A BABY BORN on the same day as the Indian republic—January 26th 1950, when the constitution went into effect—probably would not have lived to see the 75th-anniversary celebrations last month. That year, life expectancy at birth was 41.2 years, half a decade less than the global average. But progress has been dramatic. By 2023 life expectancy had reached 72, just one year below the world average.
India’s achievement is all the more impressive given its huge and diverse populace. Public-health success brings opportunities. Half of India’s population of 1.4bn is under the age of 29. This big and expanding workforce boosts economic growth, creating a “demographic dividend” that the McKinsey Global Institute (MGI), a think-tank, calculates has added an extra 0.7 percentage points annually to GDP-per-person growth in the past 25 years.
Yet success has brought a new challenge, too: for the first time in its history, India has a large and growing cohort of old people. Around 150m people are aged 60 or above. By 2050 the share will double to nearly 21%, or about 350m—more people than live in America today. Over the next quarter-century the demographic dividend will shrink, adding only an additional 0.2 percentage points to GDP growth every year. “We have just one generation” to get rich, says Anu Madgavkar of MGI. After that, “You will have a country with an age structure that looks…like North America, but at a fraction of GDP per capita.”
An India that grows old before it gets rich would be a long way from dreams of it becoming a developed country. But it would be harsher still for those adults as they retire. India’s fertility rate has dropped below replacement, to less than 2.0. Today, there are 9.8 people of working age for each old person. That number will fall by half by 2050 to somewhat above the level of present-day Europe, and plummet to 1.9 by the end of the century, about the same as today’s Japan (see chart).
With fewer working-age adults to support the elderly, and little by way of savings, India’s old may face a straitened, lonely retirement. Public services such as health care may be stretched. Moreover, as a larger share of personal and state income is diverted to look after the elderly, a generation of young people will have to face the prospect of deferred consumption and lower savings and investment.
Women, who tend to outlive men, may suffer more. Widows in conservative parts of India are expected to live austere lives, dressing only in white and excluded from social life. A deceased husband’s assets are meant to be divided among the wife and children, but it is common for widows to be deprived of their share. Few women have any savings of their own and most have never worked for a wage.
The government has plenty of policies aimed at India’s fast-growing elderly population. But many exist only on paper, says Himanshu Rath of AgeWell, an NGO. Those that exist often fall short. The state provides pensions to widows and the elderly below the poverty line. But these are insufficient to live independently, says Sonalde Desai of the National Council of Applied Economic Research, a think-tank in Delhi. And the paperwork involved can be maddening. Because India’s birth-and-death registration system is weak, pensioners must submit a “life certificate” every year to prove they are still alive. Many older people are unable to navigate such a needlessly bureaucratic system.
Last year the government announced free and universal health insurance for those aged 70 and above. Though welcome, it is a bare-bones scheme that does not cover preventive or outpatient care, even as India’s rates of non-communicable diseases such as diabetes and heart ailments soar. Nor do India’s middle classes have much cause for cheer. Private health-insurance for the elderly does exist, but at steep premiums, and comes with lots of restrictions and meagre cover. “You had better start saving,” suggests one insurance adviser. Few have that option.
Adding to the pressure is the changing structure of society. Sprawling multigenerational households are giving way to nuclear families. Many working-age people move from their villages for better prospects, leaving parents alone. Yet Indian culture has not yet accepted the idea of assisted living or care homes. Pensioners are left to deal with loneliness, isolation and depression. “Unlike malnutrition or TB, which you find in certain sections of society, this is a challenge you’re going to see across the board,” says Saraswathi Padmanabhan of EdelGive Foundation, a charity based in Mumbai.
Old wives’ tales
In India, as elsewhere, the long-term solution will require faster economic growth, more formal jobs and later retirement. But creative thinking is needed in the short term as well. One model can be found in Vendali, a village of 1,136 people in the middle of India, of whom 154 (or 14%) are senior citizens. Every afternoon except Sunday, the old women of the village gather for three hours at a temple by the river. There they sing songs, do yoga and some light exercise, and spend time on activities such as colouring or games. They also spend plenty of time gossiping.
This elder day-care, set up by Janseva, an NGO, is one of 15 in the district and costs about 100,000 rupees ($1,150) per year to run. But the benefits for its members are undoubtedly far greater. Of the 16 women present one recent afternoon, eight were widows, only one was literate and none possessed a mobile phone. If they watched television, it was whatever the family had on. The day-care routine has given them a social life. “Earlier we had nowhere to gather,” says Laxmibai, 90, who like most of the other women lives in a small room in a relative’s house. “Here we feel heard, and the physical activity has made a difference.” She demonstrates by doing some stretches. Volunteers routinely monitor the women’s blood pressure and sugar levels, catching problems early.
The women have also started to take part in village celebrations more often, and occasionally organise trips to temples. The benefits extend to their family members too: “Now I feel more welcome at home,” says Girijabai, 67. “My daughter-in-law is also calmer.” India has done an impressive job of extending lifespans. Now it must try to ensure those lives are well lived. ■
Stay on top of our India coverage by signing up to Essential India, our free weekly newsletter.