Cities. Are they safe for our elders?

Edition #4: How safety decides the place we live

How many of you have thought about safety as an important factor in deciding your place of living?

Is the city safe?

Is the neighbourhood safe?

Is it safe for my kids?

Is it safe for my parents?

Is it safe at night?

Is it worth relocating to an unsafe city?

These are questions we ask for ourselves and our families that live away from us.

In most cases, the eventual decision of your place of residence is made basis word-of-mouth experiences, convenience, anecdotal data and how well you are convinced by the builder or the broker. And, of course the budget and affordability. While finding a place has become easier with online sites and social media groups (like “flats with no brokers”), there is very little information to actually know if the place is ‘safe’. Much of this is also due to lack of accessible information at a neighbourhood level.

At a global level, the Economist publishes the annual Safe Cities Index that ranks 60 countries worldwide on multi-faced indicators like digital, infrastructure, health and personal security. If you are curious, New Delhi and Mumbai were ranked 45 and 51 while Tokyo and Singapore topped the global rankings. I am sure many are thinking, this is an American magazine, and they do not understand India. Be that as it may, this is one way to think of it, and moreover, we love rankings in this country.

The Annual Survey of India’s City Systems (ASICS) by Janaagraha, a Bangalore-based non-profit, provides independent benchmarking of Indian cities with a focus on quality of living. Smaller initiatives like Safecity were started with a focus on ‘making cities safer by encouraging equal access to public spaces for everyone especially women’, due to increasing sexual violence against women.

The HelpAge report, “Ageing and the city: making urban spaces work for older people” is a highly recommended read. It highlights systematic social, economic and spatial marginalisation and exclusion of older persons in cities, and how this is impacting their lives. HelpAge India, setup in India in 1978, offers a suite of welfare and development programs catering to elders in multiple states in India.

For many of us that live in an urban environment, safety of the family is largely associated with controlled spaces and secondary support structures like good neighbours and reliable services.

Real estate players have captured this need and today offer safe gated communities with a suite of accessible services for all age groups. Senior housing and assisted living communities are on the rise however, these affect only a few due to the nature of these projects (controlled spaces, away from cities and expensive) whereas the majority of seniors reside and navigate cities independently, and with the support of family. A lot of elders that I speak to mention how they wish to live in the same house till their last years as there is

a certain familiarity and routine associated with it, something they are unwilling to trade for higher quality of living unless it is the only option.

They like to live safely within a city.

Regardless of where they chose to live, we could make it dignified, joyful and fun for them. That is exactly what a bunch of people are doing across India.

The Senior Citizens’ Group of Besant Nagar in Chennai is an informal network of elders that share Gandhian values. They organize among themselves to make the society better for everybody.

The Silver Surfers Club in Bangalore has a created an array of programs for people over 55 to live an active, fulfilling and dignified life. This bunch loves to party and travel.

The Adhata Trust based started by Arun Nanda of the Mahindra Group, launched its 10th community center in Mumbai with a focus on ensuring psychosocial welfare of senior citizens.

The Samarth community based in Delhi has a mission to bring peace of mind to elderly and their families in India.

You may have also read this news article about how five high school girls won a global contest for developing a mobile app to connect senior citizens and their children.

These are just some initiatives that give you a glimpse of the work that is happening around you. With a little effort, you will find many more of these in your own neighborhoods and parks.


Ageing. The Decadal Indulgence.

Edition #3: Age as a number, Whipple index and age heaping among the old

What happens when you are 90 years old?

People in their 90s tend to give their age in rounded figures, usually the closest multiple of five, i.e., 95 or 100. There is even a term for it – age heaping – adding more years to your age. The 2011 Indian census identified 6 lakh centenarians but less than a lakh that were 95. The Whipple’s Index is used by the UN to account for age heaping.

I recall a visit to a village in Jharkhand where I met a very old woman, and when I asked folks her age, one guy said she was 125 and everybody around nodded. On my next visit, I asked the same question. Another guy said she was around 80. I doubt the old lady was counting or aware of this conversation.

Perception of age starts with the first birthday when your family celebrates you, and you really aren’t aware. You then celebrate the many wonderful years with your friends in school, college and work. In the process of growing up (not ageing yet), you also become eligible to do responsible adult things.

You can seek employment at 14.

You can vote and drive at 18.

You can drink in Andhra Pradesh at 18. If you are in Delhi, you will have to wait 7 more years.

You can be an elected Member of the Parliament at 25. But you need to be 35 and wiser to be the President.

Over time, age becomes a number that we love to indulge and more so when it comes with decadal tones. Life gets benchmarked to 100 and we race towards it grudgingly.

