ageing, socio-economic disparities and health outcomes: some evidence on quality of life of rural...
TRANSCRIPT
Ageing, Socio-economic Disparities and Health Outcomes: Some Evidence on Quality of
Life of Rural Aged in India
Moneer Alam, Ph.D
Institute of Economic Growth
Delhi University Enclave
Delhi – 110 007
Paper presented to the Second SQ Conference Taipei (Taiwan), March 28 – 30, 2007
The Premise
Following are the three important underpinnings behind this paper & my today's presentation:
• India - as a democratic republic and with a written Constitution - empowers its citizens with many of the rights and entitlements espoused by the European Foundation and its partners and, therefore, deserves a place within the ambit of their ongoing activities and broader research agenda.
• Despite these Constitutional references and a series of policies on important socio-economic concerns, the country is in the web of various disparities, social biases, poor economic conditions, and lack of inclusiveness.
• Status of older persons (60+) – especially those in rural areas - serves as one of the most pertinent examples to underscore most of these limitations. This happens despite a series of economic liberalizations and higher GDP growth in the country.
Given these underpinnings, the study under discussion serves to examine the following:
• One, it profiles aged by: (i) their size in total population, (ii) rural-urban, sex and age distributions, and (iii) their social caste affiliations and so on. An idea here is to suggest that the ageing in India is not isolated or caste specific. It’s a wider phenomenon with concentration of aged in the rural areas, growing feminization and rapid growth in size of older old. All these need serious public attention, which is apparently missing.
• Two, high prevalence of socio-economic disparities among the aged - examined by using data on consumption expenditure of households from different social or caste groups.
• Three, health outcomes of socio-economic disparities.
A word about the Fundamental Rights and Directive Principles Provided In Indian Constitution to Ensure Inclusion and
Socio-Economic Rights of Individuals (Major EFSQ’s concerns) (Source: Wikipedia, the free encyclopedia)
• “Fundamental Rights (FRs)” and “Directive Principles (DPs)” are the two specific sections of the Indian Constitution. Both serve to prescribe fundamental obligations of the State to its citizens. The six FRs are THE RIGHT TO: 1. EQUALITY, 2. FREEDOM, 3. RIGHT AGAINST EXPLOITATION, 4. FREEDOM OF RELIGION, 5. CULTURAL AND EDUCATIONAL RIGHTS, and 6. RIGHT TO CONSITUTIONAL REMEDIES.
• The DPs are the directions given to federal and state governments to establish a JUST SOCIETY in the country. The DPs also commit the state to PROMOTE WELFARE OF THE PEOPLE BY AFFIRMING SOCIAL, ECONOMIC AND POLITICAL JUSTICE, AS WELL AS TO FIGHT ECONOMIC INEQUALITIES.
• THIS PAPER SHOULD BE VIEWED AGAIST THIS BACKDROP.
Elderly Population in India: Basic Facts
Size of Elderly Population: India and Major States – Census 2001
India & Major States Men Women
1.Andhra Pr. 7.2 8.1
2. Bihar* 6.8 6.5
3. Gujrat 6.2 7.7
4. Haryana 7.0 8.1
5. Himachal Pr. 8.8 9.3
6. Karnataka 7.2 8.3
7. Kerala 9.6 11.3
8. Madhya Pr. ** 6.7 7.6
9. Maharashtra 7.8 9.7
10. Orissa 8.1 8.5
11. Punjab 8.6 9.5
12. Rajasthan 6.3 7.4
13. Tamil Nadu 8.8 9.0
14. Uttar Pr.# 7.1 7.0
15. West Bengal 6.7 7.5
All India 7.1 7.9
Rural – Urban Distribution of Elderly Men & Women: 2001 Census
Rural Male Rural Female Urban Male Urban Female
RURAL
URBAN
Old & Older Old by Social Groups: All India & Rural
(2001 Census)
ALL SOCIAL GROUPS SCHEDULED CASTE
Total Male Female Total Male Female
ALL INDIA RURAL
60+ 65+ 75+ 80+
Total Male Female Total Male Female
ALL INDIA RURAL
60+ 65+ 75+ 80+
Old & Older Old by Social Groups: All India & Rural
(2001 Census) …………….. Contd.
SCHEDULED TRIBE OTHERS
Total Male Female Total Male Female
ALL INDIA RURAL
60+ 65+ 75+ 80+
Total Male Female Total Male Female
ALL INDIA RURAL
60+ 65+ 75+ 80+
80+ by Social Groups & Differentials: All India & Major States (2001 Census)
SC Male SC FemaleAll Groups Male All Groups Female
80+ by Social Groups and Differentials: All India & Major States (2001 Census) ….. Contd.
A. Pr.
Bihar*
Gujara
tHar
yana H. P
r. Kar
nataka Ker
alaM.
