(Delivered in Parliament on 27 Feb 2018)
Budget 2018: Women and Ageing in Singapore
The Gender Dimensions of Ageing in Singapore
Mr. Speaker Sir, this Budget marks a significant progress from a wait-and-see posture to strategic and integrated planning to engage three major shifts affecting Singapore’s future. I focus on ageing here. I highlight that ageing is not uniformly experienced, and that men and women experience ageing and are affected by ageing very differently. There are therefore gender inequalities we need to tackle if we are to meet the challenges and opportunities of ageing successfully. Our policies targeted at ageing must factor in the gender differences for them to be effective. I focus on three sets of issues, namely, issues related to the gender income gap, issues with supporting caregivers, and the economic and health security of seniors.
Gender Income Gap
Let me start with issues related to the gender income gap. A study using data from the Ministry of Manpower last year showed that the gender pay gap has not improved in the decade from 2006 to 2016. The gap in median monthly income between male and female has remained at around 18 to 19 percent, with women earning some $610 less than men.
It is unacceptable that we have not made any progress in closing the gender pay gap in 10 years. We need to tackle the gender pay gap because it will affect our future senior women and their retirement security. Already, women are living longer than men and CPF Life is structured in such a way that discriminates between gender, with women paying a higher premium and getting less payouts. The gender pay gap has therefore a compounding effect on the retirement security of women. Using the CPF Life Payout Estimator on the CPF Board website, my estimate is that on the average men will be getting 25 percent more income than women from CPF Life due to the gender pay gap.
The gender pay gap varies across sectors. There has been some attention on the gender pay gap in the finance sector and in senior management, but I think we should actually pay more attention to the majority of our women workers who are laboring in other sectors. Health and social service is still a sector that has one of the largest gender pay gap, with women earning around $1,540 a month less than men. The health and social service sector impacts ageing and our seniors the most. It is also a sector that is arguably the most susceptible to what Minister Ong Ye Kung has noted as a key factor underpinning the gender pay gap, that is, the social norms and expectations placed on women. Minister Ong called for a mindset change. But this is also a structural issue.
The crux of the matter is nursing. Nursing makes up the bulk of the health and social service sector and most nurses are women. Nursing is also in high demand because of ageing. A strong professional body of local nurses is essential for us to successfully meet the challenges of ageing. For many decades, there has been an erosion of status and value attributed to nursing, which culminated in the 2013 Population White Paper footnote mistake in classifying nursing as a low-skilled job that is difficult to offshore. The apology and correction from DPM Teo Chee Hean then was swift and right. I believe there has been a narrowing of the prestige gap between nursing and other professions since 2013. But there are still two other associated issues.
First, while wages for nurses have been improving, there is still a lag. Based on mid-2016 data from Ministry of Manpower, the median gross monthly income from work of all full-time employed residents is $4,056, while the figure for nurses is $4,300. This is a ratio of 1.06. This is not too different from similar ratios for OECD countries. However, when compared to small countries with similar demand profile for nurses, we are behind. For example, the ratio in Israel is 1.4. In Australia, where ageing is also a major challenge for society, the ratio is 1.2. Given the high demand for nursing because of our ageing society, there is scope to further increase the wages of nurses.
Second, it has been a longstanding fact that most nurses are women, which has entrenched the perception that nursing is a female occupation. This gendered composition and perception of nursing will continue to exacerbate the supply shortage of trained nurses. Increasing the wages of nurses will kill several birds with one stone. As most nurses are currently women, increasing the wages of nurses will help close the gender pay gap.
It will also signal the increased social value and respect that is attached to nursing, that nursing is far from being a low-skilled job, that on the contrary nursing is an especially precious skillset for the ageing society. We all know that nursing is a very demanding job. It is emotionally straining, time consuming especially with the shift work and overtime, and also physically draining. Increasing the wages of nurses will make the remuneration more commensurate with the passion that is demanded of nurses.
Increasing the wages of nurses will also help to shift the mindset over time, so that more men would take up the calling and not be put off by the opportunity cost of higher pay for men in other professions.
Another issue related to the gender pay gap is the income security and prospects of women who have become mothers. Part of the reason for the gender pay gap is linked to women returning to the workforce after taking a prolonged break due to pregnancies or childcare responsibilities. Little recognition is given by employers and the Government to the years women spent in service to the family and to the nation to bear and raise children, unlike men who are often given a salary premium for the two years spent in national service.
The current emphasis on lifelong learning and continuous retraining exacerbates the issue. By the time women try to return to the workforce, they face the triple challenges of making sure their skills stay relevant, discrimination against older workers, and wage stagnation compared to their male peers. Last year during COS 2017 I proposed the SkillsFuture Mommy Awards to make reentry into the workforce for mothers less challenging. We have the social and policy infrastructure to resolve this issue. This is an area that the SkillsFuture Singapore and Workforce Singapore should look into.
