emerging challanges of ageing
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1
Thelma Kay
Director
Emerging Social Issues Division
UNESCAP
Em er g in g Ch a l leng esand Oppo r t un i t i e s o f
Age ing
Decreasing fertility in the ESCAP region
Fertility trends by major regions of the world 1950-2005
Source: World Population Prospects: The 2006 Revision, United Nations Population Division, New York.
0
1
2
3
4
5
6
7
1950-
1955
1955-
1960
1960-
1965
1965-
1970
1970-
1975
1975-
1980
1980-
1985
1985-
1990
1990-
1995
1995-
2000
2000-
2005
Totalfertility
ra
te
Europe
Northern America
Australia/New Zealand
Asia
Eastern Asia
South-Central Asia
South-Eastern Asia
Western Asia
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Lowest-low fertility (TFR 1.5)
0.0 2.0 4.0 6.0 8.0 10.0
Georgia
Armenia
Russian Federation
Japan
Singapore
Republic of Korea
Hong Kong, China
Macao, China
TFR
2005-2010
1990-1995
1970-1975
Source: World Population Prospects: the 2006 Revision, United Nations Population Division, New York.
Increasing Life Expectancy in ESCAP region
35
40
45
50
55
60
65
70
75
80
85
1950
-195
5
1955
-196
0
1960
-196
5
1965
-197
0
1970
-197
5
1975
-198
0
1980
-198
5
1985
-199
0
1990
-199
5
1995
-200
0
2000
-200
5
Years
Europe
Northern America
Australia/New ZealandAsia
Eastern Asia
South-Central Asia
South-Eastern A sia
Western Asia
Source: World Population Prospects: The 2006 Revision, United Nations Population Division, New York.
Life expectancy at birth by major region of the world1950-2010
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0 10 20 30 40 50
Japan
Republic of KoreaSingapore
China
Thailand
Indonesia
Myanmar
Viet Nam
Malaysia
Philippines
Cambodia
Lao People's Democratic Republic
Brunei Darussalam
Percentage
2005 2025 2050
Percentage of population over age 60
Source: World Population Prospects: The 2004 Revision, United Nations Population Division, New York.
Population ageing rapidly in ESCAP region
Speed of population ageing in selected countries
Number of years required or expected for per cent of populationaged 65 or over to rise from 7% to 14%
More developed countries
26
45
45
65
69
73
85
115
Japan 1970-1996
Spain 1947-1995
United Kingdom 1930-1975
Canada 1944-2009
United States 1944-2013
Australia 1938-2011
Sweden 1890-1975
France 1865-1980
Less developed countries
19
19
22
23
26
Republic of Korea 1999-2018
Singapore 2000-2019
Thailand 2003-2025
Sri Lanka 2004-2027
China 2000-2026
Source: Kinsella and Philippes (2005). Global Ageing: The Challenge of Success, Population Bulletin, vol. 60, No. 1.
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Potential support ratio (15-64/65+)
0.0 2.0 4.0 6.0 8.0 10.0 12.0
China
Thailand
Singapore
Republic of Korea
Japan
Asia
Australia/ New Zealand
No rthern America
Europe
2050 2025 2005
Source: World Population Prospects: The 2006 Revision, United Nations Population Division, New York.
2005, 2025 and 2050
Feminization of the elderly populationSex ratio of population aged 60+ in 2005
96
79
88
76
78
90
86
77
69
0 10 20 30 40 50 60 70 80 90 100
China
Thailand
Singapore
Republic of Korea
Japan
Asia
Australia/New Zealand
Northern America
Europe
Females Males
Source: World Population Prospects: The 2006 Revision, United Nations Population Division, New York.
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Feminization of the elderly population
Sex ratio of population aged 80+ in 2005
Source: World Population Prospects: The 2004 Revision, United Nations Population Division, New York.
