1. 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 India moneer@iegindia.org Paper presented to the Second SQ Conference Taipei (Taiwan), March 28 – 30, 2007

2. 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.

3. 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.

4. 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.

5. Elderly Population in India: Basic Facts

6. Size of Elderly Population: India and Major States – Census 2001 India & Major StatesMen Women 1.Andhra Pr.7.28.1 2. Bihar*6.86.5 3. Gujrat6.27.7 4. Haryana7.08.1 5. Himachal Pr.8.8 9.3 6. Karnataka7.28.3 7. Kerala9.6 11.3 8. Madhya Pr. **6.77.6 9. Maharashtra7.8 9.7 10. Orissa8.18.5 11. Punjab8.6 9.5 12. Rajasthan6.37.4 13. Tamil Nadu8.8 9.0 14. Uttar Pr.#7.17.0 15. West Bengal6.77.5 All India7.17.9

7. Rural – Urban Distribution of Elderly Men & Women: 2001 Census RURAL URBAN

8. Old & Older Old by Social Groups: All India & Rural (2001 Census) ALL SOCIAL GROUPSSCHEDULED CASTE

9. Old & Older Old by Social Groups: All India & Rural (2001 Census) …………….. Contd. SCHEDULED TRIBEOTHERS

10. 80+ by Social Groups & Differentials: All India & Major States (2001 Census)

11. 80+ by Social Groups and Differentials: All India & Major States (2001 Census) ….. Contd.

12. Low Socio-economic Standards & Disparities: Rural Aged

13. Per Capita Monthly Con. Exp. (PCMCE): All Households (in INR) STATESPCMCE (95-96)CVPCMCE (2004)CV A. Pr.32556.752353.3 Bihar28440.444349.1 Gujarat41154.966349.8 Haryana45951.071550.2 Himachal Pr.43051.369852.7 Karnataka33253.377884.4 Kerala45969.150847.1 Madhya Pr.31746.852545.3 Maharashtra34549.944092.2 Orissa28247.037052.5 Punjab54949.289166.5 Rajasthan37837.057267.4 Tamil Nadu34548.358759.9 Uttar Pr.33053.553594.9 West Bengal33746.352355.0 INDIA359 55.0 560 74.0

14. CVs of Nominal Per Capita Consumption Exp: 1995-96 & 2004 All Social Groups : RURAL

15. Per Capita Monthly Con. Exp. (PCMCE): SC Households (in INR) STATESPCMCE (95-96)CVPCMCE (2004)CV A. Pr.26539.346145.0 Bihar24933.538034.7 Gujarat36141.658932.5 Haryana35735.160339.2 Himachal Pr.38343.059046.9 Karnataka26440.144640.4 Kerala36577.156247.6 Madhya Pr.31036.842657.8 Maharashtra32741.943240.6 Orissa24332.433935.3 Punjab46352.568445.9 Rajasthan36040.651841.3 Tamil Nadu29538.250136.9 Uttar Pr.28043.745743.4 West Bengal29037.947843.9 INDIA31348.748446.8

16. CVs of Nominal Per Capita Consumption Exp: 1995-96 & 2004 Rural Scheduled Castes Households

17. Per Capita Monthly Con. Exp. (PCMCE): ST Households (in INR) STATESPCMCE (95-96)CVPCMCE (2004)CV A. Pr.26837.350369.0 Bihar22936.740335.8 Gujarat33762.349244.3 Haryana00.00 Himachal Pr.49137.078964.6 Karnataka26041.339134.5 Kerala39053.266373.3 Madhya Pr.26035.637446.3 Maharashtra28544.045741.8 Orissa21630.827839.8 Punjab00.00 Rajasthan30831.947137.8 Tamil Nadu24843.837445.7 Uttar Pr.28838.159396.1 West Bengal25335.841342.4 INDIA31552.250692.3

18. CVs of Nominal Per Capita Consumption Exp: 1995-96 & 2004 Rural Scheduled Tribe Households

19. Per Capita Monthly Con. Exp. (PCMCE): Others (in INR) STATESPCMCE (95-96)CVPCMCE (2004)CV A. Pr.34858.454353.0 Bihar29840.446150.9 Gujarat44053.272249.0 Haryana49950.975151.0 Himachal Pr.44253.073051.5 Karnataka35453.453347.4 Kerala47068.280585.2 Madhya Pr.34749.1470104.4 Maharashtra36050.954945.0 Orissa31447.241153.5 Punjab58746.499667.1 Rajasthan39735.660472.7 Tamil Nadu36148.962162.5 Uttar Pr.34454.4555100.7 West Bengal36846.555157.6 INDIA37855.458874.4

20. CVs of Nominal Per Capita Consumption Exp: 1995-96 & 2004 Rural Others Households

21. 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

22. 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

23. 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.

24. 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.

25. 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.