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Population
ageing is one of the most significant trends of the 21st century, it has
important and far reaching implications for all aspects of society and it has become
a phenomenon that can no longer be ignored. Asia’s elderly population (those
over 65 years) is projected to reach a billion people by 2050. Governments in
Asia such as Indonesia’s are generally unprepared for the vast changes to come,
which will have wide social, economic and health consequences. The rapid
demographic transition taking place, i.e. lower fertility rates therefore fewer
births and increasing life expectancy, will shape the economic directions of
developing countries. Health and wellbeing of the elderly were not major
priority areas of the Indonesian government’s policies as they represented a
small percentage of the country’s demographic. The major issues that will have
an impact on the care and wellbeing of the elderly are the provision of health
services, accessibility to such services and health personnel shortages.

The
aim of this research is to investigate whether the current health policies put
in place by the government of Indonesia are sufficient for its rapidly ageing
population or whether this is an area that the government needs to prioritise. A
literature review identifies the data currently available on population ageing
and the Indonesian government’s current policies on ageing and health. The
paper will then examine if population ageing in Indonesia will lead to more
dependency, illness and disability or whether it will be associated with greater
productivity and longer periods of good health. It will consider Indonesia’s
current challenges and priority policy areas and consider if there should be
more investment in health as opposed to other critical areas. Finally, the
paper provides recommendations for tackling the issue of an ageing population.

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The
government of Indonesia needs to develop policies that can help improve the
health of the elderly, as this portion of the population is more at risk of
poverty. If the government fails to do this, it will be forced to allocate increasing
amount of its budget to social security measures. The importance of acting now
in meeting the social, economic and health needs of its ageing population is
clear, as this paper posits that population ageing in Indonesia will lead to
more dependency, illness and disability. This is not an area that the
government is currently prioritising due to its focus on poverty reduction and
economic growth.

Background

The
increase in average life expectancy during the 20th century is ranked as one of
society’s greatest achievements. The World Health Organisation (WHO) uses the
chronological age of 65 years as a definition of an elderly or older person
(WHO, 2005). Although it is a commonly used definition of old age, there is no
general agreement on the age at which a person becomes old. Likewise, the
United Nations does not have a standard criterion, but uses 60 years or above
to refer to older population. For the purpose of this essay, 60 years will be
used to define someone as an older person. The increase in the age of a
population can be described by the Demographic Transition Model, based on the
population trends of two characteristics: fertility rates (births rates) and
death rates. Countries that are burdened by an ageing population are usually in
stage 4 or 5 of this transition model. Fertility rates have declined through
population policies such as family planning, better education, economic
prosperity and the changing status of women. People are living longer as they
have more wealth than before, advances in healthcare and a better diet. The
consequences of an ageing population can be both positive and negative for a
country.  The impact on a country ranges
from increased government spending for services such as medical care and care
homes for the elderly, to less tax revenue for the government. Concerns over
these trends has led to discourses on the most effective policies to reverse or
mitigate the consequences of ageing, such as reforming health and social
policies to ameliorate these negative consequences. 

Ageing
is a natural process and whilst there is no deterministic relationship, it is
generally associated with morbidity and disability.  Not only should the health system be prepared
for it, but also society in general. Old age is not something to be fixed in
hospitals or care homes, although medical care is required. Pensions are
crucial for providing income support in old age, and well-funded pensions
systems are a challenge. In developing countries coverage of pensions tends to
be low because of informality in the labour market. Yet, although money is
needed, old age policy is not fundamentally about money. Elderly populations
need companionship, and meaningful activities in which to occupy their time.
This requires social organization, arrangements for families, and services.

Demographics

Ageing
and the challenges associate with age were once the domain of the developed
countries but are now becoming a hard reality for developing and underdeveloped
countries. Indonesia is among those countries in East Asia and the Pacific that
are rapidly ageing. It is located between the Indian and Pacific oceans and
administratively divided between 34 provinces. As of 2015, the estimated
population is approximately 255 million inhabitants, with the rate of
population growth slowing down. The population density of the country is not
equally distributed, with the island of Java being the most densely populated
area and the province of West Papua being sparsely populated. According to data
from the Indonesian Ministry of Health, in 2015 there were 21,685,326 elderly
population (over 60 years) equating to 8.5% of the population, including 8
million high risk older people (over 70 years). The numbers of the elderly
population is expected to grow to 48.3 million by 2025, and 80 million by 2050,
(roughly equivalent to 26% of the population). Even before these increases,
Indonesia has one of the largest populations of elderly in the developing
world. The province of East Java is ageing rapidly in comparison to other
provinces due to its success in reducing the fertility rates, with increment of
older persons being 24.2% above the increment total population.   

 Life
expectancy at birth in the country has increased from 45 years in the 1970s to 71
years in 2015, with 69.2 for males and 73 for females. At the same time,
fertility rates have declined from 5.47 births per woman in 1970 to 2.44 in
2015, leading to a rapidly expanding ageing population. At the same time
Indonesia has made progress on reducing poverty but still many remain poor and
vulnerable in the cycle of poverty. Approximately 32.5 million Indonesians
currently live below the poverty line and the country is ranked 113 out of 187
countries on the United Nations Human Developmental Index in 2015, meaning that
the country is below the regional average when compared to countries in East
Asia and the Pacific. Only 25% of the older population receive some sort of old
age pension, whereas the other 75% who work in the non-formal sector have no
form of state pension. Older women are particularly vulnerable as they have
less access to education, lower earnings and are subjected to discrimination
and exclusion from decision-making processes within households and communities.
Rural areas are at a particular disadvantage, with population ageing varying
among different provinces of the country due to variations in fertility and
rising life expectancy. Approximately half of the population of the country
live in rural areas, where agriculture is the main source of income. Millions
of farmers are unable to benefit from the country’s broader economic growth as
they are often geographically isolated.

 According
to the World Bank (WB) the lifestyle choices of Indonesian people are ‘risky’,
as the country has high smoking rates and very low cigarette prices. The
country currently faces a triple burden of disease, that being nutrition,
degenerative and infections, the burden is increasing as a result health costs
will also increase. The economic growth is lagging behind the rapid increase in
the population of the elderly, meaning resources that can be achieved from a
better economic productivity will become limited and ageing will be given a
lower priority. The education of the present elderly population lags far behind
the rest of the population. 1.2% of the elderly population having a university
degree, 6.2% high school diploma, 28% with some basic schooling, whilst the
rest are without and formal education. In 2010 more than 50% of the older
population were still employed, and only 22.5% for those aged 80 years or above
were providing for themselves and their families. They are forced to do so out
of necessity, given that they receive no pension and only a tiny portion of the
society receiving low level of welfare support from the state, because majority
are employed in the informal sector. Similar to other developing countries the
incidence of poverty is high among older persons and increases with age.

Data
from the Ministry of Social Affairs of Indonesia state that 10.5 million
elderly individuals are currently living a productive life whilst approximately
3 million are neglected another 4.7 million being vulnerable to neglect.
Physical issues including a decline in mobility, senses, increase in
degenerative diseases that accompanies the ageing process and increased risk of
dementia. On the economic side they are at risk of poverty and decline of
productivity. Social challenges are neglect, loneliness, limited social interaction
and increased dependency. Law related challenges that affect the elderly
population include being victims of violence and fraud. 

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