Coping with an Aging World

July 18, 2006

In the face of rapidly aging populations in some parts of the developing world, policymakers and development experts must take steps to ensure that older people can lead healthy and productive lives.

In many parts of the world, old age is something new. Thanks to improvements in nutrition, sanitation, and health care achieved during the 20th century, many more children worldwide are living past infancy and more adults are surviving into their sixties, seventies, and beyond. These longer life spans represent a triumph of development, science, and social policy, but the aging of the population is also generating social and economic challenges. Rural populations in particular are aging at a rapid rate in many developing countries as the young people migrate, and older people are taking on increased economic and household responsibilities. These burdens take a heavy toll on older people, who often find themselves pushed into poverty and food insecurity, especially in areas where the working-age adults have migrated to cities to seek work or been stricken with HIV/AIDS.

“Population aging is likely to become a dominant feature of social change around the world,” says Wolfgang Lutz, leader of the World Population Program of the International Institute for Applied Systems Analysis (IIASA). “This poses a number of serious challenges that range from the social security of the elderly to increasing needs for health care, changing consumer behavior, and possibly changes in productivity.”

The changes taking place now will dramatically shift the age structure of developing-country populations in the next few decades. In its 2004 World Population Prospects, the United Nations projected that, globally, the number of people older than 60 years would triple between 2005 and 2050, and their share of the total population would rise from 10.4 percent to 21.7 percent. “Demographic changes may seem to take place slowly,” says John Hoddinott, a deputy division director at IFPRI, “but they can be powerful. They have important implications for how you think about poverty and where you devote public resources.”

So what can policymakers, researchers, and development professionals do to help societies cope with older populations and to help older people improve their lives and livelihoods?

The Demographic Transition Speeds Up

Just 50 years ago, in 1950–55, global life expectancy at birth averaged 47 years; by 2000–05, it had reached 65 years. Although life spans are longest in the industrial countries, people in developing countries are also living longer, with the average rising from 41 years in 1950–55 to 63 years in 2000–05, and projected to reach 74 years in 2045–50. In developing countries, the share of people aged 60 or older rose from 6 percent in 1950 to 8 percent in 2005, and projections show it rising to 20 percent in 2050.

This aging of the world population is taking place thanks to a process called the demographic transition, which consists of three main stages. In the first stage, a country experiences high birth rates and high death rates—since both rates are high, population levels are relatively stable. In the second stage, countries experience improvements in sanitation and health care, and the result is a falling death rate, especially among infants and children. As a consequence population rises rapidly, and the share of young people in the total population grows. Many developing countries are at this stage of the demographic transition. In the third stage, the birth rate begins to fall. Population growth slows, and the population ages. The industrial countries have been in this stage for decades, and now a number of developing countries have entered this stage, or will soon do so.

Demographic changes that took a century or two to unfold in the industrial world are now taking place over decades in the developing world. In France, for instance, it took 115 years for the share of older people to rise from 7 percent to 14 percent. Many developing countries are on track to achieve the same increase in 20 years or less. “Developing countries are becoming increasingly serious about population aging, and there is a growing realization that appropriate policies must be put in place sooner rather than later,” says Libor Stloukal, population policy officer at the Food and Agriculture Organization of the United Nations (FAO).

The aging of populations is not occurring at the same rate in all regions of developing countries. Some countries, especially in Africa, still have high fertility rates, and thus populations are still growing rapidly. The number of children aged 0 to 14 in Africa is projected to rise from 375 million in 2005 to 555 million in 2050, and the number of people aged 15 to 64 is projected to rise from about 500 million to about 1.3 billion. China, on the other hand, is experiencing low fertility rates and rising life expectancies, and these factors are projected to raise the share of the population over age 60 to 31 percent by 2050.

Yet rapid aging per se is not necessarily a problem, explains Zachary Zimmer, an associate at the Population Council. The issue is whether a country has an adequate health care system and other infrastructure to deal with an aging population. “A rapid rate of aging may be of little concern in a country that has the infrastructure, whereas even a slow rate of aging can be problematic for a country that does not,” he says.

Aging in Rural Areas

Issues related to aging may be most immediate in the rural areas of many developing countries. The proportion of older people is rising much faster in rural areas than in urban ones, largely because of the migration of young adults to the cities in search of work, and in some countries because of the death of young adults from HIV/AIDS. The result is a rising phenomenon of what some observers call “hollowed-out households,” made up of the young and the old. Adults in their prime working years from ages 15 to 59 are simply not present. Reliable data on exactly how many such households exist in developing countries do not exist, but experts agree that the situation is becoming more and more common and presents a significant challenge to development efforts.

A tremendous problem faced by older people in rural areas is poverty. As people find their physical capacity diminishing, their earning power often declines, especially in the physically demanding sector of agriculture. So to maintain their livelihoods, older people must depend on family or community support or on social assistance programs. Yet economic and social changes, as well as the absence of adult children, can erode traditional systems for supporting the elderly. Although remittances from adult children who have found work elsewhere can help greatly, many elderly receive none.

“The productive opportunities for older men and women may become very limited, particularly if they are left to cultivate land that is beyond their physical capacity and have no possibility to hire labor, use animal power or mechanization,” says Stloukal.

