Mumbai's elderly denied even basic health care

India is a young country. The proportion of the elderly (96 million in a population of 1.2 billion) pales in comparison to the young and able.

Leon Trotsky, the famous Russian Marxist, wrote in his Diary in Exile, “Old age is the most unexpected of all things that can happen to a man.” It is this denial of the inevitability of old age, perhaps, that allows us to treat the elderly with derision and apathy. The young, too, shall grow old, however, and with rising life expectancies, (India has an average life expectancy of 68.8 years), we will accumulate three crore people above the age of 60 over the next 40 years.

Saturday is World Health Day, a commemorative day to celebrate the anniversary of the World Health Organisation (WHO). This year, the theme is ‘Aging and Health’.

Dr Nata Menabde, the WHO representative in India, sees five major areas of improvements that India needs to focus on to make sure that the current and soon to explode elderly population age with dignity, and live in comfort and good health.
 “There needs to be more enabling environments for the elderly. The elderly should have access to basic primary health care.

Indian society should be more age-friendly. The young should take care of their health so that they can have a healthy senior life and finally, more Indians should have access to education so that they have the financial resources to take care of themselves as they age,” she says.

To achieve improvements in all these areas, there needs to be a concerted effort politically, socially, health care-wise and within the structure of the family. Experts, however, say we, as a nation, are sorely lacking in all four of these areas.

Old age and politics
“There is no state-level or national policy for the elderly in our country,” says Sailesh Mishra, director of Silver Innings Foundation, an NGO that fights for elderly rights. According to Mishra the government drafted the National Policy for Old People in 1999. But, none of the guidelines set by the policy has been implemented or acted upon. “It’s just a document. No one takes it seriously. In 2007, there was a Maintenance and Welfare Act of Parents and Senior Citizens Act that was passed by the Centre. Only 11 states in India have implemented it to date. Fortunately, Maharashtra was one of them. But, even then, the implementation has been slow because of red tape,” he says.

In accordance with the Act, rules were framed by the state government in 2010. And, it took another year to form a tribunal that a senior citizen can approach with his/her grievances, instead of knocking on a court’s doors. However, every tribunal must have a committee that includes senior citizens’ organisations and local activists No prizes for guessing this: these committees have still not been formed.

The Act also provides guidelines on old-age homes and health care facilities which haven’t been implemented.

“The problem is that old people don’t have a voice in this country. They can’t go out and protest all day, and go on dharnas. So, the political establishment takes the elderly for granted. This time for the civic body election, 30-40% of the voting public comprised senior citizens. What we’re trying to do is to form a vote bank of senior citizens, which we can use to lobby the government for services,” says Mishra.

Poor medical coverage
The Centre has drawn up a national health care programme for the elderly and its implementation is underway. Two districts, Sangli and Satara, have been selected in Maharashtra as pilot projects. The programme necessitates the existence of health care centres and speciality hospitals for senior citizens.
In Mumbai, though, the situation is quite bad. There are no speciality hospitals for the elderly. The city doesn’t even have a course in geriatrics or specialised senior citizen medicine.

Therefore, there are very few doctors who are qualified to deal with the health problems of the elderly. Often, the elderly can’t even buy expensive medicines because of a lack of income and the absence of social security or subsidies in health care.

Going by recent findings that the young are plagued with lifestyle-related illnesses which are going to manifest themselves severely in old age, this lack of proper health care facilities makes the city a ticking time bomb.

Need for attitude change
Not all troubles of the elderly can be deposited at the feet of the government, argues Mishra.

“Individual families need to change their attitude towards the elderly. Today, because they’re not productive, they are treated with derision and are often ignored. This not only affects the mental health of the elderly, but can also lead to physical complications,” he says.

The apathetic attitude towards the elderly manifests itself in bullying and abuse. According to an estimate made by the Silver Innings Foundation, 40% of senior citizens living with their families face abuse in some form of the other.

Neglect is the most common form of abuse, followed by emotional/psychological abuse, financial exploitation, physical abuse and abandonment.