POPULATION AGEING: CARE ROLES AND RESPONSIBILITIES OF

WOMEN AND MEN

Alice Nabalamba, Ph.DStatistics DepartmentAfrican Development BankTunis, Tunisia

ESA/STAT/AC.219/30

POPULATION AGEING

Population ageing is described as the rise in the median age of a population resulting in a shift in the age structure of that population.

It is largely a consequence of declining fertility rates and increased life expectancies.

One of the important outcomes of an ageing population is the shift in the dependency ratio: (the number of people 15 years or younger and 65 years and older to every 100 people of traditional working ages (15-64):

Dependency ratio declines in relation to younger dependency as the median age of the population rises

Dependence ratio increases in favor of older population as the median age rises

OECD Countries In many developed countries, population

ageing is already taking shape - the average age of populations is expected to increase rapidly in coming years;

A direct consequence of the baby boom from the late 1940s through the 1960s;

% of persons aged 65 years and older, expected to increase rapidly over the next few decades, reaching 25% of the total population in most of the OECD countries.

In contrast, < 10% of the population was 65 years or older at the end of the 20th century

Africa demographic trends

healthy life expectancy and life expectancy at birth, have been relatively low for both men and women,

the tendency has been that fewer people live to reach age 65 years and older.

Nevertheless, the overall life expectancy at birth in 1990 was 52.7

years and increased steadily to 54.8 years by 2009. In 1990, women’s life expectancy at birth was 54.3

years compared to 51.1 years for men. By 2009, women and men were expected to live up

to around 56.8 and 54.5 years respectively. Healthy life expectancy was at 39.5 years for Africa

as a whole in 2000; 48.9 years by 2007.

Africa is also witnessing a shift in the population structure: population aged 65 years and older is growing

Percent

2.00

2.50

3.00

3.50

4.00

YR1999

YR2000

YR2001

YR2002

YR2003

YR2004

YR2005

YR2006

YR2007

YR2008

YR2009

Proportion of Women and Men Aged 65 Years and Over, 1999-2009, Africa, excluding Seychelles and Somalia.

0.00%

1.00%

2.00%

3.00%

4.00%

5.00%

YR1999 YR2001 YR2003 YR2005 YR2007 YR2009

Women Men

Over the 10-year period, the growth in the elderly population was highest among women

Country Specific Demographic Changes:

Between 1999 and 2009, twelve countries recorded a population aged 65 years or older of 4% or greater

In 1999, Tunisia had the largest elderly population followed by Mauritius.

By 2009, Mauritius had surpassed Tunisia as the country with the highest proportion of the population aged 65 years or older. (5.7% to 7.3%)

The number of older persons is also on the rise in Morocco, Algeria, Libya and Egypt.

Elderly population is on the decline in Gabon, Cape Verde, and Sao Tome and Principe; Burkina Faso, Burundi, Chad, Equatorial Guinea, Kenya, Madagascar, Mali, Rwanda, Sierra Leone, Senegal, Uganda, and Zambia. (Range -0.1% to -0.7%)

Countries with population aged 65 years or older exceeding 4% of the total population, Africa, 1999-2009

3.00%

4.00%

5.00%

6.00%

7.00%

8.00%

SAO T

OM

E AND P

RINCIP

E

ZIMBABW

E

CAPE VERDE

LIBYA

GABO

N

SOUTH A

FRICA

EGYPT

ALGERIA

LESOTHO

MORO

CCO

TUNISIA

MAURIT

IUS

YR1999 YR2009

Why we should be concerned about an ageing population in Africa

Rapidly declining fertility rates;

An increasing life expectancy;

Rising median age (from 18.3 in 2000 to 27.5 in 2050);

Declining Fertility Rates, 1997-2009, Africa

1997 2000 2009

Africa 5.27 5.06 4.41

Mauritius 2.09 1.97 1.79

Tunisia 2.38 2.09 1.84

Morocco 3.02 2.70 2.33

Algeria 3.01 2.62 2.34

Egypt 3.49 3.32 2.82

South Africa 2.98 2.87 2.51

Libya 3.43 3.19 2.64

Botswana 3.75 3.41 2.82

Zimbabwe 4.12 3.86 3.36

Djibouti 5.20 4.80 3.79

Source: African Development Bank Group, Statistics Department, Social and Economic Databases

Increasing Life Expectancy (Years), Africa 1990-2009, 2002-2007

  Life Expectancy at Birth Healthy Life Expectancy

  Total Men Women Total Men Women

  1990 2009 1990 2009 1990 2009 2002-2007

Africa 52.7 55.7 51.1 54.5 54.3 56.8 48.9 43.7 45.3

Libya 67.8 74.3 65.8 72.0 70.5 77.2 66.0 62.3 65.0

Tunisia 68.6 74.2 66.9 72.1 70.6 76.3 67.0 61.3 63.6

Algeria 67.0 72.7 65.9 71.2 68.3 74.1 63.0 59.7 61.6

Mauritius 69.2 72.1 65.5 68.5 72.9 75.8 65.0 60.3 64.6

Morocco 64.1 71.6 62.3 69.4 66.1 73.9 63.0 59.5 60.9

Egypt 62.9 70.3 61.6 68.6 64.3 72.2 62.0 57.8 60.2

Botswana 64.2 55.1 61.9 55.1 66.4 54.8 48.0 36.0 35.4

South Africa 61.4 51.7 57.8 50.3 65.2 53.1 48.0 43.3 45.3

Lesotho 59.3 45.6 57.4 45.0 61.0 45.7 41.0 29.6 33.2

Swaziland 60.5 46.4 58.3 47.1 62.6 45.5 42.0 33.2 35.2

Zimbabwe 60.8 45.7 57.5 45.3 64.3 45.6 38.0 33.8 33.3

Population ageing is highly correlated with:

an increase in the prevalence of a number of long-term chronic conditions;

physical and mental disability;

increased personal care needs.

