are available, do not percolate to such unplanned habitation, forcing people to avail of private health care through out-of-pocket expenditure. The health care spends in India is low in terms of per-capita spending keeping in view the population figure of about 1 billion. The spending on health care per person is mere US $94 as against $720 in Korea, $349 in Thailand. Less than 15% of the Indian population has made provision for getting covered with some kind of pre-payment of health care services. As a result of poor coverage, two thirds of the health care expenditure is out of pocket. Scarcity of funds affects all health care systems. India is currently spending about 3% of GMP on health care as compared to 6 to 12% of developed countries. The annual cost of environmental degradation to the economy is nearly 5% of GDP. Out of this, 60% is due to water pollution and nearly 15% to air pollution and the rest attributes to various reasons. Primary health care is essential health care made universally acceptable to individuals and acceptable to them through their full satisfaction and at a cost, the community and the country can afford. The Alma Ata USSR declaration, 1978 set the goal for health care for all by 2000. India sets targets to achieve the same. Health Planning and Policy was reviewed and restructured by the recommendations of many Committees since independence. The National Health Policy 2002, set goals to be achieved by 2010 to increase utilization of public health facilities from current level of below 20% to more than 75%. To meet the challenges of development, Social Security as a welfare concept took birth, covering economic and social risks and acting as a corrective factor in the national Economy. It tends to redistribute wealth among people based on the principle that those who have more, pay more and those who have less, pay less, while benefits are almost the same. Social Security makes an effort to assure that every person has the right to a decent living and that is available in a manner consistent with the ideal of self-respect and opportunity for economic, cultural and social development. Income Security or Protection for the elderly, the disabled and the survivors, in the event of the death of the breadwinner, has been a problem facing by mankind from the times immemorial. In the beginning, this obligation was met by the family. Even now, when we are on the threshold of the Twenty-First century, in many cases, especially in the developing countries, it is met by the family, but because of extreme poverty amongst a majority of the population, the continuous rise in inflation, the breaking up of the families due to industrialization/urbanization and other factors, it has become impossible for the family to meet this obligation, leading to destitution at the vulnerable old age or in the event of total disablement and in case of death of the bread winner amongst survivors. On the other hand, the workers and others who serve the society by running the wheels of industry, by producing food grains and other agricultural commodities in the fields and by running the essential services required for living and working - not only the wage earners but also the self-employed, have a right to expect from the society, help in these eventualities. They must be assured that the society will manage its affairs in such a way that they can lead a life of dignity by having sustained monthly income, when they are not able to work due to old-age, or disability and their survivors can also lead such a life after their death. In the eighties, many of the countries - developed and underdeveloped came under the grip of economic recession due to various reasons. The developed industrial countries found a way out of this recession by furthering the pace of technological revolution, which helped in increasing production manifold. But in the developing countries, the funds required for

