SINGAPORE: Frailty and health among the elderly in Myanmar have been some of the poorest in Southeast Asia.
According to United Nations estimates, the average number of additional years that men and women aged 60 in Myanmar can expect to live is 16.7 years, compared to 21.4 years in Thailand and 25.1 years in Singapore.
Although currently improving, health services during decades of earlier military rule were among the most underfunded and poorly developed in the region.
According to the World Health Organisation, the Myanmar government spends 2.3 per cent of its GDP on health – nearly half of what Southeast Asia as a region spends. Shortages of health personnel and infrastructure are also evident.
It is thus not surprising that the Myanmar Aging Survey last conducted in 2012 - the first national survey of its kind - showed that only 33 per cent of people aged 60 and above in Myanmar reported being in good health, compared to 45 per cent in neighbouring Thailand.
Physical difficulties among the elderly in Myanmar are prevalent. Over 50 per cent of those aged 60 and above reported one or more functional limitations, which includes difficulties in walking up and down stairs, crouching and lifting 5kg, compared to only 35 per cent in Thailand.
Such physical difficulties increase progressively with age. Nearly 40 per cent of those aged 60 and above reported at least one physical difficulty. This number increases to 90 per cent among those aged 80 and older, suggesting that long-term care needs will become more acute the older the Myanmar population gets.
FAMILIES A SOURCE OF HELP
Yet, the situation is not as dire as the figures on ageing and mobility suggest. At present, most seniors with physical difficulties in Myanmar receive assistance in carrying out daily activities from family members.
Living arrangements, particularly living with adult children, is an important avenue of support for them. More than three quarters of seniors in Myanmar live with their children, so many are likely to receive help with daily living activities if and when they need it.
And fortunately for the country, there is little evidence of such co-living arrangements declining, unlike elsewhere in Southeast Asia.
Family networks are strong, when it comes to caring for the elderly. Nearly all care recipients in the national survey reported receiving help with daily activities primarily from an immediate family member.
Spouses and children make up the bulk of caregivers who provide support to the elderly. Women play a huge role. Daughters represent almost half of all primary caregivers, and spouses, primarily wives, form another one-fourth.
A strong family unit has been the building block of Myanmar society. It is widely accepted and expected that children take care of their parents in old age. Ageing parents who stay with their adult children also care for their grandchildren. Older grandchildren in turn, may provide care for their grandparents.
It is still very rare in Myanmar that care for seniors is outsourced to non-family members. Instances of this role being outsourced to domestic workers, friends or neighbours are few and far in between.
But poverty can take a huge toil on the elderly, with those in the poorest households barely scraping by. Unmet need for care as well as inadequate care for seniors are higher at lower levels of household wealth.
While Myanmar’s rapid economic development in recent years is reducing poverty and improving the livelihoods and living standards of some people, this change has also put a spotlight on social inequality, as evidenced in unmet needs in long-term care among the elderly poor.
Given mounting concerns regarding health disparities among Myanmar’s population, this pattern of inequality clearly needs to be recognised and addressed.
Attention is needed now rather than later given that reduced family size and increased migration and urbanisation pose additional challenges for the frail elderly in the coming decades.
LONG-TERM CARE PROGRAMMES FOR ELDERLY NEEDED
The proportion of elderly aged 60 and older remain under 10 per cent in Myanmar. Yet, as elsewhere in the region, an ageing population can pose huge challenges and strain a budding healthcare system. Communities and the state can play an important role to fill in the gap.
The World Bank strongly recommends that countries in Asia-Pacific adopt systematic long-term care programmes early, before the number of frail elderly becomes too large.
Evidence from the Myanmar Ageing Survey is particularly relevant given that Myanmar policy makers are currently formulating policies and action plans to address population aging and its implications for the economy, health system and society.
So far Myanmar’s welfare and health systems have done little to address the long-term care needs of the increasing number of seniors, thus leaving families to cope on their own.
Nevertheless, the government is keen to invest in social protection programmes directed to the most vulnerable in society. In doing so, it is important that these social protection policies include not only the impoverished but also frail seniors who need long-term care.
Particularly promising is community-based care through trained volunteers recruited by older person self-help groups formed in the country.
Promoted by the Ministry of Social Welfare, Relief and Resettlement in collaboration with a non-government organisation HelpAge International, the programme, however, presently remains at a nascent stage, covering less than 1 per cent of Myanmar’s senior population.
In the context of Myanmar, it is important that the practice of traditional family-based and newly developed community-based care are reinforced.
These have shown to be effective existing structures, which should be strengthened and not replaced.
Bussarawan Teerawichitchainan is Associate Professor of Sociology and Associate Dean for Research and Programme Development at School of Social Sciences, Singapore Management University. John Knodel is Professor Emeritus at Population Studies Centre at the University of Michigan. This commentary is based on findings from the authors’ research article to appear in the Journal of Cross-Cultural Gerontology.