We see health services expanding in Sri Lanka. These services range from new hospitals and diagnostic laboratories to home nursing, home medical calls and marketing of specialised devices for invalid care such as wheel chairs and walking frames. The expansion was not limited to Colombo alone, but is visible in other urban centres, for example, Kandy, Galle and Kurunegala. What does this signify? 

It signifies that the demand for health care, particularly for the elderly, has been rising, because Sri Lanka’s population is aging. The Consumer Finances and Socio Economic Survey (CFS) series of the Central Bank of Sri Lanka (CBSL) recorded that from 1963 to 2003/04, the share of children under 14 years fell from 40% to 24% and of those over 55 years doubled from 7% to 14%. Hence, the working age population share rose from 53% to 62%, while the population nearly doubled from 10.6 million to 19.3 million, during those 40 years. 

What does this mean for those of us who will be around in Sri Lanka for the next 20-50 years? 

How will Sri Lanka’s population change in our lifetime? 

“A Population Projection of Sri Lanka for the New Millennium” by Prof. W. I de Silva (2007), has projected that the share of working age population (defined as 15-59 years) is peaking now at around 65%. The publication provides standard, as well as high and low, population projections. Using standard projections, it estimates that the share of children will decline for the next 20 years and stabilise at around 15%, while the share of elderly will increase and stabilise at a third of the population in about 60 years. Hence, the working age population is projected to decline, then stabilise at just over half the population during that period. Meanwhile, the population, currently 20 million, is expected to peak at around 22 million in 20 years and decline slowly thereafter. In the 2001 Census, life expectancies at birth for men and women were 71 and 76 years, respectively, while the sex ratio was 98 men to 100 women. Life expectancy and sex ratio are projected to further favour women. 
What are the key reasons for these changes? 

First, Sri Lanka had an impressive record of preventive and curative health care since independence. Second, rising education levels have raised awareness about contraceptive methods, births supervised by skilled health personnel and infant immunisation, and also provided employment opportunities for women, thereby raising their age at marriage. Consequently, fertility rates (number. of live births per woman) and infant and child mortality rates have fallen, and, in turn reduced birth and death rates, and life expectancy has increased. Hence, the population is aging. Globally, life expectancy and sex ratios favour women. In Sri Lanka, more men than women have been lost to the country due to the civil conflict, accidents and permanent migration, further exacerbating these differences. 

How will these changes affect the country? 

As time goes on, the demand for resources – both goods and services - used by the young will dwindle and be replaced by demands of the old. This transition requires changes to infrastructure and goods and services that bring new opportunities. Some examples follow. 

Health Services 

The demand for midwives, maternal and child health clinics, maternity wards, obstetricians and pediatricians will decline as the numbers children fall. At the same time, the demand will rise for nursing care for the elderly, specialists in geriatric care - mental diseases that manifest with age, such as Alzheimer’s disease, dementia and Parkinson’s disease, and surgical procedures such as hip, knee replacements that increase with onset of age. This demand fuels expansion of health insurance schemes, as safeguards against health expenditure as people age after they no longer earn. Already, considerable new private investment in 24 hour home nursing services, marketing of products for elderly invalid care and new health insurance schemes is rising. According to the CBSL Annual Report 2007, in the last 10 years, the number of hospitals had increased from 550 to 619, while the number of Western medical doctors had doubled from 5,612 to 11,442 and Ayurvedic doctors from 15,359 to 18,651. 

Education Services 

Recently, we have seen significant expansion in private educational services from pre-school to tertiary level vocational training and academic institutions in Sri Lanka. Advertisements in luminous colours for private tuition classes catering to students sitting public examinations adorn walls and posts along main roads in every large city. The CFS 2003/04 recorded that 50% of school going children attended tuition classes- 42% in primary, 54% in secondary and 70% in post secondary. Even in the poorest 20% of households, 29% attended tuition classes. This structure will change as the child population falls and day care centres, pre- and primary schools, and later, secondary schools, will decline over time. Meanwhile the demand for tertiary education services will rise, as older workers seek new training to move to new employment opportunities. Also, as the workforce shrinks and ages, innovative new training opportunities will arise to raise worker productivity. Library services, adult learning centres, refresher courses, and distance learning programmes would expand to new dimensions. 

Employment 

The work environment will also face change. As the 15-59 age group shrinks and people live longer, it may become necessary to raise the retirement age. Else, saving for longer retirement periods will create problems Also, due to gender differences in aging, women may move into male dominated professions. The government has to address these issues, together with the private sector, towards timely policy reforms. 

Leisure Activities 

The pattern of leisure activities will also change. For example, parks and playgrounds that cater to youth may need to evolve into elderly-friendly meeting places. In Beijing, some years ago, early one morning, I visited a beautiful park in the city centre with my hosts. As we walked around, we were fascinated by different groups of adults practicing Tai Chi and other forms of exercise. In one corner of the park, music was playing for a group of elderly couples who were twirling and whirling expertly, to waltzes and tangos. By the dance floor, vendors were selling take-away breakfast foods laid out on trestle tables. Hanging on the lower branches of surrounding trees were cages holding pet birds belonging to the dancers, brought on an outing by their owners! Sri Lanka too may need to sponsor such innovative outdoor activities as her population ages. Indoor leisure activities – selection of programmes for radio and television and books for libraries- may change to meet demands of an older population structure. 

Housing Needs 

Housing for the elderly is another area for future investment and business opportunities. In many developed countries such housing projects include related services. I visited an 80 year old friend in Australia, who lives in a retirement complex which included meal plans, transport for routine shopping, leisure activities and medical emergencies. In Sri Lanka, with high migration rates of young professionals and skilled workers, the extended family system that previously supported the elderly is disappearing, already creating such a demand. As the population ages, the demand for such living facilities will expand, while the child-friendly housing market would fall. 

Retirement Benefits 

As life expectancy increases, people will live for many more years after retirement. Hence, they would need to save during their working years to sustain their life styles for longer periods thereafter. Currently, Sri Lanka’s working population is around 8 million. Of this, one million are government employees entitled to pensions. This pension scheme is non-contributory. With government expenditure currently running at nearly double revenue, the government has to effectively borrow to meet its pension payments. Hence, the sustainability of such a scheme is questionable in the long term. In 2007, the Employee’s Provident Fund had around 2 million active accounts. Other approved provident funds serve another small share of the workforce. Hence, today, formal retirement benefits are available to 3-4 million workers, less than half the country’s work force, some of which are unsustainable in the long run. The majority do not have any mandatory superannuation benefits, providing a critically important business opportunity. The newspapers conveyed recently that the National Savings Bank launched a contributory savings scheme to meet this need. This is commendable. We hope that others will also take the initiative to market more schemes that would provide superannuation benefits to workers. 

In summary, policy makers, businesses and individual should already be planning for the infrastructure needs and other requirements of significant population changes that will take place in the next 2 decades. Else, we will be ill-equipped to enjoy our old age. 

More Information on World Elder Rights Issues