Pr.**
Mahar
asht Ori
ssaPun
jabRaj
asthan T. N
adu U. Pr.#
W. Ben
galInd
ia
ST Male ST Female Others Male Others Female
Low Socio-economic Standards & Disparities: Rural Aged
Per Capita Monthly Con. Exp. (PCMCE): All Households (in INR)
STATES PCMCE (95-96) CV PCMCE (2004) CV
A. Pr. 325 56.7 523 53.3
Bihar 284 40.4 443 49.1
Gujarat 411 54.9 663 49.8
Haryana 459 51.0 715 50.2
Himachal Pr. 430 51.3 698 52.7
Karnataka 332 53.3 778 84.4
Kerala 459 69.1 508 47.1
Madhya Pr. 317 46.8 525 45.3
Maharashtra 345 49.9 440 92.2
Orissa 282 47.0 370 52.5
Punjab 549 49.2 891 66.5
Rajasthan 378 37.0 572 67.4
Tamil Nadu 345 48.3 587 59.9
Uttar Pr. 330 53.5 535 94.9
West Bengal 337 46.3 523 55.0
INDIA 359 55.0 560 74.0
CVs of Nominal Per Capita Consumption Exp: 1995-96 & 2004 All Social Groups: RURAL
Pe r Capita M onthly Consumption Expe nditure (M PCE) of R ural House holds with 60+ Co-re s ide nts : Total House holds (CV of M PCE (N ominal))
0
10
20
30
40
50
60
70
80
90
100
A. P
r.
Bih
ar
Gu
jara
t
Ha
rya
na
Him
ach
al
Pr.
Ka
rna
tak
a
Ker
ala
Ma
dh
ya
Pr.
Ma
ha
rash
tra
Ori
ssa
Pu
nja
b
Ra
jast
ha
n
Ta
mil
Na
du
Utt
ar
Pr.
Wes
t B
eng
al
Ind
ia
State s in India
Co
ffic
ien
t o
f V
ari
an
ce
C V o f M PC E (N ominal) 52nd R ound C V o f M PC E (N ominal) 60 th R ound
Per Capita Monthly Con. Exp. (PCMCE): SC Households (in INR)
STATES PCMCE (95-96) CV PCMCE (2004) CV
A. Pr. 265 39.3 461 45.0
Bihar 249 33.5 380 34.7
Gujarat 361 41.6 589 32.5
Haryana 357 35.1 603 39.2
Himachal Pr. 383 43.0 590 46.9
Karnataka 264 40.1 446 40.4
Kerala 365 77.1 562 47.6
Madhya Pr. 310 36.8 426 57.8
Maharashtra 327 41.9 432 40.6
Orissa 243 32.4 339 35.3
Punjab 463 52.5 684 45.9
Rajasthan 360 40.6 518 41.3
Tamil Nadu 295 38.2 501 36.9
Uttar Pr. 280 43.7 457 43.4
West Bengal 290 37.9 478 43.9
INDIA 313 48.7 484 46.8
CVs of Nominal Per Capita Consumption Exp: 1995-96 & 2004 Rural Scheduled Castes Households
0
10
20
30
40
50
60
70
80
90
A. P
r.
Bih
ar
Guj
arat
Har
yana
Him
acha
l Pr.
Kar
nata
ka
Ker
ala
Mad
hya
Pr.
Mah
aras
htra
Ori
ssa
Punj
ab
Raj
asth
an
Tam
il N
adu
Utta
r Pr
.
Wes
t Ben
gal
Indi
a
Major State in India
CV
of
MP
CE
(N
omin
al)
52nd Round 60th Round
Per Capita Monthly Con. Exp. (PCMCE): ST Households (in INR)
STATES PCMCE (95-96) CV PCMCE (2004) CV
A. Pr. 268 37.3 503 69.0
Bihar 229 36.7 403 35.8
Gujarat 337 62.3 492 44.3
Haryana 0 0.0 0 0.0
Himachal Pr. 491 37.0 789 64.6
Karnataka 260 41.3 391 34.5
Kerala 390 53.2 663 73.3
Madhya Pr. 260 35.6 374 46.3
Maharashtra 285 44.0 457 41.8
Orissa 216 30.8 278 39.8
Punjab 0 0.0 0 0.0
Rajasthan 308 31.9 471 37.8
Tamil Nadu 248 43.8 374 45.7
Uttar Pr. 288 38.1 593 96.1
West Bengal 253 35.8 413 42.4
INDIA 315 52.2 506 92.3
CVs of Nominal Per Capita Consumption Exp: 1995-96 & 2004 Rural Scheduled Tribe Households
0
20
40
60
80
100
120A
. P
r.
Bih
ar
Gu
jara
t
Har
yan
a
Him
ach
al P
r.
Kar
nat
aka
Ker
ala
Mad
hy
a P
r.
Mah
aras
htr
a
Ori
ssa
Pu
nja
b
Raj
asth
an
Tam
il N
adu
Utt
ar P
r.
