European societies are ageing. In 1950, only 12% of the European population was over age 65. Today the share has already doubled, and projections show that in 2050 over 36% of Europe’s population will be 65-plus years old.
The culprits are fertility rates and longevity. In the past, a woman in Europe had on average more than two children. Since 2000, the fertility rate has fallen below that threshold. Europeans are also living longer now: 78 years on average, up from 66 years in the 1950s.
Prolonged human life is a sign of Europe’s prosperity, but combined with the region’s low fertility rate it is also creating an array of social and financial problems for the continent.
Perhaps most critical is the fact that the share of working people who can provide care to the older persons is shrinking, even as the number of people needing care grows.
This imbalance between demand and supply, which leads to shortages in nurses and other professional care providers, is already challenging the fast-ageing countries of Germany, Finland and the United Kingdom.
The increased demand for care will also require significant financial resources. In 2014, OECD countries were spending on average 1.4% of GDP on long-term care, but these costs are projected to rise substantially through, reaching 6,4% by 2060.
Public spending on long-term care is highest in the Netherlands and Scandinavian countries (where it costs 3% to 4% of GDP) and lowest in Central and Eastern Europe. In Poland, Hungary and Estonia, less than 1% of GDP is spent on long-term care.
This difference in expenditures reflects not only the share of the population that’s ageing but also the diversity of long-term care systems in Europe. The Netherlands and Scandinavian countries, for example, have well-developed systems of formal care for older persons, which offer a broad range of government and private-sector services at home or in institutions.
In Central and Eastern European countries, on the other hand, elderly care is largely seen as the responsibility of families. In these countries, as in Mediterranean countries, an elderly person who needs daily care for a lengthy period of time will most likely move in with children or relatives, who provide social support and arrange medical assistance when needed.
This informal care system is facing new challenges in the modern era, too. Women, who around the globe have traditionally played the family caretaker role, are increasingly working outside of the home, further reducing the number of family members available to provide informal care for older persons.
Informal care challenges
Even as they seek to grow their stable of professional long-term care providers, countries are endeavouring to make informal family-based care – which is believed to be more beneficial for older people and exert a lower social cost – more feasible.
In Germany, unpaid caregivers have the option to reduce their working hours with a medium-term paid-leave benefit. In the Czech Republic and Ireland, there are tax exemptions for informal care givers to compensate for their efforts.
This type of support will continue to play an important role in both Western and Eastern European countries. But it also raises questions about quality control. How do countries know that their elderly are being given adequate care? And who monitors their well-being?
Informal caregivers, such as family members and neighbours, generally do not have specialised training, which means that overall they lack skills and knowledge about recognising symptoms and thus, about the type of health-care needed.
As the designated protectors of individual rights and social values, governments still have the obligation to monitor informal care provision and ensure that its elderly citizens are in good hands. Establishing quality-monitoring mechanisms in informal care is itself a formidable challenge.
Today’s seniors are not passive in this process. Widespread digitisation of society and higher tech-savviness has given older people better access to information, which may increase their expectations for the quality and type of care they should receive.
Finding new long-term care systems
Across Europe, from the wealthy west to the developing east, there are always competing demands for public resources. Any money spent on growing long-term elder care systems could also be used to meet other pressing social needs – launching new public-health or environmental programmes, for example.
In Western Europe, where extensive care structures are already in place, their increasingly hefty price tags will make them difficult to sustain in coming years as the population in need continues to balloon.
Eastern European countries face a different policy dilemma: providing care for elderly relatives takes a considerable toll on family members, and public resources for creating nursing homes and elderly houses remain scarce.
At present, as each country begins to ponder a future in which its population is working less but needing more, it is still unclear whether their paths forward will converge. Europe could respond to its divergent but shared problem with a unified response, perhaps via the European Commission, which executes all European Union programming.
To date, the Commission has begun stimulating cross-country collaboration on elderly care with such supranational platforms as the European Innovation Partnership on Active and Healthy Ageing, a portal that helps institutions, professionals and researchers in the healthcare and ageing field to find training resources, best practices, care models and the like.
This is a relatively small step towards grappling with a region-wide social problem. But one immediate hurdle to working together on care for the elderly is the fact that the European Commission has no mandate over healthcare; every EU member state is free to decide how to arrange its own healthcare provision.
In the past, the EU has responded to the need for coordinating similar national issues such as agriculture, for example, by defining subsidies, regulations and investments for EU countries.
A similarly, common European ageing programme based on the commitment and initiative of individual countries could work too, helping each EU member state construct a context-specific care system that benefits both their oldest citizens and society at large.
