Ageing with Dignity: Public Policy, Intergenerational Equity, and the Political Economy of Elder Care in India | Aneesh K A, Mishthi Chanana and Arya Joshi

Population ageing is emerging as a significant demographic and policy challenge worldwide, affecting both developed and developing economies (United Nations, 2023). Older people constitute a notable yet under-recognised repository of social and experiential capital. Yet, this population often stands among the most vulnerable, facing conjoined challenges of health access, social exclusion, and legal protection.

The psychosocial implications of ageing can be interpreted through Erik Erikson’s theory (Erikson, 1950; Erikson, 1982), which suggests that the final stage of life brings a profound psychological reckoning, a stage marked by the search for meaning, integrity, and continuity that holds the potential to enrich not only individuals, but societies at large. During middle adulthood, the central challenge lies in the balance between generativity and stagnation, where one either contributes to future generations or remains self-absorbed. In late adulthood, the stage of integrity versus despair emerges, a period when elders reflect on their lives, finding meaning, dignity, and peace, or bitterness and regret. The implications extend beyond the individual to social reproduction and institutional continuity in an economy.

Ageing is not merely a biological decline; rather, it is a psychological, economic, and social journey. It is shaped by the systems around us. The longer people live, the sharper the question becomes: are we enabling elders to age with dignity, or leaving them to age under conditions of insecurity, dependence, and subservience?

Ageing and the Political Economy of Care

We are encouraged to go beyond ageing stereotypes, recognising older persons as active economic and social agents rather than passive receivers. The aspirations of an individual do not vanish with age, but their realisation is critically based on socio-economic supports and institutional access. Older populations seek relevance, health, and dignity, but whether those aspirations are realised depends heavily on public economics, legal frameworks, and cultural attitudes. The objective measure of progress lies not in rising life expectancy alone, but in whether societies convert those years into lives of meaning and contribution.

Globally, a rise in longevity exhibits a key demographic triumph. Life expectancy has risen dramatically, climbing from around 45 years in 1950 to approximately 73 years today (Ritchie & Roser, 2023). Several high-income countries have invested in institutional arrangements to support ageing populations; the welfare states in Scandinavia, universal pensions in parts of Europe, and Japan’s so-called Silver Economy are some notable examples (OECD, 2021). Age-friendly infrastructure, digital inclusion, and lifelong learning programs provide pathways to keep the elderly population active and engaged. Such societies tend toward integrity, where older generations serve as mentors, knowledge holders, and agents of resilience.

However, in much of the Global South, the picture is starkly different (United Nations, 2023). Development ironies abound: nations still struggling with poverty and low per capita income are simultaneously confronting rapid demographic transitions. Although social security institutions are limited and underdeveloped, fertility rates are declining as literacy levels increase. Pension coverage is narrow primarily, healthcare costs are pressing, and the migration of younger generations leaves parents isolated. The result is a weakening of intergenerational support mechanisms, with a steep increase in vulnerability in old age. There is no generativity but stagnation, not integrity but despair. In regions where structural protections are fragile, elders are left dependent on family support that is itself inconsistent.

Intergenerational Equity in Transition

India sits at the heart of this global paradox. The population aged 60 and above is projected to reach approximately 347 million by 2050 (UNFPA India, 2023). It is therefore ageing faster than its institutions can adapt. The traditional reverence for elders embedded in cultural rituals, oral storytelling, and joint family living has unfortunately not translated into robust systems for elder care. Economic insecurity continues to define old age for millions even today. Less than one-third of elderly adults have access to formal pensions, and state allowances are often insufficient even for subsistence living (World Bank, 2022). Healthcare inflation has consistently surpassed general inflation. The insurance remains unaffordable or widely inaccessible. Out-of-pocket spending on medical care routinely devastates household finances (National Health Accounts, 2022). For many elders, dependence on their children is not a choice but a necessity, and with migration reshaping families, even that dependence is precarious and fraught with uncertainty. The Maintenance and Welfare of Parents and Senior Citizens Act (Government of India, 2007) recognises the family responsibility and compels children to support their parents, yet enforcement is inconsistent. It does not substitute for a comprehensive social security provision. Elders often lack the awareness or means to claim their rights. Shelters and homes exist, but they remain stigmatized, underfunded, and far too few.

These conditions are associated with rising levels of loneliness, depression, and anxiety among older adults. Dementia and Alzheimer’s disease are emerging as serious public health challenges, but specialised mental health services remain scarce. The COVID-19 pandemic revealed these structural vulnerabilities, as elders faced abandonment and systemic neglect. Gender further intensifies inequalities in later life weaknesses (World Health Organization, 2020 and 2021). The feminisation of ageing reflects that women live longer but with fewer resources, lower literacy, and a higher likelihood of widowhood (UNFPA India, 2023). In rural India especially, older women endure the compounded burdens of poverty, social invisibility, and care responsibilities for grandchildren. Cumulative disadvantages in education, employment, and asset ownership contribute to and compound socio-economic dependence in old age. The irony is that these same women, across decades, were the backbone of households and communities.