Wes
t B
eng
al
Ind
ia
52nd Round 60th Round
Per Capita Monthly Con. Exp. (PCMCE): Others (in INR)
STATES PCMCE (95-96) CV PCMCE (2004) CV
A. Pr. 348 58.4 543 53.0
Bihar 298 40.4 461 50.9
Gujarat 440 53.2 722 49.0
Haryana 499 50.9 751 51.0
Himachal Pr. 442 53.0 730 51.5
Karnataka 354 53.4 533 47.4
Kerala 470 68.2 805 85.2
Madhya Pr. 347 49.1 470 104.4
Maharashtra 360 50.9 549 45.0
Orissa 314 47.2 411 53.5
Punjab 587 46.4 996 67.1
Rajasthan 397 35.6 604 72.7
Tamil Nadu 361 48.9 621 62.5
Uttar Pr. 344 54.4 555 100.7
West Bengal 368 46.5 551 57.6
INDIA 378 55.4 588 74.4
CVs of Nominal Per Capita Consumption Exp: 1995-96 & 2004 Rural Others Households
0
20
40
60
80
100
120
A. P
r.
Bih
ar
Guj
arat
Har
yana
Him
acha
l Pr.
Kar
nata
ka
Ker
ala
Mad
hya
Pr.
Mah
aras
htra
Ori
ssa
Punj
ab
Raj
asth
an
Tam
il N
adu
Utt
ar P
r.
Wes
t Ben
gal
Indi
a
52nd Round 60th Round
Socio-economic Disparities and Health Outcomes: All India Rural Elders
Three self-reported health conditions were studied:A. CURRENT: CURRENTLY, IS YOUR HEALTH: (1) EXCELLENT
(2) GOOD (3) POOR ------- MULTINOMIAL LOGIT (2 AS REFERENCE)
B. RELATIVE: COMPARED TO PREVIOUS YEAR, ARE YOU:
(1) FEELING EXCELLENT (2) ALMOST THE SAME, (3) WORSE
MODEL: MULTINOMIAL LOGIT (2 AS REFERENCE)
C. NUMBER OF DISEASESES: NO DISEASE Vs. MULTIPLE DISEASE
MODEL: COUNT DATA MODEL BASED ON NEGATIVE BINOMIAL
HYPOTHESIS: HEALTH & SOCIO-ECONOMIC STATUS (SES) ARE UNIDIRECTIONALLY RELATED
Description of Explained and Explanatory Variables
• Explained Variables
1. Current Health:(a). Excellent(b). Good (c). Poor 2. Relative Health(a) Good(b) Almost the same(c) Worse 3. Count of Diseases:(a) No disease(b) Single disease(c) Multiple diseases
EXPLANATORY VARIABLES• social groups dummy• Gender dummy • Age dummy: 75+ and > 75 • Education dummy• MPCE = per capita monthly
consumption expenditure • Economic dependence dummy;
Economically independent & Dependent• Widowhood dummy = widow & Others• Type of drainage = open non-cemented,
open but cemented, covered, under ground drainage system, no drainage.
• Total con. Exp. of households• Availability of treated drinking water
Discussion of the Multinomial Regression Results: Current and Relative Health
• Tables 8 (a) and 8 (b) in the paper discusses these results in details, and indicate that the socio-economic status (particularly the economic independence), age/caste factors, and access to public health services like drainage and potable drinking water are among the critical factors in old age health and its outcomes.
• These results further indicate that the socio-economic factors may or may not remain decisive in individuals’ health gains, it however becomes a more critical factor against worsening health conditions over-time. Better SES and risks of worsening in health are shown to be inversely related.
• Interestingly, these results also indicate that the economic independence helps to nullify adverse impacts of widowhood on health. It implies that the income security in old age is an important measure to cover individuals against health risks.
Results of the Count Model: Single Vs. Multiple Diseases
• Text Table 8 © gives these results, which further substantiate the results described earlier. Risks to suffer single or multiple are more an outcome of poverty, low caste affiliation, age, illiteracy, lack of economic independence, inaccessibility to public health measures and so on.
• An important point to notice from both the sets of results is the role of age factor in health outcomes. Growing age amounts growing health risks. Size of older old (I.e., 75+/80+) in a population therefore needs to be monitored for added health care provisioning.
Concluding Observations
Following inferences are clear:• Demographically, India is turning to become an ageing society
with a growing feminization of elderly population. Three- fourths of the aged are in rural areas without even the modest geriatric infrastructure or provision for long term care.
• Economically, average Indians are in a much weaker situation with most of them are considerably below the dollar a day consumption level. Further, consumption level varies across households considerably suggesting very high disparities among the people and households. Lower caste people are at their worst.
• Socio-economic statuses determine the health outcomes: both current and relative.
• Constitutional provisions and guarantees are yet to bear results. The SQ arguments therefore hold and India apparently stands out as a case for a full length study with an in-depth application of SQ norms and its determinants.