Executive Summary

Economic security, health and disability, and living conditions in old age are policy concerns throughout the world, but the nature of the problem differs considerably from continent to continent and between and within countries. In sub-Saharan Africa older people make up a relatively small fraction of the total population, and traditionally their main source of support has been the household and family, supplemented in many cases by other informal mechanisms, such as kinship networks and mutual aid societies. Although very little careful empirical research has been undertaken on long-term trends in the welfare of older people, there are a number of reasons to believe that traditional caring and social support mechanisms in sub-Saharan Africa are under increasing strain.

Located on the least developed and poorest continent, African economies are still heavily dependent on subsistence agriculture, and average income per capita is now lower than it was at the end of the 1960s. Consequently, the region contains a growing share of the world’s poor. In addition, reductions in fertility and child mortality have meant that, despite the huge impact of the HIV/AIDS epidemic across much of the region, both the absolute size and the proportion of the population age 60 and over have grown and will continue to grow over the next 30 years.

In sub-Saharan Africa, older people have traditionally been viewed in a positive light, as repositories of information and wisdom. And while African families are generally still intact, development and modernization are closely connected with social and economic changes that can weaken traditional social values and networks that provide care and support in later life. Formal education, for example, leads to greater independence and au-



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Executive Summary Economic security, health and disability, and living conditions in old age are policy concerns throughout the world, but the nature of the prob- lem differs considerably from continent to continent and between and within countries. In sub-Saharan Africa older people make up a relatively small fraction of the total population, and traditionally their main source of sup- port has been the household and family, supplemented in many cases by other informal mechanisms, such as kinship networks and mutual aid soci- eties. Although very little careful empirical research has been undertaken on long-term trends in the welfare of older people, there are a number of rea- sons to believe that traditional caring and social support mechanisms in sub-Saharan Africa are under increasing strain. Located on the least developed and poorest continent, African econo- mies are still heavily dependent on subsistence agriculture, and average in- come per capita is now lower than it was at the end of the 1960s. Conse- quently, the region contains a growing share of the world’s poor. In addition, reductions in fertility and child mortality have meant that, despite the huge impact of the HIV/AIDS epidemic across much of the region, both the absolute size and the proportion of the population age 60 and over have grown and will continue to grow over the next 30 years. In sub-Saharan Africa, older people have traditionally been viewed in a positive light, as repositories of information and wisdom. And while Afri- can families are generally still intact, development and modernization are closely connected with social and economic changes that can weaken tradi- tional social values and networks that provide care and support in later life. Formal education, for example, leads to greater independence and au- 1

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2 AGING IN SUB-SAHARAN AFRICA tonomy and weakening traditional social ties and obligations, factors that tend to undermine traditional extended family systems. In parts of sub-Saharan Africa, however, these changes pale in com- parison to the effects of the HIV/AIDS pandemic. Sub-Saharan Africa has long carried a high burden of disease, including from malaria and tubercu- losis; today it is home to more than 60 percent of all people living with HIV—some 25.8 million in 2005. The vast majority of those affected are still in their prime wage-earning years, at an age when, normally, they would be expected to be the main wage earners and principal sources of financial and material support for older people and children in their families. Many older people have had to deal with the loss of their own support while absorbing the additional responsibilities of caring for their orphaned grand- children. Increasingly, then, it appears that African societies are being asked to cope with population aging with neither a comprehensive formal social security system nor a well-functioning traditional care system in place. It is against this backdrop that, in 2004, the National Institute on Ag- ing (NIA) asked the National Academies’ Committee on Population to or- ganize a workshop on advancing aging research in sub-Saharan Africa. NIA was interested in exploring ways in which to promote U.S. research inter- ests and to augment sub-Saharan African governments’ capacity to address the many challenges posed by population aging. KEY THEMES Five key themes emerged from the workshop and the discussion. The first is the lack of basic, agreed-upon definitions crucial to the study of aging in sub-Saharan African societies. Most fundamentally, who is consid- ered an older person in sub-Saharan Africa? Do the definitions used in in- dustrialized societies have the same meaning for sub-Saharan Africa? And in the African context, with its complex and extended family structures, what constitutes the household, the usual unit within which older people are studied? Research can adequately assess the situation of older people in sub-Saharan Africa only if it is conducted in a framework that can allow for a full range of actors and impacts on their well-being. A second theme and persistent lament throughout the workshop is the lack of careful empirical research and the dearth of comprehensive data needed to rectify this situa- tion. Third is the participants’ belief that the situation of older people in sub-Saharan Africa is changing fairly rapidly. Fourth is the need to recog- nize the considerable diversity across sub-Saharan Africa with respect to a wide range of indicators. The final central theme is the need to support the development of local research capacity and facilitate research.

