During this event, we shared the findings from our policy publication on what we think should be the priorities for the G20 in India and the key messages we want to disseminate to ministers and world leaders. We heard from experts on the opportunities and challenges to engage India and the G20 with prevention and healthy ageing and identify further opportunities to maximise our engagement while at the G20 in September.

1. Healthy Ageing: Priorities for
the G20 in India

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Welcome Chair: Arun Himawan, Senior Health Research Lead, ILC UK
Introduction to the Healthy Ageing and Prevention Index Arun Himawan, Senior Health Research Lead, ILC UK
ILC UK’s Priorities for the G20 Esther McNamara, Senior Health Policy Lead, ILC UK
Response Anil Patil, Founder, Carers Worldwide
Response Dr Ritu Rana, Mission-Head, Health, HelpAge India
Response Arun Balachandran, Postdoctoral fellow, University of Maryland
Q&A Moderated by Chair
Closing remarks Chair: Arun Himawan, Senior Health Research Lead, ILC UK
Agenda

3. Healthy Ageing and
Prevention Index
Arunima Himawan, Senior Health
Research Lead, ILC-UK
Twitter: @ArunimaHimawan
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4. Despite repeated commitments to prioritise prevention
action continues to lag
But across the OECD alone, countries only spend
on average 2.8% of their health budgets on
prevention.
If we increase preventative health spend by just 0.1
percentage points it could unlock an additional 9% of
spending every year by people aged 60 or over.

5. The Healthy Ageing and Prevention Index
• The Healthy Ageing and Prevention Index is a global Index that holds
governments to account on healthy ageing and prevention.
• The Index measures and ranks 121 countries on six healthy ageing and
prevention indicators including life span, health span, work span, income,
the environment and happiness.
• For the first time, this Index brings together health, wealth and societal metrics
to give us a comprehensive picture of how sustainable countries are in the
context of longer lives, and the extent to which governments are investing in
efforts to prevent ill-health.
• Aside from ranking individual countries on their performance, the Index also
ranks political and/or economic country blocs, such as G20,
EU and OECD.

6. A global perspective on healthy ageing

7. The Healthy
Ageing and Prevention
Index – the G20
• Country(ies) that rank above:
Niger and Rwanda
• Countries that rank below: Central
African Republic
• Countries that hold the same
rank: Namibia

8. ILC at the G20
Esther McNamara, Senior Health Policy
Lead, ILC-UK
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9. Our priorities
• Shifting perceptions
• Investment in prevention
• Reducing inequalities in health
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10. Ageing and the G20
What has been said and done by the G20 in the past?
What opportunities are presented by India’s presidency?
How has ILC UK impacted past G20 summits?
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11. Anil Patil
Founder, Carers Worldwide
Twitter: @CarersWorldwide
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12. Anil Patil| Carers Worldwide | 25th April 2023
Role of family
caregivers in
supporting healthy
ageing

13. WHO ARE UNPAID FAMILY CARERS?
“Carer” means an individual of any age who
cares for or nurses a relative, friend or partner
requiring this help due to physical or mental ill
health, disability, old age, frailty, substance
misuse or any other cause.
In LMIC countries, they are:
• Invisible
• Isolated
• Vulnerable

14. ISSUES AND PROBLEMS FACING FAMILY CARERS
Carers are particularly hard hit in a number
of different ways as a result of their caring
role.
These include:
• loss of employment;
• reduction in earnings;
• loss of education (in the case of
children and young people);
• poor health;
• reduction in social contacts;
• reduction in opportunities to
participate in family and socio-cultural
activities.

15. 6.5+ million Carers in UK
1 in every 8 adults
£193B
saving to UK economy
1.4 Billion
population of India
WORLDWIDE
need
for Carers
400%
increased
12+ million
with severe mental illness
3.7 million
people with dementia
116+ million
people aged 60 & above in 2020
These adults and children
all have carers...
...but just how many?