0 20 40 60 80 100
ChinaThailand
Singapore
Republic of Korea
Japan
Asia
Australia/New Zealand
Northern America
Europe
Females Males
More women not currently married (single)
Percentage of currently married population aged 60 years or over
78
83
83
87
86
76
77
81
75
80
56
49
49
37
53
50
50
50
48
47
China
Thailand
Singapore
Republic of Korea
Japan
Australia
New Zealand
Asia
Northern America
Europe
Men Women
Source: Population Ageing 2006, United Nations Population Division, New York.
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8.1
2.9
1.6
7.7
12.7
17.1
5
15
13
8.1
5.5
2.7
7.7
12.7
36.1
9
34
35
China
Thailand
Singapore
Republic of Korea
Japan
New Zealand
Asia
Northern America
Europe
Males Females
In Asia lower proportion of older persons living alone
Source: World Population Prospects: The 2006 Revision, United Nations Population Division, New York.
Percentage of population aged 60 years or over living alone
Feminization of ageing
Gender-related demographics:(a) Longer female life expectancy e.g. female
advantage in China 3.1 yr, Japan 5.3 yrs;
(b) Advantage bigger in older old
Educational attainment: Low literacy rates forolder women; cohort differences
Labour force participation: lower paid, parttime/temporary
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Living arrangement: mainly co-residence withchildren; reciprocity (more likely provide ratherthan receive support)
Universality of family formation but increasingnumbers of single, divorced
Health: more prone to chronic diseases,mobility affected, dementia
Finance: more financially dependent vulnerable,fewer assets, fewer benefits from formal socialsecurity schemes
Feminization of ageing (Contd)
Changing demographics
Decreasing fertility
Increasing life expectancy
Speed of ageing
Potential support ratio Feminization of ageing
Increasing older old
Increasing number single
Living alone
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UN and ESCAP Agenda on Ageing
1982: First World Assembly on Ageing Vienna1992: Proclamation on Ageing General Assembly1995: World Summit for Social Development
Copenhagen (Society for All)1999: International Year of Older Persons (Society
for all Ages)1999: Macao Plan of Action on Ageing2002: Madrid - Madrid International Plan of Action on
Ageing MIPAA)
2002: Shanghai Regional Implementation Strategy forthe Madrid International Plan of Action on Ageing
2007: Macao Outcome Document of Highlevel review ofMIPAA implementation
Madrid International Plan of Action on Ageing(MIPAA)
Core concepts:
Development approach - integrate evolving processof ageing into development process; more focus ondeveloping countries
Life-course intergenerational approach -inclusiveness of all age groups
Three priority directions:
Older persons and development
Advancing health and well-being into old age
Ensuring enabling and supportive environments
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Diversity of ESCAP region
Some countries with ageing population but with
cushion of affluence e.g. Australia, NZ, Japan,Republic of Korea, Singapore
Some developing countries with rapidly ageing
populations can reap demographic dividend butalso need to address unemployment,underemployment and youth unemployment
Income security for older persons
Labour force in many ESCAP countries ininformal sector where social security schemescannot or do not apply
Formal social security coverage ranges from 9-
20 percent; only Japan, ROK, Singapore havelargely universal pension systems
Limited development of multi-tiered systemse,g. 5-tier World Bank taxonomy
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Social security for older persons
Non-contributory social pensions in somecountries e.g Nepal
Challenge of coverage, targetting vsuniversality, affordability, sustainability
New and innovative instruments e.g.reversemortgage
Scope for higher social expenditure with fiscal
space from economic growth and reallocativedistribution
Health security
Subregions within the ESCAP region have lowest proportion of total
health expenditure of GDP compared to other regions
They also have lowest proportion of public health expenditure of GDP
ESCAP region has highest level of out-of-pocket expenditure in the
world
Expenditure levels on health by region
4.56.5Europe and Central Asia
3.36.8Latin America and Carribean
2.75.6Middle East and North Africa
2.46.1Sub-Saharan Africa
1.95.0East Asia and the Pacific
1.14.4South Asia
Public healthexpenditure as % GDP
Total health expenditureas % GDPRegion
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Health security
Deaths due to non-communicable, chronic diseases
set to increase
Developing countries face double burden of disease
Most countries have health policies that imply
principle of universal coverage but struggle to
implement it
Can be achieved by multi-pillar approaches (tax-
