The paucity of focus on aging illustrates the urgent need to address the issues both at the policy and implementation levels; moreover, urgent research is necessary, both at the scientific and social science levels, to delve into the complexities of meeting the needs of an ageing population.
NEPAL IN SOUTH ASIA
For some countries in Asia, an ageing cohort is still an exception rather than a big component of population composition. This is especially true for the SAARC nations with all but one having 8 percent (or less) of its population in the over-60 cohort; and with less than 6 percent in the over-65 age bracket.
The majority of the elderly population in Nepal (85 percent) reside in rural areas. This cohort often depends on agriculture for a living and experiences relatively high levels of poverty and poor health along with low literacy levels and low mobility. This brings with it challenges for the society as a whole, including health and social well-being implications for the elderly; and also raises questions about a long term strategy for meeting the needs of an ageing population in one of the poorest country in South Asia.
The issue of ageing in the SAARC region has been neglected in population research. The main health focus in Nepal over the past two decades has been reduction of maternal and infant mortality. Despite the recent political unrest, maternal mortality in Nepal has decreased over the past decade mainly due to poverty reduction, an increase in the accessibility to education and health services and family planning. Life expectancy has increased from 43 years in 1970 to 54 in 1990 to the current level of 67 years. Reductions have also been noted in the death rate as well as infant mortality rate.
Whilst some recent policy changes have been made in relation to an ageing population, further research is required in order to understand and address the complexities an ageing population poses to a nation emerging from a decade-long conflict. In recent years, Help the Aged International projected 1.6 million Nepali citizens to be aged over 60; this figure is expected to increase to around 7.2 million (14 percent) by 2050. However, the distribution of the aged population in Nepal shows regional and to some extent gendered inequalities with the largest portion in the Hill and Tarai areas and the lowest in the mountain area. According to gender, 49 percent of the female elderly in the country live in the hills, whereas only 47 percent of the males do.
The improvements in access to health care and education have an urban bias and this has been further compounded by the political unrest, resulting in the marginalization of rural areas in the development process. Whilst the improvements in maternal mortality rates have an obvious gender dimension, what is often hidden is the general gendered differences in access to health care and education which have been exacerbated by the recent conflict. Recently, women were noted to outlive men in Nepal. As women’s health improves and more people live longer, the government and the service sector are likely to face new challenges in meeting the health needs of the elderly.
Another key factor that impacts the elderly population in Nepal is migration, both internal and external. While poverty is a key factor behind migration, increasing wealth prospects has also exacerbated the trend of rural to urban migration. Remittances sent back to Nepal from overseas make important contributions to the Nepali economy. Until recently, it was the young males who migrated out of the rural areas, leaving the elderly, women and young children in the villages.
However, there has of late been an increase in the gender and generational diversity of migrants and a significant increase in the elderly population migrating to urban centres. As a result, the proportion of elderly living in urban areas grew from 6.4 percent to 24.9 percent between 1981 and 2010. While the system of short-term internal migration has long been part of Nepali culture, the new trend of migration is seen as the more permanent ‘Empty Nest Syndrome’. The loss of both the youth and more recently the elderly population in rural Nepal has hindered the communities’ ability to farm the land.
This is a major challenge facing rural communities apart from the problem of climate change. The loss of the elderly population also results in the loss of indigenous knowledge and cultural systems that often underpin the agrarian society in Nepal.
As South Asian countries have so many similarities, from geo-political to cultural, it would be judicious to share experiences, skills and knowledge in order to address ageing at government and non-government levels. Knowledge exchange at the policy level and skill exchange at the implementation level can help address the important issues of an increasing elderly population such as social pensions, healthcare and age discrimination.
In a post-conflict society like Nepal, it is vital that the new constitution secures and develops rights for and responsibilities of its citizens including the elderly. The major issues of poverty, inequality and exclusion which affect the majority of the population in Nepal are particularly pertinent to the elderly who are amongst the most vulnerable and neglected sections of the society. Unemployment, migration of the young and lack of service provision is particularly acute in rural areas.
The government and development agencies need to seize the opportunity of a ‘New Nepal’ and begin to implement effective policies and programmes to ensure that the needs of an expectant population are met, thus peaceful democracy can be maintained and the citizens of Nepal can achieve the basic human right to live long and dignified lives.
The new constitution has to secure the fundamental rights of the elderly, including their right to pensions and health care provisions. In this regards, political parties and the government have made a clear policy commitment to follow the international declaration including the Madrid Plan of Action for the benefit of its senior citizens. If they are serious about following through remains to be seen.
The writer, who is based at the University of Liverpool, has been recognized by the British Academy for his research on ageing
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