16. Statistics on Caring
The burden of caring in South Asia
37% anxious/depressed
92% financial worries
43% physical health problems without treatment
NO respite
Socially excluded and isolated
NO education for young carers

17. But there is a crisis in care due to
increased life expectancy,
combined with changing
population structures, for
example, smaller family sizes and
the reduction in extended family
living

18. Statistics on Caring
The burden of caring in South Asia
84% of carers in South Asia
are female with this figure
rising to as high as 97% in
instances of children living
with disabilities

19. Importance of Carers

20. CARERS WORLDWIDE
Carers Worldwide is the only
organisation exclusively and
strategically raising
awareness of the needs of
unpaid family carers in low
and middle income
countries

21. CARERS WORLDWIDE
VISION
Our Vision is a world in which every
carer is valued and their needs are met.
MISSION
Our Mission is to achieve recognition of
the role of carers and to transform the
lives of carers, their families and their
communities.

22. OPERATIONALISING OUR MISSION
We serve as a catalyst to:
• Change attitudes and promote
support for carers
• Inspire systemic change

23. CARERS WORLDWIDE MODEL

24. OUR IMPACT

25. OUR IMPACT
Recognised by
 Rights of Persons with Disabilities
(RPWD) Act 2016
 Mental Health Bill Act 2017
For the first time both ACTs recognises
“Support to Caregivers”
 Caregivers Allowance
 Caring itself is a job under the
Mahatma Gandhi National Rural
Employment Guarantee Act 2005
(MGNREGA)
Systemic Change

26. " It’s like a drop of ink
in a bucket full of
water. You don’t need
a whole bottle of ink
to change the colour."

27. Increasing visibility

28. Call for action
Expand access to
professional caregiving
services for older adults
who do not have family
caregivers
Increase awareness
about the importance
of family caregiving and
provide education and
training to family
caregivers.
Develop policies and
programs that recognise
and support the role of
family caregivers in
providing care to older
adults.
Provide support and
resources to family
caregivers

29. INVEST IN
COMMUNITY CARE
AND SUPPORT AND
RECOGNISE THE
IMPORTANCE OF
INFORMAL CARE AND
THE PEOPLE WHO
PROVIDE IT.

30. IN CONCLUSION…
• To healthcare systems, carers are the unpaid army keeping
everything going.
• To service providers, they are the potential catalysts to therapy
success.
• To doctors, they are the experts-by-experience turning treatment
plans into reality.
• And to patients, they are the indispensable brothers, mothers,
husbands, grandmothers, friends, and neighbours that make each
day possible.

31. THANK YOU FOR
LISTENING
Stay Connected…
Website:
www.carersworldwide.org
Facebook, Instagram,
Twitter, LinkedIn, YouTube:
@CarersWorldwide

32. Dr Ritu Rana
Mission-Head, Health, HelpAge India
Twitter: @RituRahulRana @Helpageindia
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33. Engaging the G20 on Healthy Ageing
Dr. Ritu Rana,
Mission Head –Health
HelpAge India

35. Elderly situation in India
• Estimated elders in India - 138 million
• Number of people over the age of 60 is
expected to double by 2050 (WHO)
• Older people from disadvantaged
backgrounds, with the fewest
opportunities and the fewest resources,
are likely to have the poorest health and
the greatest need

36. India’s elder (60 plus) population: ~14 Crore (2021)
• 50% live below the poverty line in rural areas (SECC 2011)
• 90% work in unorganized sector; lack of adequate social
security/pension
• 60% suffer from health problems; high prevalence of
chronic diseases and disability
• 2 Crore plus destitute widows; feminization of ageing
• 25% face elderly face abuse, often by own kin (HI Elder
Abuse report); affected by loneliness & neglect
Disproportionately affected during Covid19 pandemic –
Livelihoods, Income, Loneliness, Digital Divide
HelpAge Pan India Dipstick Study, June, 2020
The Elderly in India – vulnerable and increasingly marginalized

37. Top Trends in Ageing in India
• Longevity
• Feminization
• Disability
• Health: Morbidity Profile, mental Health and
Dementia, Facility
• Income, Work and Social Security
• Living Arrangements