funded, social health insurance, private insurance)
Economic growth has expanded fiscal space for
higher social expenditures
Addressing health security
Comprehensive strengthening of healthsystems (not stove-pipe approach)
Universal health-care coverage for basic
package of services Healthy life expectancy, compressed morbidity
Address promotion and prevention not just
curative and rehabilitative
Address long-term care
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Ensuring an enabling and supportive environments
Develop age-friendly physical environments topromote ageing in place to ensure readily
accessible community level facilities and healthservices;
Promote barrier-free physical environment,
transportation, public facilities, services, andinformation and communications to meet the
accessibility needs of older persons;
Macao Outcome Document
Promote the use of technological advances , suchas ICT applications to enhance connectivity,communications and advocacy
Increase access by older persons to information
about their rights at home and in the community,including about their publicly supportedentitlements
Foster the provision of community-based servicesto older persons by making use of existingnetworks and support to caregivers to ensure thesustainability of the services provided
Ensuring an enabling and supportiveenvironment
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Enabling and supportive environment
Ageing in place
Independent living
Accessible and affordableconnectivity/transportation
Lifetime neighbourhood/community
Ageing in place
Help older people stay at family home or home-like environment
Adapt /modify homes
Programmes that support family health givers
Financial support policies subsidies, salaries ,tax credits
Social services e.g daycare ; training forcaregivers
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Independent living
Assistive devices
Universal design ageproof homes (e.g wider
doors/internal corridors , wheelchair accessiblebathroom, lever taps/handles;
Legislation for all homes ( especially built with
public funds) /regulatory requirement for
universal design/lifetime home standards
Accessible/affordable connectivity
Telephone (landline/mobile),internet
penetration
Availability/application of ICT
Access to transportation Access to information/advice (rights,
entitlements)
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Lifetime community/neighbourhood
Mixed housing
Accessible common facilities
Community alarm , telecare schemes (esp. to
assist older persons in emergencies)
Network of barrier-free linkages to majoractivity modes and amenities
Increase the level of integration and mainstreaming ofageing concerns in national policies and povertyreduction strategies;
Establish and strengthen multi-pillared and multi-
layered social security systems ( income security,health security, long term care);
Recognize contribution of older persons in labourmarket, in reciprocity living arrangement,intergenerational support, political participation
Promote silver market for financial services, healthprovision, travel and leisure;
Future Priorities for Action
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Conduct multidisciplinary research for evidence-basedplanning and decision-making;
Mobilize international donor community to providenecessary technical and financial support to addresspopulation ageing issues at all levels;
Strengthen collectivization/solidarity/voice e.g olderpersons associations at community, local, national,global levels
Build capacities to identify challenges, formulateappropriate measures and programmes on ageing,and monitor the progress of implementation;
Future priorities for action
Sources of dataSuggested indicatorsPriorityDirections/Objective
1.Government information2.Survey3.NGO information
4.Private sector information
1.National census2.Survey3.MDG reports if
disaggregated
Instrumental : Availability,scope and coverage of
programmes promoting age-
integrated housing
Outcome: Percentage of older persons
reporting on their housing andliving conditions as age-adequate
Percentage of households witholder persons having a toilet,bathing facilities,sewage disposal,solid waste disposal , electriclighting,improved sanitation andsafe water
Housing and the livingenvironment
Objective 1: Promotionof ageing in place inthe community with dueregard to individualpreferences andaffordable housing
options for persons
Instrumental and Outcome Indicators
Ensuring enabling and supportive environments
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Moving forward
Ageing poses many challenges but can be
addressed and overcome by:
Well-focused policies
Timely preparations
Partnership of governments, private sector, civil
society esp. associations of older persons Regional and global partnerships