Thirty and officially old.
Big four-O.
Fifty. The half-way mark.
Silver sixty.
Golden eighty.

When you dig deeper, something interesting emerges.

I read this 2014 article, “Why I Hope to Die at 75” by Ezekiel J. Emanuel in The Atlantic, early this week. Ezekiel is a successful oncologist and a controversial figure, and this article is provocative if nothing else. I discussed this article with my dad who had just come back from spending time with my grandmother who is 95 (or thereabouts), is severely limited by mobility, lost much of her memory, and supported by her sons in their early to late 70s and a hired care worker. We discussed human mortality, perceptions of death among his peer group, life after death and even euthanasia. Any conversation about death (=expected end number of ageing),

somehow turns philosophical and spiritual.

What amazed me is the ease with which he had an open conversation about it.

On the other hand, my mom turns 70 in a few days. She never really cared about her birthday, and said, we remind her of her age by wishing her every year and then she forgets it. Until her retirement from a full-time job, she only counted her age by the years left to retire so she can get a pension. She is very good with numbers and has quite a memory.

She has always counted years pegged to a milestone

– my brother’s graduation, a family trip, the wedding of my dad’s last sister and so on – almost to the precise date and details leading up to it. In many ways, she is disengaged from the broader conversation around ageing, and the number game.

The third conversation with an academic was around quality of life (QoL)

among general population. I was told researchers studying ageing generally look at four broad domains – physical, psychological, social and environment – when looking at QoL standards. Various studies have been conducted on this, and across various cross-sections and demographic groups (adults, adolescents, elderly, women, etc.) to understand perceptions using structured surveys. For example, a study by Indian researchers points to education, wealth and family support as good predictors of higher QoL among the elderly.

Across these studies, and in general literature, you would notice adjectives like happy, joyful and successful associated with ‘ageing’.


Ageing India, the unsexy story.

Edition #2: Emergence of the older adult population

Jobs. Youth. Growth.

You cannot possibly miss these words in today’s India. Everything else (health, education, skills, investments, innovation, technology) folds into this meta narrative. Elections are likely won, and lost, on these promises.

Here is an April 2019 post from Dr Shamika Ravi, a member of the Economic Advisory Council to the Prime Minister of India.

The article is about jobs in the context of ease of business environment in states, pre-demonetization and GST rollout.

  • Dynamic states are defined by ease of business environment -> They tend to have lower unemployment.
  • Progressive states are defined by better human development indicators -> This doesn’t necessarily mean they are job creators.

A recent article in India Spend, a platform that analyses open data to inform policy and governance, talks about India’s demographic dividend and how the national narrative varies when it comes to states. Let us look at this a bit closely.

67 out of 100 persons in India are currently in the working age population (15 to 59 years). The rest are considered dependents.

Right now, India has a low dependency ratio and this positively correlates to higher economic growth. The working age population will continue to increase till 2031, and stay stable until 2041.

All else given, a higher working age population is suitable for high economic growth and allows us as a nation to reap (economic) benefit from the (demographic) dividend.

This is only half the story. Why?

The fertility rates are falling in Tamil Nadu, New Delhi, Andhra Pradesh, Telangana, Gujarat, Punjab and West Bengal. Moreover, in these states, the fertility rates are lower than replacement rates. Their window of opportunity from the demographic dividend will close by 2021.

For a second group of states that include Karnataka, Odisha, Himachal Pradesh, Maharashtra, Assam, J&K, Uttarakhand, Haryana, it will start closing in 2031.

States where the window of opportunity is closing have to prepare themselves for an emerging demographic – people over 60 years – commonly referred as ‘senior citizens’.

Ageing India

The number of senior citizens stands at 100 million plus today, and expected to rise to rise to 350 million by 2050. Southern states (along with Punjab and HP) show faster growth of this demographic. These are also states with human development indicators above the national average.

Longevity, i.e., average life of general population, is expected to rise from 67.5 years in 2015 to 75.9 years in 2050, and this is a key reason why the ‘ageing population bulge’ is inevitable.

Looking back into the census 2011 household data, one can see early warning signals from the changing family patterns.

What does this mean?

  • Joint family systems are breaking down due to economic migration (rural-urban, urban-urban) and other factors.
  • Seniors are increasingly living by themselves, and dependent on secondary support structures.
  • Loneliness and lack of companionship are aspects that come out strongly from multiple studies by UNFPA, HelpAge, AgeWell and other non-profits working on senior care.
  • The country is under-prepared to meet the needs of this hidden demographic. Meeting healthcare needs is only one aspect.
  • The senior care ecosystem in itself presents an area of opportunity for investment, jobs and innovation.

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