1 Analysis of the significant health reforms that affected health

Catholics and 6.2% belong to other Christian denominations (Department of Census and Statistics, 2015a).

Both Sinhalese and Sri Lankan Tamil cultures place a high value on education. National statistics indicate that secondary school enrolment (calculated as the percentage of children 10 years old who are in school) is high (97.7%, 2016). Adult literacy was high at 91.3% for males and 82.0% for females in 1981, which increased to 92.9% for males and 90.9% for females in 2017 (World Bank, 2020). In 2018, Sri Lanka was placed seventy-sixth globally on the Human Development Index (HDI) (0.770). It is noted that between 1990 and 2018, Sri Lanka’s HDI value increased from 0.625 to 0.770, an increase of 23.2% (United Nations Development Programme, 2016).

The population of Sri Lanka is ageing progressively. The population of those 65 years and over has increased from 3.7% in 1970 to 10.8% in 2019, while those 80 years and over has increased from 0.5% to 1.6% during the same period (World Bank, 2020). An important feature of this process is its feminization, as seen in Figure 1.2, and indicated by the higher LE at birth for females (78.6 years) compared to males (71.9 years). Population projections (standard) suggest that the share of the population 60 years and over will reach 16.3% by 2022 and 23% by 2024. By the year 2052, one in every four persons will be 60 years or over. This amounts to an addition of 4 million oldage persons during the period 2012–2052 (De Silva and De Silva, 2015).

Table 1.3 Trends in ageing and dependency in Sri Lanka, 1970–2019

Indicators 1970 1980 1990 2000 2010 2016 2017 2018 2019

Population aged 0–14 years (% of total) Population aged 65 years and above (% of total) Population aged 80 years and above of both sexes (% of total) Child (0–14 years) dependency ratio Elder (65+ years) dependency ratio Age dependency ratio* (population 0-14 and 65+ years / population 15-64 years) 40.3 35.9 32.1 26.8 25.4 24.6 24.4 24.2 24

3.7 4.4 5.5 6.2 7.4 9.8 10.1 10.5 10.8

0.49 0.51 0.81 1.03 1.41 1.58 1.6 1.62 1.64

71.9 60 51.4 40 37.8 37.4 37.3 37 36.7

6.6 7.3 8.8 9.3 11.1 14.9 15.5 16 16.6

78.5 67.4 60.2 49.2 48.8 52.4 52.7 53.1 53.4

* The age dependency ratio is an age – population ratio of those typically not in the labour force (the dependent part, ages 0–14 and 65+ years) and those typically in the labour force (the productive part ages,15–64 years). The total dependency ratio can be broken down into the child dependency ratio (0–14 years) and the aged dependency ratio (65 years and above). Source: World Bank, 2020