Page 36 - IJPS-4-2

Living longer in India: Better or worse?

2004, older men and older rural persons in India experienced increases in life expectancy without mobility limitation, a
reduction or no change in life expectancy with mobility limitation, as well as a reduction in the proportion of remaining
life with mobility limitation. These changes were mostly statistically significant, thus strongly suggesting a compression
of morbidity among these sub-groups of older persons. From 1995–1996 to 2004, older women and older urban persons
likewise experienced increases in life expectancy without mobility limitation. However, they also experienced increases
in life expectancy with mobility limitation and in the proportion of remaining life with mobility limitation. It is important
to point out that these changes, especially those for the proportion of remaining life with mobility limitation, were not
consistently statistically significant. Thus, while they are suggestive, they are not conclusive of, an expansion of morbidity
among older women and older urban persons in India.
There could be several reasons for the observed urban-rural difference. One reason could be that Indian urban areas,
driven by developmental and industrial objectives, have been expanding in an unplanned manner. This has resulted in
unhealthy residential areas (Bentinck and Chikara, 2001) and restricted opportunities for older persons to move freely
outside their homes. In a recent study from India (United Nations Population Fund, 2012), concern for safety was an
important reason for older people not leaving their homes; and the proportion of older people citing this reason was higher
in urban than rural areas. Another possible reason is that from the 1990s to 2000s there has been a greater increase in the
concentration of sicker, less mobile older persons in urban areas than in rural areas, and there has been an increase in the
movement of such older persons from rural to urban areas in search of health and medical care. While there is no direct
data to support this conjecture, there is some indirect support through numbers portraying a greater increase in the older
population and in medical care infrastructure in urban, versus rural, India. The increase in India, from 1991 to 2001, in
the proportion of older persons in the urban population (5.8–6.7%) was marginally higher than that in the rural population
(7.1–7.8%) (Chakrabarti and Sarkar, 2011). Concurrently, there was an increase in the population residing in urban slums
(Prakash, 1999), and older people residing in urban slums are more vulnerable to chronic diseases than their counterparts
in other urban areas (Anand, Shah, Yadav et al., 2007). Greater availability of medical services, especially specialist
services, in urban areas may be contributing to the growth in the older urban population (Chakrabarti and Sarkar, 2011).
While there was a considerable expansion in medical care infrastructure in India from 1991 to 2001, the expansion was
greater in urban than in rural areas. For example, growth from 1991 to 2001 in hospitals, hospital beds, and doctors per
100,000 people, was 43%, 28%, and 27%, respectively, in urban areas compared to 37%, 19%, and 23%, respectively,
in rural areas (Bhatia, 2013). The greater availability in urban versus rural areas of advanced medical care may have led
to sicker, less mobile older people remaining alive for longer in urban than in rural areas, contributing to the observed
increase in absolute and relative life expectancy with mobility limitation in older urban persons.
At the same time, it appears that in rural India the increase in medical care infrastructure (as stated above) as well as
in primary health-care facilities (the number of functioning sub-centers and primary health centers, specific to rural India,
increased by 6.6% and 1%, respectively, from 1991 to 2001) (Ministry of Health and Family Welfare, 2005) has been
beneficial, as indicated by the compression of morbidity seen among older rural persons in our study.
Similar to our study, previous studies, though not from India, have also documented the expansion of morbidity
(using different “health” indicators) among older women (Tu and Chen, 1994, Gu, Dupre, Wamer et al., 2009). It has
been suggested that with the progression of the epidemiologic transition, life span increases and the survival gap favoring
women over men have led to women being at a higher risk of becoming disabled at older ages and of spending a greater
time of their remaining life with disability (Myers, Lamb, and Agree, 2003). This may very well explain our finding. The
potential reasons for the gender differences in life expectancy and life expectancy with a disability could be that women
tend to have more non-life-threatening but disabling conditions, whereas men have a higher prevalence of life-threatening
conditions (Case and Paxson, 2005). Previous studies have also found that women are more likely to experience a decline
in functional status and are less likely to recover than men (Becket, Brock, Lemke et al., 1996). Thereby, women may
simply accumulate more disability throughout the life course (Laditka and Laditka, 2002).
In India, it is well known that gender disparities in health (in infancy, childhood, and adulthood) favor men (Pande and
Yazbeck, 2003, Tiwari, 2013). Our study points to the continuation of the gender disparity well into old age, as reflected
in the gender disparity in absolute and relative life expectancy without mobility limitation favoring older men. Our study
confirms the existence of the gender gap in health and mortality, generally termed “the male-female health-survival
paradox,” as observed elsewhere (Oksuzyan, Brønnum-Hansen, Jeune et al., 2010; Van Oyen, Nusselder, Jagger et al.,
2013), wherein women live longer than men but spend a larger proportion of their life with a disability.
Certain limitations of this study must be acknowledged. First, our study focuses on the decade from 1995–1996 to
2004, and not thereafter. Other than the data available through the NSS, there is a lack of national-level data on older
Indians collected through either repeated cross-sectional or longitudinal/panel surveys. Recent data collection efforts, such

30 International Journal of Population Studies | 2018, Volume 4, Issue 2