technological revolution were not available. When these countries approached the International Monetary Institutions, i.e., the World Bank and the International Monetary Fund, they agreed to provide funds on the condition that they restructure their economies so that all restrictions on trade and globalization were removed and the multinational companies in the few advanced countries were allowed to invest not only in the infrastructure or in heavy industries but also in consumer industries. These international monetary agencies also propounded a new theory called the Trickle Down Theory to the effect that when enough wealth will be produced, some of it will trickle down to the poorest sections. However, with globalization and massive restricting of old economies to new set ups, the financial institutions along with some big industrial multinationals began propounding the theory that the economies of not only the developing countries but also of the developed countries can no longer bear the burden of burgeoning social security expenditure, especially the expenditure on old-age pensions and health protection. The reasons advanced were that longevity is increasing due to advances in the medical science. Because of continued research more and more medicines have been produced which cure many chronic diseases. Moreover, there was increasing consciousness, to live in better environmental conditions. Due to increasing reliance on family planning measures, birth rate is declining. Life expectancy is increasing and the ageing process had declined. People are living longer than they used to live. Because of demographic changes, the number of old people, beyond the age of 65 years is increasing. In this regard, the Director General of the ILO in his report on Social Protection in the 80th Session of International Labour Conference held in 1993 made the following statement: "In the developed countries the ratio between number of people of active working age (broadly speaking those between the age of 15 and 65 years) to the number of elderly (those over 65 years) has rapidly declined over recent decades, largely as a decline in birth rate, but also due to increase in longevity. From an average of 7.5 individuals of working age persons over 65 years in 1968, the O.E.C.D. average has successfully declined to 5.4 in 1990 and is expected to fall to 3.8 by the year 2020. By the middle of next century there will be just two persons of working age per person over 65 years. A similar trend is occurring in developing countries where population are ageing because of decline of birth rate and increasing life expectancy." ISSUES:3 aspects are to be considered when we are discussing to provide protection for the elderly population irrespective of countries in the world. They are (1) Sustainable monthly income (2) Institutional support and (3) Health Care. Apart from the problem of sustained monthly income in the form of pension during old age, the elderly face another big problem, i.e., the health. With advancing age, chronic diseases seem to rush in. As much as 12% of our elderly population suffers from the debilitating Alzhermer's disease which requires expensive medication and institutional support which is not available due to fast disappearing joint family system. Apart from this, millions of elderly people have to face such chronic diseases as diabetes, chronic bronchitis, asthma, arthritis etc. According to the National Sample Survey Organization, as much as 45% of the 70 million plus elderly persons in this country suffer from some chronic disease or the other and over 5% are physically immobile. In this regard, it is a tragedy that the Government, Medical Council of India and premier medical institutions are not taking seriously the changing reality. According to a medical expert, even today geriatric medicine is not a specialized course in medical colleges and very few hospitals offer speciality services for the elderly. Though various State Governments in the States and Union Territories have introduced old age, widows and disability pension schemes for the destitute persons who have no other source of income or subsistence-such schemes have a very limited coverage and very meagre

pensions. There is no national policy for welfare of the aged or disabled in the country-even after 50 years of Independence. In such a situation what is the way out? Is it to enact laws to compel the young to take care of the aged as has been done by the Himachal State Government recently; and suggested by some experts i.e., to revive the joint family system by force of law or is it to force the working population to compulsory save and deposit in Private Pension Funds to get pension in old-age. Such short cuts are not going to solve the problem. In fact these may accentuate the problem. The only way out of this crisis is the well-tested method adopted throughout the world during the 20th century, which is to cover all citizens under Social Insurance and/or Social Assistance Schemes. Whereas persons working in the organized sector and a section of the self-employed having sufficient income should be covered under Social Insurance Schemes, all other sections of people whether they are working in the unorganized sector or are self employed small and marginal farmers, artisans, small shop keepers etc., should be covered under 'Social Assistance Scheme'. To make such a scheme viable a small cess should be levied on all types of industrial and agricultural production. Such a cess has already been levied in this country to finance Welfare Schemes for Beedi workers, Cine workers, employees in Iron ore, Manganese ore and Chrome ore Mines, labour in limestone and Dolomite mines etc. THE SCENARIO AS AVAILABLE IN INDIA:The Constitution of India provides a Socialist State with an over all object of removing inequalities in income, status and standards of life. Article 38 of the Constitution requires that the State should strive to promote the welfare of the people by securing and protecting as effectively as it may, a social order in which justice, social, economic and political, shall inform all institutions of national life. The Constitution also guarantees certain fundamental rights to every citizen including the right to life. The Supreme Court of India has ruled that the right to life as enshrined in the Constitution include right to livelihood which in turn means adequate nutrition, shelter, health care and clean water supply as well as security against sickness, disability death, unemployment and old age. 2. To guarantee the right to Social Security to the elderly citizens particularly in the matter of health care is fraught with great challenges. In India the percentage ages of elderly persons is already on the rise. It is estimated that by the year 2016 the elderly will constitute 9% of the total population in India. There has been increasing consciousness to live in a better environmental conditions coupled with improved medical care as available in the country which helps in decline in ageing process and increase in the life expectancy. People are living longer than they used to live earlier. India has achieved tremendous success in family planning by pursuing educative, popular methods like contraceptives and sterilizations, which have brought down the birth rate considerably. It has been estimated that the present life expectancy in India has gone upto 60-62 years. 3. Keeping in view of the projected elderly population of 9% by 2016 which is roughly calculated at 9 crores, responsibility has fallen on the state to plan and provide social security assistance to the elderly population. Sweeping social and economic changes which have already engulfed the globe has not left India untouched which is also rapidly growing as one of the biggest economic power next only to USA, Japan and China. In India rapid and unbridled urbanization has resulted in shortage of accommodation in cities and towns together with high rentals and atrophy of the joint family systems. The traditional respect care and concern for them have also come down. Simultaneously migration of younger people from rural areas to metropolitan and other towns heightens the helplessness and vulnerability of the elderly people who are left behind. Otherwise also the growing trend of nuclear family with husband, wife and a child at the best, has little concern for elderly parents. The predicament of elderly population in rural areas, more so the landless and assetless couples without having independent and supportive means of livelihood has also been accentuated due to these factors. Increasing literacy and education of women leads to increase in the number of working women and such

