As the French clean up after the riots in the street over increased retirement ages, and the UK government quietly shelves plans to do the same, AARP’s Director of Global Ageing, Vijeth Iyengar wants “equitable ageing” to be reframed as an opportunity to be seized proactively – in countries both rich and poorer. Despite the recent unrest and front-page news, high income countries are relatively better prepared to manage their ageing populations. They’ve had a lot more time to age and get ready.
It’s in low- and middle-income countries that ageing has accelerated particularly quickly, and Iyengar is pushing hard to mainstream ageing as a horizontal issue across the global policy agenda. A newly published report, Achieving Equitable Healthy Ageing in Low and Middle Income Countries (LMICs), looks at how countries around the globe are thinking and managing a shared challenge: the increasingly rapid ageing of their populations.
Vijeth Iyengar is a neuroscientist turned AARP’s Director of Global Ageing. AARP, which used to be known as the American Association of Retired People, is an influential research and lobbying group representing Americans over the age of 50. It currently has 35 million members in the US and conducts research on ageing issues internationally. This is their 4th report on the “ageing readiness” of countries, carried out with the Economist Impact.
Navigating the Longevity Lingo
In talking about global ageing, researchers and communicators quickly bump into a range of confusing terms and inconsistencies across countries and cultures. It’s good to clarify what can be compared, and what can’t. Here’s a quick glossary of a few terms to make the debate more legible.
Low- and Middle-Income Countries: The World Bank has replaced a varied, and imprecise vocabulary around rich/ poor, emerging/ developed/ developing countries with a more precise segmentation by a series of wealth metrics based on the Gross National Income (GNI):
- High-Income: GNI per capita over $12,536.
- Middle-Income: GNI between $1,036 and $12,535
- Low-Income: GNI per capita of $1,035 or less.
Equitable ageing: There is a global push to ensure fairness and justice in ageing. The idea is to address the specific disparities and inequalities that affect the older. It aims to create age inclusive environments designed to enable everyone to age with “dignity, security, and well-being.”
How do we define ‘old’? Who defines it? One of the big challenges in comparing countries is reliable, consistent data. Different countries and organisations define ageing differently and collect hugely data accordingly. AARP represents people over 50. The World Health Organisation (WHO) measures the ‘old’ as over 60. While for the World Bank statisticians it’s over 65. When reading and comparing the different reports these organisations produce, it’s hard to compare apples with apples. This AARP report goes for the over-65 segmentation.
A ‘life course model’ for ageing: The insight from this report and a rising swell of other research is that age doesn’t just concern the old. It concerns everyone, and all countries, and requires action and preparation from a range of actors and stakeholders at every stage of life.
The LMICs’ Challenges: Women, Pensions, Healthcare
By 2050, low- and middle-income countries will account for fully 85% of the world’s 65+ population growth. The rich world is busy discussing how to prepare for this Second Billion of older adults – but what of the rest of the planet? Fully four out of five older adults will live in LMICs. They aren’t ready. A variety of economic, policy, and societal challenges will require attention to ensure equitable healthy aging within and across countries. Most notably, these include:
- Gender Inequity: Fewer women in education and in the labor force has an almost automatic, knock-on effect for pension coverage and economic gender equity in ageing.
- Lack of Benefits: Large informal economies mean many people aren’t officially employed in stable jobs so don’t have access to employment benefits.
- Rural-urban Gaps are common to rich and poor countries alike, but are greater in lower income countries due to fewer social protection and health care systems. And the greater rural/ urban education divide.
- Missing Basics: Underdeveloped public institutions fail to extend universal access to social protection, healthcare, and education
Global trends are having a familiar impact on LMICs. They move people towards urbanisation and get women into both education and work. While this is widely sought after and celebrated, it also means that traditional familial networks of care, largely provided by women, are being disrupted. As in high income countries, the shifting roles of women have a particular impact on the older – but in these countries with fewer alternatives.
The Solutions: Mainstreaming Ageing, From Vertical Silo to Horizontal Priority
A big part of the solution is to start by reframing the ageing issue. It currently sits largely in a ‘demographic’ silo, where it is of interest to gerontologists, actuaries and demographers, but hardly part of the mainstream policy agenda. It needs to be recognised as the country-shifting, development-dependent economic and social imperative that it is. As Iyengar says, “it needs to move from being a vertical silo off to the side, to being a major factor in every other policy dimension – social, economic and political.”
This would be copying from both the climate and gender playbooks, which have followed similar paths. When the numbers and the impacts affect the competitiveness and security of countries, they need to be prioritised up the leadership agenda. “The silver lining of the pandemic,” observes Iyengar, “may have been to draw our collective attention to the older. Everyone, at every age, was shocked by what happened to our elders. We can do better. But we need to design it in.”
Four Recommendations for Action
The ARC 4.0 Report outlines four key ideas:
- Get Decent Data: Build systems to collect, standardise and disaggregate data so that the reality of populations can be tracked and evaluated. For the moment, there are too many ‘data deserts’ which impede focus and leave too many behind simply through being uncounted.
