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A Demographic and Socio-Economie Profile of Ageing in Malta %eno CamiCCeri

CICRED Paris FRANCE

INIA
Valletta MALTA

A Demographic and Socio-Economic Profile of Ageing in Malta

A Demographic and Socio-Economic Profile of Ageing in Malta

%g.no CamiCCeri

Reno Camilleri Ministry for Economic Services Auberge d'Aragon, Valletta

Published by the International Institute on Ageing (United Nations - Malta) INIAICICRED 1993 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of the author. Reno Camilleri A Demographic and Socio-Economic Profile of Ageing in Malta ISBN 92-9103-024-4 Set by the International Institute on Ageing (United Nations Malta) Design and Typesetting: Josanne Altard Printed in Malta by Union Print Co. Ltd., Valletta, MALTA

Foreword
The present series of country monographs on "the demographic and socio-economic aspects of population ageing" is the result of a long collaborative effort initiated in 1982 by the Committee for International Cooperation in National Research in Demography (CICRED). The programme was generously supported by the United Nations Population Fund and various national institutions, in particular the "Universit de Montral", Canada and Duke University, U.S.A. Moreover, the realisation of this project has been facilitated through its co-sponsorship with the International Institute on Ageing (United Nations - Malta), popularly known as INIA/ There is no doubt that these country monographs will be useful to a large range of scholars and decision-makers in many places of the world. The monographs are the expression of the great dedication of the researchers participating in the endeavour and of their Coordinator, George C. Myers. We would like to congratulate them for such an achievement. As stated in the introduction by George C. Myers, the programme would not be possible without the tenacious efforts of Jean Bourgeois-Pichat, who was the Chairman of CICRED from 1972 to the 15th April 1990, date of his death. In remembrance of what he has done, we dedicate this series to his memory.

Lon TABAH President of CICRED

Alfred GRECH Director of INIA

INTRODUCTION
George C. Myers, Ph.D. Center for Demographic Studies Duke University Durham, North Carolina, U.S.A.
The decade of the 1980s heralded the coming of age, with worldwide attention to population ageing and its implications for societal development and the well-being of older persons. The appearance of this series of national monographs on the demographic features of population ageing attests to the vigorous research activity that has occurred recently within both developed and developing countries. The series fulfills a main goal of the International Program on Population Ageing, initiated in 1982 by the Committee for International Cooperation in National Research in Demography (CICRED) based in Paris, France. The inspiration for the creation and maintenance of the lengthy effort is due primarily to the President of CICRED, the world-renowned demographer Jean BourgeoisPichat. Our esteemed colleague provided the basic formulation for the field of the demography of ageing with his primary contributions to the no w classic United Nations volume on The Ageing ofPopulation and Its Economic and Social Implications, published in 1956. The past 35 years have seen ample fulfillment of the message conveyed in that study: ... it is reasonable to expect a continuation of the ageing process among populations both economically and demographically advanced. With regard to the under-developed countries:., the ageing process seems, however, to have begun, and although accurateforecasting is difficult, this trend will likely become accelerated in the more distant future. An examination of these trends toward population ageing, its determinants and implications for countries at different levels of social and economic development served as the impetus for the international research effort. The CICRED project held its initial meeting in Montebello, Canada in 1983. The meeting drew 45 participants from 20 countries, who decided upon three main objectives for the project. Subsequent conferences were held in Florence, Italy in 1985 and at Duke University, in Durham, North Carolina in 1988, which enabled the participants to meet and discuss progress in achieving the following goals: 1. A sound database of national statistics should be developed to capture the dynamic aspects of the rapid growth and increasing proportions of the older population throughout the countries of the world. 2. Demographic centers in a large number of countries should be encouraged to undertake a series of systematic studies, which would provide information not only on population ageing and its main determinants, but also the societal implications of these demographic changes. 3. Results of these research investigations should be presented in the form of national monographs, which would be published in an integrated series. The systematic collection of national statistics, it was agreed, would provide a much-needed data source for the assessment and evaluation of older populations in countries around the world. A set of model tabulations was envisioned to capture the historical changes in population ageing as well as projections of future developments. Data were to be drawn from national censuses for the most part, particularly the round of 1980 censuses that had been recently conducted. Especially important would be more detailed age/sex breakdowns within the older population to aid in understanding the diversity of social, economic and health characteristics of these persons. Such statistics were supplied from a number of countries and constituted a sound initial basis for the International Database on Ageing (IDB A), which the Center for International Research of the U.S. Bureau of the Census graciously offered to coordinate and disseminate. At present, that effort continues through support from the U.S. National Institute on Ageing and U.S. Agency for International Development. The IDBA, in an expanded form, is presently available for researchers on computerized files from the Inter-university Consortium for Political and Social Research/National Archive of Computerized Data on Ageing (ICPSR/NACDA) located in Ann Arbor, Michigan. The participation of a large number of demographic centers was sought to systematically obtain data on a broad range of topics. These included the life conditions of older persons with respect to dimensions such as family and kin, economic, housing, health, and culture. Also deemed important was how these conditions might vary by geographic regions within countries, especially between rural and urban areas. The second conference of national representatives that was convened in Florence, Italy in 1985 provided an opportunity to further elaborate on the research objectives and to coordinate the national efforts. To structure the preparation of national monographs, a comprehensive chapter outline was prepared before the Florence meeting, along with a set of suggested tables and graphs. The third and concluding meeting at Duke University in Durham, North Carolina in 1988 was attended by 40 persons. Several completed monographs, as well as others in progress, were discussed at the meeting. This enabled participants to assess the overall project and draw conclusions about the rapid changes in population ageing taking place throughout the world. A positive collaborative arrangement with the newly-established United Nations International Institute on Ageing (INIA) in Malta has now made the monographseries a reality. In addition to monographs prepared for the CICRED project, the series has been augmented by the

inclusion of three additional monographs that resulted from a project on Population Aspects of Ageing: Their Economic and Social Consequences, sponsored by the Population Division of the United Nations. Country monographs, such as those in the series, are first, but necessary, steps towards understanding the main descriptive aspects of population ageing and its major determinants and consequences. Such information forms the basis for future studies that can periodically update information on a country's ageing population structure, as new census and supplementary data become available. The effective achievement of comparative, cross-national investigations, however, will continue to require attention to standardized measurement and reporting of the main parameters of the ageing process. So too, the conceptual framework and analytic procedures for examining intra-country and inter-country patterns will need to be more systematically advanced. Concrete steps can be taken, for example, in drawing detailed demographic, social and economic data for older age and sex groups from the round of censuses undertaken in 1990 and the years ahead. There also is a great need for more detailed tabulations by geographic and regional classifications within countries that will facilitate further research. These goals seem to be well within the gTasp of researchers and international organizations. However well these initial efforts have been established, further steps are needed toward more in-depth research. A second stage of research was explicitly recognized by those responsible for the CICRED project. The original research program envisioned both a core set of activities - which has largely been realized in the country monographs - and another set of more specialized research efforts. In hindsight, the agenda was probably too ambitious at the time, but certainly seems feasible for the decade ahead. Let us examine briefly the types of studies of importance in several domains. Demographic. These might include: a) cohort studies of the changing size and composition of generational groups as they pass through the life course and, particularly, as they reach old age and beyond; b) studies of oldest-old populations, which consist of persons, often predominantly female, who are subject to high risks of disablement that requires external support from families and state welfare systems; c) research on geographical/locational patterns of older persons and how those are influenced by migration of both younger as well as older persons; d) assessment of the quality of data used in research as a primary requirement for sound knowledge. Social and Economic. Among the many topics of importance, several priority areas can be noted: a) studies of changing family and kinship structures from the standpoint ofdemographic factors (e.g., survival risks) and behavioural patterns (e.g., marriage and divorce); b) following from this, studies of the living arrangements of older persons, which have profound implications on the life conditions of older persons; housing requirements; and the support systems often necessary for their maintenance; c) examination of the economic conditions of older persons in sufficiently greater detail for assessing the relative importance of wealth and assets, income from employment, social welfare payments (e.g., social security payments upon retirement), intergenerational flows of monetary resources, and consumption patterns of older persons; d) studies of the collective attitudes of both young and older generations towards societal developments emerging from the ageing of populations, including political participation. Health. Concerted attention also needs to be directed toward a broad range of health factors involved in the process of individual ageing, which includes disease onset, disability and death. Major issues include: a) the issue of whether prolongation of life expectancy has been accompanied by associated extension of life years free of major chronic diseases and disabilities; b) examination of long term care of older persons and the financial and emotional costs of such care on the recipients and providers (often families, but increasingly the state); c) important differentials in the health status of older persons that exist with respect to sex, socio-economic status, race and ethnicity and residence. The research topics that have been suggested confront major issues that are likely to shape societal policies and programs in the future. To effectively link research to policy will require more explicit acknowledgement that findings must be incorporated into models that can help forecast further developments. To do so, the research is likely to be multidisciplinary in focus, capable of yielding quantitative results that are national and regional in scope, and designed to examine dynamic perspectives. There is clearly a need for both synchronie (cross-sectional) and diachronic (longitudinal) studies. A fundamental premise of the CICRED project, and one clearly shared by INIA and other UN organizations, is that cross-national, comparative investigations can enable individual countries to assess the implications of population ageing more effectively if the phenomenon is seen as world-wide and shaped at particular points in time by the progression of the demographic transition within countries with varied social and cultural conditions. Our knowledge about ourselves is incremented by knowing more about our neighbours. This is as true for developing countries beginning to experience the ageing of their populations as it is for developed countries that have been involved in the process for more protracted periods of time. The CICRED project has served an important function in stimulating the preparation of these country monographs, but the successful completion of this project mainly derives from the voluntary efforts of researchers who have collaborated in these efforts.

Contents
Page INTRODUCTION I. POPULATION GROWTH Growth profile Population density Determinants of population growth Migration Natural increase Marital status The fall in household size Fertility and work References and notes II. DEMOGRAPHIC TRANSITION The effects of industrialisation Transitional stages Main factors causing fertility decline A second demographic transition? The 'gerontological transition' Changing age composition Inner Harbour Region Outer Harbour Region South Eastern Region Western Region Northern Region Age structure - Gozo Demographic problem areas References and notes III. THE AGEING DIMENSION The old A twentieth century phenomenon Social age and functional age Dynamic ageing thresholds Life expectancy without incapacity The ageing problem The 1984 Mexico City Conference The 'new The lifestyle of the Aged in Malta Voluntary groups Inadequate income? The education of the elderly University of the Third Age The ageing trends 15 18 18 18 19 19 22 22 23 25 26 27 27 29 31 31 32 32 34 34 34 35 35 38 38 41 42 42 43 44 45 45 47 48 49 49 50 51 51 53 54

rich'

Page

Malta's ageing curve Dependency ratios The burden of the Aged Ageing ratio Future trends Population growth and density Projected age pyramid References and notes IV. EFFECTS OF A GROWING AGEING GROUP Social expenditure Public health The social security system in Malta Legal framework National pension schemes Pensionable age Retirement age flexibility Pensions' expenditure Old age pensions Invalidity pensions Survivors' pensions The rising costs of pensions Some policy options Changing benefit rates Increasing retirement age Phased retirement Financing public pensions The widening gap Future outlook References and notes

55 56 57 58 62 65 65 68 70 72 73 73 74 75 76 76 77 77 77 77 78 79 80 80 80 81 81 85 88

CONCLUSION

89

Appendix - Selected Demographic Indices of the Maltese population (as at end 1991) 90

Bibliography

'

92

list of Tables
Page .Table 1.1 Table 1.2 Table H.l Table .2 Table 113 Table 11.4 Table HI. 1 Table m.2 Table I.3 Table m.4 Table I.5 Table in.6 Table L7 Table III.8 Table m.9 Table IV.l Table IV.2 Table IV.3 Table IV.4 Table IV.5 Table IV.6 Percentage distribution of the population aged 15 years and over by marital status Malta & Gozo, 1931-1985 Percentage distribution of multi-person households by size - Malta & Gozo, 1948-1985 Birth and death rates in European Countries Percentage distribution of population by broad age groups - Malta & Gozo, 1851-1985 Percentage distribution of those aged 65 and over by sex - Malta & Gozo, 1901-1985 Percentage distribution of population by selected age groups and locality - Malta & Gozo, 1985 Life expectancy without incapacity - Indexes of selected countries Population by age groups-Malta & Gozo, 1851-1901 Dependency ratios - Maltese Islands, 1985 Dependency ratios - Gozo, 1985 Ageing indices in selected European states, 1990 Ageing or structural ratios of the population of Malta & Gozo by locality, 1985 Dependency ratios of the population of Malta & Gozo by locality, 1985 Population projections - Malta & Gozo, 1995-2020 Selected age groups in Maltese Islands, 1990-2010 Ratios of 'per capita' public health expenditure on the elderly in selected countries Pensionable age in selected European countries Expenditure on Pensions % of GDP - Malta & Gozo, 1981-1990 Payments under the Social Security System - Malta & Gozo, 1981-1990 The Welfare Gap - Malta & Gozo, 1981-1990 Population aged 61+ in Malta & Gozo, 1990-2020

22 23 30 33 33 36 47 56 57 57 59 60 61 63 64 72 76 79 82 84 86

List of Figures
Figure I.I Figure 1.2 Figure 13 Figure 1.4 Figure n.l Figure n.2 Figure n.3 Figure III.1 Figure in.2 Figure m 3 Figure m.4 Figure in.5 Figure IV.l Figure IV.2 Figure IV3 Figure IV.4 Figure IV.5 Figure IV.6 Figure IV.7 Growth of population-Malta & Gozo, 1840-1990 Post-war migration 1946-1985 - Malta & Gozo Migration after 1975 - Malta & Gozo Mean number of live births per marriage cohort - Malta & Gozo, 1912-1959 Infant mortality rate in Malta & Gozo, 1910-1980 Demographic transition in Malta & Gozo, 1930-1990 Population structure by broad age groups - Valletta, Floriana and Sliema, 1948-1985 Percentage distribution of persons aged 65 and over -Malta & Gozo, 1901-1985 Expectation of life - ages 55-85, Malta & Gozo Illiterates in age group 50 and over as percentage of total population - Malta & Gozo, 1985 Trends in percentage of population 65 years of age and over, selected countries, 1850-2000 Persons aged 65 and over as percentage of total population - Malta & Gozo, 1985 Life expectancy at age 65 in Maltese Islands, 1871-1989 Life expectancy at age 75 in Maltese Islands, 1871-1989 Time relationships between a birth and future services requirements Social Security Expenditure - Pensions - Malta & Gozo, 1981-1990 Social Security Act, 1987 - Receipts and Payments - Malta & Gozo, 1990 The Welfare Gap - Malta & Gozo, 1981-1991 Percentage distribution of projected population for 1995 & 2005 - Malta & Gozo 19 20 21 24 28 29 39 44 46 53 55 58 71 71 73 78 83 85 87

A Demographic and Socio-Economic Profile of Ageing in Malta

Introduction
The evolution of a country ' s population age structure is a long and complex process. In some cases, it is essentially a reflection of fundamental changes in values and behavioural norms; in others, it is also influenced by government migration polices. The structure of Malta* s population has been affected both by abrupt changes in lifestyles and also by the mass migration policies pursued during the past fifty years. Malta has forcenturies experienced the interactions between population growth and the availability of economic resources. The range of policy options has always been extremely narrow and decisions hard to take. In the wake of the conclusions reached following the 1955 fertility survey, the only policy option available to Government to immediately ease population pressure and poverty seemed to be emigration, which is described in some detail elsewhere in this monograph. The social and religious environment prevailing in the 1950s was such that made it virtually prohibitive to consider other options (such as family planning) to keep fertility under control. It is no wonder that the only demographic dimension resorted to was emigration. The huge exodus of Maltese which had started in 1948 and continued unabated for the next quarter of a century has been a main determinant of the Maltese population structure. The upper strata of the present age pyramid, which provide the main theme of this study, are an important indicative reflection of the migratory movements of the late fifties and early sixties. The role of the other dimensions, that is, fertility and mortality, may now be considered of less significance in the debate on the present ageing process observed in Malta. Fertility and mortality levels were infact already fairly stabilised by the late sixties, but the post-war migration policies have been and are still manifesting themselves in the gradual modification of the age pyramid. The elderly segment of the population has been growing both in absolute terms and as a proportion of the total population. In this respect, the process of population ageing in Malta was essentially different from that of most European countries but similar to that of countries (notably Israel), where mass migration rather than a decline in fertility was the main determinant of the present ageing process. Ageing is a relatively new issue in the process of development planning in Malta. It has, however, attracted Government attention following a number of initiatives taken by voluntary associations in the last two decades in favour of the elderly. The report on the 1985 Population Census highlighted the extent and the socio-economic consequences of the ageing population hitherto not sufficiently recognized and addressed to in Maltese society. The document served as a catalyst for further research and discussion on the subject. Of special significance to the theme developed in this monograph are the policy measures implemented during the last few years to meet the challenges posed by a growing elderly population. They are intended to provide the best possible conditions to satisfy the special needs of this group. Since 1987, Malta has for thefirsttime a Parliamentary Secretary for the Elderly. His department is entrusted with the implementation of welfare programmes for senior citizens. These take into account the provision of nurses and domiciliary services to enable the elderly to continue to live in their homes, hostel accommodation and day care facilities in regional centres to assist the elderly to enjoy an active life in familiar surroundings, services for health improvement and rehabilitation in geriatric institutions and activities aimed at the promotion of gerontological studies and education.

The main objective of this monograph is to contribute in a small way towards a discussion of some aspects of the ageing process in Malta and to focus attention to particular problems. An economic rather than a social approach has been adopted in the treatment of the theme since it is recognised that, within a local context, the economic consequences of ageing are of considerable significance even though some of these effects may not be felt for several years. The first chapter outlines the growth pattern of the Maltese population and assesses the relative influences of the main determinants to population growth. It underlines the progressive fall in household size mainly as a result of changes in lifestyles and traditional values. The demographic transition is described in some details in the next chapter. Particular attention is focussed on the population age structures prevailing in different geographical areas. The rest of the monograph explores the broad financial implications of the ageing process in Malta and Gozo. It examines the effects of an ageing population on social expenditure (particularly social security and health) and discusses possible policy responses. As in the case of other countries, 'per capita' benefits from public funds over an average life cycle assume a U-shaped pattern, being highest in the early and later years of life. The demand on social expenditure rises sharply with age from 61 onwards reflecting government's wide responsibilities under local legislation. Some of the policy options, for example, those related to flexible retirement age, would need early attention. Others, such as those related to cost-effective schemes of encouraging self-provision for retirement, may need more study to be implemented.

I. Population growth
Growth profile The Maltese population was estimated at 362,644 as at end of 1992, consisting of 179,285 males and 183,359 females - a sex ratio of 978 males for every 1000 females (1). There has been, therefore, an average growth rate of 0.9 percent during the last decade. A slight easing of the growth rate had been observed between 1985 and 1987; thereafter a marginal increase in the growth rate from 0.7 per cent to 1.0 per cent was observed. The net reproduction rate is estimated at unity. Since 1842, when the first population census in a series of regular censuses was taken, there has been a more or less continuous growth of the population during each intercensal period except in 19111921 and the early sixties. Lack of jobs forced thousands of workers to settle in Australia and North America so that the census taken in 1921, when compared to the previous one, showed a small reduction in the total population. The decline was the net result of a decrease of 3,061 in the male population and a rise of 2,950 in the female population. In the years following the First World War, the picture was a fairly consistent one of accelerated growth in the female population, with a male population fluctuating widely in its rate of increase depending on the migration outflow. After 1948, planned emigration became a major policy of Government, and whole families took up permanent residence abroad so that, within a few years, the age structure of the population and, as a consequence, the birth-rate were drastically readjusted. During the intercensal period 1948 to 1957, the population increased by only 13,629 persons of whom 11,186 were females (2) . The average rate of increase during these years of heavy emigration was less than 0.5 per cent per annum; the corresponding rates for males and females being 0.2 and 0.7 per cent per annum, respectively. After 1962, the Maltese population reversed its long history of almost continuous growth and started on a slow declining trend brought about by a renewed emigration spurt in the wake of the rundown of U.K. Government employment in Defence Establishments. This emigration drive caused a marked tendency for the birth-rate to decline and brought about a reduction of 3,814 persons, that is, 1.2 per cent of the population between 1957 and 1967.