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3 EXECUTIVE SUMMARY KEY AREAS FOR FUTURE RESEARCH Five key areas of research—all closely interrelated—emerged as es- sential to the advancement of understanding of the situation of older people in sub-Saharan Africa and as necessary precursors to the development of sound aging policy in the region. These are (1) income, wealth, and expen- diture; (2) health and well-being; (3) the nature of family support and social networks; (4) the changing roles and responsibilities of older people as a function of the AIDS crisis; and (5) the nature and role of various kinds of formal and informal social protection schemes. RECOMMENDATIONS The panel’s recommendations fall into three groups: (1) recommenda- tions for a research agenda, (2) for enhancing research opportunity and implementation, and (3) for translation of research findings. Research Agenda There can be little doubt that, as a function of the emerging fertility transition in sub-Saharan Africa, the changing macroeconomic climate, and the impact of the devastating HIV/AIDS epidemic, researchers are paying increasing attention to the social, economic, and demographic dimensions of aging in sub-Saharan Africa. The five key areas listed above and de- scribed in detail in this report constitute an agenda of needed research on aging in sub-Saharan Africa. To carry out this agenda, we recommend the following: 1. Increase Research on Aging in Sub-Saharan Africa Increased attention can be turned into action only with increased fund- ing directed to this arena. Funders should consider mechanisms—existing or new—to enable the research agenda identified in this report to be carried out. 2. Explore Ways to Leverage Existing Data Collection Efforts to Learn More About Older People in Sub-Saharan Africa National governments will need both to invest more in basic research and to develop mechanisms to establish common definitions that will facili- tate the harmonization of data collection across countries. Improving un- derstanding of the situation of older people will also require a better picture of the simultaneous interplay among multiple factors, including health, eco- nomic, and social characteristics. Hence, the development and use of

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4 AGING IN SUB-SAHARAN AFRICA multidisciplinary research designs will be essential in the development and production of any new data on aging in sub-Saharan Africa. Enhancing Research Opportunity and Implementation 3. Improve Support for Library Infrastructure and Dissemination Tools to Create a More Integrated Body of Knowledge in Sub-Saharan Africa There is a need for more support for library and information services as well as a need for greater information sharing and professional networking, perhaps through the sponsorship of more local or regional conferences. Given the rapid takeoff of electronic journal retrieval systems, such as JSTOR, increased investment in Internet access—both to high-speed Internet itself and to rights to use resources available on the Internet—may be one of the most effective means of closing the gap between continents in terms of access to existing research. 4. Improve Archiving of Past Censuses and Surveys Data handling and storage technology are advancing so rapidly that the burden of making data available in a useful format cannot rest with indi- vidual researchers. There is a need for a more systematic archiving of Afri- can microdata. 5. Improve Access to Ongoing Data Collection Efforts If investments in new data are to be realized, better mechanisms will need to be put in place to improve storage, retrieval, and access to aging data. Much of the best research undertaken to date has been made possible only by the establishment of international research partnerships between researchers in the developed and the developing world. These partnerships are quite complex to establish and maintain, since they involve negotiating such thorny issues as fair allocation of research roles, balance in infrastruc- ture investments, and fairness in ascribing authorship and related credits. The challenge will be to strengthen these partnerships in ways that both support local institutions and increase timely access to data. 6. Strengthen International Collaboration and Capacity-Building in the Short Term More and better research on various dimensions of aging in sub- Saharan Africa cannot happen without an increase in the funding for re- search, more well-trained local researchers, and improvements in adminis-

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5 EXECUTIVE SUMMARY trative procedures that currently hinder the execution of research projects. Because it is unlikely that sub-Saharan African governments are going to increase their level of research funding substantially in the near future, for- eign financial and technical assistance will remain essential in the short term to the development of local universities and the strengthening of local research capacity. 7. Remove Barriers to Implementation of Research Collaborative research with sub-Saharan African institutions requires approvals by all collaborating institutions, frequently involving more than one review board for the ethical conduct of research as well as government offices and officials in the country in which data collection takes place. If research on these important subjects is to be carried out in timely fashion, it is essential that institutions, review boards, and government bodies at all relevant levels establish procedures and processes that make speedy review possible, without repetitive reviews of scientific merit. 8. In the Long Term, Sub-Saharan African Governments Must Give Reasonable Priority to Aging Research and Strengthen Local Research Capacity In the long run, the importance of foreign-supported research in the region must be reduced. It will be up to sub-Saharan African national gov- ernments to prioritize aging as a focal area and to find the resources needed to be able to drive the region’s research agenda on aging. Numerous related processes are already under way in Africa aimed at strengthening research institutes and building research capacity. Nevertheless, sub-Saharan Afri- can governments generally need to place a greater value on the role of higher education and find funding to rebuild and strengthen local universities. In many countries, pay scales will need to be adjusted in order to attract and retain the best researchers. Translation of Research Findings 9. Improve Dialogue Between Local Researchers and Policy Makers Researchers need to do a better job of drawing out the main policy and programmatic implications of their work, and policy makers need to better articulate what information they most need for more effective planning and program design. Otherwise, the danger is that local programs and policies will be only marginally based on a solid understanding of local needs and conditions, while research will continue to be undervalued by policy mak- ers and therefore underfunded.

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