women have no time to take care of the elderly family members who are left behind at home to recline on their own condition. 4. The incidence of ageing people, being on rise, the state, as part of its mundane duty to guarantee, a good, decent and respectful life, has to work out a successful action plan. One of the most fundamental plans call for the elderly population is health care. It is the age factor which is prone to disease, debility and decaying process in the physiology and which needed the state care. Right now in the state sector no easy and affordable care is available particularly for the elderly population left with lean means of resources. To add to worries the cost of medical care is also sky diving. The Five year Plans gave focus and the structure for health policy and planning to the States. Inspite of the these, the following health problems persists:a) Poor living conditions:- According to Director General, WHO, poverty is the main source of ill-health. People are forced to eat inadequate and poor quality food, to live in congested dwelling and to use smoky fuels, makes peoples condition worse, causing those who have fallen sick to die. b) Nutrition:- Nutritional anemia, protein energy mal-nutrition due to insufficient food and food gap. c) Environmental Sanitation:- A gigantic problem as most of the people have scarcity of pure and whole some water supply, where water is not easily accessible. Provision for waste disposal facility and sanitary latrines are inadequate. d) Communicable diseases:- Due to insanitary conditions at indoor and outdoor, communicable diseases such as malaria, diarrhea, T.B., acute respiratory problems are facing and people who have fallen sick from above are more likely to die. The ESI Act, a piece of social welfare legislation aimed at providing certain benefits to the working class in the organized sectors of employment in the society, in contingencies like Sickness, Maternity and Employment Injury, enacted in Apr il, 1948, had completed more than 50 years of its existence. During this half century, it has gone through many amendments to suit the changed times and needs of the Society. The Act is today applicable to the power using manufacturing units employing 10 or more persons for wages, and non-power using manufacturing units, Shops, establishments, Hotels, Restaurants, Cinemas including preview theatres, news paper establishments, Road Transport agencies, employing 20 or more persons for wages. All categories of employees employed in these organizations, receiving wages upto and including Rs.6,500/- p.m. come under the orbit of this Scheme. In view of the Amendment brought under Section 1(6), a Factory or an Establishment to which this Act applies shall continue to be governed by this Act notwithstanding the number of employees employed therein at any time falls below the limit specified by or under this Act or the manufacturing process therein ceases to be carried on with the aid of power. The ESI Scheme in India can play a vital National role in providing medical care to the elderly persons. In fact the ESI Scheme has already started providing medi-care to disabled and elderly IPs in a very limited way with a nominal annual contribution of Rs.120/- ($2.5). With this nominal contribution, the insured person (retired and disabled) and his spouse get free and full medical care for a year. However, this Scheme is yet to take off in a big way. Under the ESI Scheme a huge medical infrastructure has already been created in the country which is as follows as on 31.3.2000. 1. 2. No. of State/Union Territories where ESI Scheme is 22 working Total No. of Centres 655 (with 19410 beds)

3. 4. 5. 6. 7.