38. Risk being
LEFT BEHIND
INVISIBLE & LOST
LAST IN LINE

40. How these extra 20
years can be spent
depends on health.
?
People are living longer….

42. Major Health issues in elderly
• NCDs : CVDs, diabetes mellitus and respiratory diseases
contribute to a major share of chronic health conditions
among those aged 45+ as well as elderly
• The prevalence of heart disease, stroke, diabetes mellitus,
chronic lung disease and neurological problems, cancer
• In India, 23% of the elderly have been diagnosed with multi-
morbidity conditions and; elderly women are more likely to
have multi-morbidity conditions.
Mental wellbeing
• In 2015, an estimated 4.1 million persons aged over 60
years had dementia in India. This is estimated to rise to 6.35
million by 2025 and to 13.33 million by 2050
LASI study

43. Issues in access, availability and
affordability
LASI study

45. Arun Balachandran Ph.D.
Postdoctoral fellow, University of Maryland
Twitter: @Arun_balachandr @UofMaryland
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46. Rethinking Population Ageing
in India
Arun Balachandran
Postdoctoral Fellow
University of Maryland College Park
Presented at Healthy ageing: Priorities for the G20 in India,
International Longevity Centre, UK
April 25, 2023

47. Population ageing in India
• Officially the most populous country in the world- 1.4 billion
• 138 million elderly population (60+) today; expected to grow to 315 million in
2050
• 8.6% of total population; around 20% by 2050
• Decadal growth in elderly population in 2011-21 is ~36% (Vs 12.4% for general
population)
• Population ageing is universal- guided by (a) rise in life expectancy and (b)
reduction in fertility; India follows the trend
• India’s LE grew over years; TFR is at replacement level (17 states has below
replacement level)
• Certain states (Kerala, Himachal, Tamilnadu) has higher LE and lower TFR- hence,
more share of population ageing
• Elderly in India has multiple discriminations access to health, jobs, finance,
care, lack of basic income and social security, abuse, denial of property rights,
degradation of intergenerational care, gender issues etc.

48. Differences across the country
• Differentials across sex: India has 67 million male elderly and 71 million
female elderly
• Differentials across region: 3/4th of the Indian elderly live in rural areas; but
Urban area has higher share of elderly within its population
• Differentials across geography: Southern and western states have higher
share of Indian elderly
• Kerala has 16.5% elderly as share of population; Bihar has 7.7%
• “Ruralization” and “feminization” of Indian elderly
• With debates around demographic dividend, population ageing issues are
sometimes considered issues of certain sections of population  this talk
argues that it is a national issue of India

49. Illustrations

50. Population Pyramids - 1950,2015 &2050

51. The issue
• In Rajasthan the rural life expectancy at age 60 is ~3 years longer than urban
life expectancy
• Can a person in rural Rajasthan be considered same as a person in urban Rajasthan?
• Rural female life expectancy at age 60 in Andhra Pradesh is ~5 years more
than a female in rural Chhattisgarh (~19 vs ~14)
• Can a rural person of age 60 in Andhra Pradesh be considered same as a person in rural
Chhattisgarh?
• Can an older person in Kerala (with LE and TFR as high as Western European
countries ) be considered same as that in Bihar (LE and TFR similar to African
countries)
• Increases in life expectancy is guided by improvements in health, healthcare
utilization, and social development
• Urban-rural LE has widened post the pandemic

52. Concept of ‘Age’
• Overtime life expectancy at birth and at different ages has
increased across India
• A 60 year old Indian has nearly more than double the remaining life
expectancy today than an Indian in 1950
• In 1950, at age 55, Indian population had 15 more expected life years
• In 2015, at age 65, Indian population had 15 more expected life years
• Is age 65 the new 55?
• However, concepts of ‘old-age’ has remained stagnant; and is
based on a fixed old-age ‘threshold’ such as age 60.
• Our work improves existing measures and formulates new
measures for population ageing across the globe

53. Prospective Age approach
• Proposed by Sanderson and Scherbov (2005, 2013, 2016). “Re-defines”
the concept of ‘old-age’
• A person has simultaneously 2 ages: Chronological age (retrospective)
and prospective age; Gives holistic idea on ageing
• Prospective age looks at how many birthdays are expected for a person
• Prospective old-age threshold looks ageing as a start of a certain
remaining life expectancy
• It is the age at which remaining life expectancy is 15 (according to S&S;
we have improved this)
• Borrowed from the concept in economics: economics between values
measured in current prices (nominal values) and those adjusted
for inflation (real values)- A person can have 2 ages: nominal and real

