The World Population hit the seven billion mark on 31 October this year.
Having increased by one billion since 1999 and by two billion since 1987, what is astounding is that the last two billions have been reached in record time. “The population has been adding new billions every 12 years in the past 25 years,” Hania Zlotnik, Director of the Population Division at the UN Department of Economic and Social Affairs (DESA) has observed.
Come 2040, our little island will face some of the most serious challenges in recent years. No, it is not another civil war. Nor is it an epidemic of a contagious disease such as, dengue or Zika. It is a Population Explosion, perhaps the biggest this country has ever seen in its long history, and one that will test our nation to the extreme due to the wide ranging repercussions of its fall outs.
The signs of our zooming population growth combined with the dubious distinction of being one of the fastest aging nations in the world, has placed our island under a terrific strain which will become unbearable in the future. For, if the predictions of two sociologists, Prof. Indralal de Silva and Dr Ranjith de Silva come true, the country’s population will balloon to 25mn from its present 22 million by 2042, and peak to 25.8 million by 2062, after which the figures will stabilize. (Sri Lanka: 25m People and Implications’.)
What do these new population projections imply?
For one thing, it will mean a drastic change in virtually all areas of life: education, housing, employment, health and care for the elderly. The last mentioned is perhaps the most important with the aging population expected to rise to 20 percent by the year 2030.
Signs of our burgeoning grey presence are already visible.
Look around. Wherever you turn, you are likely to find an elderly, retired person (over 55 years.) searching for a job, food, shelter.
Meeting their needs will be one of the biggest challenges we would have to face, considering our dwindling resources vis a vis a general population boom.
Challenges
What are the specific challenges likely to accompany an aging population in Sri Lanka?
More medical care, to begin with.
The older the population, the more the investments will be required in medical care due to the countless non communicable diseases (NCDs) associated with old age, such as, diabetes, cardiac problems, hypertension, stroke, dementia. Recent statistics from the Health Ministry have revealed, NCDs have now overtaken the incidence of communicable diseases (CDs) in the country. They are also the leading cause for morbidity and mortality among aged persons. In its recent publication, the Global Burden of Diseases (GBD) has endorsed this unfortunate fact when it lists Sri Lanka as a country with a high prevalence of NCDs.
The World Health Organisation in its latest report rightly says, the solution is in preventing the disease rather than treating it, due to the strain on national budgets.
However, while prevention is undoubtedly the way forward, a question that needs to be addressed will be how elders, already stricken with diabetes, cancer, cardiac failure, or stroke, will be looked after, once they are discharged from hospital.
Opinions on this matter are divided, as authorities continue to mull over various options.
Being cared for in one’s own home is one. This option for many is probably the more attractive, but only if they have family members to look after them, who have undergone some basic training in caring for their specific illnesses, which is woefully lacking in this country.
Then, what about those who have no one to look after them when they are no longer able to care for themselves?
Are Elders’ Homes the answer?
Institutional care as in an Elders’ Home could be an option. But how many elders can afford Elders’ Homes that offer quality care? Not only do they charge steep prices, their numbers are limited, most of them being confined to Colombo and its immediate peripheries, where the more affluent elders mostly live.
In this context, what choice do our less privileged roofless elders have?
Yes, State Homes offering free board and lodging would be the most practical and affordable solution. Since we already have a network of such Homes islandwide, expanding this network is certainly an option worth considering. But, let’s tread cautiously here. It is imperative and I repeat imperative that any new state run Elders’ Home in the future, must adhere to the following requisites, which are already in the Social Services Act: clean toilets, proper bedding, sanitary, elders friendly environments and wholesome balanced meals. This is the least any society can offer for people forced to live out their twilight years imprisoned inside an alien, unfamiliar home. Ideally, they should also have a doctor on call with free checks ups on the premises, at least once a month.
All this however costs money. The very limited allowances doled out to the Department of Social Services per inmate of every state Elders’ Home, is barely sufficient to meet their total requirements for even a week, a matron in charge of a state Elders’ Home told the Sunday Observer. She noted, the decision to increase the current allowance by a few hundred rupees under the 2017 Budget was still very inadequate to meet the costs of providing the inmates clean sanitary environments with recreational facilities, like, board games etc.