No. of ESI Hospitals No. of Medical Annexes Beds reserved in other Hospitals No. of ESI Dispensaries No. of ESI Medical Practitioners' Clinics

136 43 3443 1443 2988

The Scheme is making steady inroads in the new areas, new sectors of employments through out the country. According to a policy decision taken recently whole territory of a district in each State is being adopted with proposal to extend ESI Scheme to the remote villages having coverable factories/establishments. Thus the ESI Scheme has the net-link of medical care through out the country, apart from its heavy presence in the mega cities of Chennai, Mumbai and New Delhi as well as in the emerging mega cities like Ahamedabad, Bangalore, Hyderabad and Kanpur, where highest percentage of elderly people having left their active lives due to superannuation or otherwise live and crave for medical care. As already stated above, the ESI Scheme is already providing medical care to superannuated insured persons and disabled insured persons and their spouses on payment of a nominal contribution of Rs.120/- per annum. This Scheme is getting more popular day by day with more number of conscious elderly insured persons coming forward to avail such benefit. Right now the Scheme is already on hand to extend the facility to insured persons availed VRS from service. Formulation of the Scheme in this behalf is already in an advance stage. With the vast medical infrastructure already in hand, the ESI Scheme is in a position to throw open its medical care to various segments of the society. i) Nearly 60 thousand widows/old parents of insured persons died due to Employment Injury/Occupational Diseases are already in receipt of dependants benefits under ESI Scheme. These widows and their dependant children and also old parents can be considered to be provided atleast a reasonable medical care under ESI Scheme. With the death of the bread earning husband/son, these dependants face the threat of leading undignified lives in terms of health and finance. At present employees in receipt of wages of Rs.7500/- are coverable under the ESI Scheme. A sizeable number of employees in receipt of wages above Rs.6500/- are still left out of the umbrella of the Scheme. Such employees on superannuation or on taking VRS can also be provided medical care under the Scheme on payment of a reasonable contribution. Elderly persons of beyond the active age of 60/65 belonging to non-industrial and other segments of Society can also be enrolled under the medical Scheme of ESI Scheme on payment of reasonable contribution.

ii)

iii)

It is quite possible to formulate a workable and sustainable Scheme for rendering medical care to the growing elderly population of the country. ESI Scheme is the premium Social Security Scheme at the National Level in India. The Scheme is likely to play a greater role in the coming days-involving health and income protection of organized sector. As for unorganized sector, keeping in view uncertain flow of income, suitable social assistance scheme needs to be formulated. To make participation voluntarily by the working population for the retired/aged population, 3 considerations are to be taken into account: 1. 2. 3. by providing Tax incentive for looking after elders by according Social recognition by suitable award system for taking care of elders Finally let us remember that it is artificial - and perhaps cruel - to put a person out of grass at age 60, or even 65. People do not age in the same way. Exceptionally gifted

persons like Beethoven and Einstein had been creative in old age. Less gifted persons could be active in what has been come to be called the third age of man. The report of 2nd National Commission on Labour constituted by Government of India has since been made public and is being debated involving various recommendations made by the said Committee. Its examination and recommendation pertaining to elderly persons is as reproduced below:

