In Bangladesh poverty remains widespread about one third of the population living with an income less than one dollar a day. Bangladesh's cultural traditions have resulted in a strong extended family system upon which older people have traditionally relied for their support and care. However, the traditional form of family support for older people has been weakening due to formation of more and more nuclear families. The decline in the ability of families to provide in-home care will decrease because of poverty.

In the context of Bangladesh where the majority of older people live in absolute poverty after a lifetime of deprivation, old age is likely to mean ill health, social isolation and poverty. Most of the older women are widows and are most vulnerable in society. Many older women, an estimated 42 percent over the age of 60 years, are widow and rely on relatives and neighbours for their livelihood.

The trend in the size and growth rate of the elderly population in Bangladesh reveals that aging will become a major social challenge in the future when a considerable resources will need to be directed towards the support, care and treatment of the elderly population. Although children and other close relatives not living in the household can provide strong support, but rapid out-migration coupled with poverty can morally disrupt the fabric of intergenerational caring and reciprocity.

Population aging will also place an increasing burden on national health care systems. Whatever the level of economic development, it presents challenges in financing and delivering healthcare. The increase in life expectancy offers new opportunities but it also creates challenges for the future. As people live longer, there is a growing demand for care related to conditions such as cardiovascular disease, cancer, chronic obstructive pulmonary disease, arthritis, vision impairment and disability.

The old age support and care, which can be provided by the family, may be simplified into three categories: physical, social and economic. Physical support is required only when the elderly person is ill and/or too frail and weak to attend him or herself. Economic support from Boisko Bhata scheme covers only a very small proportion of the elderly population, and mainly those living in rural areas. This is why most elderly persons depend on the family support. The care and support provided to parents are usually in the form of shared housing, food and other necessities and less often in the form of direct transfer of income.

Health care system at various tiers up to upazila level is designed for the general population and is traditionally focused on mothers with children under five and women in the childbearing ages. However, the utilisation of these facilities is very low. Until now, the needs of the elderly people have not been considered to be a major issue in Bangladesh. The country has neither separate health care provision nor infrastructure for elderly population. There is only one non-government organisation (Bangladesh Association of the Aged and Institute of Geriatric Medicine) in the country that explicitly addresses the health problems for this particular section of the population on a limited scale in Dhaka city only.

One of the major financial burdens facing the family is related to health care. The increased longevity of the population means health problems of the elderly are likely to grow as well. In the past, the elderly were not considered a specifically vulnerable group because of their proportion and absolute number were not large enough to consider special measures for providing medical care for aging. The current statistics suggests that there is an immediate need to look after increased number of elderly population through existing health care facilities. Old age diseases are demanding diagnostic equipment, long duration of hospitalisation, treatment and rehabilitation. This would pose new challenges for our existing health system.

National policies need to incorporate the issue of aging and appropriate support mechanisms for older people into the mainstream of their social, economic and health planning. Policies for employment, health, transport and social care should take account of the needs of the elderly population. In the rural areas, the problems of health care for the elderly are even worse. Those who visit health centers encounter typically very long queues, and providers rarely had time for detailed examinations. Reducing queues at government health facilities, increasing contact time with the providers, and strengthening outreach services will not be an easy task.

In 1976, Bangladesh government introduced two-child family policy, which has a major impact on the kinds of support systems parents expect to foster. The policy eliminates the tendency towards large families, affects the system of social security that depends on children's support of elderly parents. With the emphasis on two-child family norm, there may exist more and more family structures characterised by two grandchildren being shared by four grandparents. When more children are sharing the cost of supporting the elderly, the burden may not be great; however, if one couple has to support four grandparents, who, in addition, may live longer in the future, the cost may be excessive. Besides, the heavy family burden may create some inner-family conflicts and worsen intergeneration relations. Because of migration and poverty the family will not support most of the elderly in future. How much the burden of caring for elderly population can be transferred from the family to the community or to the government depends on the importance attached to caring for the elderly, economic situation and policy for the elderly population of Bangladesh. The current Boisko Bhata scheme is a beginning but certainly too inadequate to meet basic needs of the elderly population who are extremely poor.

Although any attempt to predict the direction of future socio-economic changes is involved with uncertainty because of fragile economy, the increase in the size of Bangladesh's aging population in the near future will be challenging one. Therefore, the government must take the aging of its population into account in socio-economic planning. The possible policy options may be the programme that enhances traditional support, encourages able elderly population to participate in income-earning activities. Families alone do not have the capacity to provide the care and support for increasing number of elderly population. Government and NGOs should consider polices and programmes to facilitate and strengthen family support.

Professor M Kabir of the Department of Statistics, Jahangirnagar University is Vice-President, Forum for the Rights of the Elderly in Bangladesh.