What about Geriatric hospitals?
This suggestion we are told is already being considered by Health officials, while some private hospitals taking up the suggestion have now set up separate, fully equipped geriatric wards for long stay-in patients. But again, how many can afford to pay for such care?
What then is the most workable, affordable solution?
Informal Home Care
This suggestion from a trained nurse abroad is certainly a welcome proposition. Not only does it help slash hospitalization bills for in-patients, but, promises better outcomes, since the patients are treated in friendly, familiar home environments. The Care givers could range from family members, friends or even volunteers, Mrs. N told the Sunday Observer. However, she emphasised that since their patients are critically ill persons after strokes or cardiac surgery, they would have to be trained to feed, bathe , and move their patients, to prevent further complications. Training school leavers awaiting results, and others willing to volunteer their services, could be the start of a whole new trend in changing the pattern of care that the sick elderly persons, especially, in underprivileged areas, now receive in this country.
Anaemia
Proud as we are of our achievements in setting up records for a country with the lowest Infant Mortality and maternal Mortality rates, the widespread prevalence of anaemia among women and children, is a matter of concern for health officials. They have a right to be worried, if statistics are anything to go by. As for the causes, a Demographic and Health Survey of 2006/7 by the Department of Census & Statistics (DDS), showed that the prevailing anaemia among women and children was due largely to nutritional deficiency of iron. It was also found that anaemia was closely linked to the level of education of women and girls, and poverty.
Girl child
The rise of the female population and the surge in the number of females expected to enter the reproductive age in the next few years, brings us to another important challenge, meeting the girl child’s needs. As the future mother of future citizens, issues that challenge us include,: her nutritional needs from birth to motherhood, equal benefits from free education without being forced to drop out of school early to look after the younger siblings, and growing up in secure safe environments that protect her from sexual violence and abuse.
Ending child abuse and gender violence, including wife battering, is also a priority challenge in our increasingly violent, abusive society.
It calls for stricter implementation of existing laws and stiffer penalties to offenders. While the recently amended law on child abuse has seen increased penalties ranging from fines to jail sentences upto 20 years, the laws on domestic violence are still weak. For battered women in need of a half way home, Women – in Need (WIN) is currently the only NGO which has set up transit homes for them, offering counselling and legal services free of charge.
Abortion
Resolving the problem of unsafe abortions which have recently surged across the country, is yet another daunting challenge, one that could aggravate with more women entering the reproductive age in the future. Surveys by the Family Planning Association of Sri Lanka have revealed that hundreds of Lankan women undergo backstreet abortions performed by untrained persons, in unhygienic conditions, since abortion is illegal in Sri Lanka. Many die in the process. To avert these needless deaths, women activists are now urging a change in the present abortion laws and to decriminalize them to allow more women access to safe abortion.
HIV/AIDS
HIV/AIDS in Sri Lanka, (Sri Lanka has the lowest prevalence rate, 0.01% in the Asian region,) is another challenge. The Health Ministry has already started addressing this, following its concern over a slight increase in numbers of HIV/AIDS cases in recent years. Spearheaded by the National STD/AIDS Control Campaign, the Health Ministry just this month put out three publications to guide all primary health care professionals to reach the goal of an HIV/AIDS free country, by 2030.
According to Director NSACP Dr Sisira Liyanage, a national strategic plan for 2013-2017 has already been implemented to fast track the triple goals of zero new HIV infections, zero discrimination and zero AIDS. The National Condom Strategy 2016 - 2020 for which the UNFPA has given technical expertise, will also facilitate the achievement of these goals UNFPA Country Representative, Alain Sibenaler said, at the recent launch of the publications.
No matter what obstacles Sri Lanka faces, as it rides on the crest of a population wave, the inputs already set up by the government towards meeting these challenges will no doubt ease our path towards meeting those challenges. More political will, commitment and sustainability of programs that have already been introduced, however, will help us make that leap over the hurdles we face, as we move forward.