Population density During the last sixty years there have been marked fluctuations in the overall density of Malta's population. To some extent, these were brought about by the number of foreign residents who, in the past, included the wives and children of U.K. servicemen stationed in Malta. In the 1931 census, the enumerated population resulted in a density level of 765 persons per km2. This went up to 969 persons per km2 in 1948 and hiked to 1013 in 1957. At that time, the foreign element accounted for 4.5 percent of the total population. The trend was interrupted in 1967, when the population density stood at 995 persons per km2, but went up again in 1985 to stand at 1094 persons per km2. Presently, the overall population density is 1149 persons per km2. One must point out that the 1992 index takes into account merely the Maltese element, since the foreign element is only determined during census taking.

A Demographic and Socio-Economic Profile of Ageing in Malta

19

Determinants of population growth

Population growth is the result of two factors: the excess of births over deaths and the balance of inward and outward migration. In so far as natality is concerned, this depends to a very large extent on the number of married couples, the rate at which they build their families, and their ultimate family size. Mortality is influenced by biological factors and social conditions particularly the availability and quality of health services. In the late fifties and the sixties, the migration dimension can be generally considered as the more important determinant of the Island's population growth and its age composition.
Figure I.I Growth of population - Malta & Gozo, 1840-1990
Thousands ofPersoni 700.
Aciual Census as at Year
4

30 5

300
/ / / /

20 S

200

10 5

100 1840 IS70 1900 1930 1960 1990

Source:

Census Reports and Demographic Review of the Maltese Islands 1990 - Central Office of Statistics (Malta).

Migration

The potential effects of migration on population structure can be easily gauged by tracing briefly the history of the Maltese migratory movement. Before the twentieth century, Maltese emigrants had sought employment in countries bordering on the Mediterranean such as Tunis, Egypt and Algeria. By 1911, around 34,000 Maltese had by then settled in such places. After the First World War, Canada, U.S.A. and Australia emerged as 'traditional' countries for Maltese emigrants. Since then, Maltese settlements in these countries have been very rapid. By the year 1921, Australia was already taking more Maltese than any other country. Government policy, governing emigration, had by this time been amply defined and the Department of Emigration was set up to guide Maltese emigrants and provide them with assistance abroad (3). After the Second World War, efforts to facilitate emigration were intensified. Agreements were entered into with Australia, U.K. and Canada for implementing an extensive emigration programme to

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beat unemployment. Australia continued to take in the majority of Maltese migrants. Canada provided an alternative for those who wanted to settle in North America but could not do so when restrictions on immigration were imposed by the U.S.A. Government, while the U.K. tended to attract young men seeking their first job abroad but determined to return home at the first opportunity. Before the introduction of the Emigrants' Passage Assistance Scheme in 1948, emigration had been averaging less than 3,000 departures per year, but soon after the introduction of this Scheme, more and more people sought their future abroad. In 1950,5,400 persons left the Island while 8,500 departed in 1951. Four years later, a new peak had been reached when 11,400 persons emigrated; 75 per cent going to Australia. In the following year, another 9,000 Maltese left the Island; thereafter the trend continued on a lower scale. The number of Maltese who left the Island to settle abroad picked up again during the sixties when nearly 49,000 Maltese emigrated. Between 1931 and 1980 no less than 155,000 persons, amounting to nearly half the present Maltese population, left Malta to settle abroad (4).
Figure 1.2 Post-war migration 1946-1985 - Malta & Gozo

19 7 a 9 1950 51 5 5J 5 55 56 57 5 9 19*0 u E2 I) M IS U (7 U H 1770 7 1 7 7 J 7 * 7 5 7 S 7 7 7 7 9 19ao al K )

Source:

Census '85, Vol. I - Central Office of Statistics (Malta).

Although the economic factor could be considered as the main determinant behind the Maltese migratory movement, one should not ignore the fact that a considerable number of emigrants view their departure from their homeland as a short-term venture. Their intention is to return home as soon as their economic conditions improve. Others may want to return on attaining pensionable age in the hope of being able to live comfortably on their savings in their homeland, among their relations and former acquaintances. In general, it has been observed that in countries like Italy, Spain and Cyprus, where migration was on a large scale, most people migrate with the intention of returning back. The influx of returnees has been clearly visible in Gozo particularly in some localities like Gharb, Qala, Xewkija and Nadur where the ageing index is particularly elevated.

A Demographic and Socio-Economic Profile of Ageing in Malta

21

Until 1975, the number of returned emigrants was relatively low and most of them re-emigrated within a short time. Since then, however, a new phenomenon has been evident, in that there had been an influx of returnees which was greater than the number of those leaving to settle abroad. A heavy net inflow was observed during the period 1975/77 when net returnees averaged 1,200 per year. At present the yearly net migration inflow is in the region of 800 or nearly thirty per cent of the natural population increase (5). Although in Malta's case emigration has acted as a safety valve in easing post-war population growth, it has disturbed to a marked extent the age structure of the population. Since emigrants are not drawn equally from all age groups, but primarily from the younger age groups, the short-term effect is the relative increase in the size of the older age groups. It will furthermore affect the sex ratio of the population since in any substantial migratory movement there is always a predominance of males. In our case it has created a surplus of women in Malta's population and this imbalance is more defined in the case of Gozo. The fertility survey report of 1955 refers to a sex ratio of 3 females for every two males in the 20-30 age groups of the population. The counter-effects of returned migrants are not likely to correct the imbalances referred to, since their number has been relatively moderate (until 1975) and falls within the older age groups.
Figure 1.3 Migration after 1975 - Malta & Gozo

Number

3500

197^6 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92
Years

Emigrants VM Immigrants
Source: Demographic Review of the Maltese Islands - Central Office of Statistics (Malta).

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Natural increase

There has been a dramatic decline in fertility and mortality rates since the end of the Second World War as will be explained later on. The main reason underlying the decline in fertility is more of a sociological than of an economic character. Prior to the fifties, parents were more inclined to emigrate to alleviate their poor standing rather than restrict the number of children. On the other hand, the high mortality rate reflected the lack of medical and welfare facilities. Rising standards of living and education and the development of social services since the late fifties contributed a good deal to lower the birth rate and prolong life. The natural increase in population has been, however, kept to a minimum or offset for a number of years through emigration as already pointed out, so much so that, during the intercensal years 1957-1967, the population registered a drop of over 5,000. Since 1970, other factors particularly the changing role and status of women in Maltese society could be considered relevant causes of family limitation.

Marital status

One need not go beyond the findings of the 1948 census in order to assess the changes in the marital status of the Maltese population brought about by the periodic upswing or slump in emigration and other social and economic factors, such as housing and the distribution of income. In 1948, of the population of 15 years old and over, 53.5 per cent were married and 7.5 per cent were widowed. The ratio of single males and females to the total population aged 15 years and over stood at 42.0 per cent in respect of males and 37.6 per cent in respect of females. Moreover, the married segment included 54.9 per cent males and 52.0 percent females. A marked difference between the sexes could be read in the widowed portion of the population. Whereas 4.1 per cent of the males were returned as widowed, 10.4 per cent of the enumerated females in the 1948 census were widowed. A decade later (i.e. in 1957), 55.7 per cent of the males and 52.2 per cent of the females aged 15 years and over were married. The widowed segment showed, however, that while the number of widowed males went up to 4.7 per cent the number of widowed females retained its high ratio of 10.3 per cent.
Table I.I Percentage distribution of the population aged 15 years and over by marital status - Malta & Gozo, 1931-1985 1931 Status Males Females 1948 Males Females 1957 Males Females 1967 Males Females 1985 Males Females

Single Married Widowed

46.2 47.8 5.0

41.4 48.3 10.3

42.0 54.9 4.1

27.6 52.0 10.4

39.6 55.7 4.7

37.2 52.5 10.3

43.2 53.1 3.7

41.7 48.8 9.5

34.3 62.5 3.1

31.4 59.1 9.5

Source:

Census '85, Vol. I - Central Office of Statistics (Malta).

During the 1967 census, it was established that 53.1 per cent of males and 48.8 per cent of females were married. The number of widowed stood at 3.7 per cent in the case of males and 9.5 per cent in the case of females. There were thus nearly three widowed females to every widowed male. Moreover, the married segment of the population within the 20-30 year age group was also higher than that recorded during the previous census.

A Demographic and Socio-Economic Profile of Ageing in Malta

23

The last census showed that 62.5 per cent of males aged 15 years and over and 59.1 per cent of females were married, giving an overall ratio of 60.7 per cent of the population aged 15 years and over. The increase in the married portion of the population was mainly reflected in a sharp decline in the number of single persons which dropped to 34.4 per cent and 31.4 per cent in respect of males and females respectively. The widowed portion of the population, which had demonstrated a modest downswing at the 1967 Census, remained at the same level in 1985, and continued to be dominated by females. For every enumerated widower there were just over three widows. The situation in Gozo was certainly more pronounced: for every widowed male there were nearly four widowed females. One should also make reference to two other important factors: first, there has been a gradual stepping up in the median age at first-time marriage of both the bride and bridegroom during the past twenty years. The median age of brides is now 22.5 years compared to 20.5 years, while that of the bridegroom has shifted to 25.0 years from 23.5 years during the last two decades. Secondly, births are not only fewer but most of them are being postponed to later years in marriage.

The fall in household size The dramatic fall in family size during the past forty years is a salient feature of Maltese demographic history and is a good indicator of how the young age groups are getting smaller in relation to older ones (6). The following table illustrates the gradual transition of the average Maltese household from a large" group of 4-6 persons in 1948 to a smaller unit consisting of 3-4 persons in 1985.
Table 1.2 Percentage distribution of multi-person households by size - Malta & Gozo, 1948-1985 Census Year Number of persons in household

2-3
1948 1957 1967 1985 38.3 42.1 42.8 49.6

4-6
42.4 38.8 41.2 47.8

7-9
16.0 14.9 12.6 2.5

10+
3.3 4.2 3.4 0.1

Source:

Census Reports - Central Office of Statistics (Malta).

Whereas the large households consisting of 10+ persons and 7-9 persons represented 19.3 percent of multi-person families in 1948, the 10+ family is now practically non existent, while the 7-9 member households account for only 2.5 per cent. The shift is, in the first instance, discernible in the 4-6 person households which in 1948 accounted for 42.4 percent of all households and now represent 47.8 percent. The number of smaller households (2-3 persons), which in 1948 made up 38.3 per cent, now account for 49.2 per cent of all households. An analysis of the last census results shows also that: a) the 3 or 4 persons households are a common feature of all localities particularly in those areas where the population is rather very old or very young. Nearly 20 per cent of all households living in S ta. Lucia consist of three persons, while around 40 per cent are made up of four persons. One must emphasise, however, that this feature is not only linked to newly-formed

24

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communities like the ones just mentioned but is also a characteristic of the older ones which had expanded during the last decades, e.g. Qormi and Zejtun; and b) it is difficult to locate the traditional 'big' household so that there is very little correlation between household size and the rural or urban areas of Malta and Gozo or with some other traditional dimension.

Further indication of the fall in the size of the average Maltese family is provided by reference to the mean number of births related to selected marriage cohorts. Those women who were married during the years 1912/23 had an averageof7.38 births; 1924/35 marriage cohorts had an average of 6.71 births; while births related to marriages taking place between 1948 and 1960 averaged 3.93 per marriage compared to 5.63 births to women married between 1936 and 1947. Moreover, the last census findings reveal the negative correlation between the number of births and the educational achievement of the mother. The more 'educated' mothers are having smaller families.
Figure 1.4 Mean number of live births per marriage cohort - Malta & Gozo, 1912-1959

iv? s MARRIAGE COHORTS

Source:

Census '85, Vol. I - Central Office of Statistics (Malta).

A Demographic and Socio-Economic Profile of Ageing in Malta

25

Fertility and work

Population conferences (e.g. Budapest 1974, New Mexico 1984) reaffirmed the principle of equality of men and women, rejected discrimination and called for the promotion of the status of women. Governments were asked to "pursue more aggressively action programmes aimed at improving and protecting the legal rights and status of women particularly the right to participate or not in the workforce". It was also emphasised that the biological role of women in the reproductive process should in no way be used as a reason for limiting women's right to work. Governments were urged to provide due support to the important role of women as mothers and opportunities for personal fulfilment in both familial and non-familial roles (7). Changes in the status of women throughout the world have been acclaimed as one of the most important landmarks in socio-economic development during the past sixty years. An important indicator of such 'status' is the level of female participation in the workforce. The extent of female participation in a country's workforce is partly determined by economic forces, but social and cultural factors play a more decisive role in creating an environment that is amenable to female participation in the development process. Women's role in society is assuming new dimensions. For many women, going out to work and at the same time bringing up a family is not only a matter of choice, it is primarily an economic necessity particularly in the case of one parent families having a woman as the family head who is expected to earn a living. Some estimates in respect of Europe put the number of households headed by women at 35 per cent - a situation which calls for a close examination of potential consequences on the traditional family structure. The local female participation rate is perhaps the lowest in Europe. Less than 30 per cent of those aged 16-59 are gainfully occupied and, although women have the right to enter into all forms of paid employment and to assume managerial positions, very few female managers are in control of the country's industrial establishments. Female participation rates in most European countries, including Eastern European ones, are more than half as much and in some cases (e.g. Sweden) are nearly double the local index. The existing low female participation rate may be attributed to a number of social and cultural factors. One may mention the traditional size of the average Maltese family, lack of job opportunities in the past, the relatively recent expansion of the services sector which provides a number of job opportunities particularly attractive to females. Increased investment in the educational system which coincided with the changing role of women in Maltese society and the introduction of equal pay, maternity leave and job tenure after child birth are measures which were introduced during the past twenty-five years. One would therefore expect that the female work-age population will increase its participation in the labour force mainly for two reasons. First, there is a growing desire on the part of more and more women to have a job and to hold on to the job on marriage, combining their family commitments with their outside work. From a demographic viewpoint, one would expect that increased female employment would lower fertility still further and may encourage women to postpone childbearing. Secondly, a growing number of women possess the required skills because their educational levels have improved. Within the local context, the most remarkable change has been noticeable in tertiary education where the female yearly intake at University has been growing steadily. Twenty years ago, the university student ratio was 31 females to every 100 males. In 1990, the sex ratio stands at 45 females for every 100 males.

26

Reno Camilleri

References and notes (1) (2) (3) Central Office of Statistics (Malta). Economic Trends, January 1993. Central Office of Statistics (Malta). 1957 Census Report. The Department of Emigration was set up in October 1919 on the advice of the 1912 Royal Commission which had reported on the finances, economic conditions and judicial procedures of the Maltese Islands. The Commission had recommended emigration as one of the measures that could be adopted by Government to ease the unemployment situation. Central Office of Statistics (Malta). Census 1985 - Vol. I. Official data on emigration before 1948, and on returnees, are not always reliable. Up to 1974, areturned migrant was one who returned to Malta within two years of departure. Estimates of returned migrants between 1947 -1975 have been put at up to 25 per cent of those who had emigrated. These estimates are very much higher than the official yearly figures of returnees. For the purpose of this monograph, the 'household' family as distinct from the 'nuclear' one has been considered. U.N. Report by the Population Division, Department of the International Economic and Social Affairs Division - Population Bulletin of the United Nations No. 18 -1985.

(4) (5)

(6)

(7)

A Demographic and Socio-Economic Profile ofAgeing in Malta

'

11

II.

Demographic transition

The restructuring of the age pyramid of the population is, in the absence of migration, a function of the 'demographic transition' - a term widely used to demonstrate the changing features of a population under the impact of economic and social development. Malta's demographic transition has followed closely the pattern of the 'model' founded mainly on European experience. There is, however, one important difference: whereas, by the 1930s, most of the Western countries had completed the full cycle of their demographic transition and in some cases their fertility indices even fell short of replacement levels, Malta had still one of the highest birth rates in Europe. Yet it had later succeeded to accomplish, within the following two decades, a chapter of demographic history which most other European countries had taken much longer to write. The demographic transition in most European countries has been, by and large, related to the pace of industrialisation and other economic, social and cultural factors which include the level of education of women, job opportunities, female participation rate in the work force, the income and urbanisation levels and family planning activities. This does not mean that the onset of industrialisation coincides with visible changes in the mortality or fertility level of a population. In various instances (e.g. Finland and Malta), demographic changes preceded the event of industrialisation (1). In the case of Malta, the decrease in mortality rates, particularly the infant mortality rate, was not in any way related to the industrialisation process. It was brought about by the quick upgrading of the then existing pre- and postnatal health services. The crude mortality rate tumbled suddenly after 1942 marking the initial process of demographic changes. There has been, however, a visible relationship between population trends and industrial development

The effects of industrialisation The industrialisation process in the Maltese Islands may be considered to have begun in the early sixties. One should explain that, within the local context, industrialisation was primarily intended to provide alternative employment opportunities to absorb redundant employees as a result of the then anticipated run-down of the British Military Base on the Island. Malta'sfirstdevelopment plan ( 1959/64) sought to stimulate the growth of a competitive industrial sector geared towards export markets. A wide range of financial inducements, including tax-free holidays, import duty concessions and other assistance under the 'Aids to Industry' legislation, were introduced. At the same time, an extensive public sector capital programme was launched in order to develop the necessary infrastructure. The development plan also sought to promote Malta's image as an ideal tourist resort. The same development objectives and strategies were contained in the second development plan (1964/69). Emphasis was laid on infrastructural works, and on the expansion of a viable export-oriented manufacturing industry. Throughout this period the role of the public sector acted as a catalyst for the establishment of manufacturing units. Industrial development continued unabated during the seventies. Malta's traditional dependence on the British Military Base for the livelihood of the people and as the main source of foreign exchange earnings had been gradually phased out during the 1970s while the manufacturing sectors provided the main stimulus to industrial development. During the fourth development plan (1973-80) manufacturing output rose from Lm65.0 million to Lm215.0 million while employment registered substantial increases. At the same time income from tourism surged ahead from

28

Reno Camilleri

Lml6.2 million to Lm76.2 million while tourist arrivals which stood at 211,000 in 1973 spiralled to 618,300 in 1979 (2). The rapid expansion of the manufacturing industry can be gauged by the increase in the number of workers in this sector which from 21,800 in 1972 rose to 34,500 by the end of 1979 Moreover the expansion of the textiles and clothing industries which employed labour intensive techniques during the seventies was also instrumental in attracting female labour and enticing women away from home In 1972, there were 8,300 women working in manufacturing; by 1979 this number grew to 15 110 or by 82 per cent. Job opportunities were also increasing in the expanding services sectors, particularly the tourist sector, and most of these proved particularly attractive to women. One can, therefore, identify a strong correlation between the demographic transition process and the pace of industrial restructuring and expansion of the local economy. This is in consonance to observed trends in the countries where the female participation rate is relatively high. In most European ooumnes the growing female participation in the labour force has been a major factor in reducing fertility with its consequential effects on the existing age-structures of populations. During the sixties and seventies the country's demographic transition process accelerated simultaneously with industrialisation even though the onset of this process was observed much earlier. The exposure of the Maltese population to new ideas and concepts about lower fertility was visible during the early sixties and definitely intensified during the following decade when various contraception methods were already y familiar to most married couples.
Figure II. 1 Infant mortality rate in Malta & Gozo, 1910-1980

1910

IV40

1900

1910

1910

Source:

Census '85, Vol. I - Central Office of Statistics (Malta).

A Demographic and Socio-Economic Profile of Ageing in Malta

29

Transitional stages
The 'first' or early stage of demographic transition - a situation characterised by high birth and mortality rates resulting in a slow fluctuating growth rate of population - persisted right up to the first half of the forties. The Crude Birth Rate (CBR) averaged 31 while the Crude Death Rate (CDR) averaged 25. Such rates were much higher than those obtaining in most European countries (3). This situation symptomised a society in which the standard of living was low, proper medical care particularly in the prenatal and postnatal stages was practically non existent, and the level of the more basic social services was extremely poor. In such a state of affairs, epidemics like cholera, smallpox and gastroenteritis had at times claimed a large number of victims. As will be argued later on, these epidemics were the main cause of fluctuations in the aged segment of the population during the past century particularly around 1865 and 1890. The 'second' phase of the demographic transition may be considered to have coincided with the steep decline in the Infant Mortality Rate after 1942. In that year, infant mortality accounted for over a third of live births and could be considered as one of the highest in most European countries. It was five times that of the U.K. and three times that of Italy. But, in 1943, it had dropped from 345 to 210 per 1,000 live births and stood at 116 per 1,000 live births in 1944. By 1977, it was marginally less than that of the U.K. and a fifth below that of Italy. The Crude Birth Rate, as a result of the post war baby boom, reached 39.3 in 1944, which is the highest yearly rate recorded during the present century. The 'third' phase, characterised by a decline in the Crude Birth Rate, and a constant levelling off of the Crude Mortality Rate, started towards the mid-fifties. There is some evidence to suggest that, at that time, public awareness of the acute social and economic problems which the country would have to face in the future, in the absence of any controls of population growth, might have been triggered by a fertility survey of the Maltese Islands carried out in 1955. The formation of a Church organisation to tender advice to married couples on matters related to fertility controls coincided with the compilation of this report. Founded in 1956, this movement may be considered as the pioneer in this social field. Figure II.2 Demographic transition in Malta & Gozo, 1930-1990
DEMOGRAPHIC TRANSITION IPcf [000 repugnen)

1985 Cnau

Source:

Census '85, Vol. I - Central Office of Statistics (Malta).

