CPD-UNFPA
Programme on Population and Sustainable
Development
Paper 4 (Summary)
Social and Health
Status of the Aged Population
in Bangladesh
Professor Samad Abedin
INTRODUCTION
The
study identifies some critical social
and health related issues which
need to be addressed in order to
improve the well being of the elderly
in Bangladesh. The paper considers
the population aged 60 years and above
as the aged population and categorises
as young-olds-those who belong to
60-69 years group, old-olds those
who are between 70-79 years and
extremely olds as those who are
80 years and over. The population
of Bangladesh has already (in mid-1999)
reached the mark of 127 million
and the share of the aged (population
age 60 and over) in the population
is about 6.35 million. The population
of Bangladesh is projected to be
about 142.5 million by the year
2005 based on the estimated growth
rate of 1.75 per cent for the period
1991-2005. The projected changes
for age structure involve a rise
in the share of the elderly and
a decline in the share of the youth
in the near future. Ageing of population
in the country is not primarily
due to an increase in life expectancy,
but mostly on account of reductions
in birth rates and a reduced proportion
of population belonging to the young
age cohorts. However, improvement
in overall life expectancy is leading
to a situation where the elderly
people are becoming the fastest
growing age group in the population.
OBJECTIVES
The objectives of the study are
to:
· investigate the status
and roles of the elderly in the
family and community in the context
of household structure and composition
· explore the health status
and health care issues
· identify the linkages
between well-being and economic
development
· look at the living arrangements
of the elderly and the system
that promotes the exchange of
the aged with kin and others
· look at the support system
that currently exists for the
elderly in the country
· identify some policy
implications and suggest recommendations.
FINDINGS OF THE STUDY
Aged
People in Family and Community
The authority of the aged in the
family largely depends on the structure,
composition and function of the household
and their status in the family.
In respect to issues related to
status, roles and functions of the
aged population a household survey
showed that 91 per cent of people
aged 60 years or above lived either
with, or adjacent to, a mature son.
The kinship network allowed the
elderly to maintain their status
within the household. The survey
showed that the traditional familial
structure was prevalent and served
as a strong livelihood strategy. The
older men played a strong role as
household heads whilst older women,
including widows, tended to rely
more on their sons. There were,
however, a growing number of female-headed
households, which constituted about
6-7% of total households; some of
these households were supported
by a non-resident household member.
The study indicates that 49.6 per
cent
of older men in rural areas had
a dominant role in making major
or most household decisions. Older
women from rural areas reported
that 34.7 per cent of the major decisions
were made by their sons, and 37.5
per cent of the respondents reported
that no one was the main decision-maker
in the household.
This indicates the valued communal
decision-making, which informs the
culture of many extended households.
Economic Activity and Household
Chores
The study shows 44.5 per cent
of women and 7.6 per cent of
men had no income. Furthermore,
in rural areas 62.5% of men and
26.8% of women elderly are the main
breadwinners whereas 31.8% and
52.5% of men and women elderly
respectively reported their children
as the main breadwinner. Similarly,
in urban areas 65.7% of men and
31.8% of women elderly were observed
to be the main breadwinners, whilst
26.5% of men and 62.5% of women reported
their sons to be the main breadwinner.
Once again older women were reliant
on their sons for economic and
old age security. The motivation
of the elderly to live with their
children is not due to the difficulties
in maintaining their own household
but because of Bangladeshi tradition
that values living in joint or
extended families. As regards economic
activities performed by the elderly,
the majority of activities done
by the elderly in Bangladesh are
related to agricultural work
and household chores. These are
not directly income-generating
and for the most part these activities
are performed by women.
Health Status and Care
The most common health problems
aged people in Bangladesh
face include
stomach ache and diarrhoea, followed
by asthma, peptic ulcers, blood
pressure, diabetes, cardiac, dental
and eye problems. The study indicates
that the perception about health
problems in terms of the principal
chronic diseases do not vary between
men and women within the elderly
age cohort. Although a greater
proportion of older women reported
sickness, or having suffered from
one or more diseases (79%
of
women
versus 67% of
men), there were no
conclusive data which showed that
women suffered more than men,
except perhaps in case of the
mortality data. The mortality
data indicates that the health
status of female
elderly was reportedly
worse than male
elderly, which
was in fact consistent with their
shorter life expectancy. Hence,
having adjusted for gender-specific
mortality selection, gender differences
in health status were still prevalent
and significant. The study indicates
that the elderly suffer from tension
and anxiety for a variety of socio-psychological
reasons. Loneliness and worry
are serious emotional problems
faced by older people, mostly
young-olds and elderly women who
live apart from their children
and/or spouses.