- Integrate Intersectionality: The complexity and inter-dependence of multiple factors in ageing need to be recognised upfront in policy design. Gender, ethnicity, socio-economic status each have huge overlaps with ageing equity. Innovative solutions often come from focusing in on a particular segment’s needs. For example, the report explores Bangladesh’s cash-transfer programs, which focus on older women living in poverty.
- Make it Local community-driven: Make programs locally relevant and managed by local actors. The report outlines a range of grass roots initiatives whose heightened impact comes from being culturally relevant.
- Governments Must Lead: Governments will want to take decisive, intentional action to manage ageing as a potential competitive advantage and national security priority. The report outlines 14 initiatives by different countries that can serve as ideas and best practice. The subtext: ageing can’t be left to market forces. Governments will be the key driver.
“Most people still think of ageing somewhere in the ‘human services’ bucket of their brains, but it’s much bigger,” insists Iyengar. It’s a multi-stakeholder, cross-sectoral issue that will require a coordinated push across players. Both public & private sector, civil society, individuals, and governments have a role to play. Everywhere.
The World’s Biggest Case Studies: China, India & Nigeria
Three of the world’s biggest countries are at three different points along the ageing spectrum, and each are experimenting with solutions watched by many. AARP presents case studies of different countries’ efforts.
Together, China, India and Nigeria represent almost three billion people, some 38% of the world’s population. Each of these populous countries has a challenge just evaluating what they are up against. Decent data is often step one, and all three are involved in trying to get an idea of the current situation on ageing.
Lack of data creates challenges for developing policies and solutions. Data deserts are common. Less than a third of the world’s countries (32%) have nationally representative data on older populations publicly available. These countries are trying to get the measure of their demographic realities. Here are some examples of how:
CHINA
DATA: 2022 marks the year China’s population began to decline. Getting good data to help manage the country’s huge ageing population is a challenge. The national government started the China Health and Retirement Longitudinal Study (CHARLS) more than a decade ago, in 2011. It involves 10,000 households and 17,500 residents over age 45. It is building a database to facilitate research and collects data on everything from demographics and health status to work, income and wealth. Since 2011, surveys have been conducted every two to three years, and the data is publicly accessible.
HOME CARE: Since 2014, Buurtzorg, a nonprofit based in the Netherlands, is offering services in 10 Chinese cities. They offer nurse-led, patient-centered home care and health services for over 1,000 older adults. Daniel Chiati Huang, the General Manager of Buurtzorg China, says the similarity of elderly care needs across high-income and middle-income countries facilitates replicability of models developed in rich countries. In conjunction with the government’s pilot experiments of long-term care insurance, Buurtzorg aims to increase equity in older-age care by cutting costs. Their home nursing services are half the cost of alternatives like senior living facilities or 24-hour in-home help.
INDIA
DATA: Having taken over the mantle of the world’s most populous country from China, India is also busy mapping the situation of older adults in its much more youthful, but fast-ageing perimeter. The government sponsored the first Longitudinal Ageing Study in India in 2017-19. It is a full-scale national survey of the health, economic and social consequences of population ageing, it will be run every three years. A major contribution of this study is that it is disaggregated data by both gender and age (over and under 60) as well as other variables (e.g., place of residence, marital status, living arrangement, religion, and caste). The survey was conducted in every state and union territory in India, generating data that should help direct policy responses. Given the size of both the endeavour and the population, it should yield research of interest everywhere.
Nigeria
In the late 2010s the government established a single senior citizens center organisation to provide for the needs of citizens over 70. Meanwhile, a pending bill called ‘Older Persons (Rights and Privileges),’ if passed, would offer a comprehensive legal framework for older adults. Nigeria signed the Protocol to the African Charter on Human and Peoples’ Rights on the Rights of Older Persons and is now considering becoming the next member of the African group at the bureau of the UN’s Open-Ended Working Group on Ageing. In 2021, Nigeria adopted its first comprehensive National Policy on Ageing.
All Hands On Age
The speed at which LMICs are ageing requires a full throttled effort from every part of society to address the new generational balance emerging in countries across the globe. If everybody did their part, it would look something like this:
- The private sector would integrate the needs of older adults when designing, developing, and providing products and services.
- Employers would support and embrace multigenerational workforces and increase investment in employees’ health and well-being – at every age and stage.
- Governments would strengthen national legislation on protecting equal rights by age and implement stronger national aging policies. Existing infrastructure (pensions, healthcare, and education systems, and transport) would broaden to reach everyone.
- Individuals would accept personal responsibility in raising their own and others’ awareness of the growing consequences of age and ageing populations in their countries. People would contribute to building age-friendly societies by combating ageism and responding to older people’s needs, through acts like volunteering or engaging with other older adults.
For the moment, this may sound like a distant pipe dream. But as this report highlights, efforts and initiatives on ageing are emerging across the globe. We learned from the Covid pandemic that the health and wellness of people in LMIC’s are not separate from our own, but intrinsically connected. Today, there are a billion people over 60 around the globe. Preparing for the predictable arrival of the second billion should be on the agenda of every country – at every income level. A growing number of countries are showing the way.
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