Supporting Caregivers
Let me move on now to second set of issues related to caregivers, who, like nurses, are at the frontlines of the ageing society. Like nurses, most caregivers are women. So again, we see gender closely connected to ageing. As with nurses, getting our policy right in supporting caregivers is essential for us to successfully meet the challenges of ageing. There are two issues associated with caregivers. If we can resolve these two issues, we will be able to support a strong body of caregivers who would form the bedrock of our silver care system, close the loop between healthcare and community care, and allow our seniors to successfully and actively age in place.
The first issue is recognition and reward for unpaid caregiving. It was estimated that there were over 210,000 caregivers in 2004. The numbers should have gone up by now. This is not a small number, as it represents around 10% of our resident workforce. In a national survey of informal caregiving of older adults aged 75 and above presented in 2013, only 55.6% of the caregivers reported that they were working full-time or part-time and the caregivers reported they spent an average 38 hours a week in providing care.
Among the three problems of lack of family support, negative financial impact and negative impact on schedule and health, caregivers rated financial impact as the heaviest burden, followed closely by negative impact on schedule and health. This is despite the fact that 49% of caregivers had the support of foreign domestic workers.
The same survey shows that caregivers living in private property and therefore assumed to have better means experienced lower stress, while caregivers who were working and who were facing more financial problems due to caregiving experienced higher stress. This is only one of many surveys and studies that have shown consistent results. I think it is time we recognize that the caregiving is full-time work, which prevents caregivers from realizing their employment potential and affecting their financial security.
How can we better support caregivers in this respect? Two years ago, during COS 2016, I asked the Government to consider giving means-tested refundable tax credits to caregivers, so that caregivers who do not work or work part-time would get some cash refund. This would lessen their financial burden and improve their retirement adequacy. Senior Minister of State Sim Ann replied that the Government’s approach focused on direct subsidies of services to lessen the costs borne by caregivers rather than providing cash allowances to people looking after family members. I am of the view that the two do not have to be mutually exclusive. Cash allowances to caregivers suffering from extreme negative financial impact would allow them to access the subsidized services.
If we recognize full-time caregiving of seniors as unpaid work, then it is not far-fetched to consider them as low-wage employees who need income supplement. We should rethink the orthodoxy and provide income support to caregivers. There is already one scheme that is suited for this purpose, the Workfare Income Supplement Scheme. WIS is means-tested and with older workers receiving higher payments, it will ensure the benefit will go to needy caregivers. Also, since 40% of the payment is given out in cash and 60% in CPF contributions, this will help take care of the immediate financial needs and enhance the retirement needs of the eligible caregivers.
The second issue is the stress faced by caregivers of seniors, which in the worst case, can lead to depression and anxiety. Studies of caregivers in Singapore have consistently shown high stress levels among caregivers. But there are important differences. Caregivers of seniors with dementia experienced higher stress. Female caregivers of seniors, namely wives and daughters, tend to experience a lot more stress than male caregivers. These female caregivers reported feeling rundown and exhausted and experienced restless sleepless nights. Many of them reported the desire to be involved in culturally relevant recreational activities such as a game of Mahjong, but they lack the social networks to get involved.
Our caregivers are a heroic bunch with strong Asian family values. Another study has shown that caregivers often report concerns about the caregiving and much less about the effect of caregiving on their own physical and mental well-being. What this means is that while they know and are driven to care for their loved ones, the caregivers do not know how to care for themselves and tended to neglect their own well-being.
Last year, during COS 2017, I asked the Government to provide better support to caregivers of seniors by setting up caregiver support centres at Senior Care Centres. I was glad to hear from Senior Minister of State Amy Khor that the Agency for Integrated Care started a three-year pilot since September 2015 to embed caregiver support services in 5 Senior Care Centres, and that AIC had also started AICareLinks centres at 5 hospitals and its office at Maxwell Road for caregivers to receive advice on services and schemes. I think these are great initiatives, but we are starting from a very low baseline of no support for caregivers.
There is a lot more we can do, especially given the general reticence of caregivers to seek help for themselves. I suspect the caregivers are not too forthcoming in seeking caregiver support services at the Senior Care Centres and AICareLinks centres. It may well be that we would need to use the Social Service Offices and Family Service Centres infrastructure to bring the support to the caregivers to enhance their well-being.
I understand the logic to integrate health and social support for seniors under MOH and empowering AIC to be the central implement agency to coordinate the services announced in the Budget Statement. But I hope this integration will not come at a cost to the cross-functional integration between MOH and MSF, and between AIC and the SSOs when it comes to needy seniors and vulnerable caregivers of seniors. In fact, with seniors ageing in place and in their communities, the delivery of services is most effectively achieved by leveraging the community networks of the SSOs and FSCs.