The available medical facilities
are not adequate to meet the health
care requirements of 120 million
people in Bangladesh, let alone
the 7 million elderly. Those who
have greater mobility receive
differential care. There is difference
between men and women, and between
those who are socio-economically
advantaged. The study indicates
that 75% of those who have reported
having consulted a physician at
one time or another reported difficulty
in getting proper treatment due
to lack of financial resources
to pay for medicine and related
expenses.
Living Arrangements and Supports
Exchanges
The responsibility of caring for
older people is predominately
undertaken by the children or
the spouses (in the case of men).
Women are burdened with increased
responsibility because they are,
for their spouses, the primary
care givers. Children, generally
the daughters, take care of older
women. Women, however, still rely
on their sons for financial support.
The flow of support is from the
elderly parents to their children
since younger elderly are more
likely to co-reside with children.
Many elderly continue to play
a parental role by providing economic
and other support to dependent
children. This puts pressure on
the elderly in terms of the need
to maintain economic productivity.
Elderly also make contributions
to their families in care giving
(to the grand children / others),
household tasks and other daily
activities.
Three kinds of on going activities
are available in Bangladesh for
the elderly. These are: (a) government
programmes including formal pension
schemes, old age pension schemes,
schemes under the annual development
programme (ADP), poverty alleviation
programmes under the fifth-five
year plan, formation of the National
Committee on Ageing; (b) non-government
initiatives including the activities
of the Probin Hitoishi Sangha
(PHS), Elders Rehabilitation Centre,
Resource Integration Centre (RIC),
Service Centre for Elderly People
(SCEP), Elderly Development Initiatives
(EDI), Bangladesh Retired Government
Employees Welfare Association,
Bangladesh Retired Officers Welfare
Association, Defence Personnel
Welfare Trust and (c) the role
of religious teaching and practices.
However, in view of the above
multi-dimensional problems the
number of organisations actually
dedicated to the welfare of the
elderly is very limited in Bangladesh.
POLICY IMPLICATIONS
·
Policy makers and planners, community
leaders and government should pay
more attention to issues which have
adverse impact on the
capacity of families to support and care for older
persons. Shrinking family size,
increasing number of women joining
the work force, diminishing importance
of extended family arrangements
and the geographic mobility of family
members are some of the contributing
factors in this respect. These factors
reduce the number of potential caregivers
within the family and reduce the
options for burden sharing. Given
these changes, it becomes an imperative
on the part of the government to
take necessary steps to enhance
the care-giving capability of families
by introducing appropriate programs.
The programs should include, as
suggested in the Macau Plan of Action
(held in Macau in 1998), elements
such as- (i) promotion of co-residence
through housing policies and financial
incentives; (ii) provision of home
nursing services for older persons;
(iii) provision of facilities for
care; (iv) provision of programs
of counselling, professional guidance
and emotional support and (v) strengthening
inter-generational relationships.
· The aged requires direct
humanitarian assistance and they
should receive special attention
and be adequately covered by the
social safety net. Government
should identify and assess the
size of these groups and the extent
to which assistance is required.
In this regard, widows, one of
the most vulnerable groups, should
receive
particular
attention to meet
their special needs.
· The promotion and implementation
of low cost, prevention-based
initiatives such as health and
physical education and social
participation could significantly
enhance the possibility of maintaining
good health for the elderly.
· Health needs of older
persons are multidimensional.
Not only physical health but also
mental and emotional health of
older persons is equally important
for their well being. A system
of coordinated care needs to be
provided instead of person-oriented
intervention. Health education
programs should be introduced
to understand and create
awareness about the health
problems amongst the elderly,
and help them adopt a healthy life style.
· Preparations for a productive
and meaningful role in
old age
should be undertaken at both individual
as well as societal levels.
· There is a need to conduct
research on questions related
to demographic, social, health
and economic characteristics of
aged people and their
implications
for formulating public
policy. There is very little information
available on the well being of
the elderly population. Therefore,
immediate research needs are on
forecasting ageing through projections
and estimates; growth and structure
of family pattern and status,
roles and functions of the older
persons; care and living arrangements
of the elderly; co-residency and
support exchanges; health status
and health care; support system
currently available and future
demand; violence against elderly;
status of elderly women who are
not in marital union, distressed
and deserted; poverty, ageing
livelihood and well-being strategy.
· 'Bangladesh Elderly Survey'
is required in order to understand
the situation of the elderly covering
the aspects stated above.
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