Public Policy and Institutional Gaps

Yet, amidst this fragility, there are seeds of integrity. Community-driven elder clubs provide companionship, activity, and solidarity. Senior citizen associations provide stronger protections and create support networks. The digital literacy initiatives and intergenerational mentorship projects show how older persons can remain active contributors. In villages and towns, elders are stepping up as custodians of sustainable practices, including recycling, seed preservation, and traditional medicine. The practices indicate the continued productivity and social contributions of older populations. Their accumulated knowledge in farming, crafts, and community governance carries a form of immeasurable social and economic value that is rarely encapsulated in formal accounting.
Public Economics offers a critical perspective; treating eldercare solely as a fiscal burden is analytically incomplete. Instead, in reality, it is an investment with significant multiplier effects (HelpAge International, 2020). Pensions and social transfers stimulate local economies, particularly in rural areas, where elders spend their funds on essentials. The elderly population provides unpaid caregiving for their grandchildren, which gives young adults an opportunity to pursue work more efficiently. Though neglecting elders can impose significant opportunity costs, including higher hospitalisation rates, weakened intergenerational solidarity, and erosion of social trust. When calculated honestly, the returns to investing in elder dignity are far greater than the expenditures (Bloom et al., 2015).

Beyond economics, the cultural dimension of aging in India presents unique opportunities. The Ayurveda tradition emphasizes preventive care, balance, and longevity. The Gurukul model of lifelong learning positions elders as teachers and mentors, rather than dependents. Spiritual practices embedded in the Vedas emphasised detachment and peace in later life, offering resilience against psychological despair. These traditions can be understood as culturally embedded frameworks that inform attitudes towards aging and care. Policymakers can draw from them to design culturally resonant health programs, intergenerational education models, and sustainable ageing frameworks. As climate change intensifies, elders are also key custodians of sustainable practices, including water conservation, herbal medicine, and circular lifestyles, which modern economies urgently need.

Integrity versus despair can thus be read not only as a psychological state but also a reflection of policy assortments. Nations that invest in dignity through pensions, healthcare, infrastructure, and cultural respect enable integrity. Nations that fail leave their elders in despair. This lens is also a moral test of how societies treat their oldest members as a measure of their civic and ethical health. A nation that ensures integrity in old age strengthens intergenerational harmony, resilience, and credibility.

Ageing with Dignity: The Way Forward

India stands at a decisive moment. It can continue treating elders as afterthoughts in policy design, or reimagine them as active participants in building the future. The nation-building strategies for the elderly population emphasize the importance of current and forward-looking policies, such as raising the marriage age to promote women’s education, strengthening healthcare access, expanding social protection, combating age discrimination in both formal and informal sectors, and investing in inclusive infrastructure. A need also arises to design an Indian Ageing Survey, which will help policymakers collect granular data on rural versus urban elders, economic vulnerabilities, and the psychological toll of ageing, thereby creating evidence-based pathways rather than broad generalisations. Such a tool would make older persons visible in policy, which is the first step to dignity.

Population ageing raises fundamental questions about the capacity of the welfare systems, labour markets, and social institutions to sustain dignity in later life. Older persons should be understood beyond being passive recipients of care and beneficiaries of support to being agents of action, contributing wisdom to the social and economic life. As demographic aging accelerates in India, it confronts the dual realities of rapid ageing and fragile systems. One truth stands out: the future of ageing is not only about the old, but about everyone. Ensuring integrity in old age means ensuring dignity for all generations to come. The conditions under which populations age will ultimately reflect the capacity of societies to uphold intergenerational equity, social protection, and the credibility of public institutions.

References

• Bloom, D. E., Canning, D., & Fink, G. (2015). Implications of population ageing for economic growth. Oxford Review of Economic Policy, 26(4), 583–612.
• Erikson, E. H. (1950). Childhood and society. W. W. Norton.
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• Government of India. (2007). The Maintenance and Welfare of Parents and Senior Citizens Act, 2007. Ministry of Law and Justice.
• HelpAge International. (2020). Social pensions database. HelpAge International.
• National Health Accounts. (2022). National health accounts estimates for India (2018–19). Ministry of Health and Family Welfare, Government of India.
• OECD. (2021). Pensions at a glance 2021: OECD and G20 indicators. OECD Publishing.
• Ritchie, H., & Roser, M. (2023). Life expectancy. Our World in Data.
• UNFPA India. (2023). India ageing report 2023: Caring for our elders. United Nations Population Fund.
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• World Bank. (2022). World development indicators: Social protection coverage. World Bank.
• World Health Organization. (2020). COVID-19 and older people. WHO.
• World Health Organization. (2021). Global status report on the public health response to dementia. WHO.

(Authors:

Arya Joshi is an intern at the Centre for Studies in Population and Development (CSPD), CHRIST (Deemed to be University), Delhi NCR Campus. Email ID: arya.joshi[at]bapecoh.christuniversity.in )