1. Understanding the inter-linkages between Economic Status and Subjective Health among Indian ElderlyBy
Sanjay Kumar, Ph.D
National Programme Officer (M&E), UNFPA – India
12th Global Conference on Ageing, June , 2014, HICC, Hyderabad, India

2. Outline of the presentation:
Demographic Change and Population Ageing in India
Beliefs about Indian Elderly
Data and Methods
The connection between subjective and psychological health of the elderly with their economic status
Major conclusions of the Study

3. Demographic Changes and Population Ageing in India
India has 104 million elderly population, consisting of 8.6 per cent of the total population
By the year 2050, it is likely to increase by three times, around 300 million, accounting for 20 per cent of the total population
Changing Size of Young and Old Population and Age Dependency in India

4. Well-known Beliefs about Elderly in India
Indian elderly are generally considered happy as they live their children and within the family environment
There has been several attempt to measure happiness around the world
The studies show that happiness does not necessarily have a connection with economic status
The most happier countries are not the economically advanced ones
The present study examines the subjective well being of the elderly reflecting their mental status in India and its relationship with economic factors

5. Data and Method
The data is drawn from BKPAI Survey conducted among elderly in 2011 in selected states
A total of 9852 elderly from 8329 households were interviewed from seven states which have higher proportion of elderly population
Gujarat
Jharkhand
Manipur
Jammu & Kashmir
Andaman & Nicobar Islands
Goa
Andhra Pradesh
Himachal Pradesh
Karnataka
Chhattisgarh
Assam
Arunachal Pradesh
Bihar
Haryana
Sikkim
Uttarakhand
Tamil Nadu
Odisha
Meghalaya
Tripura
Madhya Pradesh
Nagaland
Maharashtra
Uttar Pradesh
Rajasthan
NCT of Delhi
Punjab
Kerala
Lakshadweep
West Bengal
Mizoram
Bi-variate and Multivariate Statistical Analyses were conducted to examine inter-linkages between subjective health status and socio-economic factors

6. Measures Used Self Rated Health – rating by the elderly themselves
Self-rating of health is mainly influenced by physical health conditions like chronic diseases, functional disability, sensory performance, the number of sick days etc.
Subjective Well-Being (Mental Health)
The assessment of mental health can be done with more objectivity due to the methodology available
Several efforts are made to quantify subjective well-being through various instruments. This study explored two such well known instruments:
General Health Questionnaire (GHQ)
Subjective Well-being Inventory (SUBI)

7. Self-rated Health by the Elderly
The self-rated health is assessed in three ways:
Current Health Status
excellent, very good, good, fair, poor
Health in comparison to the previous year
better, same, worse
Health in comparison to peers

8. Self Rated Health by the Elderly
Self Rated Measures
Men
Women
Total
Current health
Excellent
2.9
1.7
2.2
Very good
14.3
10.9
12.5
Good
30.6
28.9
29.7
Fair
37.0
37.2
37.1
Poor
15.1
21.1
18.3
Compared to 1 year earlier
Better
8.5
6.4
7.4
Same
58.7
54.5
56.5
Worse
31.0
35.9
33.6
Compared to peers
18.8
14.4
16.5
50.7
47.4
49.0
25.8
31.6
28.8
Number of elderly
4,672
5,180
9,852

9. General Health Questionnaire (GHQ-12)
GHQ is an instrument for screening psychological distress
The scale asks whether the respondent has experienced a particular symptom or behaviour recently
Each item is rated on a four point scale
less than usual, no more than usual, rather more than usual, or much more than usual
The survey used GHQ-12 , the scoring is based on the Likert scale, ranging from [Scale reliability coefficient: 0.90]
The accepted threshold is 12. Mean GHQ score was computed
A higher score indicates a greater degree of psychological distress

10. Subjective Well-being Inventory (SUBI)
SUBI is another instrument used for measuring mental health
The SUBI is designed to measure “feelings of well-being or ill-being as experienced by an individual or a group of individuals in various day-to-day life concerns”
It evaluates one’s life in terms of overall life satisfaction as well as one’s experience of pleasant and unpleasant emotions
9 questions in SUBI measure feelings of well-being through a scale ranging from one to three [Scale reliability coefficient: 0.89]
The total score ranges from 9 to 27 with lower scores indicating greater well-being