2006, the WHO projected that diseases associated with ageing such as Alzheimer’s disease and other dementia, Parkinson’s disease and others collectively accounted for 6.3% of disability-adjusted life years (DALYs).

The contribution of HIV/AIDS, all cancers, heart disease and respiratory diseases to DALYs is (5.5%, 5.3%, 4.2% & 4.0% respectively.)

More recent studies suggest that these conditions are on the rise in the general population due to an ageing population.

More alarming is that these conditions will increase more rapidly in developing countries such as those in Africa, Asia and elsewhere than they have been in developed countries.

Management of long term chronic conditions and related disabilities requires a considerable amount of resources from governments and families.

In much of Africa, governments still spend far less per capita on health care and social protection.

Few African countries have public pension programs or formal systems for caring for the elderly; most rely on traditional family structures.

In 2005, governments in 48 of the 53 African countries spent $25.70 per capita on households while private households spent more than twice that amount ($58.20) per capita (ICP-Africa, 2005).

Such a high disparity in health care expenditure between governments and households has several implications among which is the increasing burden of care being shifted to those least able to afford it.

Changing family structures resulting in shrinking social support networks that many older Africans have depended upon for generations.

With increasing urbanization, and the ravages of HIV/AIDS, this support network is being dismantled.

In societies experiencing the HIV/AIDS epidemic, older parents are increasingly caring for grand children left behind by victims of HIV/AIDS.

The rise in HIV/AIDS death rates has also led to a rapidly increasing new category of neglected elderly individuals or older adults living alone without any caregivers.

Care roles and responsibilities of Men and Women in Africa Care roles of men and women in the

context of population ageing are varied.

The general perception is that older people are care receivers while younger ones are care givers.

Recent evidence, in Africa, suggests that older people are increasingly playing the role of care givers as much as they are care receivers.

A few sample surveys have been undertaken in Africa to estimate the cost and other challenges of care giving.

The surveys are usually ad hoc The samples are usually very small and

may not be representative of entire country populations.

These sample surveys do not characterize care givers to allow an assessment of the varied responsibilities of men and women in care-giving.

The surveys tend to focus on care giving to terminally ill persons such as those living with HIV/AIDS.

Measuring care roles and responsibilities of women and men

There is an urgent need to shed more light on the important characteristics of care roles and responsibilities of men and women.

It is important to establish who provides care to our aging population in order to better understand the consequences of care giving and how best to assist caregivers.

Available evidence on care giving in Africa suggests that care giving is done by both young and old for various reasons.

Younger caregivers may be working, in good health, have children of their own and often providing care to someone older than them; often juggle many demands in order to provide care to their loved ones.

The psychological and practical dimensions of the relationship between care giver and an older care receiver are quite different than those of a care giving relationship between people within the same age group such as siblings, friends, etc.

Elderly caregivers face different types of constraints and challenges, whether giving care to their own adult children, orphaned grandchildren, or contemporaries.

First, there is need to ascertain:

• who the care receivers are, i.e., the proportion of men and women in a population aged 65 years or older who report receiving assistance during a reference period with at least one task because of a long-term health problem.

• the frequency of care receiving (daily, weekly, biweekly, monthly, quarterly etc.,) by number of hours.

• the care provider(s), both young and old, men and women, who report providing assistance, during a reference period, with at least one task because of a long-term health problem of the care receiver.

The frequency of care giving (daily, weekly, biweekly, monthly, quarterly etc.,) by number of hours spent.

Characterize the typical care-giving tasks or responsibilities performed, by male and female care givers;

Characterize the tasks for which care receivers typically receive assistance, taking into account the cultural and social context of the population being investigated.

Given the unique experiences of younger and elderly care givers, there is need to ascertain the physical, emotional and psychological wellbeing of the care givers, and the physical and mental challenges they face everyday.

It is important to separate care giving involving remuneration versus care giving without any compensation.

The actual estimate of compensation should also be obtained in order to impute the cost of care-giving for those who do it voluntarily.

To fully appreciate care-giving and care receiving roles, it is also imperative to obtain information on other correlates such as age, sex, income (personal & household), level of education, geography (urban/rural) of the caregiver and care receiver;

Way Forward

In light of the ageing population and related disabling conditions, the increased burden of HIV/AIDS in Africa, it is important to establish who provides care and to whom, as well as the type of care, in order to better understand the human, psychological and financial cost of care giving and how best to assist caregivers.