Mauritius is one of the pioneer countries in Africa, which adopted family planning and reaped the benefits thereof. Today, it is facing a different set of conditions, which it shares with a few countries in Africa but with the majority of developed countries ? that is of an ageing population. The ?baby boom? phenomena of the 1950s occurred in many industrialized as well as in some developing countries. In Mauritius, it was followed by an almost equally steep decline in fertility levels, which led to declines in population growth rates. These rapid and unprecedented changes in fertility levels and hence population growth rates have impacted on the age structure of populations, family patterns and the health and social welfare provisions and, in some countries, changed the direction of the transfer of resources among the different age groups.

After being inhabited and colonized for about three hundred years, the first time there was a sustained period of natural increase in the population ? that is increase in birth rates over death rates ? was only after the end of the Second World War in 1944. A spurt in the population growth rate occurred with the fall in the death rate due to the near eradication of malaria and other epidemics. The latter being due to the introduction of modern medicine and DDT.

High fertility till the 1970?s

This period of high fertility continued till the 1970s with birth rates having reached 44.3 per thousand live births in the 1954 ?55 period - the highest levels recorded in Mauritius and the population growth rates shooting up to 2.26 % between 1944 and 1952 and to the highest ever reached in Mauritius of 3.12 % between 1952 and 1962. Since 1970s, fertility levels have been declining and birth rates reached a plateau in the mid 1980s.

The introduction of family planning by the non governmental organization, the Mauritius Family Planning Association (MFPA) in 1957 and the Action familiale all contributed to the rapid reduction in the crude birth rate and the population growth rate. As from 1972, the Ministry of Health adopted a population policy which was to bring about a reduction in fertility levels and also became actively involved in providing advice and family planning services .

The ageing process

The swift demographic transition which occurred between 1962 to 1973 and the improvement in the health of the population ? measured by the change in life expectancy which increased from 60.8 years for males and 65.89 years for females in 1971-73 to 67.37 years for males and 74.62 years for females in 1998-2000 ? has set in motion another process ? that of ageing. The ageing process impacts on the age structure of the population and has significant implications on the economy and the government budget. In the Island of Mauritius, the population below 14 as a percentage of the total population fell from 45.3 in 1962 to 29.3 % in 1990 and 25.6 % in 2000. This trend will continue with the percentage falling further to 20.4 % in 2020. The percentage of active population (those in the age group of 15 ? 59 years), which has been increasing to reach the maximum of 65.5 % in 2000 but took a dip after that, will continue falling to 63.7 % in 2020. The population over 60 years which has been following a gradual upward trend increasing from 5.4 % of total population in 1962 to 8.9 % in 2000 ? taking almost four decades to increase by three percentage points ? will almost double to 15.9 % by 2020. In numerical terms the over 60 population will more than double from 102, 400 in 2000 to 213,100 in 2020.1

The ??graying? of Mauritius is as much a reality as the ?baby boom? dilemma of the 1950s. However, there are significant differences in the outward manifestations of the two conundrums. While high fertility was highly visible and steps were taken at the international and local levels to understand and stop the situation,?Ageing is a silent process, which remains hidden in the vicissitudes of a population with no external and noisy display, as for example in the case of unemployment. It manifests itself as a completely new issue in the history of mankind, upsetting age-old balances, and there is no temporal, territory, political or operative elements and parameters to make references to.? 2

Writing fifty years ago, Frank W. Notestein did not view the problem of ageing as a problem. He considered it as a pessimistic way of looking at the control over unwanted births and early mortality which was a great triumph of civilization3. What is clear is that the full implications of the change in age structure of the population are not fully understood. Kofi Annan, Secretary General of the United Nations, at the launching of the International Year of Older Persons on 1 October 1998, raised this point when he referred to ageing ?as a silent revolution that extends well beyond demographics, with major economic, social, cultural, psychological and spiritual implications?.4

?Health expectancy?

The change in the age structure will have multiple repercussions such as on family structures, the provision of services e.g. health and social welfare, employment and training. In Mauritius, the economic aspect is getting the most attention as it is going to become increasingly difficult to support the fairly comprehensive system of social welfare in place and which already costs the government about 20.3 % of total government expenditure. Of the several other issues needing to be addressed, this article focuses on the health dimension of the ageing quandary. Other issues will be taken up in subsequent articles.

Because of improvements in life expectancy, people have greater probability of becoming elderly, old, and oldest old. To date, the health policy of Mauritius has focused on improving the life expectancy of the population; but with the change in the age structure there is a need for greater differentiation in the treatment of the graying population and we have to examine the ?health expectancy? of the population.5 The quality of life is as important as the length of life. ?Health expectancy? helps to monitor the health of the population and to ?divide life expectancy into life spent in various states of good and bad health, thus extending the concept of life expectancy to morbidity and disability.?6

Health expectancy measures disability-free life expectancy. It is necessary to calculate disability-free life expectancy so as to estimate whether the extra years of life that a person has gained are spent in good health or in a state of bad health. One needs to ask, does moving from an elderly to an old or oldest old mean spending these additional years being riddled with chronic disabilities? Data needs to be collected on the occurrence of chronic diseases and disabilities among the old. Once data is available on the health status of the old, only then can we ? meaning the families themselves, NGOs and government ? plan on how best to cope with the situation.

The concept of disability ? free life expectancy is fairly new and it would be difficult to apply a model to Mauritius; nonetheless, steps can be taken in Mauritius to collect disability data which can be done as part of the next continuous multipurpose household survey or in conjunction with other relevant surveys to supplement existing data. The rapid decline in the fertility levels has far-reaching consequences on society and the economy ? calling for more than pension reform.

Adapted from paper presented at the Small Island Development Conference, February 2005, Mauritius/International Research Foundation for Development, IRFD

V. H.

1. Ministry of Health & Quality of life, Republic of Mauritius, Evaluation Unit, Family Planning & Demographic Yearbook 2000, Vol. 26 October 2001

2. GOLINI A, Teaching Demography of Aging, appearing in GENUS, Volume LVIII, No. 3-4, July ? December 2002, Rome as quoted in Paper presented at the SIDS Conference

3. Ibid, GOLINI

4. Ibid GOLONI

5. VARIPEL.J, Demographic Insights into Longevity, appearing in POPULATION Vol. 13 ?1, 2001, Institut National d?Etudes Demographic, INED

6. ROBINE J, et al, Disability-free Life expectancies in the European Union countries, calculation and comparison, appearing in GENUS, Volume LVII, No. 2, April ? June 2001, Rome.