54. Comparative Prospective Age approach
• We have improved this methodology in Balachandran et al. (2020,
2021) & Balachandran and James (2019, 2022)
• Old-age threshold was based in the context of advanced countries.
We adjust adult survival probabilities to reach higher ages, and
include not just life expectancy, but cognition, education and
health into the calculations
• Borrowed from the concept in economics: economics between
values of currencies across countries. One dollar is not same as
one rupee, just as 65 is not same across countries. Thus, a person
can have 2 ages: nominal and real (adjusted)

55. Advantages
1. Accommodates the improvements in life expectancy of a
population into calculation of ‘old-age threshold’
2. A dynamic old-age threshold that changes with time
3. A life-course perspective to understand ‘old-age’
4. Recognizes the differences in the advent of ‘old-age’ across
populations
5. Sees population ageing as a new ‘beginning’ of certain phase of life
than as a “burden”
6. A new way to think on population ageing and a supplement to
existing measures

56. Trends in different Old-Age ‘Threshold’ for India
 With increase in life expectancy, old-age threshold increases
 A dynamic old-age threshold
Year Traditional Old-Age
threshold (60+)
Prospective Old-Age
threshold (POAT)
1978 60 60
1983 60 61
1988 60 61
1993 60 62
1998 60 63
2003 60 64
2008 60 64
2013 60 65
2016 60 65

57. Counterfactual-Age at which different states have the same remaining
life expectancy as the standard population’s life expectancy at age 65
53
55
57
59
61
63
65
Calculations using female aged 65 in Kerala was the standard population
Data Source: SRS

58. Rural-Urban differentials
Calculations using female aged 65 in Kerala was the standard population
Data Source: SRS
50.0
52.0
54.0
56.0
58.0
60.0
62.0
64.0
India Rural Urban
Old-age thresholds for India
Total Male Female

59. Social group differentials
54
55
56
57
58
59
60
SC ST M OBC HC
Old-age threshold across social-groups in rural area
Calculations using life table by social groups data generated by Vyas et al., 2022

60. Scope & extension
• Gender differences- Balachandran and James (Ageing and Society,
2022)
• Region specific RLE- Balachandran et al. (Journal of Aging and Health,
2019)
• Multi-dimensional approach- Balachandran and James (SSM-Population
Health, 2019)
• Projections of future ageing scenarios by levels of education-
Balachandran et al., 2020
• Understanding across states, regions, gender, education and
socioeconomic status
• Health adjusted life expectancy can also be used

61. Conclusions
• Population ageing is not homogenous across populations
• India is several countries within a country
• Certain section of the population in India “reach old age” earlier in their
life course (Rural, Northern states, Males, vulnerable social class etc.)
• If these differences across life course are considered, population ageing
in India is a concern for all regions and sections – rural and urban, male
and female, upper and lower social groups, north and southern states
• In short, a life course and health based approach to understanding
population ageing argues that population ageing is a “national” issue of
India

62. Implications
• Implications are not just limited to labor market and pensions
• An investment in health care system is called for; both short & long term
focusing both old and early old, particularly across vulnerable areas & social
groups
• Health care workers and informal care givers (and family members) should be
trained to deal with complex and provided with life-course perspective of
diseases and disabilities
• Government schemes should be sensitive to differentials in healthy ageing
across life course improve &expand old-age benefits below age 60 for
lagging sections of the population
• An expansion of preventive healthcare policies & Universal healthcare for
elderly recommended

63. Q&A
Please submit your questions using the
Q&A feature.
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64. Closing remarks
Arun Himawan, Senior Health Research
Lead, ILC-UK
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65. Upcoming events
G7 high-level side
events in Japan:
Healthy ageing and
prevention
10 May - Niigata
18 May - Hiroshima
Global launch of the
Healthy Ageing and
Prevention Index - 76th
World Health Assembly
Geneva, Switzerland
Tuesday 23 May

66. Thank you
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