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Reno Camilleri

Although the report of the fertility survey did not contain any explicit reference to the introduction of fertility controls, yet the overall message was that, given the then broad base to the age pyramid, the population was likely to continue to grow and to reach alarming levels within two decades unless the fertility level was immediately brought down (4). The signs of a decline in fertility which were first visible in the fifties continued unabated since then. During the years 1950-55 Malta still had one of the highest average birth rates in Europe. According to the 1978 U.N. World Population Prospects, this index was only surpassed by the indices in respect of Albania, Poland and Turkey. Twenty years later, it could be compared to that of most European countries, while the projected rate for the last quinquennial of the century is expected to be among the lowest in Europe. By 1970, Malta had therefore reached the fourth or last phase of its transition cycle when both birth rate and death rate had reached 'low' levels, resulting in a slow population growth. This phase comprises a situation where the death rate stays low on account of advanced developments in the economic, social and medicalfields,while the birth rate fluctuates within acceptable limits. Table II. 1 Birth and death rates in European Countries (annual averages)
Birth Rate Death Rate 1995-2000 21.5 14.5 14.1 15.3 16.3 13.7 12.1 14.9 13.8 13.1 14.6 13.8 15.9 18.4 14.5 13.5 13.7 14.8 14.9 14.3 15.9 17.5 18.6 14.3 13.6 16.5 16.1 16.3 26.5 16.3 1950-55 14.0 12.3 12.2 10.2 10.9 1970-75 1995-2000

Countries
Albania Austria Belgium Bulgaria Czechoslovakia Denmark Finland France Germany East Germany West Greece Hungary Iceland Ireland Italy Luxembourg Malta Netherlands Norway Poland Portugal Romania Spain Sweden Switzerland U.K. Yugoslavia U.S.S.R. Turkey Cyprus Source:

1950-55 38.0 15.0 16.7 23.7 22.0 17.9 22.8 19.5 16.6 15.8 19.4 21.1 27.9 21.4 18.3 14.7 29.3 22.1 18.7 30.1 24.1 24.9 20.3 15.5 17.3 15.9 28.8 26.3 44.9 27.4

1970-75 33.4 14.7 14.8 16.6 16.9 14.0 13.2 17.0 14.0 12.0 15.4 15.2 19.2 22.1 16.0 13.5 17.5 16.8 16.7 16.8 18.4 19.3 19.5 14.7 14.7 16.1 18.7 17.8 39.4 22.2

6.5
12.2 11.2

5.5
11.2 11.2 11.0 11.0 11.5 12.0 10.1 11.4 11.1 11.4 12.0

9.1
10.7 10.1

9.0 9.7
12.8 11.9 10.8

9.3
10.6 13.2 12.1

7.2
11.4

9.4
11.5

7.5
12.6

7.7
19.4

8.1 8.6
10.7 12.5 10.0

9.9
11.7 10.2

9.8
11.7

7.5 8.2
11.1

9.0 8.7
10.1

9.5
11.2 .9.1 10.4

8.5
10.0 10.3

7.2
12.0 10.2

8.3
10.5 10.0 11.7

9.5 9.5
12.0 10.5 11.0 10.2

9.8
10.1 11.7 12.1

9.2
17.5

9.2 7.9
12.5

7.5

6.8

9.6 6.8 7.9

U.N. World Population Prospects 1978.

A Demographic and Socio-Economic Profile of Ageing in Malta

31

Main factors causing fertility decline There are several factors which together have caused Maltese society to complete the full cycle of its demographic transition within a relatively short period. The main factor seems to have been the diffusion of education. Other factors included the changed role of women in Maltese society. The success of any policy designed to reduce the birth rate must, in the first instance, depend on the creation of public dispositions and conditions of life in which individuals perceive it to be to their own advantage to reduce the number of children. Fertility control is therefore primarily a matter of individual choice in most countries, and this is determined following a thorough evaluation of a number of alternatives which may influence the household's economic and social position. Secondly, there should be a diffusion of information about family planning methods. Neither of these two aspects can be tackled in isolation from the other and both depend on the standard of education, particularly that of women, obtaining in the country. Given the official policy of non-intervention, the diffusion of education has, in Malta's case, proved to be the most significant factor behind a declining birth rate.

A second demographic transition? The transition from high to low mortality and fertility rates as already defined above may be considered as having been primarily motivated by the desire of parents to be able to provide the best social and economic conditions for their families. This attitude had also the primary objective of extending the most advantageous educational environment for their children. Hence the decision to have a small household may be considered 'child oriented1. A number of social demographers (Arias, Lesthaeghe and Van de Kea) are now observing different motives on the part of couples for insisting in having a small household. They suggest that the developed countries' consumer-oriented environment and the couples' desire for self satisfaction and fulfilment are the main motives behind a behavioural change in family formation. In contrast to the objective behind the fertility decrease described earlier, the present decline may be considered as 'self-oriented'. Hence the increase in abortions (legal or otherwise), voluntary childlessness, consensual unions and the hike in contraceptive use during the last two decades. The observations referred to as the second demographic transition based, as it is, on the concept of 'self-orientation' to explain new levels of fertility have been strongly supported by some social demographers and rejected by others (5). The concept of a 'second' demographic transition provides, nonetheless, an interesting hypothesis, in relating gradual changes in couples' values and motives towards a smaller family. In Malta the 'self-oriented' motives behind present fertility trends can only be established through research. However, one can already observe some fundamental changes in traditional values as more and more women have become financially independent making possible a shift towards greater selffulfillment. In various instances, although parenthood is still a desired and challenging commitment, an additional child strongly competes with other pursuits such as more leisure, social activities and other personality and cultural standards. It seems difficult, therefore, to dismiss the existence of such motives behind fertility levels among Maltese couples.

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The 'gerontological transition1 The demographic transition has been and is likely to remain the central theme in population research providing the traditional basis for investigations in fertility and mortality trends with their consequential effects on population structure. But, while the demographic transition covers adequately the human life process from birth to old age, there are various aspects of population ageing where the demographic transition seems to offer little guidance. One has, therefore, to address the wider implications of changes in the number and features of an ever growing proportion of elderly as evidenced in countries where the full cycle of the demographic transition has long been completed and which are experiencing a noticeable growth in their elderly population. The demographic transition seems to stop short of explaining the various characteristics of the ageing process, since it considers ageing as the natural outcome of fertility and mortality whereas ageing could be considered as a distinct formative process on its own. Indeed it may be argued that the most important phase in the process of ageing begins after the full stabilisation of fertility and mortality rates. According to D.T. Rowland new concepts and theories are required which are specifically suited to the detailed examination of demographic features of ageing and their interrelationships with social and economic aspects. Examples include changes in the characteristics of the elderly, their life styles, life chances, health status and welfare needs over time (6). This new concept of the ageing process has been termed as the 'gerontological transition' and tries to regard the extent of population ageing as depending on cohort flows with the number of the elderly increasing in accordance with the size of cohorts reaching older age. The composition of the older groups will likewise change depending on the characteristics relating to education, marital history and socio-economic attainments of the cohorts moving into the older age groups. Rowland refers to the concept of population momentum, expounded by N. Keyfitz, to measure the potential of cohort flows. Momentum refers to the potential change in population numbers if fertility were to shift to replacement levels. In the less developed countries, where fertility is generally well above replacement level, there is thus a large potential for the older age groups to expand as the large cohorts in the younger age groups are assimilated into older ones. Population 'momentum' is low in both the pre-transition and post-transition phases but high as cohorts move upwards and are absorbed into the older age groups. The older age groups in the Maltese population structure have been experiencing a moderate momentum for the past decade as bigger cohorts are shifted to later life. This rate of change is expected to continue if and until such time that fertility drops to below replacement level. One would expect, however, that within the next two decades this transitional momentum would reach its peak, and will continue at a lower pace thereafter. On the basis of present trends the post-transitional phase of the gerontological transition is not expected before the first quarter of the next century.

Changing age composition The obvious relationship between the natural components of growth, that is, fertility and mortality, and the population age structure has already been mentioned. An undeveloped society is characterised by high levels of fertility and mortality, but many children and others pertaining to older age groups die

A Demographic and Socio-Economic Profile of Ageing in Malta

33

prematurely. Life expectancy is not high. Fifty years ago the life expectation in Malta was around 43 years for males and about 46 years for females. As the infant mortality rate falls and fertility remains high, the population is constantly becoming younger. With the onset of the third phase of the demographic transition characterised by a fall in both fertility and mortality, the youthful portion of the population was gradually reduced and the ageing process became evident. Spanning a period since 1851, one does not notice any marked change in the age composition of the Maltese population prior to the twentieth century. This is in sharp contrast to what happened in other countries which were already in the process of their demographic transition. In 1851,32.4 per cent of Malta's population were in the 0-14 age group. By the turn of the century the proportional representation of this segmentfluctuatedwithin very narrow margins. The 15-64 age group and the 65+ age group retained also more or less their percentage representation hovering around 61 per cent and 7 per cent respectively during a period of fifty years. Table II.2 Percentage distribution of population by broad age groups - Malta & Gozo, 1851-1985
Age groups 15-64 61.4 61.0 64.5 62.2 60.3 60.5 61.3 62.6 62.1 59.4 55.8 61.8 66.0

Census Year 1851 1861 1871 1881 1891 1901 1911 1921 1931 1948 1957 1967 1985 Source:

0-14 32.4 32.9 29.6 30.7 32.9 34.1 33.6 31.8 32.1 34.9 37.4 29.8 24.1

65 +

6.2 6.1 5.9 7.1 6.8 5.4 5.1 5.6 5.8 5.7 6.8 8.4 9.9

Census '85, Vol. I - Central Office of Statistics (Malta).

Table II.3

Percentage distribution of those aged 65 years and over by sex - Malta & Gozo, 1901-1985 MALTESE ISLANDS

MALTA

GOZO

M
1901 1911 1921 1931 1948 1957 1967 1985

F 5.3
5.0

T 5.2 4.9 5.5 5.6 5.4 6.4 8.0 9.7

M 6.9 6.0 7.7 8.0 9.3


11.1 12.4 13.9

F 6.9 6.1 6.5 7.6 8.4


10.3 12.3 16.1

T 6.9 6.1 7.0 7.8 8.9


10.7 12.4 15.1

5.1 4.8 5.5 5.6 5.1 6.0 7.4 8.6

5.5 5.6
5.6 6.7 8.6
10.9

5.4 5.1 5.6 5.8 5.7 6.8 8.4 9.9

Source:

Census Reports - Central Office of Statistics (Malta).

34

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Atthe 1901 census, the 0-14 age group represented 34.1 per cent of the enumerated population but this segment has been gradually declining and stood at 24.1 percent in 1985. The post-war baby boom, however, can be read in the data for 1948 and 1957. The difference had been shifted to the older age groups. Whereas the 15-64 age group now accounts for 66 per cent compared to 60.5 per cent in 1901, the most significant upswing could be discerned in the 65+ age group which rose to 9.9 per cent from 5.4 per cent in 1901. This was the combined result of natural ageing and migration. A detailed account of the aged population segment will follow later on. At this stage one may analyse in some detail the present age composition of the Maltese population on a regional basis (7). This regional pattern was retained for the sake of analytical comparability. Since data regarding specific age groups in respect of different localities are not available on an annual basis, all ratios relating to localities are those resulting from the last population census.

Inner Harbour Region

This region represents the 'oldest' inhabited part of the Island and marked differentials in age groups are exhibited on a locality basis. It includes some parishes whose territorial size has not changed much during the past fifty years with the consequence that newly-married couples had to move out to other areas. With the exception of Sta. Lucia, Ta' Xbiex, G'Mangia and Piet, the structural ratios (8) in respect of most of the other localities are high. The highest ratio has been obtained in the case of Sliema. Just under 17 percent are under 15 years of age while 18.4 per cent are aged 65 and over. Sliema with an 18.4 percent of its resident population aged 65 and over is, in fact, the locality with the highest proportion of senior citizens in Malta and it is followed closely by Valletta and Floriana with 15.4 per cent of the residents aged 65 and over. All the other localities, with the exception of Hamrun and Paola, exhibit ageing ratios close to the national average.

Outer Harbour Region

The overall age structure of this region is influenced by the markedly young populations of Fgura and San wann with 31.7 per cent and 30.7 per cent of their residents aged less than 15 years. The working-age groups are also relatively large compared to other places while the 'aged' account for very low proportions. Their percentage representations are the lowest recorded on the Island, namely, 3.3 per cent and 3.4 per cent in the case of Fgura and San Gwann respectively. Fgura has, in fact, the lowest percentage of its residents aged 65 and over.

South Eastern Region

All localities listed under this region are traditionally rural areas which experienced substantial expansion during the last thirty years. In all cases the young segment of their population is very close to the national average (24.1 per cent) with the exception of Ghaxaq where those under 15 years of age account for 18.1 per cent. The working age groups generally exhibit a constant ratio in all cases. There are, however, differentials in the 'old' segment: while Ghaxaq, M'Xlokk, Safi and Kirkop are well below the national average, Qrendi has an 'aged' representation of 11.1 per cent, a ratio considerably above the national average.

A Demographic and Socio-Economic Profile ofAgeing in Malta

35

Western Region

With the exception of Mdina which has an elderly population - ageing ratio 84.5 - and Rabat where the 'old' segment of the population is influenced to some extent by the inclusion of Ta' Saura Home for the Aged and Haz-Zmien ( a residential home for the elderly), the other localities are characterised by a relatively young population. Dingli has 26.2 per cent of its residents aged 0-14 years but 9.7 per cent of its residents are aged 65 and over, while the proportion of the 'young' in Attard, Balzan and Lija is very close to the national level of 24.1 per cent. Siggiewi and Zebbug have high ratios of persons aged 0-14 years, while the 'old' segments are below the national average. It is also interesting to note that the 25-54 age groups fluctuate within very narrow limits in the case of Balzan, Dingli, Siggiewi and Zebbug. They make up 43.1 per cent of the population in respect of Zebbug and 43.6 per cent in the case of Siggiewi.

Northern Region

This region exhibits some diverging features. The development of the old established locality of Mellieha during the last decades was rather directed towards the provision of additional accommodation in the form of summer residences than for enlarging the housing stock for newly-formed households. It has therefore an ageing population. Mgarr exhibited the same features. The increase in the number of newly-formed households was very limited and the population is ageing fast - 20 per cent are aged 55+. In both cases the ageing ratio is well above the national index. Most of the other localities, particularly Mosta, have a normal age group distribution.

36

Reno Camille ri Percentage distribution of population by selected age groups and locality - Malta & Gozo, 1985 Age groups Region and Locality

Table II.4

0-4

5-14

15-24

25-54

55-64

65+

Inner Harbour Region Cospicua Floriana G'Mangia/Pieta Gzira Hamrun Kalkara Marsa Msida Paola Santa Lucia Senglea Slicma Valletta Vittoriosa Taf Xbiex Outer Harbour Region Birkirkara Fgura . Luqa Qormi San Gwann St. Julian's St. Venera Tarxien 2abbar South Eastern Region Birzebbuga Ghaxaq Gudja Kirkop Marsaskala Marsaxlokk Mqabba Qrendi Sail 2ejtun 2urrieq

8.5 5.2 8.6 7.3 6.7 8.0 7.0 8.0 7.0 7.4 8.4 5.0 5.6

in
10.4

16.0 13.2 17.7 17.3 14.9 15.1 15.4 14.3 14.9 21.5 17.2 11.9 12.6 15.8 19.4

16.5 15.2 14.5 15.0 15.3 15.2 15.7 14.9 14.6 18.0 14.8 15.1 15.3 15.2 15.4

39.8 38.1 41.8 41.4 40.3 41.4 40.8 42.4 41.1 43.8 40.8 36.3 37.3 41.7 43.6

10.2 12.9

9.0
15.4

8.8 9.7
11.1 10.6 10.8 10.1 11.4

8.6 9.4
11.7

9.7
10.2 10.1 11.1

6.7
10.2 13.3 13.7 10.0

2.6 8.7
18.4 15.4

6.2 8.5 4.8 8.0 1.1 5.0 9.4 8.4 8.5 7.8

9.5 5.0 8.0 3.3 1.1 6.1 3.4 8.4 8.4 8.2 7.9

8.5
11.1

1.1 9.8 9.4 1.1 1A 9.1 8.9

16.6 20.6 17.6 17.0 21.3 16.6 17.4 16.5 18.0

15.3 13.6 15.1 15.7 16.0 15.3 15.7 13.6 13.8

43.0 46.6 43.8 43.5 45.2 42.8 42.7 44.1 43.7

8.4
10.0

9.6
10.9

9.8 9.9 8.6 8.6 9.9 8.1 9.8

16.0 18.1 15.9 15.3 16.1 18.2 17.8 15.8 17.1 16.3 16.3

14.5 13.5 12.5 14.6 13.6 13.2 15.3 12.4 13.3 14.2 13.6

43.9 45.1 45.3 45.3 45.5 45.6 43.0 42.2 46.6 43.8 45.3

9.3 7.3 8.7 7.5 8.0 6.6 7.9 9.0 6.8 9.0 8.1

8.2 6.1 8.1 6.7 7.0 6.4 7.6


11.1

6.3 8.6 7.1

A Demographic and Socio-Economic Profile ofAgeing in Malta Table II.4 Percentage distribution of population by selected age groups and locality - Malta & Gozo, 1985 (contd.) Age groups Region and Locality Western Region Attard Balzan Dingli Lija Mdina Rabat Siggiewi 2ebbug Northern Region Gharghur Mellieha Mgarr Mosta Naxxar St. Paul's Bay Gozo and Comino Fontana Ghajnsielem Gharb Ghasri Kercem Munxar Nadur Qala San Lawrenz Sannat Victoria Xaghra Xewkija 2ebbug 5-14 15-24 25-54 55-64 65+

37

7.9 9.5 10.7 8.6 7.1 6.8 9.7 9.1

15.9 14.9 15.5 16.3 10.7 14.8 15.9 17.2

13.4 14.3 11.9 14.0 13.2 15.4 14.2 15.2

46.3 43.2 43.4 44.1 41.5 40.7 43.6 43.1

8.1 9.0 8.5 8.6 12.2 10.3 8.1 7.6

8.4 9.0 9.7 8.3 15.2 12.0 8.4 7.7

8.0 7.1 8.3 9.5 9.7 9.5

16.6 16.2 15.3 17.1 15.1 15.2

14.5 15.0 17.1 13.8 15.7 15.3

42.5 43.3 39.4 43.8 44.5 43.0

10.1 8.4 8.8 7.6 6.9 8.1

8.2 10.1 11.2 8.2 7.8 9.0

8.8 7.7 7.1 5.7 7.7 5.1 7.5 6.4 7.7 6.8 8.0 7.1 7.3 7.7

14.5 17.2 12.9 13.2 13.8 14.1 12.4 10.6 12.5 14.3 14.6 13.0 12.4 15.2

14.0 13.0 14.3 14.1 16.0 22.3 12.9 11.6 15.8 17.3 14.7 14.4 15.5 16.7

38.4 42.3 35.1 37.2 37.5 37.3 36.9 39.2 36.2 40.9 39.7 37.5 38.6 38.8

11.8 9.0 11.9 13.5 10.1 9.2 11.5 11.5 9.4 10.0 9.9 11.0 11.5 9.1

12.7 10.9 18.8 16.5 15.1 11.8 19.0 20.9 18.4 10.6 13.4 16.6 14.6 12.6

Source:

Census '85-, Vol. I - Central Office of Statistics (Malta).