11. Levels of Subjective Well-being Scores Among Elderly GHQ and SUBI
Mental Health Measures
Men
Women
Rural
Urban
Total
GHQ-12 (Score 0-36)
% of elderly reported scores <= 12
56.4
47.6
49.4
58.1
51.7
Mean score
13.1
14.6
14.1
13.3
13.9
Number of elderly
4655
5145
5109
4691
9800
Subjective Well-being Inventory (SUBI) (Score 9-27)
18.5
19.4
19.2
18.6
19.0
4541
5033
4977
4597
9574
With mean score around 14 and 52% of the elderly having below the threshold level in GHQ, indicates a good mental health status for the half of elderly population. The other half requires further investigation for psychological distress
Men and urban elderly seem to be faring better in mental health compared to their counterparts
SUBI with mean score of 19, higher among women and rural elderly, indicating relatively poor mental well-being among them

12. Self-Rated Health Status and Subjective Well-being
The mean scores of both GHQ and SUBI increases with deteriorating self rated health
The results indicate a strong positive relationship between physical and mental health

13. Subjective Well-being by Age and Sex
Age is an important factor determining mental health status, GHQ and SUBI mean scores are higher for higher ages
Male elderly have marginally better mental health than women

14. Subjective Well-being by Wealth Index and Education
Mean GHQ and SUBI scores decreases with higher wealth quintiles and educational status, indicating better mental health among well off elderly

15. Subjective Well-being by Marital Status and Living Arrangements
Currently married elderly and those living with spouse have better mental health status

16. Subjective Well-being by Work Status and Place of Residence
Elderly working by choice have better mental health status as compared to not working at all. Urban elderly have slightly higher mental health compared to their rural counterparts

17. Multivariate Analysis
Dependent variables
Mean GHQ scores
Mean SUBI scores
Independent variables
Age
Sex
Marital status
Education
Religion
Caste
Employment
Living arrangements
Wealth Index (based on 30 assets and housing characteristics)

18. Association between Subjective Well-being Economic Status – Regression Analysis
GHQ
SUBI
 Background variables
Beta coefficient
Sig.
Age
60-69 (Ref)
70-79
1.14
0.000
0.51
80+
2.38
1.09
Sex
Male (Ref)
Female
-0.13
0.394
0.05
0.566
Marital status
Currently married (Ref)
Widowed
0.56
0.001
0.36
Others
-0.35
0.388
0.42
0.074
Education
No formal education (Ref)
<5 yrs
-1.03
-0.55
5-7 yrs
-1.07
-0.73
8+ yrs
-2.14
-1.36
Religion
Hindu (Ref)
Muslim
0.37
0.109
0.34
0.013
Sikh
-2.82
-0.75
-1.10
-1.13
Caste
Others (Ref)
SC/STs
0.25
0.140
0.10
0.297
OBC
0.88
-0.09
0.301
Coefficients with negative value indicate better mental health status.
Increasing age is negatively associated with GHQ and SUBI
Sex of the elderly does not show a significant impact on their mental health
Widowed and less educated categories of the elderly had significantly higher levels of distress

19. Association between Subjective Well-being Economic Status – Regression Analysis
GHQ
SUBI
 Background variables
Beta coefficient
Sig.
Employment
Not working (Ref)
Working by choice
-2.57
0.000
-1.21
Working for economic need or compulsion
-0.96
-0.03
0.776
Wealth index
Lowest (Ref)
Second lowest
-1.56
-0.90
Middle
-2.58
-1.77
Second Highest
-3.59
-2.47
Highest
-4.44
-3.76
Living arrangements
Living alone (Ref)
Living with spouse
-0.97
0.003
-0.23
0.227
Living with others
-0.28
0.301
0.13
0.409
Residence
Rural (Ref)
Urban
0.18
0.180
0.47
R squared
0.1718(N=9792)
0.2121(N=9566)
Living with spouse has significant better effect on their mental health, but this is true only for GHQ and not for SUBI
Elderly working by choice had significantly better off in terms of their mental health
Economic status has significant impact on the well being of the elderly. The subjective well being significantly improves with each higher wealth quintile

20. Conclusions
Both the measures of mental health indicate high positive relationship with work status (working by choice)
The elderly living in households in higher wealth quintile have better subjective health
The role of economic factors are found to be true event controlling for other socio-demographic variables
Thus the assumption that merely living with children and in a family environment is not entirely true in the Indian context
This has profound implications for the economic security of the elderly

21. Thank You