Make ageing manageable

POLICY PROPS: POVERTY AND BAD HEALTH PRONOUNCED IN ELDERLY

There is a greater share of population reaching older age across world.

Population ageing is often associated with health-related challenges, but its effects also reach other spheres of life. In particular, an ageing population has a big impact on countries’ economies. Research shows it can influence economic growth and a similar effect can be found at the household level.

This is of greater relevance, given there is a greater share of the population reaching older age across the world. This makes it even more important to understand how ageing influences household wellbeing, what challenges exist and, more crucially, how policies can be designed to improve general welfare.

Our research in South Africa seeks to understand how different social policies can influence health and income at older ages. The findings are relevant to other developing countries, too. Our research has been conducted in 31 villages in rural northeast South Africa, close to the Mozambique border, since 2013. The study, which is ongoing, involved collecting income and health information on older people every two years.

Ageing can influence a households’ economic wellbeing because it has a bearing on employment. Employment rates drop off even before people reach retirement age. In SA there is no legal retirement age, but men and women qualify for an old age grant at 60. This means a large share of older people are not in the labour force.

There are two potential explanations for this. One is the very high levels of unemployment, which affects older people too. Being out of the labour force is associated with lower incomes and, thus, a lower capacity to consume.

Health is the other factor affecting the economic wellbeing of households. This can happen in two ways. First, unhealthy ageing means greater need for health services. This expenditure reduces the money available for other needs, like food. This can lead to medical impoverishment – when a household’s income falls below the poverty line because of money spent on health services.

Most of the people living in the study communities are already living below the poverty line. Unhealthy ageing can also impact economic wellbeing by forcing other household members out of work to care for the elderly – compounding the burden on the household.

Economic wellbeing itself can have an impact on health. While health influences economic wellbeing, the inverse is also true – economic wellbeing influences health.

Results from the baseline wave of the study show that individuals in the highest wealth quintiles are more likely to be in better health. For example, an individual in the highest wealth quintile is two times less likely to be in the bottom quintile of disability.

And there’s evidence that individuals in the lower wealth quintile are less likely to access healthcare or follow guidelines for disease prevention. This can be due to knowledge or financial capacity reasons. This implies that already impoverished households can be made worse due to the health consequences of their economic position.

The relationship between income and health underlines the need for strong government policies to break the cycle. A myriad policies could be considered. In SA the focus has been on establishing an extensive social grant net. These grants have become a valuable tool for tackling poverty among older people.

But there are still challenges. The main one is that administration isn’t perfect. For example, about 10% of those eligible for the old age grant aren’t receiving it. This number increases to over 85% for the disability and carer grant, according to our estimates in the town of Agincourt in Mpumalanga.

The reasons for this are either lack of knowledge, stigma, or lack of documents, such as a national identity card. What’s clear is that there’s a need to improve access.

As the population ages in developing countries, it is vital to remember the dual relationship between health and income. This can be helpful in the development of policies that contribute to healthy ageing and protect households.

This is important, given that poverty rates and bad health are often greater for older people.

Carlos Riumallo Herl: assistant professor, Erasmus University Rotterdam

David Canning: professor of population sciences, Harvard

Mark A Collinson: MRC/Wits Rural Public Health and Health Transitions Research Unit – Republished from TheConversation.com