38

Reno Camilleri

Age structure - Gozo As one would expect, a more ageing population is now living in Gozo, although the younger sector (0-14 years) is also larger than in most localities in Malta. It has an overall ageing ratio of 70.9 which is seventy three per cent above the national ratio. The 'young' segment, which is dominated by males, accounts for 21.3 percent while 15.1 per cent of the resident population are in the 65+ age group. This represents a substantially higher portion than the overall ratio of 9.9 per cent for the Maltese Islands. This trend has gradually developed during the present century and is expected to continue for a long time. As in Malta's case, the younger cohorts have been progressively eroded but at a faster rate, particularly following the last War, by the emigration of young people in the 18-40 age group. Moreover, during the last few years, the number of returned emigrants mainly in the 50+ age group has been greater than in the past with the consequence that the older cohorts have become more numerous. Longevity, particularly among the female segment of the population, is also a characteristic of the Gozitan population; around 3.0 per cent of persons are aged 80 years and over compared with an overall ratio of 1.6 per cent in respect of the Maltese Islands. It is difficult to point to differentials among localities. In all cases the ageing ratios are substantially higher than the national one. Qala has the highest index in the Maltese Islands.

Demographic problem areas A fairly detailed account of the changing composition of a population on a national or regional basis is, in itself, an important instrument for planning purposes. Many would raise an eyebrow on the usefulness of such an exercise taking into consideration very small localities. It may be claimed that such an account may be relevant only for academic or historical purposes. Nonetheless an attempt has been made to illustrate the changing age composition of three localities in Malta, i.e. Floriana, Sliema and Valletta which, demographically considered, could be regarded as displaying similar characteristics. The three broad age groups are of the same magnitude and subjected to the same growth or decline pattern during the last forty years. In all cases, the 'youth' segment shrunk considerably while the 'old' portion of their population reached a very high level. The population density of Floriana (768 per km2), although well below the average density for Malta (1301 per km2) is also much lower than that of other localities within the Inner Harbour Region. A large part of the Floriana's land area is in fact taken up by first class roads linking the city with other towns and villages, public gardens, government offices, commercial outlets and recreational areas. New encroachment on such areas for residential purposes is hardly possible. An appreciable proportion of buildings are three storeyed, a characteristic which is not found in most other localities. Real population density is, therefore, very high and is a problem in itself in that housing and other related amenities are difficult to upgrade. The proportion of the elderly to the locality's population merits special attention. Since the beginning of the century Floriana's elderly population segment has been progressively growing. The young had to leave the place and settle somewhere else since it was difficult to provide additional housing units for newly-married couples. The 65+ age group is 56 percent higher than the national index while the 'young' age group is well below (by 24 percent) Malta's overall index. A home for the senior citizens has recently been opened in Floriana. Valletta's population density is nearly three times that of Floriana, reflecting the lack of open space

A Demographic and Socio-Economic Profile of Ageing in Malta

39

and recreational areas. As the Island's capital city, Valletta is the seat of Government and a commercial centre so that most of the buildings are taken up by Government offices and business establishments. As in the case of Floriana, residential expansion is not possible, with the result that newly-married couples have to seek their permanent residence outside their birthplace. The young age groups (0-14 years) have been contracting continuously during the past fifty years. Their present population representation (18.2 per cent) falls short of the national index and is very close to that in Floriana and Sliema. Its ageing population -15.4 per cent are 65 years and over - is again comparable to that of Floriana although somewhat less than that of Sliema. The ageing process will continue to be more pronounced as those within the large 55-64 age group get older. Valletta has been acclaimed as a city built 'by gentlemen for gentlemen', a magnificent gem of art which is admired by tourists and treasured by its senior citizens.
Figure II.3 Population structure by broad age groups - Valletta, Floriana and Sliema, 1948-1985

Floriana

1003 o- M yti. 10-94 yit as yia.

Sliema
70 P Cwil

Valletta
p Com

60

BO

40

40

CD

20

10

1848

W03

1B48 O-Myr * 13-04 yis.

1009 - * - 63 yra

O-14 yi

13-4yis.

*-3yji.

Source:

Census Reports 1948-1985 - Central Office of Statistics (Malta).

40

Reno Camilleri

Exhibiting the highest population of elderly citizens, Sliema may be regarded, from a demographic viewpoint, as an old peoples' home. Its 65+ age group represents 10.4 per cent of its declining population and is nearly twice the national index. Its youngest segment (0-4 age group) is also the lowest and nearly half the national average. These two indices provide a clearer indication of the age composition of this locality. Most of the houses of character particularly on the seafront have been converted into luxury units for touristic purposes. In contrast to Floriana and Valletta, a lot of housing development has taken place in the form of vertical expansion, but the additional accommodation has been taken up by the tourist industry. Both ends of the population pyramid exhibit the usual characteristics of a fast ageing population. The apex is thinner while the base is much larger than that of the other localities in Malta. This ageing process has been particularly pronounced during the past three decades, when this locality was being progressively converted into Malta's principal tourist resort. The three selected localities: have retained more or less the same residential area during the last decades; have suffered a decline in the number of residents due mainly to smaller households; have a large portion of the residential households consisting mainly of old couples; feature the newly-married couples who had to leave their place of birth and settle somewhere else; have expanded vertically on existing sites; this was either not enough to meet the demand for housing or was rented to foreigners or used for commercial purposes; include the birth cohorts of forty years of age who were not being replaced as they passed from one age group to an older one with the consequence that the younger cohorts were being gradually eroded and were disappearing; it is interesting to observe that a high ageing index is characteristic of most of the old towns in European countries, such as, Paris where some of the arrondissements have 20 per cent or more old residents, Oslo, Copenhagen and, to a certain extent, London; have structural curves which exhibit similar features indicating a changing population structure that has been evolving on the same lines; may be regarded as 'demographic problem areas' whose population shows marked deviations either above or below the national average in more than one respect, particularly ageing and population concentration; in all cases the ageing index (o/y) is well above the national average.

A Demographic and Socio-Economic Profile of Ageing in Malta

41

References and notes (1) Lindgren, J.: "Demographic and Socio-Economic Aspects of Population Aging in Finland"- INIA/CICRED 1990. Economic Division - Office of the Prime Minister (Malta): Development Plans -1959/64, 1964/69 and 1973/80. United Nations: World Population Prospects - 1978. Seers, D.: "Fertility Survey of the Maltese Islands" - London 1956. Council of Europe: Population Studies No. 23 - "The second demographic transition: fact or fiction?". Rowland, D.T.: "Ageing in Australia: Population Trends and Social Issues" - Melbourne Longman: Cheshire, 1991. The regions are those dealt with in the last census report and coincide, by and large, with the same geographical areas reported upon in previous censuses. Structural ratio: 100 (Age 65+) . (0-14 age group)

(2)

(3) (4) (5)

(6)

(7)

(8)

42

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III. The ageing dimension


The old Before proceeding to describe the extent and some of the main features of the world ageing problem with particular reference to Malta, one may attempt to define certain relevant terms. Who are the 'old'? Publications issued by the United Nations and the Council of Europe generally apply the term to those aged 65 years and over. But pension considerations, which vary from one country to the other, often determine who should be regarded as aged or old in a particular country. In 1970 Norway adopted the term 'aged 67 and over' when referring to the country's senior citizens but ten years later it was realised that the working population included an important group aged 65-69 and 'old age' applied to persons aged 70 years and over. On the other hand, some countries consider the 'old' segment to cover those aged 60 and over. In the case of Malta the term may be restricted to those who have completed their 60th year of age, since at that age they are entitled to a pension and few choose or are in a position to retain their employment (1). But when comparisons with other countries are made, the term 'aged' is being related to those aged 65 years and over. Moreover, a population as a whole is sometimes classified under three broad headings: 'young', 'mature' and 'aged' but there is no one definition of these three terms. The determining factor, however, seems to be always the proportion of those aged 65 and over to the entire population. The United Nations used to consider young populations as those having less than 4 per cent aged. 65 and over, those having4 to 6 percent as 'mature' and those having7 percent or more as 'aged'. Social demographers later suggested that a 'young' population should not have more than 6 per cent aged 65 years and over, while the term 'mature' was linked to a situation where those aged 65 and over represented 7 to 9 per cent of the population. Moreover, an 'aged' population should be considered as one where the 65 years plus cohort accounted for 10 per cent and over. If one were to apply these measures to selected European countries, say the member states of the Council of Europe, one would find that only Turkey can be regarded as having a 'young' population while Liechtenstein and Malta have 'mature' populations; the remaining countries have an 'aged' population with Sweden topping the list followed closely by Norway, Denmark and the Federal Republic of Germany. One should also bear in mind that these countries include foreign nationals, whose age is usually below 65, in their population data. If this group is not considered, the resulting ratios of the 'aged' to the 'national' population tend to be higher. The proportion of foreign nationals to the total population varies considerably from country to country. It is very low in the case of Italy, substantial in the case of France and the Federal Republic of Germany - around 7 percent - but very high in the case of Liechtenstein, Luxembourg and Switzerland where foreigners constitute 36 per cent, 26 per cent and 15 per cent of the total population. It has been further established that the fertility levels of many ethnic groups is much higher than that of the host country. The total fertility rate in the Federal Republic of Germany in 1979 was 1.33 for Germans, but

A Demographic and Socio-Economic Profile ofAgeing in Malta

43

1.37 for the total resident population. A better indicator, the net reproduction rate, was 0.655 for German women but 1.061 for alien women. In the Netherlands, similar differentials were recorded towards the later half of the seventies. The total fertility rate for the Dutch was 1.53, but for foreign born groups it was 3.42 (2).

A twentieth century phenomenon The ageing of populations is both a world-wide feature and a twentieth-century phenomenon and it is only following the Second World. War that governments, with few exceptions, and international organisations began to regard population ageing as an issue of common concern and vital interest. Moreover, this phenomenon, which until recently was regarded as being of particular significance to industrialised countries, is fast becoming a feature of developing countries including Malta. Roughly, half of the 258 million old people, which the United Nations estimated in the 1980s, lived in developing countries. Moreover the 'aged' portion of population, in both industrialised and developing countries, constitutes the single fastest growing population segment. In the present-day context, the ageing problem has assumed five important dimensions. First, although the ageing of population is regarded as a world-wide phenomenon affecting all countries irrespective of their level of development, the most dramatic increase in the old age groups during the next decades will be in developing countries; secondly, in the study of this problem, one has to direct attention not only to the proportional representation of the 'aged' in the population pyramid but should consider the 'aged' in absolute terms as well; thirdly, the same attention should be focussed on the characteristics of the aged, such as their need for supportive services, their risk of dependence and the housing and social environment; fourthly, the demand on the limited financial resources of the state is continually growing in most countries as their populations pass from one demographic transitional phase to the other or following the completion of their transition cycle; fifthly, the number of old persons in a civilised society is not directly amenable to change. < Unlike other population variables, such as fertility and mortality which can be influenced to a considerable extent by government policies and intervention, the process of ageing cannot be directly influenced, at least, in the short term. Government's attention has, therefore, to be directed not on whether it can alter the basic process of ageing but to the issues that arise from this process.

44

Reno Camilleri Percentage distribution of persons aged 65 and over - Malta & Gozo, 1901-1985

Figure III. I

I
u u
y .

1901
Source:

1921 1948 1967 1911 1931 1957 1985

Census '85, Vol. I - Central Office of Statistics (Malta).

Social age and functional age An important characteristic of the present ageing factor in most European countries and in other developed economies which is widely accepted today is that biological ageing has been pushed back to older ages. Most of those who, on account of attaining a certain age, are being called 'old' are still healthy and mentally lucid, lead an independent life and are able to give their economic contribution. Indeed, demographic data, particularly relating to morbidity characteristics, point to a growing number of those who have surpassed the 60 - 65 years threshold and are still able and willing to play their part in the social life of their country.

A Demographic and Socio-Economic Profile of Ageing in Malta

45

There is, in fact, a strong relationship between the biological and socio-economic aspects of ageing. Very often, the individual's life style is conducive to the late convergence of his biological and chronological (old) age. Ageing does not follow absolute and immutable patterns. It is generally influenced by the general socio-economic conditions of countries but it is also dependent on how far the individual can adapt to the existing social and economic factors which affect his environment and lifestyle. Chronological age has therefore become an increasingly ineffective indicator of the individual's functional age, making obsolete the segmentation (also normative) of the individual life course which is based on it. In other words, there is an ever widening gap between individual functional ageing and individual social ageing, by which we mean the process in which the individual is gradually alienated economically and socially according to chronological ageing. It has therefore become necessary to re-examine the static approach to ageing in which successive generations, independently of their life history, find themselves going through the same stages by reaching the same ages. At the moment, a more dynamic view is being tried out in which the various phases of the individual life course can be adjusted to the real psycho-physical status of the individuals and to their new life-styles (3).

Dynamic ageing thresholds

These observations have prompted demographers to introduce what has been termed 'dynamic ageing thresholds' in contrast to the usual link between ageing and a fixed age even if this generally fluctuated within thefiveyearly band of 60-64 years. Livi Bacci emphasised the influence of differences which are fast becoming most evident between social and biological ageing. Ryder was more specific in that he proposed defining the threshold of old age no longer in terms of the number of years lived but of the further expectation of life. It was suggested that the threshold age should be defined as that age for which the life expectancy was 10 years. This can be easily read from the relevant life tables. In the case of Malta, life expectancy for males is 73.8; the threshold age works out at 63.8 years compared to 65 and 67 years in the case of Italy and Sweden respectively. In the case of females, the threshold age is 4.3 years more.

Life expectancy without incapacity

The ageing process in a population is often directly correlated with the state of health which differs widely from one country to another. For this reason qualitative concepts relating to functional ability or capacity have been developed by researchers in order to assess health standards. Combining demographic techniques with such health coefficients based on investigations on the different aspects of functional incapacity, an index called 'life expectancy without incapacity' has been formulated by the American demographer Sullivan. It provides a relationship between the life expectance at age 65 of a population and the number of years that these may be expected to live without incapacity, i.e. the permanent restrictions of their activities.

46

Reno Camilleri

Although this index is subject to severe limitations, it demonstrates at a point in time and, subject to the possibility of a reversal of the situation, the state of health of the elderly age groups by distinguishing those with a high degree of dependence from those who may expect to enjoy more years of good health. Surveys carried out during the 1980s show very high indices in respect of both males and females in the case of Quebec (Canada) and substantially lower indices in the case of U.K. and the U.S.A., notwithstanding that the life expectancy indices at age 65 in respect of these countries demonstrate no significant differentials. It should be pointed out, however, that dependency due to physical deterioration should not be construed as the only factor determining or characterising old age. One should rather enlarge his field of observations to cover such factors as the economic or social dependence, social and recreational activities of the 'aged', solitude, and other life style characteristics. Figure III.2 Expectation of life - ages 55-85, Malta & Gozo

ou i

AGE GROUP MALES FEMALES

Source: Demographic Review of the Maltese Islands 1990 - Central Office of Statistics (Malta).

A Demographic and Socio-Economic Profile of Ageing in Malta

47

Table III.l

Life expectancy without incapacity - Indexes(1) of selected countries Country Canada (Quebec) U.S.A. France England & Wales Men 74.6 46.5 63.6 57.5 Women 64.6 48.4 53.5 50.9

(1)

(Life Expectancy) 100 (Life Expectancy without incapacity) Robine J.M.: "Rapport trimestriel de statistiques sanitaires modiales" -1989.

Source:

The ageing problem What are the dimensions of the present ageing problem and its future prospects? The answer to this question has to take into account the following: the number of persons aged 65 years and over residing in developing countries account for slightly more than half of those persons aged 65 years and over living in all regions. Around 129 million persons live in developing countries while the same number reside in developed countries. Since 1950, the world's aged population went on increasing steadily and this process will continue for many years, particularly between 2010 and 2015 when those bom during the World War II baby boom will enter the older cohorts. The median age of population in all regions is therefore expected to continue to increase in future. It was 22.4 years in 1980 but is projected to go up to 26.45 years by the year 2000. Europe will continue to lead the list of world territories in this respect. by the year 2000, these proportions will change in a dramatic way. Around 60 per cent of the world's older population will be living in developing countries since most of these are expected to complete within the next few years their demographic transition. It means that, whereas the older population in developed countries will increase by around 30 per cent, the developing countries will experience a growth in their older population of more than twice that rate. The highest percentage increase is expected to be in South East Asia. In some developing countries the older population will be more than double by the year 2000. In absolute terms, by the turn of the century, the proportion of persons 65 years and over in the world will have gone up from 11.4 per cent to 13.1 per cent in the developed countries compared to a smaller increase from 3.9 per cent to 4.6 per cent in the developing countries. As expected, the ageing factor will be particularly visible in the developed countries. Moreover, as the populations of the developed economies assume stationary or zero growth, the aged dependency ratio is likely to go as high as 17 to 20 per cent compared to only about 8 per cent in the developing countries. "The ageing process and its consequences should be considered, therefore, not only as an evolution in a selected age segment, but as part of the structural transformation of the population as a whole and, moreover, as a process associated with a slow overall increase in population"^.

48

Reno Camilleri

The 'very old1 (those aged 80 and over) who are at high risk to long-term chronic illnesses are expected to exert pressures on the countries' resources as their number will go up by over 20 million by the year 2000. Nearly 60 per cent will be in developing countries. In analysing the ageing problem one should not only focus attention on the overall population structure as graphically represented by population pyramids but should also consider very carefully the growth in absolute numbers. On looking at the age pyramids of the world populations in developed and developing countries by the year 2000, one can hardly realise that the number of those aged 65 years and over would have reached about 228.7 million while around 167.2 million will be living in developing countries. A fifth factor concerns the sex ratio of the ageing segment of world population. Developing countries will have a higher ratio of males to females over the next 20 years or so, thereafter the sex ratio will tend to follow the pattern observed in developed countries. Longevity is also directly linked to modernisation and economic development. Modern and economically advanced societies have a larger segment of old people than those where the gross national product is still relatively low by European Standards. The pattern of ageing is generally influenced by economic and social factors. By and large, it is correlated to the level of industrialisation of the country though other factors such as medical services and education should also be considered. One may, therefore, expect that the ageing pattern in different countries follows closely the state of industrial and social development: "the problematic status of elderly in modern society is not so much the result of changes in any one institution such as the family, economy, state or religion as it is an immediate manifestation of a broad demographic change underlying and surrounding the whole modernisation process. Rising incomes, improved sanitation, and advanced medical care all combine to produce better health. The result is that more people live longer, and more of the population is made up of old people" (5).

The 1984 Mexico City Conference Ten years after the United Nations World Population Conference held in Bucharest in 1974, the Mexico City Conference had to examine and determine how far had the 1974 World Population Plan of Action been a success. The W.P.P.A. had focussed on four types of structural issues, and Governments were invited to examine and to consider their implications: the desirable balance of population age structure, its sex composition, the socio-economic implications of the labour force structure and fertility issues calling world attention to two distinct structures - youthful population and high fertility in developing countries and ageing population and low fertility in developed countries. The welfare of the aged was the crucial theme of a recommendation: "all countries should carry out... comprehensive, humanitarian and just programmes of social security for the elderly". During the following decade, intergovernmental activities focused on issues of demographic structure by celebrating the international Year of the Child, the Youth Year and the World Assembly on Aging. In reviewing the practical proposals which such events had made to highlight the contribution that each population segment would make to society, the World Assembly called on Governments to secure the welfare of the aged: "Governments should view the aging sector of the population not merely as a dependent group, but in terms of the active contribution that older persons have already made and can still make to the economic, social and cultural life of their families and the community".

A Demographic and Socio-Economic Profile of Ageing in Malta

49

The 'new rich* The emergence of a 'new rich' social group consisting of senior citizens has therefore been the subject of a number of contributions in periodicals and journals (6). These tell how the income and other financial assets of the elderly in developed and developing economies have been growing in a number of countries in recent decades. The proposition of wealthy elderly will continue on an upward trend. In the 1950s and 1960s many countries made their pension schemes more generous both in coverage and through enhanced rates. More pensioners topped their state pensions through receipt of benefits from private contributory schemes. A lot of pensioners are also in a position to save and to channel such savings to assist in the general development of their countries. In this sense, one may argue that the elderly are not only recipients but also givers. Surveys show that in some countries the elderly own more movable and/or immovable property than people in other age groups. Some studies indicate that very few are assisted financially by their children. On the contrary, paternal handouts often prove a valuable source of financial support to the middle-aged heads of families who are still rearing their children. In the middle of 1980s, the Bank of Japan found that people over 60 years owned more financial assets than those in other age groups. In UK the disposable income of the average pensioner has been rising steadily during the last thirty years. Elderly couples in America aged over 65 are enjoying a higher real income than they did before and 72 per cent own their home compared to national average of 65 per cent (7). An interesting study carried out in 1985 by the Ministry of Social Affairs and Health in Finland to determine the impact of social security benefits on the livelihood of pensioners' households shows that savings are more common among the elderly than among other household groups (8). Savings accounted for 15 per cent of total disposal income in the case of elderly households compared to 3.2 per cent among the control group. The highest quintal of the elderly saved nearly 30 percent of theirdisposal income compared to 5.5 percent in the lowest quintal. The study showed also that the savings coefficient increases in the higher age groups of the elderly which may be partly explained by the fact that the propensity to consume declines (except in the case of private medical and health use services) as people grow older. Moreover, in all Nordic countries it has been the custom to manage one's life without outside support. Psychologically, this social disposition provides for self-sufficiency through savings for a rainy day. How far can one say that the income of the elderly in Malta is sufficiently high to enable most of the local pensioners to save?

