Investing in an ageing population
The World Health Organisation (WHO) has stated that the number of old people in the world will be one of the most profound forces affecting health and social services in the next century (WHO, World Health report, Health of the Elderly, 1995). While the world’s population has been growing at an average annual rate of 1.7%, the population aged over 65 is increasing by almost 2.7% annually.
The most rapid changes are being seen in the developing world, with predicted increases in some developing countries of up to 400% in people aged over 65 during the next 30 years. Alongside the increase in the number of people over age 65, there is also expected to be a rise in the numbers of the “old old” – people over 80 (WHO, World Health report, Health of the Elderly, 1995).
The long-term care of the frail elderly is becoming one of the most debated medical and political issues in many developed countries, and the developing world is now following suit in grappling with these issues and raising awareness surrounding social and health-based mechanisms for support of the elderly.
In just one decade the elderly population is expected to swell by 200-million, taking it well beyond 1-billion people and potentially putting a greater strain on welfare and medical systems around the world (UN Population Fund Report, 2012).
In South Africa the percentage of the population aged 60 years and older rose from 7.1% in 1996 to 8% in 2011, constituting an increase from 2,8-million to 4,1-million individuals (Profile of Older Persons in South Africa report, Stats SA, 2014).
A key question for health planners and politicians is whether increased life expectancy means more years of health or more years of sickness. WHO launched a Commission on the Social Determinants of Health to investigate the gross inequalities that exist in health provision for the elderly. The commission reviewed evidence, raised societal debate and recommended policies with the goal of improving health of the world’s most vulnerable people by turning public health knowledge into political action and improving health equity (Commission on the Social Determinants of Health, Final Report, "Closing the Gap in a Generation", 2008).
While this is an area that is still greatly underresearched, it is clear that keen attention needs to be paid to putting policies and practices in place to ensure that the elderly are not left destitute and uncared for at the end of their lives. A study by the UN Population Fund and private group HelpAge International exposed that the elderly are often denied basic human rights and fundamental freedoms and are also underemployed and vulnerable to discrimination, abuse and violence.
South African social pensioners face significant socioeconomic pressure as many are sole providers for families and primary caregivers for their grandchildren. A large number of social pensioners are dependent on R1,350 per month with the public health system unable to satisfactorily address the needs of older persons or able to provide adequate opportunities for independent living, encouraging “active ageing” as enshrined in the Older Persons Act of 2009.
In contrast to these growing needs, the older persons sector is financially neglected as corporates, foundations and the government favour education and youth initiatives. In 2014, almost half of all CSI expenditure in South Africa went to the education sector, with the social and community development sector receiving about 15% of CSI funding. Of this 15% only 4% went to interventions that assist the elderly (Trialogue 2014 CSI Handbook). With only marginal funding, resource-strapped older persons organisations are unable to scale sector solutions or pilot innovative services effectively.
This scenario prompted the creation of an extremely effective collaboration of leading NGOs within the older persons sector who have committed to improving the lives of South African state pensioners from low-income communities. Sector Task Team for Older Persons (STTOP) member organisations provide state pensioners with access to effective and affordable healthcare, housing (residential, community-based and frail care) and support programmes. Central to STTOP’s work is the belief that the older person is a valuable and economically contributing citizen, and to ensure that older persons remain active, excited about life and involved in their communities throughout their lives.
One of the member organisations of STTOP, Neighbourhood Old Age Homes (Noah), has the unique solution of providing old age homes within communities, allowing residents to live in familiar surroundings, enabling elderly people to retain their independence in their communities for as long as possible. Residents pay a nominal fee and the Department of Social Development subsidises the running costs.
Noah has innovatively partnered with the Western Cape Department of Health to make access to healthcare easy and convenient. It runs a primary healthcare clinic in Woodstock that is manned by a trained nurse and a sessional doctor and more than 200 Noah members and local pensioners frequent the clinic.
It is clear that ageing issues need to be integrated into national development programmes and poverty reduction strategies, including creating an enabling environment in terms of infrastructure, training of caregivers and health professionals, exposing elder abuse and discrimination and access to affordable and age-friendly healthcare services. With the right measures in place to secure healthcare, regular income, social networks and legal protection, there is a longevity dividend to be reaped worldwide by current and future generations.
Investing in enabling the elderly to retain their independence in their communities for as long as possible will have a far-reaching positive impact on reducing the burden on state facilities such as hospitals and social services in the future.