Source: Series II , Working Paper-5
The government recognizes the trend of demographic ageing in India and its attendant health issues. The Central and state governments have taken a few important policy initiatives in this direction. In 2010–11, the Ministry of Health and Family Welfare (MoH&FW), Government of India launched a National Programme for Health Care of the Elderly (NPHCE). The NHPCE aims to create a network of public facilities and hospitals in more than 100 districts of about 21 states to provide geriatric medical services. It aims also to strengthen eight regional medical centres to meet the tertiary healthcare requirements of the elderly.
However, many such initiatives have been mired for lack of the necessary literature and data on health issues of elderly population, especially the aetiology of old age diseases (Alam and Karan, 2014). This study, based on a large, representative sample, is expected to provide the MoHFW some key inputs for NPHCE initiatives. Two issues bear particular significance. The first emanates from the health inequalities across spatial locations and population groups, and the second arises from inter-state differentials in combinations of various health domains. The latter points to the need for profiling diseases in each state to run the elderly health care programme more effectively. Admittedly, these are complex issues and, therefore, may not be decided on the basis of one study or even a few studies; a decision needs sustained data collection and research effort.
Our results clearly underline that physical age of older persons is significantly associated with overall wellbeing. Studies from other countries confirm this (Kelleher et al., 2003). Some studies also highlight that the socioeconomic status (SES) differentials in health expand through late middle-ages and start declining thereafter (Beckett, 2000; Deaton and Paxson, 1998). Health inequalities in later life have been attributed to selective mortality, social sector programmes targeting older adults, dominance of biological determinants Inequalities in Elderly Health and Wellbeing in India: An Exploration 15 over social determinants at later ages, and the cohort effects (Herd, 2006). However, some studies have shown that these differentials start widening after middle age, possibly reflecting the accumulated effects of social disadvantage (Ross & Wu, 1996).
From the present study, it may be argued that economic conditions appear to be a crucial factor for the elderly. This confirms the findings of earlier studies, which show a positive association between household wealth and elderly wellbeing (Guilmoto and Rajan, 2002; Rajan and Kumar, 2003; Alam, 2008; Ghosh and Husain, 2010). Elderly who have a higher per capita monthly consumption expenditure (MPCE) experienced better HWB. This finding clearly endorses studies that demonstrate a unidirectional relation between poor economic status and poor health (Ng et al., 2010). Likewise, the HWB indices turn out to be better among those elderly who engaged in economic activity in the preceding year. This suggests that the elderly with independent income sources may have control over spending as well.
The socioeconomic variations in elderly wellbeing across different states or regions may be due partly to diverse conditions in terms of access to various resources and of socioeconomic and demographic conditions Inequalities in Elderly Health and Wellbeing in India: An Exploration 16 of the region or state. The states chosen by the UNFPA and its collaborating partners from the Central and Eastern regions for their household survey are characterized by lower levels of socioeconomic and demographic conditions than states in the South and North. In the chosen states, primary health care infrastructure and resources are below average, and access to these facilities is mostly skewed. An early demographic transition in most South Indian states has led them to face an increased proportion of the elderly population, but it also helped them lay the groundwork for making policies in support of the elderly and their wellbeing.