The lifestyle of the Aged in Malta During the past few years a number of articles appeared in local periodicals and the press on the financial standing of Malta's senior citizens but most of these contributions purported, in one way or other, to appeal for better pension rates, cost of living adjustments and other similar cash benefits. An interesting and fairly comprehensive survey on the characteristics and life style of the Aged in the Maltese Islands was carried out in 1982 (9). It covered 901 persons representing some 2.3 per cent of those aged 60 and over living in private households. Although the questionnaire did not include a

50

Reno Camilleri

specific question about savings, it did succeed in providing some vital information on the financial standing of the elderly which was hitherto unknown. Some of the results of the survey showed that: a) b) 54 per cent owned the house or flat where they resided. Moreover, 9 percent were land owners; 40 per cent had an additional income beside the pension, while 55 per cent depended entirely on pension income; there was a direct relationship between the level of education and the income groups of pensioners; 77 per cent thought their income was sufficient for their needs while 15 per cent said they needed additional income in cash or in kind. Only 9 per cent were receiving some financial support from their families; the interviewers considered that 2 per cent of respondents were very poor, 45 per cent of 'modest' means, while 10 per cent appeared to be well-off. Clearly, a high level of subjective judgement could have been involved in determining what is modest or adequate; other findings of the Survey showed that the Elderly are generally physically well and mentally alert, live in clean surroundings, do not feel lonely, abstain from smoking and alcohol and are active in religious organisations.

c)

d)

e)

f)

Voluntary groups

Voluntary assistance towards the Aged is not a new feature of Malta's social environment. In the past, such voluntary work was mainly provided by the Church. In the late forties, a limited form of old age and blindness pensions was introduced through the Old Age Pensions Act of 1948. This was followed by the National Assistance Act of 1956 which provided three kinds of assistance, namely: social household assistance, medical assistance and special unemployment assistance. The benefits were largely determined through a means test that took into account the applicant's household movable property. During the past forty years, a package of various forms of financial assistance and other old age benefits has gradually evolved through a number of legislative measures (10). Voluntary work is, however, still important to supplement the state's commitment in caring for the financial needs of the elderly and voluntary groups still play a leading role in providing various services to the elderly. It is not the scope of this monograph to describe in any detail the various forms of voluntary services provided to the elderly in Malta. Some reference is, however, being made to a particular scheme by way of illustrating the valuable work which is being provided by Caritas, a leading Church organisation in the social field. The 'Good Neighbourhood Scheme1 is intended to provide, on a regular basis, assistance to lonely people by groups of volunteers who ensure that such help is extended in a friendly and trustworthy manner. The groups are formed within parishes and group members are trained for this work. They inform elderly people about Government's assistance schemes, assist in applying for such services and encourage the elderly to form social groups. Some volunteers phone their 'clients' every morning to see to their daily needs. The elderly themselves are encouraged to participate in such schemes and around

A Demographic and Socio-Economic Profile of Ageing in Malta

51

sixty-five per cent of volunteers are elderly persons themselves. The official policy of Caritas is to encourage the elderly to lead an independent life in their own home whenever possible. At present around 3.5 percent of Malta's elderly population live in residential institutions run by Government, the Church and other private bodies but the list of those applying for admission in such homes has always been on the increase. The 'Good Neighbourhood Scheme' enables the elderly to remain at home and assist them in coping with their daily tasks.

Inadequate income? Despite the introduction during the last decade of new social programmes and the expansion of old ones aimed at assisting the elderly, a recent survey of those aged 60 and over held in 1989/90 in conjunction with a post-graduate degree at the University of Malta produced some thought provoking results, although most of the findings of the 1982 survey already referred to were basically confirmed. The main contrast was deduced from replies to a question concerning the adequacy of the income of the elderly. Whereas, in the 1982 survey, 77 per cent thought their income was sufficient for their needs, the 1990 study found out that only 21 per cent of those interviewed considered their income adequate notwithstanding that 14 per cent were receiving additional financial help compared to 9 per cent ten years earlier. This paradox has to be considered in the light of the increase in transfer payments from the state and the extension of free services in favour of the elderly. One plausible explanation could be that there has been a marked change in life styles and expectations of the Maltese elderly population which was not matched by enhanced economic benefits and assistance either by the state or by voluntary associations. For example, notwithstanding that a wide range of medicines and medicinis related to 'chronic' illnesses may be obtained free from Government clinics, the price of other drugs has increased considerably during the last years. The increase in pensions is also considered by some to be lagging behind the general level of prices. The problem one has to consider is whether the upgrading in lifestyles and expectations of the elderly may be regarded to have reached a peak and that some levelling-off may be expected in the near future. It is difficult to assess what the future situation will look like but one should realise that the GDP per capita is bound to go up at a fast rate if Malta will eventually become a member of the European Community whose average GDP 'per capita' is substantially higher than Malta's. In such a situation one may expect that state outlays on pensions and other social services in support of the elderly have also toriseconsiderably. The results of this survey cast some doubts as to whether the elderly are really receiving therighttype and mix of economic and social assistance that they really need, notwithstanding the rise in public expenditure and other transfer payments, and support the call for a closer examination of policy options in this regard.

The education of the elderly In describing the educational characteristics of the elderly during the past fifty years, one has to make reference to certain socio-economic features of the local population during the first half of the present century. Historically, the educational attainment among the elderly has been of a low standard and this was mostly due to the inability of various social groups to complete even their elementary education. The 1911 population census reported a very high illiteracy rate of73.6 per cent of thoseaged

52

Reno Camilleri

11 and over. Twenty years later, this level declined to 52.6 per cent. As one would expect the literacy rate varied between males and females, with a higher illiteracy rate being related to the female component of the population, and to the older age groups. Social factors caused rural areas to display higher illiteracy ratios as in the case of the small island of Gozo, whose economy has traditionally been heavily oriented towards agriculture. This situation can be read from Figure III.3. During the last fifty years, the educational level of the Maltese population was distinctly upgraded through the operation of two legislative measures. The Compulsory Education Act came into operation in 1946, while the Education Act of 1974 provided for compulsory education up to the age of sixteen. In addition, a programme of adult education has now been running for a number of years. The progress made in the eradication of illiteracy during the present century can be illustrated from the following data which concern the population aged 10 years and over, the age when the average young person has had sufficient time and opportunity to learn to read and write. YEAR 1911 1921 1931 1948 1985
ILLITERATE PERSONS NUMBER 119,555 111,942 103,603 77,088 34,274 PER CENT

73.6 66.4 52.6 33.4 12.0

Source:

Census '85, Vol. I - Central Office of Statistics (Malta).

Information concerning the literacy levels of the older age groups collected during the last census contrasts sharply with the comparable data emerging from the 1948 census to which reference has already been made. In 1985,34 per cent of those who were illiterate were aged 65 or over. In the 1948 census, the same age groups accounted for only 14 per cent of the illiterate population since at that time all age groups displayed high levels of illiteracy rates. But, whereas in 1948,52 per cent of those aged 65 and over could not read or write, this ratio tumbled to 34 per cent nearly forty years later.

A Demographic and Socio-Economic Profile of Ageing in Malta

53

Figure III.3

Illiterates in age group 50 and over as percentage of total population - Malta & Gozo, 1985

'252 NO OVER 944 TO <1J52 6J6 TO <t44 328 TO < < ] LESS 'HAN J2S

Depi. of Geography Keele Univ.

Source:

Census '85, Vol. I - Central Office of Statistics (Malta).

University of the Third Age The Universities of the Third Age, which have spread throughout almost all the five continents, originated in Toulouse, France, in 1973. Although these institutions have different names, they all share the same objective, that is, to update the education of the elderly through programmed courses and lectures in order to help stall the ageing process and to encourage research. This helps all those who follow the courses to be in a position to solve their own problems and make their newly-found leisure meaningful. On January 23, 1993 a University of the Third Age aimed at attracting citizens over 60 years of age was inaugurated in Malta to run programmes specially planned to be intellectually challenging,

54

Reno Camilleri

culturally enriching and informative about matters of general concern to the elderly. Participants will be given every opportunity to identify common areas of interest and to utilise their creativity. The first programme titled, 'For a Longer and Fuller Life', covered aspects of social rights, pensions, health care, and the prevention of illness and disability. Other sessions are aimed at the cultural development of the elderly and at enabling them to lead a more productive life. This is closely linked to their use of free time which may be utilised to facilitate their fuller participation in social and cultural activities. The U3A is not primarily intended to qualify people and give out certificates and diplomas but to provide the means and basis for the harmonious integration of the elderly in the national development process.

The ageing trends Figure III.4 illustrates the ageing trends represented by different curves, in countries purposely selected to represent different groups (of countries) with similar ageing patterns. France and Sweden are examples of 'early ageing1 countries whose proportion of those 65 years and over has been steadily increasing at a constant rate during the last one hundred and fifty years, although the aged 'curve' for France exhibits a more uniform gradient of growth than that in respect of Sweden. Greece witnessed a steady ageing process particularly during the last forty years as can be read from the graph which also draws a comparison with local conditions. Other European populations like Bulgaria and Italy began ageing at a later stage but, after 1920, their ageing process followed the same pattern as that of other European countries which could be regarded as 'intermediate' ageing countries. Another group of countries like Japan and Argentina, where fertility remained high up to the middle of the present century but has now been declining at a fast rate, could be regarded as 'later' ageing countries. In such cases, their rate of ageing had been rapid and followed more or less the gradient of the ageing curves of Bulgaria and Greece. One may then consider countries like Turkey and Sri Lanka where the ageing process is still 'nascent' and the proportion of the aged will be around 7 per cent by the turn of the century.

A Demographic and Socio-Economic Profile of Ageing in Malta

55

Figure III.4

Trends in percentage of population 65 years of age and over, selected countries, 1850-2000

percent (65 years +)

0 1850

1875
FRANCE GREECE

1900

1925
SWEDEN Japan

1950

1975
MALTA Sri Lanka

2000

Source: U.N.F.P.A. - International Perspectives on Aging: Population and Policy Challenges -1982.

Malta's ageing curve Malta's ageing curve exhibits interesting and certain particular features that call for comments because, whereas the gradient andfluctuationsof other curves generally conform to their demographic transitions, in the case of Malta the demographic model does not explain the high proportion of those aged 65+between 1850 and 1950, with a particular low proportion in 1910. It was, in fact, only in 1950 that the 'ageing' curve assumed a uniform upward trend. One should therefore focus his examination to specific local conditions that could have influenced the number of those aged 65+ in the period 1850-1950. Table III.2 provides a clue. One may note that, while each age group under 20 years and 40 years or over in 1861 exceeded the corresponding age groups in 1851, the age groups 25-35 show a decrease of 2,436 on the corresponding groups ten years earlier. In 1871 this shortfall is reflected in the age groups 35-45 but it is reduced to 1,562. Ten years later, the decreased cohort is again reflected in the 45-55 age groups, thereafter it is wholly absorbed in the 65+ group in 1901. It is known that: (a) during the ten-year period 1852-1861 deaths from gastro-enteritis were numerous and claimed a considerable number of children under 5 years of age; (b) between 1852-57 there were outbreaks of smallpox and cholera; the returns of mortality covering the period 1852-57 show that 1,373 died of smallpox while a cholera epidemic claimed 770 victims; the number of deaths from gastro-enteritis was also high during the same period;

56

Reno Camilleri

the average number of deaths during the period 1853-56 stood at 3,103 compared with 2,854 in 1857; (c) the drop of 2,436 persons in the 25-35 year cohort in 1861 was a direct consequence of (a) and (b). As one would expect, this difference diminished gradually over the years as the 1851 cohort (25-35 years) moved up to the age scale. Those who in 1851-1861 were aged 25-35 years would have been 65 years and over in 1901 had they survived. The decline in number in 1901 in this group may therefore be partly traced to the large number of persons between 25 and 35 years carried away by the epidemics in 1851-1861.
Table III.2 Population by age groups - Malta & Gozo, 1851-1901 (In thousands)

AGE GROUP

1851 14.9 13.5 11.6 10.5 11.0

1861 15.3 14.7 14.1 13.4 11.2

1871 15.4 13.8 14.8 14.6 14.0 10.2

1881 16.7 15.1 14.2 13.6 15.0 11.6 11.6

1891 21.1 17.5 15.6 15.0 14.3 12.0 12.9

1901 21.9 21.5 19.5 17.2 16.0 13.3 13.2

0-4 5-9
10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64

65+
Source:

9.2 9.7 8.1 8.5 4.6 5.8 3.2 5.0 7.7

8.5 9.3 6.8 9.6 6.5 8.1 3.5 4.8 8.2

9.5 6.6 8.9 5.9 8.4 5.0 6.2 8.3

7.5 8.9 5.6 8.1 4.5 6.9


10.6

9.1
10.8

9.8
12.2

6.9 8.1 4.4 6.1


11.1

8.2
10.0

5.4 6.4 9.8

Census Reports: Central Office of Statistics (Malta).

Dependency ratios In assessing the ageing problem, it is generally relevant to construct some basic indices or ratios, such as the dependency ratio and the ageing or structural ratio of the population. These two ratios give a valid indication of whether the 'old1 segment of a population has reached a high level that calls for particular policy options. The notion of age dependency may, however, have different connotations depending on whether social or economic relationships are being discussed. In all cases, certain basic parameters have to be considered in the compilation of these indicators. Firstly, the young or aged segments of the population, theoretically considered as economically inactive, are always related to those working or potentially economically active; secondly, the definitions of the terms 'young', 'old' and 'working age' are generally determined taking into account local conditions, although for international comparisons these terms cover the age groups referred to earlier; thirdly, these indices should be regarded as ways of determining population structure for analytical purposes rather than a conclusive assessment of economic dependence which may vary between one country and another. It is a fact, however, that the working segment of the population has usually to support, either directly or indirectly, the burden of the non-active segments; fourthly, the total

A Demographic and Socio-Economic Profile of Ageing in Malta

57

dependency ratio (TOR) for the developing countries is usually influenced to a considerable extent by the large proportion of children, as their TDRs are usually high, but they also have a very low aged dependency ratio relating to their level of economic development. As has already been concluded, economic and social development causes the TDRs of such countries to decline even though the aged dependency ratio goes up. It has been estimated that the 'young' and the 'old' (meaning those under 15 years of age as well as those 64 years and over) constitute around 70 per cent of the active world population. It has been forecast that the world TDR will come down by around 11.4 per cent by the turn of the century depending, of course, on the rate of growth of the developing world economies of Africa, South Asia and Latin America.

The burden of the Aged In order to assess in a general way the burden of the inactive segment of the Maltese population upon the active part, three types of dependency ratios have been worked out taking into account local conditions in that education is compulsory up to age 16, so that those aged 15 are included within the 'young' component while those aged 61 and over are being included within the 'old' segment. Since the ageing factor in Gozo is much higher than in Malta, separate indicators have been worked out as follows: Table III.3 Dependency ratios - Maltese Islands, 1985
0-15 age group 61+age group 0-15 & 61+ age group

As a percentage of 16-60 age group


40.7 Source: 22.6 63.3

Census '85, Vol. I - Central Office of Statistics (Malta). Dependency ratios - Gozo, 1985 0-15 age group 61+ age group As a percentage of 16-60 age group 39.4 33.0 72.3 0-15 & 61+ age group

Table III.4

Source:

Census '85, Vol. I - Central Office of Statistics (Malta).

One cannot overlook the situation in Gozo which, as already pointed out earlier, has a relatively higher ageing population segment. The index stands at 70.9 which is 73 per cent higher than that in respect of the national index. Tables III.6 and III.7 show the ageing indices and the dependency ratios for each locality in Malta and- Gozo.

58

Reno Camilleri Persons aged 65 and over as percentage of total population - Malta & Gozo, 1985

Figure III.5

V.

H 0 0

20! NO O E VR 1544 ro <204l 1047 T O344 O 550 T O047 O LESS T A 550 HN

Produced by Degartaent of Caoaraphy Keale Unlvareity in conjunction with Cintrai Offict or Stattatlca

Source:

Census '85, Vol. I - Central Office of Statistics (Malta).

Ageing ratio The ageing ratio is another statistical means of comparing the relative representation of the young and the old segments in a population. It is, in other words, a ratio of these two proportions: the higher the ratio, the more aged a population is. One would, therefore, expect tofindthat in developing countries the ratio is relatively low. The aged are, in fact, only 10 per cent as numerous as the young. In Africa, they represent less than 10 per cent; in South Asia and in Latin America the proportion is only slightly higher. In contrast, the ageing ratio for Europe is about 60 per cent followed by that in respect of North America which is marginally higher than 50 per cent. In the case of Malta, the overall ratio is 42.1 per cent which is the lowest, with the exception of Turkey (11.3 percent), among those of other states. The highest ratios exhibited by European populations are in respect of Sweden and the Federal Republic of Germany as illustrated in Table III.5.

A Demographic and Socio-Economic Profile of Ageing in Malta


Table III.5 Ageing indices in selected European states, 1990 Number of persons of 65 years and over per 100 persons below 15 years of age 83.2 75.0 41.2 87.8 66.2 102.8 66.7 41.5 38.3 72.7 47.5 78.7 Number of persons of 65 years and over per 100 persons below 15 years of age 42.1 65.7 82.5 54.5 58.6 99.4 84.4 11.3 80.4'

59

Country

Country

Austria Belgium Cyprus Denmark France Fed. Rep. of Germany Greece Iceland Ireland Italy Liechtenstein Luxembourg Source:

Malta Netherlands Norway Portugal Spain Sweden Switzerland Turkey United Kingdom

Council of Europe. Recent demographic developments in the member states of the Council of Europe -1990 Country Reports.

60

Reno Camille ri Ageing or structural ratios of the population of Malta & Gozo by locality, 1985

Table III.6

O/Y

O/Y

MALTESE ISLANDS Inner Harbour Region Cospicua Floriana G/Mangia/Piet Gzira Hamrun Kalkara Marsa Msida Paola Santa Lucia Senglea Sliema Valletta Vittoriosa Ta1 Xbiex Outer Harbour Region B'Kara Fgura Luqa Qormi San Gwann StJulian's St. Venera Tarxien 2abbar Northern Region Gharghur Mellieha Mgarr Mosta Naxxar St. Paul's Bay

24.1

9.9

40.9 South Eastern Region

24.5 18.4 26.3 24.6 21.6 23.1 22.4 22.3 21.9 28.9 25.6 16.9 18.2 23.5 29.8

9.0
15.4

8.6 9.4
11.7

9.7
10.2 10.1 11.1

36.7 83.7 32.7 38.2 54.2 42.0 45.5 45.3 50.7

2.6 8.7
18.4 15.4

9.0
34.0 108.9 84.6 40.4 16.8

B'Bugia Ghaxaq Gudja Kirkop M'Scala M'Xlokk Mqabba Qrendi Safi Zejtun Zurrieq Western Region Attard Balzan Dingli Lija Mdina Rabat Siggiewi Zebbug GOZO Fontana Ghajnsielem Gharb Ghasri Kercem Munxar Nadur Qala San Lawrcnz Sannat

24.4 28.1 25.5 26.2 25.9 28.1 26.4 24.4 27.0 24.4 26.1

8.2 6.1 8.1 6.7 7.0 6.4 7.6


11.1

6.3 8.6 7.1

33.6 21.7 31.8 25.6 27.0 22.8 28.9 45.5 23.3 35.2 27.2

9.5 5.0

25.1 31.7 25.3 26.8 30.7 24.3 24.8 25.6 26.9

8.0

3.3
7.7 6.1 3.4 8.4 8.4 8.2 7.9

31.9 10.4 30.4 22.8 11.1 34.6 33.9 32.0 29.4

23.8 24.4 26.2 24.9 17.8 21.6 25.6 26.3 21.3 23.3 24.9 20.0 18.9 21.5 19.2 19.9 17.0 20.2 21.1 22.6 20.1 19.7 22.9

8.4 9.0 9.7 8.3


15.2 12.0

8.4 7.7
15.1 12.7 10.9 18.8 16.5 15.1 11.8 19.0 20.9 18.4 10.6 13.4 16.6 14.6 12.6

35.3 36.9 37.0 33.3 85.4 55.6 32.8 29.3 70.9 54.5 43.8 94.0 87.3 70.2 61.5 95.5 122.9 91.1 50.2 59.3 82.6 74.1 55.0

24.6 23.3 23.6 26.6 24.8 24.7

8.2
10.1 11.2

8.2 7.8 9.0

33.3 43.3 47.5 30.8 31.5 36.4

Victoria
Xaghra Xewkija Zebbug

Y = 0-14 years; O = 15-64 years Source: Census '85, Vol. I - Central Office of Statistics (Malla).