"NATIONAL POLICY FOR OLDER PERSONS:The ageing of population is a global phenomenon. In 1950, there were about 200 million persons aged 60 and over in the world, constituting 8.1% of the total global population. It is projected that by the year 2050, there will be a nine-fold increase in the population of the aged to 1.8 billion representing about 20% of the total population. India is no exception to this trend. According to the 1991 census, the proportion of the elderly persons has risen from 5.3% in 1961 to 6.58% in 1991 and is expected to be 9.08% in 2001 and 9.87% in 2021. More than four-fifths of the elderly persons live in rural areas, and the female elderly out number the male elderly. According to the 42nd round of the NSSO, 34% of the rural elderly were financially independent as against 28.94% in urban areas, 12% of the male elderly were staying alone, and this percentage was a little above 1% for females. There are three ways in which social protection is provided to the elderly, namely, social assistance, social security and provident funds. We will reiterate the need for a national policy for older persons. Moreover, assuming that at least 1% of the aged require institutional care, facilities would have to be created for providing institutional care to about fifteen lakh persons. It is difficult to believe that an adequate number of voluntary organizations will come forward to set up so many old age homes. There is, therefore, no alternative to the Central and State Governments taking the initiative to set up their own homes in sufficient numbers. One cannot be content with the setting up of homes. The quality of service provided in these homes needs to be monitored. The existing arrangements in this regard are less than adequate. It is, therefore, necessary to establish a well-organized regulatory system to ensure that standards are maintained, and exploitation avoided. With the growth in the population of the aged, the associated problem of caring for the aged is becoming increasingly important. Lately, long term care of the elderly in some of the developed countries has been systematized in the form of social care insurance as a part of social security. It has been reported that in 1991, in Germany, approximately one-third of the social security expenditure was devoted to care provision. The concept of care dependency is distinct from treatment for illness, and it covers help with daily tasks that do not fall under any medical treatment plan, e.g., personal hygiene, feeding, mobility or housework. The normal and preferred arrangement for taking care of the aged is to encourage them to live with their families. This would also be consistent with our national tradition. Where there are either no families, or where the families cannot look after them, they would have to be provided with institutional care. Appropriate schemes would need to be designed for the health care as well as long term care of the elderly. It may be mentioned here that the health insurance schemes of the GIC do not cover persons who are above the age of 70 who required greater attention, for reasons that are obvious.

Maintenance is a civil right that enables needy persons to receive economic support from those who are liable to protect and maintain their spouse, children, parents, etc. By law, parents are bound to maintain minor children, major children their parents, the husband his wife, and vice versa. The quantum of maintenance varies depending on the economic status of the parties. The various personal laws such as the Hindu marriage Act, 1955, the Hindu Adoption and Maintenance Act, 1955, the Indian Divorce Act, 1859, the Parsi Marriage Act, 1954, the Shariat Laws etc., provide for maintenance, also known as alimony or allowance. Civil courts take a long time to dispose off cases. Even if a competent civil court passes a judgement and decree, execution takes months and even years due to cumbersome legal procedures. Even before the maintenance is realized the decree holder may die of starvation. Realizing the above, the right to maintenance has been incorporated in Chapter IX of the Criminal Procedure Code (Cr.P.C.). It is an entitled 'order for maintenance of Wife, Children and Parents.' Under Section 125 of the Cr.P.C., 'if any person having sufficient means neglects to maintain (a) his wife, unable to maintain herself, or (b) his legitimate or illegitimate minor child, whether married or not, unable to maintain itself, or (c) his legitimate or illegitimate child (not being married) who has attained majority, where such child is, by reason of any physical or mental abnormality or injury unable to maintain itself, or (d) his father or mother, unable to maintain himself or herself, a magistrate, of the first class, may upon proof of such neglect or refusal, order such person to make a monthly allowance for the maintenance of his wife or such child, father or mother, at such monthly rate not exceeding five hundred rupees on the whole, as the magistrate thinks fit, and to pay the same to such person as the magistrate may from time to time direct. A ceiling of Rs.500/- per month towards maintenance will not prevent vagrancy though that is the object of the provision. Various women's and civil rights organizations and other activists have raised their voice against this ceiling. In West Bengal the amount was raised to Rs.1500/-. In Tamil Nadu, after a long debate with various sections of society and women's organizations and the Tamil Nadu Women's Commission, it was decided to amend the Cr.P.C. and remove the ceiling, and to vest in the magistrate, the power to grant maintenance in his discretion, taking into account the capacity of the person to pay, and the need of the person seeking maintenance. The Legislative Assembly unanimously passed a bill to amend the Cr.P.C. accordingly, and it was sent to the Central Government for obtaining Presidential assent. In the meantime, the Government changed, and the Bill has been withdrawn on the ground that the Central Government itself is contemplating a similar amendment. In sum, the Union Law Minister announced that the Government of India is planning to enhance the interim maintenance limit for an estranged wife from the existing Rs.500/- to Rs.5000/- on the recommendation of the Law Commission. We are glad to learn that this has now been done through an amendment to Section 125 of the Cr.P.C. We welcome this move and suggest that the ceiling on the amount to be paid for maintenance of dependants may be removed as was proposed by Tamil Nadu, and it may be left to the courts to decide the amount depending on the facts of the case." In order to ensure that the elderly keep healthy, it is necessary that they remain gainfully active. Their service can, therefore, be utilized in various activities of the community such as manning child care centres, cultural clubs, vocational training centres, etc., for which they may be paid appropriate remuneration.

