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Commonwealth Health Partnerships 2015

Little consideration has been given to issues of old age in Sub- Saharan Africa, which remains the world’s poorest and youngest region. Development and health agendas for that region, including those being discussed in relation to targets to succeed the Millennium Development Goals, understandably centre on how to increase the capacity of and opportunities for the region’s young people. Yet strong arguments exist for why the health of older people (aged 60 years and older) should not be overlooked. Not least is the substantial size of these populations – already double the number of older adults in northern Europe – which is expected to grow faster than anywhere else, increasing from 46 million in 2015 to 157 million by 2050 (Unicef, 2007). Furthermore, life expectancy at 60 years in Sub-Saharan Africa is 16 years for women and 14 years for men, suggesting that, for those who survive early life, a long old age is already a reality. However, perhaps the most important reason to consider the older population in present plans for increased human and economic well-being in Sub-Saharan Africa is that, contrary to common assumptions, older Africans play roles that are crucial to achievement of this well-being. Within families, older people are often carers or guardians of younger kin. They directly shape younger generations’ access to health, education and other capabilities, and thus their future human capital. The extent of older people’s caregiving is increasingly recognised in the context of HIV/AIDS – more than 60 per cent of orphaned children in Namibia and Zimbabwe, for example, are looked after by their grandmothers (Unicef, 2007). This care function is also important in everyday settings of poverty or labour-related parental absence – in the urban slums of Nairobi, Kenya, for instance, more than 30 per cent of older women and 20 per cent of older men (aged 60 years or older) care for one or more non-biological child (African Population and Health Research Center, Centre for Research on Ageing, University of Southampton). Beyond the family, older African people have key economic roles. In most Sub-Saharan African countries, older people largely remain in the labour force, particularly in smallholder agriculture, which encompasses the bulk of food production, and must be revitalised if nutrition security and sufficient job opportunities are to be ensured for younger generations. As a result of selective rural–urban outmigration, incapacity or uninterest of younger adults in farming, older people constitute a substantial share of smallholders. In Kenya, for example, the average age of a farmer is estimated to be 60 years (Olwande and Mathenge, 2011). Similarly, preliminary analyses of national survey data from Malawi and Kenya show close to 20 per cent of decision-makers on smallholder land use in both countries to be aged 60 years and older (African Population and Health Research Center). The extent to which older African people can execute their social and economic functions effectively depends heavily on their physical and mental capacity. Conversely, if their health deteriorates to a point at which they themselves need care, the responsibility is likely to fall on female younger kin, whose own health, and employment and education opportunities, can be affected. Impaired health in older age in Sub- Saharan Africa thus affects not only older individuals, but families, communities and prospects for development more broadly. Evidence of heterogeneity in health and function within older populations, and the importance of modifiable factors in shaping it, underscore the importance of health-promoting interventions to enable successful ageing in the region (Gureje et al., 2014). Yet, a large proportion of, or even most, older Africans lack the requisite care – results of the WHO Study on Adult Health and Ageing in Ghana, for example, showed 96 per cent of those with hypertension to have no adequate treatment for the disorder. Despite having worse health than younger age groups, older people in Sub-Saharan Africa have been observed to use health services substantially less than younger people do (McIntyre, 2004). This disparity points to possible age-based inequalities in access to health care that need attention in addition to the widely considered axes of inequities in health (economic status, sex, ethnic origin, or rural or urban residence). Barriers to health care faced by older African people include absence of an escort or high costs of transport to health providers, and private sector fees for medicines or treatment. Older patients use commercial providers because of the unavailability, perceived poor quality or age insensitivity of services in government facilities (Aboderin and Kizito, 2010). These providers, in a bid to achieve the health Millennium Development Goals, typically remain focused on services for infectious diseases, children and reproductive-age adults. The supply-side difficulties are exacerbated by important demand-side factors. Such obstacles include resource allocation norms within poor families, which can prioritise the needs of the young at the expense of the old, and older adults’ often little appreciation of the value of, or need for, management of asymptomatic chronic disease. In view of the direct importance of older African people’s physical and mental health for the achievement of core development goals, their burden of ill health and likely inequitable access to necessary care provide compelling economic and social grounds for action. References Aboderin, I. and Kizito, P., 2010. Dimensions and Determinants of Health in Old Age in Kenya. Nairobi: National Coordinating Agency for Population and Development. Gureje, O., Oladeji, B. D., Abiona, T. and Chatterji, S., 2014. ‘Profile and determinants of successful aging in the Ibadan study of ageing’. Journal of the American Geriatrics Society, 62, pp. 836–842. McIntyre, D., 2004. ‘Health policy and older people in Africa’. In: P. Lloyd-Sherlock, ed, 2004. Living Longer: Ageing, Development and Social Protection. London: Zed Books, pp. 160–183. Olwande, J. and Mathenge, M., 2011. Market Participation among Poor Rural Households in Kenya. Nairobi: Tegemeo Institute of Agricultural Policy and Development. Unicef, 2007. The State of the World’s Children: The Double Dividend of Gender Equality. Geneva: Unicef. Isabella A. G. Aboderin and John Beard Commonwealth Health Partnerships 2015 41 Older people’s health in Sub-Saharan Africa


Commonwealth Health Partnerships 2015
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