A Demographic and Socio-Economic Profile of Ageing in Malta

61

Table III.7 Dependency ratios of the population of Malta & Gozo by locality, 1985 0-14 + 0-14 +

0-14

65+

0-14

65+

65+
in%of 15-64 age group Inner Harbour Region Cospicua 36.8 27.8 40.4 37.3 32.4 34.4 33.2 33.0 32.7 42.2 39.0 26.1 27.4 35.1 45.7 13.5 23.3 13.2 14.2 17.5 14.4 15.1 14.9 16.6 50.3 51.1 53.6 51.5 49.9 48.8 48.3 47.9 49.3 46.0 52.2 54.5 50.6 49.3 53.4 South Eastern Region B'Bugia Ghaxaq Gudja Kirkop M'Scala M'Xlokk Mqabba Qrendi Safi Zejtun Zurrieq Western Region Attard Balzan Dingli Lija Mdina Rabat Siggiewi Zebbug GOZO Fontana Ghajnsiclem Gharb Ghasri Kercem Munxar Nadur Qala San Lawrcnz Sannat Victoria Xaghra Xewkija Zebbug 36.4 38.8 32.7 29.3 33.9 27.8 32.6 27.4 32.9 30.9 35.3 31.8 30.0 35.5 19.8 17.0 30.7 25.5 23.8 17.1 31.1 33.6 30.0 15.5 20.9 26.2 22.2 19.5 35.1 36.6 40.9 37.3 26.6 32.5 38.8 39.8 12.4 13.5 15.1 12.4 22.7 18.1 12.7 11.7 36.2 42.7 38.4 39.0 38.6 42.9 40.0 37.8 40.5 36.4 39.1 12.2

65+
in % of 15-64 age group

Floriana
G/Mangia/Piet Gzira Hamrun Kalkara Marsa Msida Paola Santa Lucia Senglea Sliema Valletta Vittoriosa Ta' Xbiex Outer Harbour Region B'Kara Fgura Luqa Qormi San Gwann StJulian's St. Venera Tarxien Zabbar Northern Region Gharghur Mellieha Mgarr Mosta Naxxar St. Paul's Bay

9.3
12.2 10.0 10.4

9.8
11.5 17.2

9.4
12.8 10.6

3.8
13.2 28.4 23.2 14.2

48.4 52.0 50.6 49.0 49.0 52.7 51.5 55.0 49.9 49.2 49.7

7.7

37.5 48.8 37.8 39.9 46.6 36.1 37.1 38.7 41.3

12.0

5.1
11.5

9.1 5.1
12.5 12.6 12.4 12.1

49.5 53.8 49.3 49.0 51.7 48.6 49.7 51.1 53.4

47.5 50.1 56.0 49.7 49.3 50.6 51.1 51.5

36.6 35.0 36.2 40.8 36.8 37.2

12.2 15.2 17.2 12.6 11.6 13.6

48.8 50.2 53.4 53.4 48.4 50.8

56.2 55.8 63.4 54.8 57.7 44.9 63.7 61.0 62.9 46.4 56.2 58.0 52.2 55.0

Source:

Census '85, Vol. I - Central Office of Statistics (Malta).

62

Reno Camilleri

Future trends
A main objective of this monograph has been to describe the changing age composition of the Maltese population. What will the population composition look like in thirty years' time? Demographic forecasts up to the end of the century hardly present problems, but a scenario reaching into the future for a period almost as long as one generation poses the usual problems of scientific projections. It has also to be pointed out that the social and economic implications of future population forecasts have been mentioned in a cursory way, since these have to be very carefully analysed if an assessment of their macroeconomic effects is desirable. For this reason, theWorld Population Plan of Action1, adopted during the International Population Conference held in Mexico City in August 1984, underlines Governments' responsibility to give appropriate consideration to future shifts in family and household structures and their implications in considering policy options. Policy makers should also analyse carefully the issue of ageing particularly its implications for overall development, social services, medical care and other related fields and, on the basis of such data, attempt to secure the welfare of older people. They should view the ageing sector not merely as a dependent group or in terms of its needs, but also in terms of the active contribution that older persons can make to the social, cultural and economic welfare of their community (11). Forecasts of the changing age structure of the Maltese population have been made by employing the standard method of population projections, i.e., the component method which takes the population by sex and age at a base year and carries it forward year by year, cohort by cohort, taking into account the following parameters: (a) the de jure population which has been considered as the base population since the foreign element is very small and is not expected to grow in the near future; the average death rates for each single year of age and sex of the last three years; the average natality rates specific for age of female from 14 to 49 over the last three years; and nil migration.

(b) (c)

(d)

The last parameter is considered a convenient one for such projections but should be modified in the event of any change in outward migration. Future observations will also determine whether a new variable relating to migratory inflows should be considered in working out projections. Since 1975, net migration inflows varying between 900 and 300 have been recorded (12). In the case of Malta, the age structure of the population has in the past been influenced to an appreciable degree by emigration. The parameters are, moreover, worked out on the 1989 population estimates which are based on the 1985 census. On the above assumptions the Maltese population is projected to grow by 6.4 per cent by the year 2000, and by a further 5.1 per cent during the following decade. However, if account is taken of an assumed trend in the number of returned migrants, a positive migration balance of some 500 per year may be added. This (a) will push up the projected level at the year 2000 by a further 5000 persons, in which case the Maltese population may grow by 7.8 per cent instead of 6.4 per cent and (b) may cause the older age groups to grow further in relation to the other age groups since the majority of returnees tend to inflate the older cohorts.

A Demographic and Socio-Economic Profile of Ageing in Malta

63

Table III.8

Population projections - Malta & Gozo, 1995-2020

1995

2000 % TOTAL % MALES %

AGE MALES % GRP


04 59 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ 13495 13799 14169 14613 13563 12112 13687 14478 13760 14652 10280 8507 7324 6146 5211 3057 1776 1096

FEMALES

FEMALES

TOTAL %

7 4 13106 . 7 6 13129 . 7 8 13656 . 8 0 13643 . 7 5 12834 . 6 7 11448 . 7 5 12866 . 8 0 14162 . 7 6 13577 . 8 1 14839 . 5 7 10839 . 4 7 9505 . 4 0 9092 . 3 4 7675 . 2 9 6754 . 1 7 4218 . 1 0 2812 . 0 6 1966 . 100 186121

7 0 26601 . 7 1 26928 . 7 3 27825 . 7 3 28256 . 6 9 26397 . 6 2 23560 . 6 9 26553 . 7 6 28640 . 7 3 27337 . 8 0 29491 . 5 8 21119 . 5 1 18012 . 4 9 16416 . 4 1 13821 . 3 6 11965 . 2 3 7275 . 1 5 4588 . 1 1 3062 .

72 . 13251 73 . 13473 7 6 22.1 13799 . 77 . 14159 72 . 14578 64 . 13517 72 . 12087 13642 78 . 74 . 14399 80 . 13615 57 . 14382 49 . 9961 4 5 66.8 7944 . 38 . 6549 5107 33 . 20 . 3761 12 . 1848 0 8 11.1 1146 .

71 . 72 . 74 . 76 . 78 . 72 .

65 . 73 .
77 . 73 . 77 .

53 .
42 . 35 . 27 . 20 . 10 . 06 .

12863 13072 13129 13656 13643 12834 11438 12831 14108 13502 14689 10656 9141 8505 6818 5421 2950 2072

67 . 68 . 69 . 71 . 71 . 67 . 60 . 67 . 74 . 71 . 77 . 56 . 48 . 44 . 36 . 28 . 15 . 11 .

26114 6 9 . 26545 7 0 . 26928 7 1 21.0 . 27815 7 3 . 28221 7 5 . 26351 7 0 . . 23525 6 2 . 26473 7 0 28507 7 5 . 27117 7 2 . 29071 7 7 . 20617 5 4 . 17085 4 5 67.3 . 15054 4 0 . . 11925 3 2 9182 2 4 . 4798 1 3 . 3218 0 9 11.7 . 378546 100 100

TOTAL 181725

100 367846 100 100 187218

100 191328 100

2005

2010 % TOTAL % MALES %

AGE MALES GRP 04 59 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ 13684 13229 13473 13789 14124 14528 13477 12052 13565 14239 13363 13909 9342 7099 5450 3682 2242 1203

FEMALES

FEMALES

TOTAL %

7 1 13299 .
69 . 70 . 72 . 73 . 12834 13072 13129 13656 13643 12824 11410 12781 14026 13372 14421 10276 8548 7552 5471 3755 2187

75 . 70 . 63 . 70 . 74 . 69 .
72 . 49 .

68 . 65 . 67 . 67 . 70 . 70 .

65 . 58 .
65 .

71 .
68 . 73 .

52 .
44 . 38 . 28 . 19 . 11 .

37 . 28 .
19 . 12 . 06 .

26983 26063 26545 26918 27780 28171 26301 23462 26346 28265 26735 28330 19618 15647 13002 9153 5997 3990

69 . 14080 67 . 13661 6 8 20.5 13229 . 69 . 13463 13754 71 . 72 . 14074 68 . 14478 60 . 13433 68 . 11982 73 . 13415 69 . 13973 73 . 12925 5 0 67.4 12995 . 40 . 8368 33 . 5895 24 . 3936 15 . 2191 0 9 12.1 1375 .

71 . 69 . 67 . 68 . 70 . 71 .

73 .
68 . 61 . 68 . 71 . 66 . 66 . 42 . 30 . 20 . 11 .

07 .

13695 13263 12834 13072 13129 13656 13633 12789 11369 12711 13896 13126 13864 9625 7586 6057 3789 2637

68 . 66 . 64 . 65 . 65 . 68 . 68 . 64 . 57 . 63 . 69 . 65 . 69 .

48 .
38 . 30 . 19 . 13 .

27775 26924 26063 26535 26883 27730 28111 26222 23351 26126 27869 26051 26859 17993 13481 9993 5980 4012

70 .
68 . 6 5 20.3 . 67 . 68 . 70 . 71 . 66 . 59 . 66 . 70 . 65 . 6 7 66.8 . 45 . 34 .

25 .
15 . 1 0 12.9 .

TOTAL 192450

100 196256

100 388706 100 100 197227

100 200731 100

397958 100 100

64

Reno Camilleri Population projections - Malta & Gozo, 1995-2020 (contd.) 2015 AGE MALES GRP % FE% MALES 13720 13659 13263 12834 13072 13129 13646 13598 12739 11307 12582 13646 12626 12960 8608 6079 4193 2784 6.7 6.7 6.5 6.3 6.4 6.4 6.7 6.7 6.2 5.5 6.2 6.7 6.2 6.3 4.2 3.0 2.1 1.4 100 TOTAL % MALES % 2020 FEMALES 13617 13684 13659 13263 12834 13072 13119 13611 13547 12669 11202 12353 13124 11805 11496 6953 4202 3020 % TOTAL %

Table III.8

0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ TOTAL

14109 14056 13661 13219 13428 13704 14024 14428 13363 11852 13168 13512 12076 11610 7029 4248 2350 1418 201255

7.0 7.0 6.8 6.6 6.7 6.8 7.0 7.2 6.6 5.9 6.5 6.7 6.0 5.8 3.5 2.1 1.2 0.7

27829 27715 26924 26053 26500 26833 27670 28026 26102 23159 25750 27158 24702 24570 15637 10327 6543 4202

6.9 6.8 6.6 20.3 6.4 6.5 6.6 6.8 6.9 6.4 5.7 6.3 6.7 6.1 64.6 6.1 3.9 2.5 1.6 1.0 15.1

14010 14085 14056 13651 13184 13378 13654 13974 14348 13218 11637 12732 12619 10791 9653 5134 2526 1494

6.9 6.9 6.9 6.7 6.5 6.6 6.7 6.8 7.0 6.5 5.7 6.2 6.2 5.3 4.7 2.5 1.2 0.7 100

6.6 6.6 6.6 6.4 6.2 6.3 6.3 6.6 6.5 6.1 5.4 6.0 6.3 5.7 5.5 3.4 2.0 1.5

27627 27769 27715 26914 26018 26450 26773 27585 27895 25887 22839 25085 25743 22596 21149 12087 6728 2637

6.7 6.8 6.8 6.6 6.4 6.5 6.5 6.7 6.8 6.3 5.6 6.1 6.3 5.5 5.2 3.0 1.6 0.6

20.3

63.8

15.9 100

100 204445

405700 100 100 204144

207230 100

409497 100

Source:

Central Office of Statistics (Malta) - Unpublished data.

Table III.9

Selected age groups in Maltese Islands, 1990-2010

1990 Age Group 65+ Cumulative Increase Cumulative % Increase 70+ Cumulative Increase Cumulative % Increase 75+ Cumulative Increase Cumulative % Increase Source: Males 16122 Females 21323 -

1995 Males 17286 1164 7.2% 11140 1283 13% 5929 276 4.9% Females 23452 2102 9.9% 15750 2029 14.8% 8996 528 6.2% Males

2000

2005 Males 19676 3554 22% 12577 2720 27.6% 7127 1474 26.1% Females 27513 6190 29% 18965 5244 38.2% 11413 2945 34.8%

Females 25766 4443 20.8% 17261 3540 25.8% 10443 1975 23.3%

18411 2289 14.2% 11862 2005 20.3% 6755 1102 19.5%

9857 -

13721

5653 -

8468 -

Central Office of Statistics (Malta) - Unpublished data.

A Demographic and Socio-Economic Profile ofAgeing in Malta

65

Population growth and density

It is not always meaningful to draw a simplistic relationship between population growth and density. Afiveper cent growth in the population of most European countries, e.g. Italy and France, will not influence to a significant extent the density aspect and it may not cause problems in so far as the demand for land area and the environment is concerned. In the case of Malta, the projected 6.4% increase in total population by the end of the century will mean a population density of 1200 per km2. In twenty years' time, population density will be more than 1255 persons per km2, an increase of 11.5 percent on the present density factor. In these projections, no account has been taken of the number of foreign residents, nor of the reverse trend in migration which, in recent years, has been a source of demographic change of some importance mainly affecting the older age groups. This very high land/ population ratio should be of particular interest to both social and economic planners. Apart from its impact on the environment, it may have other significant repercussions of a social and financial nature.

Projected age pyramid Population projections for the next two decades establish the likely movements in the proportional representation of the three main sub-divisions of the age pyramid. The young segment (0-14 years), which in 1990 accounted for 23.3 per cent of Malta's population, is expected to decline by one percentage point every five years until the turn of the century and will stand at 22.1 per cent in 1995 and 21.0 per cent in the year 2000; thereafter it will continue to ease at a much slower rate going down to 20.5 per cent by 2005, and will represent 20.4 per cent of the total population by the year 2010. One can also discern a marginal change in the sex composition during this period. The working age group (15-64 years) exhibits more or less the same characteristics. Its proportional representation is expected to increase slightly during the next two decades, going up from 66.1 per cent in 1990 to 67.3 per cent in the year 2000; thereafter it will level off to stand at 67.0 per cent by the year 2010. One may, therefore, infer that the 65+ age group will absorb most of the population increase during the next twenty years. As at end of 1990, this age group represented 10.6 per cent of Malta's population. Its ratio is expected to continue on a rising trend throughout the period. It will stand at 11.1 per cent in five years' time, going up to 11.7 per cent at the turn of the century. Within the next decade, this age group will increase to 12.9 per cent. In absolute terms, the increases will be as follows:

66

Reno Canillen Year 1990 1995 2000 2005 2010 Persons aged 65+ 37445 40711 44177 47189 51459 Cumulative Increase

3266 6732 9744 14014

This cumulative increase will therefore represent 33.3 per cent of the projected total population increase during the next two decades. Special attention should be focussed on a particular ageing threshold in so far as this is related to the country's finances, which in the case of Malta may be taken as age 61. Population projectons demonstrate that, by the year 2000, the 61+ age group will grow by 17.5 per cent. In absolute terms this means that another 8602 persons, consisting of 3221 males and 5381 females, will have moved to the 61+ age group within the next decade. As a proportion of total population, the ratio will go up from 13.8% in 1990 to 15.2% in the year 2000. But, in twenty years time, the number of persons aged 61+ will increase by 23,400 or 47.5 per cent on the present level. Proportion wise, it willriseto 18.3 percent of theprojected population. This means that this age group is forecast to go on increasing by a yearly average of 0.23 per cent per annum, of whom the female component will be around 56 per cent, but the yearly increase will be more pronounced after the year 2000. As a matter of fact, it is projected that during the next ten years this age group will experience a yearly increase of 860; thereafter it will continue on an upward trend at an accelerated rate, going up by some 1480 per annum between the years 2000 and 2010. On the basis of such projections, the 61+ age group will reach a high level of 87,300 persons by the year 2020 representing some 21.2 per cent of projected population. It is anticipated that the dependency ratio will fluctuate only marginally during the next decade, since the proportional representations of the 'young' and the 'old' components of the populaton will retain more or less their ratios to the total population. The small reduction in the 'young' segment will, in fact, be taken up by the 'old' portion, while the working age population will rise slightly from 66.1 per cent to 67.3 per cent. The fluctuations in the dependency ratios are considered important for projecting future social security expenditures. In attempting to assess the additional burden of a growing aged population, the OECD assumes that spending on pensions as a proportion of GDP increases in line with countries' oldage dependency ratio, implying that average pensions rise in line with wages. This assumption may not always yield realistic results. In Britain, unlike some other countries, social benefits are closely linked to rises in the consumer price index (13). On the other hand, since Britain became an elderly nation before others started to turn grey, the pensions bill as a percentage of GDP may actually start declining in the near future. The future age structure, therefore, will continue to be determined by natality and migration issues, since mortality rates have stabilised, although the infant mortality rate is slightly higher than in most European countries. Following the trend in all developing countries and taking into account local

A Demographic and Socio-Economic Profile of Ageing in Malta

67

circumstances, one may expect a marginal decrease in fertility. The present rate of 15.4 live births per 1000 population surpasses that in respect of other countries of Southern Europe (except Turkey). The general long-term trend of fertility in Europe is also one of decline, whether this is expressed in terms of the crude birth rate, total fertility rate or net reproduction rate (14). A number of European countries, e.g. Denmark and the Federal Republic of Germany, have gross reproduction rates well below unity, with the consequence that they are experiencing a population decline. In the case of Malta, the rate is around 1.0 and the population has experienced an average growth rate of under one per cent during the past five years. It is expected that, in the short-term and provided net emigration is kept more or less at this year's level, the yearly percentage rate of population growth will drop marginally.

68

Reno Camilleri

References and notes (1) (2) (3) In the case of females, pension rights may be enjoyed on reaching the age of 60. Council of Europe - Country reports 1990. CDPO (91) 12. Egidi, V.: "Population aging and changing lifestyles in Europe" - Council of Europe SEM (20)4. ECE 1983 Report. Cowgill and Holmes: "Aging and Modernisation". (New York: Appleton, Century, Crofts 1972). The ECONOMIST: Article titled "Granny Power". January 1990. Ibid. Lindgren, J. : "Demographic and Socio-Economic Aspects of Population Aging in Finland". INIA/CICRED 1990. Delia, E.: "The classification and lifestyle of the aged in the Maltese Islands". MAS publication (Malta). 1982.

(4) (5)

(6) (7) (8)

(9)

(10) The following services are provided by the State. Hostels The Elderly can make use of four hostels situated in different localities. These may be found at Floriana, Msida, Gzira and Mosta and may accommodate 170 persons. Another hostel is expected to open at Zejtun later in 1993. Privatised home care In 1992 around 2000 persons including the elderly made use of services provided by some 400 trained personnel at home. MMDNA services Though a private organisation, the MMDNA (Malta Memorial District Nursing Association) has collaborated with Government in making some 260,000 visits to the elderly during 1991. Telecare Some 2500 persons subscribe to this emergency telephone service introduced in 1991. It is mainly intended for those living on their own and may prove useful particularly in an emergency. Hot Meals A relatively new service started in June 1991 and is operated jointly with a Church organisation and a voluntary organisation (the Maltese Cross Corps). The elderly particularly those living on their own may ask to have a hot meal delivered at home.