Investing in the Older Generation

The industrial countries have made social assistance for the elderly a key social policy, and some advocates argue that it is time for developing countries to do the same. HelpAge International, a nongovernmental organization (NGO) based in the United Kingdom that seeks to improve the lives of older people in developing countries, has compared the two largest noncontributory pension programs in developing countries—those of Brazil and South Africa. HelpAge found that these social pensions cost relatively little: Brazil’s pension programs reach 5.3 million poor older people at a cost of 1 percent of gross domestic product (GDP). In South Africa, they reach 1.9 million people at a cost of 1.4 percent of GDP.

Equally significant, HelpAge reports that the programs can keep whole households out of poverty, because older people tend to share their pension benefits with their families. In both countries, households that included a pensioner were significantly less likely to become poor than households without a pensioner.

Pensions can also help older people carry another large burden—caring for people living with HIV and children orphaned by AIDS. “Older people are the backbone of AIDS care,” says Jo Maher, HIV and AIDS coordinator for HelpAge International, “and the cost of care is enormous.” HelpAge reports that up to two-thirds of people living with AIDS receive care from parents over age 60. Moreover, 9 out of 10 orphaned children live with their extended family, and in many countries this means a grandparent.

“Older people find that their roles have changed dramatically,” says Maher. “They are returning to work and care-giving at a time when they could once have expected to be getting care themselves.”

Moreover, older people are often left out of campaigns to give people information, treatment, and resources for coping with the HIV pandemic, she says. Information on the disease needs to be targeted to older people in ways they can make use of—for instance, many older people in rural areas of developing countries get information via radio rather than newspapers or magazines. And direct financial support like pensions can ease the burden tremendously.

There are other options besides direct payments to older people, Zachary Zimmer points out. In developing countries, families are responsible for supporting older people, and policy measures can help maintain or enhance these strong family traditions. For instance, policies can ensure that workers get time off to care for older people or give them tax benefits for doing so. “In many parts of the world, people see the Western system—where support for the elderly comes from the government and where people go into some kind of institution when they are no longer able to care for themselves—as a failure. They want an intergenerational approach that gives more dignity to older people and allows them to keep a place in the family and in society,” says Zimmer.

Not only governments, but also NGOs will have to change their work in response to the needs of older people, says Bernd Dreesmann, chairman and chief executive officer of All Help the Aged (AHA), a German NGO affiliated with the International Federation on Aging. “The aging process in many developing countries—among them India and China—will force NGOs to add new instruments to their aid programs,” he says, “including special medical treatments, care facilities adapted for older people, and support measures for poor families who must care for their elderly relatives much longer than in the past.”

At the international level, developing countries have agreed on the need for policies designed to help older people. In April 2002, at the Second World Assembly on Aging, the United Nations member states adopted the Madrid International Plan on Action on Aging. The plan calls for, among other things, allowing older people to be full participants in society and development, for enabling them to work as long as they want and are able to, for improving living conditions and infrastructure in rural areas where many older people live, and for eradicating poverty among older people, including through social pensions.

Despite good intentions, many countries have not followed through with commitments made in the action plan. To push authorities to keep their promises, older people in five countries—Bangladesh, Bolivia, Jamaica, Kenya, and Tanzania—are monitoring their countries’ actions with the help of HelpAge International and local NGOs. The case of Bangladesh suggests that such monitoring groups can achieve real results. Advocacy by older citizens helped push the Bangladesh government to raise the old-age allowance from US$2.50 toUS$2.75 a month in 2005 and to extend coverage from 1 million to 1.32 million people. Monitoring groups also helped older people sign up for the allowances they were entitled to and stimulated banks to improve their procedures for disbursing these payments to older people.

Preparing for the Population of the Future

The projections related to aging may seem alarming in some cases, but on the positive side, they give valuable information that can help policymakers and others prepare for the coming changes in population structure. “Population aging will be affecting most of the world between now and 2050,” says Zimmer. “It’s not something unpredictable—we have a lot of advance warning.”

What the projections show is that the aging of populations worldwide is going to require policy action and investment from policymakers and development specialists—and soon. “Governments and NGOs should initiate aid programs for the senior sector without further delay so that they have the necessary experience by the time the old-age ‘tsunami’ hits many developing countries in 10 to 15 years,” says Dreesmann. Delaying policy actions until large population shifts have already occurred will make the task of integrating older people into a strong and healthy economy and society much harder.

In 2050, a huge share of the world’s older population—approximately one fifth or more depending upon the future course of fertility and mortality—will live in China. Currently the great bulk of the Chinese population is of working age, but eventually these workers will grow old, and they have fewer children to support them than did past generations. Thus China’s actions may offer important lessons for other rapidly aging countries, Zimmer explains.

For all countries, attempting to meet the needs of the different generations will raise the possibility of difficult trade-offs. “How much do you want to devote public resources to the old as opposed to the young?” John Hoddinott asks. “This is not an easy question to answer, but governments will need to address it as these population changes take place.” As democracy spreads among developing countries, older populations may use elections to demand public support.

The evidence suggests that investments in older people’s well-being and livelihoods can offer significant benefits by reducing poverty. Ultimately, then, such investments may help improve the lives of people of all ages.

Reported by Heidi Fritschel