Economic and Health Security
I turn now to the third and last set of issues, which are directly related to the retirement security of senior women. There are two issues here I would like to highlight, economic security and health security.
First, existing cohorts of elderly women and soon-to-be senior women cohorts are experiencing economic vulnerabilities. In 2016, it was reported that for those over 60 years of age, the average CPF balance for women is only 69% that of men. This gap is narrowing for younger cohorts as gender equality improves with better educational attainment by women in recent decades.
However, this problem will remain with us for at least another 20 years, as the gender CPF gap is similar for those aged 45 years and above. Back in 2008, the Housing Development Board found that just over half of elderly residents living in HDB flats planned financially for retirement, with women much less likely to do so. Many elderly women, much more so than elderly men, are dependent on their spouses and children for financial support, and many continued to work in low-paid jobs to supplement their meagre income.
One study showed that 26% of those aged 55 years and above in 2011 reported they perceived occasional or regular financial inadequacy, with more women reporting this than men. Another study estimated that the relative poverty rate among the working elderly had jumped from 13 per cent in 1995 to 41 per cent in 2011. This means that among the working elderly, 41 per cent had income from work, family members and state assistance amounting to less than 40 per cent of the median income in the workforce. This suggests that many seniors are working past retirement age not just because they want to, but because they had to, and many in this category are women.
It does not look like this issue is going to abate in the next decade. Instead, the scale of the economic insecurity problem will increase due to the doubling of the number of seniors to 2030. I would like to call on the Government to study this issue of the elderly working poor, especially involving women, more closely and adopt urgent measures to tackle the issue. One possible line of attack would be to look at how social service and community development agencies helping to place the elderly in jobs could also help the elderly draw up favourable contracts for service and provide advice and retraining opportunities to improve their income prospects.
In the meantime, the Silver Support Scheme could be enhanced to mitigate the problems faced by the elderly working poor. As many of the seniors are dependent on their spouse and children for their housing needs, we should make sure this housing dependence do not erode the efficacy of state assistance to support the needy seniors.
The Silver Support Scheme payouts to needy seniors are currently tiered according to the HDB housing types they are living in. This is unnecessary as the beneficiaries of the Scheme are already means-tested. A needy senior living in a 5-room flat receiving $300 a quarter and a needy senior living in a 2-room flat receiving $750 a quarter are already means-tested to be facing low household support, with a monthly income per person in the household of not more than $1,100. One may be living in a bigger flat, but they are facing the same financial difficulties of meeting their everyday needs.
The 5-room flat is a long-term asset and cannot be simply unlocked to support the everyday needs. How is the size of the HDB flat related to the provision of household support to the elderly poor? Is the tiered payout signaling to the family that they should downsize the flat to better support their seniors? I believe needy seniors should receive $750 a quarter regardless of the size of the HDB flat where they live.
The second issue is health security. Our seniors are now living longer, fruitful lives and receiving better healthcare. While women are living longer than men, women are also facing more downsides in health security than men. Senior women spend more years in disability than men, and women are 2.5 times more likely than men to report difficulties in carrying out typical activities of daily living. The gender-differentiated ElderShield premiums reflect this, but again this means it compounds the gender income gap and greater financial insecurity faced by women.
Senior women are also more prone to suffering from dementia and higher rates of depression, which are more home-bound diseases that compound the caregiving burdens faced by female family members. The concern is that women are caught up in an intergenerational vicious circle of caregiving and deterioration of mental well-being. We need a more targeted approach to tackle dementia and mental well-being among seniors and the general population at the national level.
Gender Budgeting
Mr. Speaker Sir, back in May last year, I asked a parliamentary question on whether the Government practices gender budgeting to determine the effect of policies on women. Gender budgeting involves analyzing the Government’s annual budget and programmes for their different impact on men and women and then adjusting allocations and programme details to promote gender equality.
Minister Heng Swee Kiat replied to the question saying that in the design, planning and delivery of programmes, the Government accounts for the impact of policies on different segments of society, including gender, and target benefits at those in need, and that Government policies have over the years enabled the advancement of women in Singapore. Indeed, they have. I read this reply positively as the Government does do some form of gender budgeting for its programmes though it is not formalized as such.
I especially like the part on targeting benefits at those in need. As I have made the case in this speech, gender equality is not just an aspiration, but a need. It is a need because, whether absolutely or relatively, the financial security of women through their career from young workers to would-be mothers to caregivers to seniors is paramount to the mitigation of neediness among our ageing population. It is a need because gender equality is one of the key upstream solutions to the downstream challenges of ageing and where opportunities for successful ageing of our seniors are shaped and forged. To promote gender equality is thus to be strategic and integrated, as this Budget seeks to be.