CONCLUSION:This is one of the challenges facing this country in the Twenty First Century. We are at the threshold of the new century and the Government and non-government organizations together should draw out a national policy for the elderly to provide, firstly sustainable monthly income to the aged, disabled and survivors in case of death of the bread winner under Social Insurance and/or Social Assistance Schemes, secondly to provide adequate health care facilities

without any cost and thirdly to provide a net work of well managed Old Age Homes. To implement this policy a separate Ministry of Social Security should be created at the Centre and an autonomous Social Security Institution/Board/Authority accountable to the Parliament, manned by experts in this field be set up. Such institutions be set up at the State level with branches in all the Districts to take care of entire gamut of social security for the entire society, young to old and organized or unorganized. Three issues, which are presently confronting both developed and developing countries, namely, terrorism, environmental pollution and illiteracy. One of the measures causes for terrorism is lack of proper guidance and morale education particularly for youth of the country for which elders can be utilised for a sustained campaign to spread the sense of positivism spiritual and moral aspects of life so that the youth of today does not fall pray to antisocial elements of the society in which we are living. Secondly, the environment is continuously getting deteriorated due to various kinds of pollution air, water etc. Why cannot we use the vast number of elders in educating protection of environment, besides involving them in taking up environment related work like plantation and horticulture etc. Last but not least is the need for educating crores of children particularly in developing countries, who are lacking in physical infrastructure in the shape of lack of teachers. The ageing population can be utilised for imparting basic elementary education thereby not only saving the high cost of expenditure involved in payment to regular teachers but also gainfully engaging such retired elder persons to keep them healthy and wealthy physically mentally for the betterment of the society at large. Our goal should be to evolve such a national policy for the elderly scheme by the year 2005. Let all political parties, Trade Unions and Non-Government organizations and the Government combine to take up this challenge so that all senior citizens who have spent their lives working for the country in the fields, factories, services etc. can live a life of dignity in their old-age. SUMMARY: 1. The health of a nation is sum total of the health of its citizens. 2. There has been tremendous increase in elderly population throughout the world due to the increase in life expectancy and declining birth rate. 3. The health care spends in India is low in terms of per capita spending and scarcity of funds effects all health care systems.. 4. Primary health care is essential health care made universally acceptable to individuals, based on the principle that those who have more, pay more and who have less, pay less. 5. With the breakdown of the traditional family bond, social security for the aged is diminishing. 6. It is a challenge for the Government and society to take care of the aged. 7. Issues for their social security involve provision of healthcare, institutional support and sustainable monthly income. 8. Government institutions like social security administrators/ organizations like Employees State Insurance Corporation and Provident Fund can play a vital role, supplemented by community efforts of NGOs and other private bodies. 9. Funding of social security by imposition of a cess / tax from earners and through liberalized tax scheme for Pension contributions. 10. Punitive action for those who do not care for elders in the family / society. 11. To meet the challenges of terrorism, environmental pollution and illiteracy which are presently confronting the country, it is the high time to utilize the services of elders for social causes.

12. Altogether to have a mission to help the elders. By - Sri B.K. SAHU

To Dr. Jane Barrat Director General International Federation of Ageing Dear Madam, Recently, I was in Bangalore and found from newspaper that you are available in India for function involving old age population. I am working in ESI Corporation under Ministry of Labour & Employment, Government of India which deals with social security for working population of the country. I keep on writing on various issues and particularly for ageing population for which my article titled "Global Ageing -- Role of Social Security for sustaining elders' Development" was presented in International Conference of Ageing held at Singapore during the period 5-8 September, 2004. I am sending a copy of the article to involve me in such programmes undertaken by your Association for which further correspondence may please be made.

B.K. Sahu Additional Commissioner ESI Corporation Panchdeep Bhawan, CIG Road New Delhi-110 002 Tel : 011-23239424 Fax : 011-23235664