A Demographic and Socio-Economic Profile of Ageing in Malta

69

Institutions St. Vincent de Paule Residence accomodates over 1000 senior citizens and is entirely run by Government. Zammit Clapp is a 60-bed acute geriatric hospital providing medical and rehabilitation facilities; it is fully subsidised by Government, but independently administered. in Gozo, a 100-bed geriatric wing forms part of the public general hospital. (11) United Nations: Overall economic perspective to the year 2000 - New York 1988. (12) Central Office of Statistics (Malta): "Demographic Review of the Maltese Islands" -1989. (13) The ECONOMIST: April 1991. (14) Council of Europe: Country reports 1990 - CDPO (91) 12.

70

Reno Camilleri

IV. Effects of a growing ageing group


People in Malta and Gozo are living longer and they are also having fewer children although the fertility rate has not fallen below the replacement threshold (1). As a result, there will be fewer workers to support an ever growing number of pensioners. Faced with this trend, unprecedented in the demographic history of these Islands, Government has to make choices as to how to distribute national output between workers and non-workers without endangering economic growth. In the absence of compensatory benefits from the introduction of high technology on a bigger scale, the changing age structure of the population affects the labour market and, generally, the output. One can also assume that, in the short-term, it also influences consumption and savings patterns. In the long run, the course of economic development is, by and large, inextricably bound up with changes in the size and composition of the population. But in spite of the vast literature on the subject, considerable difficulties exist in understanding the interaction of demographic and socio-economic variables. Since ageing will mean a smaller workforce, it could lower (all other things being equal) the rate of unemployment. On the other hand, one would expect that an older workforce will be more experienced and more productive, provided workers would have the facilities and will adapt themselves to new technologies. Neo-classical models generally demonstrate that a slow population growth is often accompanied by an increase in the amount of capital per worker and a higher level of 'per capita1 income. Such models tend however to ignore the possible relationship between population trends and technological progress and other variables existing within the national economy, such as the tax structure. Ageing is in itself an important determinant of the private consumption and savings functions influencing to a considerable extent the levels of national savings and investment. An ageing population consumes less transport and education, but more services and health care. This process may, in the longterm, trigger shifts from one labour sector to another causing structural unemployment in some sectors, if the country's planning strategy failed to take such changes into account (2).

A Demographic and Socio-Economic Profile of Ageing in Malta

71

Figure IV.l

Life expectancy at age 65 in Maltese Islands, 1871-1989

18 17 16 15 14 13 12 11 10

I 1871

I I I I 1 I 1 1911 1931 1957 1985 1891 1921 1948 1957

Source:

Census Reports - Central Office of Statistics (Malta).

Figure IV.2 Life expectancy at age 75 in Maltese Islands, 1871-1989

11

i
1871 1891 1911 1921

r
1931

i
1948

i
1957

i
1967

i
1985

r
1989

Source:

Census Reports - Central Office of Statistics (Malta).

72

Reno Camilleri

Social expenditure

The pattern of social expenditure data is markedly determined by the age structure of the population. Expenditure on pensions and widow benefits are heavily oriented towards the older age groups, while family allowances are concentrated on the young. Similarly, education expenditure is related to the younger age groups in contrast to unemployment payments which are concentrated on the potentially active age groups. Health expenditure is less linked to the overall population age structure but is relatively high for the very young and women of child-bearing age, and very high for the elderly groups. Estimates worked out in a number of countries in the 1980s show that 'per capita' public spending on health for those aged 65 and over is, on average, 4.3 times that for persons aged under 65. 'Per capita' expenditure on those in the older age groups, i.e. 75+, is higher still and reaches a ratio of nearly six times that for those under 65 years (3).
Table IV. 1 Ratios of 'per capita' public health expenditure on the elderly in selected countries Expenditure Ratio 65+/<64 75+/<75 2.4 2.2 4.5 5.5 4.3 2.8 6.2 9.2 6.6

Country France Italy Netherlands Sweden U.K. Source:

Year 1981 1983 1981 1983 1980

OECD: Social Expenditure (Paris 1985).

The marked differentials, discernible when comparing the total 'per capita' social expenditure on the elderly with that on the young, are clearly illustrated through ad hoc surveys. Data relating to the Netherlands show that 11.2 per cent of 'per capita' social expenditure was related to those under 20 years, while the 20-44 age group accounted for the smallest percentage representation of such expenditure, in contrast with the very old age group (80+) which absorbed 43.7 per cent of 'per capita' social expenditure. Surveys held in the 1980s in other countries support to a considerable extent the findings of the Netherlands research. It was demonstrated that 'per capita' outlays on those aged 65+ exceeded outlays on those under 15 years by a ratio of around 2.7.

A Demographic and Socio-Economic Profile of Ageing in Malta


Figure IV.3 Time relationships between a birth and future services requirements

73

HIGH

LOW

PERSONAL HEALTH SERVICES 1 25 _!_ 30


t I

tlRTH

IS

20

35

*O

45"

55

SO

is

7o

75

YEARS AFTERBIRTH

(Modified to take into account local conditions - Fro L. Corsa and D. Oakley, 1971).

Source:

L. Corsa and D. Oakley, 1971 (Modified to take into account local conditions).

Public health Variations in 'per capita' social expenditure patterns across countries are partly explained by differences in the public/private health care mix. In several countries as in the United States, public health care programmes are heavily directed towards the elderly while the remainder of the population rely heavily on benefits under private insurance schemes. In other countries, e.g. Greece, Cyprus and Malta, the State has to support to a large extent the social security bill. Although one should keep in mind that such indices are drawn from a variety of survey sources across countries which may not be easily compared, it has been established however that, while there are variations across countries with respect to age-related social expenditure, there has not been any case where the 'per capita' social expenditure pattern showed a one-for-one relationship between the young and the elderly. It follows therefore that any projected increase in the proportion of the elderly is likely to have an appreciably greater increase in the proportion of social expenditure absorbed by the older age groups.

The social security system in Malta During the last twenty years, various measures have contributed towards the amelioration of living standards and well-being of the people and the creation of a better social environment. These included the introduction of children's allowances and a national minimum wage in 1974; the compulsory payment of a yearly bonus to all workers as from 1975; the grant of parity in wages to women in all labour sectors in 1976; the compulsory grant of cost-of-living increases to workers in private employment equivalent to those payable in the public sector; the introduction in 1977 of adult wage rates to employees on reaching the age of 18 years; the introduction in 1979 of free hospitalization as a first step towards a comprehensive national health service; the introduction of two-thirds pension scheme for all

74

Reno Camilleri

those who retire after reaching pension age and the introduction in 1981 of maternity benefit and maternity leave (4). The 1980s witnessed the consolidation of the system and a progressive improvement in the yearly bonus and benefits' rates. Certain anomalies in pension entitlements were removed and the Budgetary provisions of 1991 included more liberal pension conditions covering the 'self-employed1. Of particular significance is the reform of pension provisions in respect of widowhood. Widows whose husbands die before reaching pensionable age may now qualify for a widow's pension calculated on her late husband's earnings. Through the other provisions of Act XVI of 1990, the existing social security system has been brought in line with those of other European countries. During 1990/1991 social security agreements were concluded on a bilateral basis with Australia and Canada (awaiting signature) and the existing ones with the U.K. and Libya were revised (5).

Legal framework The legal framework of the present social security system emanates from the Social Security Act of 1987 which repealed the National Insurance Act of 1956, the National Assistance Act of 1956 and the Old Age Pension Act of 1948. Contributions under the Social Security Act of 1987 originate from two main sources. The Act provides for the collection of contributions from those in gainful employment and from employers and for a global payment in the form of a state grant. The payment of N.I. contributions by employees is incorporated in the PAYE System of income tax and is withheld at source at a flat rate of 8.3 per cent of the salary/wage, subject to a maximum weekly wage of LmlOO = (US$ 260). The contributions of the self-employed in weekly amounts ranging from Lm4.4c to Lm 13.76 p.w. are assessed according to eight income brackets. These are collected through provisional tax payments on the basis of declared income for tax purposes. The third type of contributions are those paid by private employers and Government (as an employer) and equal the contributions of employees. A second source of revenue consists of the direct contribution by Government in terms of the Social Security Act of 1987. This state grant is equal to that contributed by each employee (in the private and public sector) and to half the amount paid by self-employed. In 1989, the various amounts paid in the form of contributions to the Social Security Fund were as follows: (6) Lm Government Employees Private Employees Self-Employed Private Employers Government as Employer Direct state grant Total Government Contribution 6.2 11.3 4.0 11.3 6.2 39.0 19.4 58.4 25.6 % 10.6 19.3 6.8 19.3 10.6 66.8 33.2 100.0 43.8

These contributions are utilised tofinancethe retirement pensions and other benefits administered under the system as well as health services and community care. The benefits (other than retirement pensions) payable under the existing Social Security System (1989) may be considered under two broad headings and consist of:

A Demographic and Socio-Economic Profile of Ageing in Malta

75

Contributory Bonus to pensioners Child allowance Disablement pension Disablement gratuity Injury pension Invalidity pension Marriage grant Maternity benefit Orphan's allowance Parent's allowance Sickness benefit Unemployment benefit Widow's pension and allowances

Non-Contributory Blindness pension Bonus to beneficiaries and non-government pensioners Handicapped child allowance Handicapped pension Medical assistance Old age pension Social assistance Unemployment assistance

National pension schemes European national pension schemes are basically a product of the present century although some go back to the end of the nineteenth century. After the Second World War retirement schemes progressively adopted considerable similarity in so far as the nature, purpose and coverage are concerned. Where these mainly differ is in the mix between private and state provisions, the types of pension coverage, i.e. whether basic, general, 'special' or complementary schemes, the institutional framework within which they operate and the sources of funds. After health (which is not considered in this review), pension schemes are generally regarded as the most significant branch of social security that is particularly sensitive to changes in demographic variables. Population trends influence the whole structure of a social welfare system and pose the question of how Governments could eventually bridge the 'welfare gap' within their overall national economic and social strategy. In many instances the most important consideration concerns the extent of coverage of pension schemes. Many countries including Malta have adopted 'universal' schemes. The idea is to give an overall protection to all those who have contributed towards the general well-being of society. Risks are pooled and the impact of demographic trends, such as the increase in the number of citizens, can be shared by all. 'Special' schemes classified to cover workers in the co-operative sectors were popular in Eastern countries. A number of countries, e.g. Austria, France, Italy, Germany etc., operate special schemes to cover various socio-occupational groups (agriculture workers or the self-employed) alongside their broad-based national programmes. Such arrangements are either made compulsory for special groups by legislation or are provided for in negotiated agreements as in the case of the establishment of company pension funds between workers and private industry. The most significant examples can be found in Germany and the Nordic countries. In such cases, the pooling of risks arising from demographic causes is provided for through the general and broad coverage of such schemes.

76

Reno Canillen

Pensionable age
In theory, demographic considerations should be taken into account in establishing the national pensionable age, because experience has proved that several European countries notably Italy and Spain have shown particular reluctance to change the pensionable age once this has been adopted. One would expect that any attempt to postpone the local official retirement age would face severe opposition from various pressure groups. In other countries, e.g. Switzerland and Denmark, the pensionable age has been deliberately changed from time to time. Some notable differences exist in the 'normal' statutory retirement age.

Retirement age flexibility The most significant trend in the 1980s has been the move towards greater 'flexibility' in full retirement age through legislation allowing persons either to retire before the normal statutory age or to postpone retirement and claim a partial pension. Although such flexibility has been introduced in times of high unemployment or full employment, such provisions are being considered or have been introduced in normal times to form an integral part of pension regulations. In France, partial pension provisions were introduced in 1988, allowing workers aged 60 and over having completed a full 'insurance career' to work on a part-time basis while drawing part of all their pension entitlements. In 1987, Finland introduced legislation providing for a part-time pension while similar arrangements may be found in several other European countries such as Bulgaria, Greece, Hungary, Sweden and Belgium. A number of countries provide for 'general flexibility' which ensures that all insured persons may advance or postpone pensionable age under the conditions stipulated by law. Other countries such as Austria and Luxembourg provide for 'special flexibility' favouring only certain categories of insured workers (i.e. those who have worked in unhealthy and hazardous occupations). Some countries including Sweden and Romania have legislated for both types of retirement age flexibility. In Malta, only members of the Police and the Armed Forces may be allowed to retire on full pension at the age of 55 instead of the normal retirement age, i.e. 61 years. Table IV.2 Pensionable age in selected European countries Country
Austria Belgium Cyprus Denmark Fed. Rep. of Germany Malta Norway Switzerland United Kingdom France Italy
i

Males 65 65 65 67 65 61 67 65 65 60 60

Females 60 60 65 67 65 60 67 62 60 60 55

Source:

ILO - "From Pyramid to Pillar" - Geneve 1989.

A Demographic and Socio-Economic Profile of Ageing in Malta

77

Pensions' expenditure There are considerable differences in the financial arrangements operating in different countries to provide for the payment of benefits under pension schemes. The relative representation of 'employers' and 'employees' shares towards the funding of pensions varies from country to country. As in the case of several European countries, the 'pay-as-you-go' method is employed in Malta which means that the working population provides (through taxation) the required revenue to meet present pension outlays while future generations will have to finance the pensions of the present working population. It means also that the rising ageing index of the Maltese population will present considerable problems since it may necessitate the imposition of more taxes to meet bigger outlays in the near future. Total pension expenditure usually covers three contingencies, i.e. old age, invalidity and widowhood. The expenditure shares of each of these three contingencies expressed as a percentage of total pension outlay have changed during the last two decades. Of more significance is the relative importance of old age pension expenditure to the other two categories.

Old age pensions In almost all countries, old age pensions are the main determinant of total pension expenditure, accounting for more than half of total pension expenditure. In some countries such as United Kingdom, Canada and Switzerland the level is around 80 percent. The most pronounced increases have been noted in Portugal and Japan where old age pension expenditure in relation to total pension expenditure surged ahead, in the past thirty years, from 30 per cent to 60 per cent in the case of Portugal and from 40 per cent to 80 per cent in Japan. In most countries, it has levelled off at around 70 per cent while in the Netherlands it has been decreasing steadily since the latter half of the 1970s and now stands around 50 per cent. In Malta it represents around 64 per cent of total pension expenditure.

Invalidity pensions The second largest share of pension expenditure is generally taken up by invalidity pensions although this varies considerably from country to country. Exceptions to this development may be found in Ireland where this category of pensions accounts for less than 5 per cent - one reason being their relative recent introduction in the late 1960s - and New Zealand where their share stands at around 5 per cent of total pension outlay. The other extreme is the Netherlands where invalidity pensions are absorbing about 40 per cent of public pension expenditure. In Malta, the share of invalidity pensions is, more or less, at the same level of most countries, i.e. 8.0 per cent of total pension expenditure.

Survivors' pensions Survivors' pensions account for 10 to 20 percent of total pension expenditure although, as one may expect, notable variations exist. Nonetheless, examined over a period of time they have exhibited relative stability. They have the highest share in pension expenditure in Germany and Ireland (25 per cent) and the smallest share in Denmark and New Zealand (5 percent). In Malta, this category of pension outlay has reached 25 per cent of total pension expenditure in 1990.

78

Reno Camilleri Social Security Expenditure - Pensions - Malta & Gozo, 1981 -1990

Figure IV.4

5O

5 O

>c
o 5 3O

! O

xo

1983

1984

19S5

19S6

19S9

Pensiona Invalidity

[ C o n t r i \*. ~\ Pension

Survivors' Penaion Pension

[Oontrib.]

[ t*son. - O o la " i i a 3 Crl -

Source:

Financial Report 1990 - The Treasury (Malta).

The rising costs of pensions Data show a marked growth in pension expenditures as a percentage of GDP in several European countries during the 1970s with most of the increase noticeable in the first half of the decade, as a consequence of the general commitment by States to extend their pensions to cover the general working population. During this period one could notice an increased awareness on the part of most European Governments to support the elderly and to extend financial assistance to those who need it; coverage was extended and the buoyant economic conditions in various countries enabled Governments to

A Demographic and Socio-Economic Profile of Ageing in Malta

79

improve benefits. In Denmark, pension expenditure as a percentage of GDP grew from 5.0 per cent in 1970 to 6.4 per cent in 1975. In Sweden, it went up from 5.3 per cent to 7.3 per cent while the U.K. recorded a rise of 1.4 percentage points during this period. The most pronounced growth rate was registered in Portugal where the pension/GDP ratio which stood at 0.9 per cent in 1970 went up to 3.2 per cent in 1975. This period was followed by one of relative slow growth until the 1980s when pension expenditure in relation to GDP remained fairly constant with few exceptions such as Greece, Austria and Italy where such relativities continued to trend upwards. These differentials between countries reflect differences in policy objectives, benefits structure, the strength of their economies and the composition of their populations. In Malta, the level of pension expenditure as a percentage of GDP grew steadily during the seventies, peaked in 1984 and started to decline thereafter. As explained earlier, and in line with developments in other European countries, one could notice an expansion of the social security system taking place during the 1970s. In 1970, the ratio of pensions ' expenditure to GDP stood at 2.8 per cent but went up to 6.1 per cent by the end of the seventies. Expenditure in real terms registered progressive growth rates going up from Lm26.9 million in 1981 to Lm51.1 million in 1990 - an average annual growth rate of about ten per cent. The highest growth rate was recorded in 1990 due mainly to the enhanced benefits introduced in the 1990 Budget (7).

Some policy options One generally meets with very few policy options that may be considered in an attempt to ease the financial burden falling on the state in the form of outlays on retirement pensions. These options tend also to present problems, because they often fail to attract social consensus for their introduction. Somehow or other, a particular group or groups of citizens, be they the pensioners or the tax-payers, are going to be adversely affected. These options may be broadly grouped under three main headings: changes in the rates of benefits aimed at ensuring some savings in total state outlays in pensions a reduction in eligibility which may take various forms an increase in the revenue collected in the form of contributions aimed at narrowing the 'welfare gap' in so far as this relates to pensions. Table IV.3 Expenditure on Pensions % of GDP - Malta & Gozo, 1981-1990
1981 1982 1983 1984 1985 1986 1987 1988 1989 1990

1. Expenditure on Pensions

28.7

2. Increase per cent 3. Gross Domestic Product (Lm million) 4. (1)%(3) 5. Real (x) aggregate Pension Expenditure (Lm million) 6. Increase per cent
(x) Adjusted by the Consumer Price Index Source:

6.6
26.9

33.3 16.0

34.0

37.0

2.1 7.4
34.4

8.8 8.0
37.2

35.9 -3.0

37.0

38.1

40.3

42.3

3.1 7.2
36.4

3.0 6.9
37.6

5.8 6.6
39.8

5.0 6.3
42.1

52.6 24.3

436.5 461.8 457.6 461.1 476.0 511.9 549.2 606.5 670.1 737.0

7.2
31.3 16.4

7.5
34.3 -7.8

7.1
51.1

3.0

8.1

6.1

3.3

5.9

5.8 21.4

Financial Reports - The Treasury (Malta).

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Reno Camilleri

Changing benefit rates Thefirstoption may be the easiest to administer but conflicts with the need to extend more financial support to the elderly particularly in periods of inflationary pressures and reduced work opportunities for the elderly. It could also mean a deterioration in the purchasing power and standard of living at a time when Governments are committed to work towards the establishment of a social and economic environment where the elderly will not be expected to be burdened by excessive financial worries. In the case of Malta, where the female participation rate is very low by European standards, one has to give special consideration to widowed pensioners. It seems, therefore, that the case for any savings through lower benefit rates will cause hardship to a large segment of the elderly. No developed economy is at present contemplating or undertaking a radical reform of the existing pension benefits involving reductions in rates (8).

Increasing retirement age The second option involving a change in retirement age, assuming benefit rates remain constant, is often considered in pension reforms. Retirement age may be defined as the age of full and definite withdrawal from the labour market without any intention of taking up work again. It is also that age at which an insured worker becomes entitled to a full public pension. In our case it is age 61 for males and 60 for female workers (provided he or she has, to his/her credit, the number of paid contributions stipulated by law). An increase in the average retirement age should reduce the number of years that an individual enjoys his pension rights and both in the medium and long term this will mean a reduction in pension expenditure by the state. This option may find opposition on social considerations particularly at a time when some of the more industrialised countries are contemplating the introduction of a lower minimum age for the eligibility of a pension. In the late 1970 and early 1980s, many European countries were confronted by severe unemployment problems and introduced early retirement programmes providing for earlier retirement pension rights in order to free jobs for younger workers by encouraging older ones to leave the labour market.