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- In terms of Equity, in the Large States category, Chhattisgarh has the best Delta rate on Equity indicators, this is also reflected in the performance of Chhattisgarh in the Equity Pillar where it ranks 4th. Following Chhattisgarh is Odisha ranking 2nd in Delta-Equity ranking, but ranks 17th in the Equity Pillar of PAI 2021. Telangana ranks 3rd in Delta-Equity ranking even though it is not a top performer in this Pillar in the overall PAI 2021 Index. Jharkhand (16th), Uttar Pradesh (17th) and Assam (18th) rank at the bottom with Uttar Pradesh’s performance in line with the PAI 2021 Index
- Odisha and Nagaland have shown the best year-on-year improvement under 12 Key Development indicators.
- In the 60:40 division States, the top three performers are Kerala, Goa and Tamil Nadu and, the bottom three performers are Uttar Pradesh, Jharkhand and Bihar.
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- Among the 60:40 division States, Orissa, Chhattisgarh and Madhya Pradesh are the top three performers and Tamil Nadu, Telangana and Delhi appear as the bottom three performers.
- Among the 90:10 division States, the top three performers are Manipur, Arunachal Pradesh and Nagaland; and, the bottom three performers are Jammu and Kashmir, Uttarakhand and Himachal Pradesh
- Among the 60:40 division States, Goa, West Bengal and Delhi appear as the top three performers and Andhra Pradesh, Telangana and Bihar appear as the bottom three performers.
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In a diverse country like India, where each State is socially, culturally, economically, and politically distinct, measuring Governance becomes increasingly tricky. The Public Affairs Index (PAI 2021) is a scientifically rigorous, data-based framework that measures the quality of governance at the Sub-national level and ranks the States and Union Territories (UTs) of India on a Composite Index (CI).
States are classified into two categories – Large and Small – using population as the criteria.
In PAI 2021, PAC defined three significant pillars that embody Governance – Growth, Equity, and Sustainability. Each of the three Pillars is circumscribed by five governance praxis Themes.
The themes include – Voice and Accountability, Government Effectiveness, Rule of Law, Regulatory Quality and Control of Corruption.
At the bottom of the pyramid, 43 component indicators are mapped to 14 Sustainable Development Goals (SDGs) that are relevant to the States and UTs.
This forms the foundation of the conceptual framework of PAI 2021. The choice of the 43 indicators that go into the calculation of the CI were dictated by the objective of uncovering the complexity and multidimensional character of development governance
The Equity Principle
The Equity Pillar of the PAI 2021 Index analyses the inclusiveness impact at the Sub-national level in the country; inclusiveness in terms of the welfare of a society that depends primarily on establishing that all people feel that they have a say in the governance and are not excluded from the mainstream policy framework.
This requires all individuals and communities, but particularly the most vulnerable, to have an opportunity to improve or maintain their wellbeing. This chapter of PAI 2021 reflects the performance of States and UTs during the pandemic and questions the governance infrastructure in the country, analysing the effectiveness of schemes and the general livelihood of the people in terms of Equity.
Growth and its Discontents
Growth in its multidimensional form encompasses the essence of access to and the availability and optimal utilisation of resources. By resources, PAI 2021 refer to human resources, infrastructure and the budgetary allocations. Capacity building of an economy cannot take place if all the key players of growth do not drive development. The multiplier effects of better health care, improved educational outcomes, increased capital accumulation and lower unemployment levels contribute magnificently in the growth and development of the States.
The Pursuit Of Sustainability
The Sustainability Pillar analyses the access to and usage of resources that has an impact on environment, economy and humankind. The Pillar subsumes two themes and uses seven indicators to measure the effectiveness of government efforts with regards to Sustainability.
The Curious Case Of The Delta
The Delta Analysis presents the results on the State performance on year-on-year improvement. The rankings are measured as the Delta value over the last five to 10 years of data available for 12 Key Development Indicators (KDI). In PAI 2021, 12 indicators across the three Pillars of Equity (five indicators), Growth (five indicators) and Sustainability (two indicators). These KDIs are the outcome indicators crucial to assess Human Development. The Performance in the Delta Analysis is then compared to the Overall PAI 2021 Index.
Key Findings:-
In the Scheme of Things
The Scheme Analysis adds an additional dimension to ranking of the States on their governance. It attempts to complement the Governance Model by trying to understand the developmental activities undertaken by State Governments in the form of schemes. It also tries to understand whether better performance of States in schemes reflect in better governance.
The Centrally Sponsored schemes that were analysed are National Health Mission (NHM), Umbrella Integrated Child Development Services scheme (ICDS), Mahatma Gandh National Rural Employment Guarantee Scheme (MGNREGS), Samagra Shiksha Abhiyan (SmSA) and MidDay Meal Scheme (MDMS).
National Health Mission (NHM)
INTEGRATED CHILD DEVELOPMENT SERVICES (ICDS)
MID- DAY MEAL SCHEME (MDMS)
SAMAGRA SHIKSHA ABHIYAN (SMSA)
MAHATMA GANDHI NATIONAL RURAL EMPLOYMENT GUARANTEE SCHEME (MGNREGS)