By Sadia Abdullah
An Ageing Global Population
Population throughout the world is ageing: nearly every country in the world is undergoing growth in proportion of older persons (aged 60 or above) in their population. It is a consequence of declining fertility and increasing life expectancy known as demographic transition. Ageing in population has been declared as one out of four global demographic “megatrends” – growing population, population ageing, out migration and urbanization have persistent and long-term effects on sustainable development.
The neglected fact is the speed of increase and significance of aged population. Considering the fast pace of this demographic change, by 2050, 1 out of 6 people in the world will be above the age of 65, up from 1 out of 11 in 2019 (United Nations, 2019). This indicates, for the first time in history, older people will outnumber children below 14 years old (British Council, 2019). In 2050, two out of every three oldest-old persons will be residing in developing countries (United Nations, 2019).
Ageing in Pakistan
Pakistan is ranked as sixth most populous country in the world. As elderly population is rising worldwide, similar trend is witnessed in Pakistan. It is estimated that 7% of the population (about 14 million) is over 60 years of age in the country (British Council, 2019). Alarmingly, it is expected to reach 8.5% and 12.9% in 2030 and 2050 respectively. This substantial change in population age structure is a consequence of increasing longevity, as life expectancy at age 60 is 17.6 for men  and 18.1 for women. It is a human success story of added years to lives with significant improvements in medical equipment and health.
We persistently augment our physical infrastructure and healthcare workers (comprising dentists, doctors and nurses), both public health measures. Our national health infrastructure includes 1,279 hospitals, 5,527 Basic Health Units, 686 Rural Health centers and 5,671 dispensaries (Government of Pakistan, 2019). Despite these improvements, population growth and other factors have imposed much pressure on our healthcare system.
Elderly’s Role in the Economy and Our Initiatives
Elderly people play an important role in resolving societal and familial disputes with their lifelong experiences. They are caretakers of grandchildren, which encourages mothers to enter the job market. Besides, most countries recognize the services of elderly people in voluntary activities such as serving at worship places. In families where cultural norms still prevail, we consider the chance to care for older persons a privilege.
The country has taken some positive initiatives to protect the rights of older people as legislation. There are existing national and provincial policies for older people; Senior Citizens Welfare Council established under Senior Citizens Act 2014, Balochistan Senior Citizen Act 2017 for legal protection, Sindh Senior Citizens Welfare Act 2017, Khyber Pakhtunkhwa Senior Citizens Welfare Act 2014 and National Program for the Health Care for the Elderly (NPHCE). Still, there is a major implementation gap between policy and application: policies must lead to intervention programs for the welfare of older men and women across the country (British Council, 2019).
Consequences of Ageing
Population ageing brings profound consequences as economic, social and health problems. Global Age Watch Index (GAWI) analyzes the data available internationally to estimate and monitor vital aspects of the socio-economic wellbeing of older population globally. GAWI considers income security, health status, employment and education, and enabling environments. Pakistan’s rank was 92 out of 96 in 2015 and 81 in the domain of enabling societies and environment which is quite low. It clearly indicates that Pakistan needs to overcome this worsening situation to cope with the prevailing population structure.
Worldwide, older people experience an array of vulnerabilities including; lack of income, health insecurity and the requirement for care. Pensions play a significant role to ensure income security, rights and dignity for older people. However, about half of men and women over pensionable age do not get pension. In case of Pakistan, it ranks second lowest overall (95th) in the income security domain. It has one of the lowest pension income coverage (2.3 percent) in the world (HelpAge International, 2018). At old age, males and females in Pakistan face difficulties in meeting their income requirements as their ability to work decline due to fall in employment opportunities and health issues. The labor force participation rate at 60-64 was 51.0 and dropped to 28.7 at 65 above for both genders for the year 2017-18 (Pakistan Bureau of Statistics, 2017). Hence, participation in labor force falls significantly in old age and gives a rise to dependency ratio.
Greying of Our Population
Nationwide “greying” of the population means more pressure on healthcare system as old age denotes greater health problems and disabilities. Despite the enhancement of healthcare arrangements, developing country like Pakistan, currently and in near future, will face burden. We label old age as being socially inactive and around 15% of adults aged 60 or above suffer from a mental disorder (WHO, 2017). With the prevalence of mental disorders, dementia is also present, which rapidly increases after 70 years of age . Given the predicted growth in the proportion of older population, which will take place in nearly every country of the world in the near-term decades, healthcare systems should organize now to address the specific health and mental concerns of older persons.
Moving towards the need for care at old age, Maslow’s Hierarchy of Needs highlights different needs of individuals that they reach throughout the life; however, because of certain aspects, the needs remain unfulfilled. This can harm the quality of life. In case of elderly population, the quality of life is ruled by three factors including, the aged individuals, the caregiver, and the laws; hence complementing one another to confirm quality of life. As people age in Pakistan, they become solely the responsibility of their family with no support from the state. The elderly share the process of ageing and a deteriorating culture of reverence, causes agony and anxiety among them. Ultimately, confirming the quality of life at old age requires the involvement of elderly themselves, caregivers, and the state.
Population ageing is an achievement considering the longevity factor, but the state needs to handle it efficiently and proactively. As greying of population continues, it is imperative that states design innovative policies specially targeted to cater the needs of older persons, inclusive of those addressing housing, employment, health care, social protection and other types of intergenerational sustenance. Pakistan must consider the following arrangements for the prevailing demographic shift:
- Functioning leadership at ministerial level to confirm the implementation of existing legislative and provincial policies,
- Enhancing coordination between local administration and non-governmental and private bodies working for the older people,
- Expanding coverage and simplifying pension provision to cover all older people including those living in rural areas which are actually greater in proportion,
- Improving employment and educational opportunities for older men and women,
- Enhancing access to quality healthcare by adoption of WHO’s plan on health and ageing,
- Distinguishing between the responsibilities of social services and public sector while clarifying the role of family, society and the private sector,
- Providing adequate support for societies and families taking care for older people, and
- Encouraging campaigns to eliminate negative stereotypes of elderly population and intergenerational solidarity.
 Global Age Watch. Available at: http://www.globalagewatch.org/countries/country-profile/?country=Pakistan
 Trading Economics, 2017.
 Trading Economics, 2017.
 For details, see Global Age Watch Index. Available at : https://www.helpage.org/global-agewatch/population-ageing-data/country-ageing-data/?country=Pakistan#collapseFour
 Social Protection for Older persons, International Labor Office, 2014.
 Trends in Ageing and Health, Pakistan by HelpAge International.