Phased retirement A modified set of arrangements for early retirement may take into account a phased transition from full employment to full retirement. Recent proposals in some countries provide for a 'decade of retirement' between age 60 and up to the age of 70. It is claimed that this approach can be adjusted to individual preferences by providing work opportunities to elderly workers. This would, moreover, allow the pensioners to adapt gradually to a new lifestyle while at the same time ensuring that his financial needs are safeguarded. The case for an increase in the average retirement age in most states (including Malta) rests therefore on the length of life expectancy which is still rising in most countries. Life expectancy linked to various age cohorts has been increasing in many countries (including Malta) both for men and for

A Demographic and Socio-Economic Profile ofAgeing in Malta

81

women implying an increase in potential pension periods. This increase is higher in the case of women by an average of 4 years. A rise in longevity may be translated into corresponding increments in state outlays on pension even if one were to assume no increase in rates. In the case of Malta life expectancy went up from 67.0 years in respect of males and 71.3 years for females in 1965, when the National Insurance Act was introduced, to 73.79 and 78.04 years for men and women respectively in 1989.

Financing public pensions In most countries (including Malta), 70-90 per cent of pensions are financed from contributions by employers and employees and out of general revenue in the form of transfer payments to meet any resulting difference between contributions and payments. A small portion of expenditure is met out of other sources. Few countries rely almost exclusively on contributions or on Government revenue. As a general rule, in countries with earnings-related pensions and where the contributory element is the dominant form of financing, the projected expenditure of public pensions puts considerable pressures on the fiscal structure. In any revival of the debate about the principles of social security financing, social and demographic considerations are generally in conflict with the general feeling that the level of taxation is already too high and should not be pushed further up through bigger transfers to meet pension payments (9).

The widening gap As already explained Malta's social security system which is administered by the Ministry of Social Policy incorporates also the planning and administration of health services. These services have been expanding at an accelerated rate and cover a vast range of operations. Of particular significance is government's financial commitment towards the care of the Elderly which in recent years has assumed new dimensions. Private health expenditure which includes also outlay on medicines and other related items has gone up from Lml0.7 million in 1980 to Lml9.3 million in 1989. Proportion wise, this category of expenditure rose from 9.3 per cent of total private consumption expenditure in 1980 to 11.4 per cent in 1989. A larger proportion of the 'average' family budget is also being addressed to health services. The Household Budgetary Surveys held since the early seventies clearly demonstrate that the relative expenditure on private health services has been growing steadily. In the 1971/72 HBS the health category of expenditure represented 4.81 per cent of total family expenditure; it accounted for 5.55 per cent in 1981/82 and has been estimated at 6.5 per cent of total expenditure in the 1987/88 Survey. In line with the trend in other countries, the State also has been spending more and more, both in absolute and relative terms, for the provision of health services. Table IV.4 shows that state outlays on such services in 1981 accounted for 18.0 per cent of all government expenditure under the social security system but stood at 21.7 per cent during 1990. In nominal terms this means that the cost of health services more than doubled during the last ten years. With the introduction of the general practitioner service scheme in the near future and the expansion of existing and the introduction of new health services, this category of expenditure is likely to accelerate

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in the short-term. Proportion wise, while public expenditure on pensions has declined by four percentage points, expenditure on health services has added just over three and a half percentage points.
Table IV.4 Payments under the Social Security System - Malta & Gozo, 1981-1990

1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 Value (in Lm million) Total Expenditure under Contributory Schemes 41.1 Total Expenditure under NonContributory Schemes 8.8 Administration Expenses 0.4 Expenses i.e.w. National Health Schemes 11.0 Total Payments under the Social Security Act'87 47.7 10.4 0.5 14.3 49.0 11.3 0.6 15.1 52.7 11.6 0.6 15.1 51.7 12.1 0.6 15.6 53.0 12.5 0.6 16.3 54.9 12.3 0.7 19.0 57.6 13.7 1.3 19.7 59.3 16.7 1.3 21.7 67.3 17.9 1.4 24.0

61.3

73.0

76.0

80.0

80.0

82.5

87.0

92.3

99.0 110.5

Percentage Distributions Total Expenditure under Contributory Schemes Total Expenditure under NonContributory Schemes Administration Expenses Expenses i.e.w. National Health Schemes Total Payments under the Social Security Act'87 Source: 67.0 14.3 0.7 18.0 65.4 14.3 0.7 19.6 64.4 14.9 0.8 19.9 65.9 14.5 0.7 18.9 64.7 15.1 0.7 19.5 64.2 15.2 0.8 19.9 63.1 14.1 0.8 22.0 62.5 14.8 1.4 21.3 60.0 16.8 1.3 22.0 60.9 16.2 1.2 21.7

100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Financial Reports - The Treasury (Malta).

The steady escalation in health expenditure was not the result of demographic factors alone but was mainly brought about by the extension and provision of new services. A study prepared by the International Monetary Fund shows that, if the ageing factor of a population was the only determinant of the increase in medical expenditure, the share of such expenditure as a proportion of GDP would decline.

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83

Figure IV.5

Social Security Act, 1987 - Receipts and Payments - Malta & Gozo, 1990

Class I Cont. Class II Cont. Direct Govt. Cont. Welfare Gap Benefits (Soc.Sec.) Non Cont. Benefits Nat. Health Scheme Care of the Elderly Administ. Expenses

10

20

30

40

50

60

70

Lm (Millions) Receipts Payments

H I Expenses

Source: Financial Report 1990 - The Treasury (Malta). An obvious question one has to consider at this stage is: how far will the 'welfare gap1 widen in the near future? As can be observed from Table IV.5 and Figure IV.6, the difference between total payments and total contributions under the present social security scheme has been growing steadily during the 1980s. From Lm4.2 million in 1981 it went up to Lm40.6 million in 1989 and, were it not for Government's efforts during 1990 to collect outstanding contributions thereby pushing up the revenue figure, the gap for 1990 could have reached Lm46 million. While contributions have registered a growth rate of amere 11.2 per cent between 1981 and 1989, total payments went up by 88.4 per cent during the same period.

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Table IV.5

Total Payments Total Contributions Welfare Gap Source:

52.5 48.4

62.5 52.2 10.4

64.7 52.5 12.3

68.5- 67.9 50.1 52.0 18.3 15.8

70.0 52.3 17.7

74.7 53.5 21.2

92.3 57.9 34.3

98.9 58.4 40.6

110.5 71.2 39.3

4.2

Financial Reports - The Treasury (Malta).

Since the term refers to the shortfall in state revenue derived from contributions under the 1987 Act and the transfer payments to beneficiaries as well as the state outlay on health, and bearing in mind Government's intention to extend the social security system, it would seem that the future magnitude of the "gap" depends to a large extent on new measures to increase revenue. Alternatively Government may consider the easing of the state's burden by encouraging the younger age groups to subscribe to private pensions/insurance schemes ensuring at the same time that the future savings in respect of health services or pensions exceed the loss in revenue. Another option which may prove acceptable to the social partners in Malta is the extension of tax incentives or allowances to taxpayers who are willing to save and invest in private pension schemes aimed at relieving the full burden on the state finances. Such measures depend clearly on policy decisions which no one can predict, much less quantify, in the absence of official pronouncements on this subject. One may, therefore, only refer to certain policy options based on experience in other countries, which may stimulate discussion in this regard.

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85

Figure IV.6 The Welfare Gap - Malta & Gozo, 1981-1991

M million

140

120 100

1981 82

83

84

85

86
Years

87

88

89

90

91

Payments ~+~ Contributions


Source: Financial Reports - The Treasury (Malta).

Future outlook On demographic considerations alone, one would expect that payments in respect of retirement pensions under the contributory system, which in 1990 stood at Lm29.3 million, will go up to Lm39 million by 1995 and climb to around Lm50 million by the year 2000. Old age pensions and old age allowances under the 1948 Social Assistance Act may be expected to go down as the number of beneficiaries will continue on a downward trend. During the five-year period between 1985 and 1990, the number of beneficiaries went down from 5385 to 4842. Payments have accordingly dropped from Lm3.3 million to Lm3.0 million. Any expected decrease in payments due to demographic factors may, however, be counterbalanced by yearly increases in benefits since the yearly cost of living adjustments

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in wages and salaries are normally reflected in such pensions. Other pensions, such as invalidity and disablement pensions and early survivors' pensions, are also adjusted to take into account the cost of living. On past trends, it may be assumed that the number of beneficiaries of such pensions is expected to stand at the same level as at end of 1990, i.e. around 4,400. Any increase in the outlay in respect of this type of pension will therefore be expected to reflect mainly enhanced pension rates. Another important element in pensions' outlay relates to widows' pension (excluding survivors' pension). This has been rising steadily partly on account of the increase in the number of beneficiaries and partly on account of enhanced rates which are also adjusted for cost of living increases. During the past five years, although another 600 beneficiaries were added to their number (8,634) in 1985, overall payments went up from Lm7.4 million in 1985 to Lml 1.0 million by the end of 1990. In the short-term, state outlays on future pension payments will, therefore, continue to be determined by two factors. The number of beneficiaries will mainly influence outlays on pensions under the contributory scheme. Assuming that the present official retirement age will be retained, the number of workers entitled to such a pension is expected to continue on an upward trend. A crude indication can be read from Table IV.6 which shows that, by the turn of the century, the number of those aged 61 and over may be 17.5 per cent more than the present 61+ age group, as more and more workers become entitled to this form of pension. The increase in the number of beneficiaries rather than government's policy governing rates will therefore determine the total outlay. The other forms of pensions will be mainly influenced by increases in rates. Official pronouncements confirm Government's commitment to maintain the real value of social benefits and to improve whenever possible the standard of living of beneficiaries. One would therefore expect that the overall pension outlay will continue to rise. Widows' pensions hiked from Lm9.0 million in 1989 to LmlO million in 1990 as a result of better benefits, notwithstanding a small increase in the number of beneficiaries. Similarly, invalidity pensions went up from Lm3.5 million in 1989 to Lm4.2 million in 1990 even though the number of beneficiaries dropped from 4860 to 4397 between 1989 and 1990 (10).
Table IV.6 Population aged 61+ in Malta & Gozo, 1990-2020 As % of Total Population Year Persons Increase Cumulative %

13.8 14.5 15.3 15.8 18.3 19.8 21.2


Source:

1990 1995 2000 2005 2010 2015 2020

49275 53484 57877 61303 72673 80487 87341

4209 8602 12028 23398 31212 38066

84 . 17.5 24.4 47.5 63.3 77.3

Demographic Review of the Maltese Islands 1990 and unpublished data concerning projections Central Office of Statistics (Malta).

A Demographic and Socio-Economic Profile of Ageing in Malta

87

Figure I V.7 Percentage distribution of projected population for 1995 & 2005 - Malta & Gozo

Percent

10

15

20

25

30

35

40

45

50

55

60

65

year group
1995 2005

Source:

Census Report '85 - Central Office of Statistics (Malta).

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References and notes (1) (2) Central Office of Statistics (Malta) - Demographic Review of the Maltese Islands 1991. Uner, S.: Paper titled "The Changing Structure of the European Labour Force" - Council of Europe Seminar 1990. I.L.O. - "From Pyramid to Pillar". Geneve 1989. Ministry for Social Policy - Yearly Departmental Reports. Ibid. The Treasury (Malta) - Financial Report 1989. The Treasury (Malta) - Financial Repon 1990. Tamburini, G.: "Commitments of national pension systems in OECD countries. Strategies for the future". I.L.O. publication. I.L.O. - "From Pyramid to Pillar". Geneve 1989.

(3) (4) (5) (6) (7) (8)

(9)

(10) The Treasury (Malta) - Financial Report 1990.

A Demographic and Socio-Economic Profile ofAgeing in Malta

89

Conclusion
The link between demographic and socio-economic factors is a reality that has been well understood during the past few decades. Man has been accepted as the focal point of all development and as the starting point of all profound changes that are taking place all over the world, even if one notices that the materialistic environment of some societies still blurs this primary reality. There is a growing fund of awareness among demographers, political and church leaders, family policy experts and researchers that demographic considerations should be taken into account in any discussion of the present social and economic problems and their short and medium term consequences on the quality of life. The problems of ageing are generally regarded as having landed suddenly on public opinion and on those responsible for social and economic policies. But the 'grey revolution' will continue to dictate the face of social and economic reforms in the industrialised countries and will have a profound impact on progress in the developing economies. Malta is no exception. Although it was relatively recent that it dawned on Maltese society that the ageing process is due to accelerate in the near future, public awareness of this phenomenon has responded with vigour and sympathy. Both Government and voluntary associations are addressing these problems through specialised courses and other study sessions and social work. While the increase in life expectancy is a positive characteristic in any society, it is often feared that this optimism stems from a quantitative rather than a qualitative vision of the phenomenon in that the lifestyle and economic conditions of the elderly may be ignored. International literature makes reference to the fact that until recently data on the quality of life of the elderly has been very limited, although the World Health Organization has began to conduct epidemiological surveys. This type of research should be a logical extension of the wide range of services and assistance that are available to the senior citizens of Malta. The continuous enrichment of human life in Maltese society cannot be attained if planned in isolation of demographic considerations.

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Appendix
Selected Demographic Indices of the Maltese Population (as at end 1991) Index Population density per km 2 Malta Gozo Maltese Islands Malta Gozo Maltese Islands 1354 375 1139 979 937 976 14.8

Sex ratio (males per 1000 females)

Crude birth rate (live births per 1000 population) Total fertility rate

2.00

Gross reproduction rate

0.98

Crude marriage rate (marriages per 1000 population) Median age at first marriage * (in years) Literacy ratio (1) * Brides Bridegrooms Males Females

7.3

22.5 25.0 88.0 88.0 51.4

Dependency ratio (2) * Ageing ratios (3) * Malta Gozo Maltese Islands Males Females

63 75 64 73.7 78.1 8.1

Life expectancy (in years) Crude mortality rate (deaths per 1000 population) Crude infant mortality rate (deaths under 1 year per 1000 live births)

9.1

A Demographic and Socio-Economic Profile ofAgeing in Malta

91

Density of room occupancy * (persons per living-room) Mean household size (4) * (number of persons) Malta Gozo Maltese Islands Maltese h/hold Foreign h/hold

0.8 3.25 3.15 3.25 3.26 2.45

Mean household size * (number of persons)

(1)

Number of persons who can read and write aged 10 years and over Number of persons aged 1C1 years and over (0-14 years and 65+years) x 100 (15-64 years) (60-64 years) x 100 (15-19 years) Persons in private households Number of households

(2)

(3)

(4)

* As at 1985 Census

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BIBLIOGRAPHY
ATTARDE.L. - The Great Exodus (1918-1939)-PEG Publications (Malta) - Early Maltese Migration ( 1900-1914)-PEG Publications (Malta) BERELCON B. - Population - Challenging world crisis -1969 C.O.S. (Malta) Census Reports 1948,1967,1985 Demographic Review of the Maltese Islands -1989 Census '85 - Vol. Ill Census '85 Vol. I - A demographic profile of Malta and Gozo National Accounts of the Maltese Islands -1989 Proceedings of a seminar on present demographic trends and lifestyles in Europe. Strasbourg 18 - 20 September 1990 Recent demographic developments in the member states of the Council of Europe. Strasbourg 1990 The Demographic prospects of Southern European Countries and Ireland (1983) by P. Festy The background of recent fertility trends in the member states of the Council of Europe (1985) by J. Schmid World demographic trends and their consequences in Europe (1990) by L. Tabah Household structures in Europe (1990) by Prof. W. Linke Divorce, judicial separation and remarriage. Present trends in member slates of the Council of Europe (1985) by P. Festy Opening Address of Demographic Seminar 1990 by D. Avranov Population Studies No 23 "The Second demographic transition - fact or Fiction?" (1991) by R.L. Cliquet

COUNCIL OF EUROPE

COX PETER E. DELIA E. DEPT. OF LABOUR (Malta) EGIDI V. I.L.O. IMF/IBRD

- Demography and Addendum to Demography C.U.P. - The classification and lifestyle of the aged in the Maltese Islands. MAS 1982 - Yearly reports

Population ageing and changing lifestyles in Europe - Council of Europe SEM (90) 4 Demographic development and social security. Report II Geneve. September 1987 Finance and Development - Volume 6 No 1 March 1970 - Article titled "Population Growth and Economic Development" by G.C. Zaidan Finance and Development - Volume 8 No 4 December 1971 - Article titled "Women Jobs and Development" by M.G. de Vries Short-term Training in Income Security for the Elderly in Developing Countries. Proceedings of an Expert Group Meeting, Malta 1990 Population, aid and development - Proceedings of an international meeting held in Florence 1985 - Edited by R. Cagiano de Agevedo The Second demographic transition revised: theories and expectations. Conference on Population and European Society. Florence 1988 Demographic and Socio-Economic Aspects of Population Aging in Finland - INIA/ CICRED 1990

INIA-MALTA

I.U.S.S.P.

KAA DJ. VAN DE

LINDGRENJ.

A Demographic and Socio-Economic Profile of Ageing in Malla


NIDI & CBGS ROWLAND D.T. Population and Family in the Low Countries III -1983

93

- Ageing in Australia: Population Trends and Social Issues. Melbourne: Longman Cheshire (1991) - Notes on stationary populations. Population Index Vol. 41 - A fertility survey of the Maltese Islands. London 1956 - Recent Population Change Calling for Policy Action. Athens 1990. Proceedings of a Demographic Seminar - Commitments of national pension systems in OECD countries: strategies for the future. ILO publication - Demographic Yearbook 1989 - Population Ageing: The Social Policy Implications. Paris 1988 - Ageing populations: economic effects and implications for public finance by R.P. Hagemann and G. Nicolette - From Pyramid to Pillar 1989 - The state of World Population 1990 by N. Sadik - International Family Planning Perspectives Volume 9 No 4 Volume 10 No 4 Volume 11 No 4 - Population Issues. Briefing kit 1991 - Charter of the Rights of the Family -1983

RYDER N. SEERS D. SIAMPOS G.

TAMBURINI G.

UNITED NATIONS OECD

UNFPA

VATICAN POLIGOT PRESS VELLA CHARLES G.

Proceedings of the European Conference on Integrating Social and Family Policy for the '90s -1/5 November 1989 - Malta

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A Demographic and Socio-Economic Profile of Ageing in Malta

95

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History of IMA:

The Vienna International Plan of Act!-,: * ;ng, adopted by the World Assembly on Aging in 1982 and endorsed by the t i u : ^ >^uuns General Assembly in ils resolution 37/51, recommended, inter alia, that practical training institutes should be promoted and encouraged in order to act as information exchange centres between and among developed and developing countries. In harmony with the spirit and objectives of the Vienna International Plan of Action on Aging, the Government of Malta proposed to the Secretary General, in September 1985, that a United Nations International Institute on Aging should be established in Malta. The United Nations reacted ! --' - \ initiative by Malta and conducted a feasibility study which was s.>"-.-. -\ -,.-tined by an intergovernmental expert group, which recommended the establishment of an International Institute in Malta. As a result, the L'N Economic and Social Council, in its resolution 1987/41, recommended to the Secretary General the establishment of the International Institute on Aging (INIA). The Secretary General re^; ' ' positively to - - luilonandaccep ' ' 'ivernment of Malta's role as host te i : * i i ;ute. On (>.-. nh, 1987, the I'm: '. -;: ions signed an officia) agreement with the Government of Malta to establish INIA as an autonomous body under the auspices of the United Nations. INIA was Inaugurated on 15th April 1988 by the United Nations Secretary General, His Excellency Mr. Javier Prez de Cullar. INIA publishes a quarterly gerontological journal, BOLD, and the papers, proceedings and recommendations of the Institute's Expert Gronp Meetings.

History of CICRED: The Committee for International Cooperation in National Research in Demography (CICRED) was created as a result of the meeting of directors of national population research institutes, organised by the Population Division or Hi united Nations Secretariat in Lyons (France) from June 3rd to 11th, 1971. At that time, the United Nations was preparing the World Population Conference, foreseen for 1974, and the Population Division was seeking a means of establishing some kind of link with the world community of national population research institutes. Moreover, during the Lyons meeting, a number of participants emphasised the necessity of providing support to national research and of developing mutual collaboration. CICRED is a non-profit association, its members are all the 300 centres conducting population research in the world. Its budget is jointly shared by UNFPA and the French Government. The activities of CICRED are currently covering three fields: (1) population literature storage, retrieval and exchange; (If) promotion of inter-institutional cooperative research on population topics; (lii) assessment of population research potentialities. CICRED publishes a quarterly, the Jt eview of Population Reviews, and several books gathering the findings of Its various collaborative research projects.

The collaboration between CICRED and INIA in the publication of this series of country monographs enhances the common aim of both institutions to disseminate information

ISBN 92-9103-024-4