Academic journal article Public Health Reviews; Rennes

Understanding and Advancing the Health of Older Populations in Sub-Saharan Africa: Policy Perspectives and Evidence Needs

Academic journal article Public Health Reviews; Rennes

Understanding and Advancing the Health of Older Populations in Sub-Saharan Africa: Policy Perspectives and Evidence Needs

Article excerpt

INTRODUCTION

International debate on the policy challenges associated with the health of ageing populations in sub-Saharan Africa (SSA) has intensified in recent years, based on two key points of departure. The first are current demographic projections, which (though tenuous, given the absence of reliable vital registration systems in most SSA countries)1 show SSA to have the fastest growing older population of any world region. While the share of persons aged 60 and over* will remain much lower than elsewhere (increasing from presently 5 percent to only 9.1 percent by 2050), their absolute number will see the sharpest rises globally: from 42.6 million in 2010 to 160 million by 2050.2 Second is SSA's status as the poorest and 'least developed' major world region,3,4 which implies that the ageing of its populations is largely unfolding in contexts of widespread economic strain.5

Against this backdrop, the discourse on challenges of ageing and health in SSA centres not, as it does in industrialized countries, on queries about expected trends in old age morbidity, mortality and disability and the sustainability of existing health and care systems.6-8 The focus, rather, are concerns about a heightened vulnerability of older persons to detrimental health outcomes - in two respects. On one level, older populations in SSA are deemed to be at particularly high risk of ill-health and disability from age-related chronic non-communicable disease (CNCD), due to a lifetime of exposure to conditions of deprivation and a growing prevalence of modifiable CNCD risk factors.5,9,12 On a second level, older persons are believed to lack access to even basic healthcare and, crucially, to have less access to services than do younger age-groups - suggesting an element of age-related exclusion.9,10,13

POLICY CHALLENGES

In response to the concerns, two recent international frameworks, the 2002 United Nations Madrid International Plan of Action on Ageing (MIPAA)9 and the 2003 African Union Policy Framework and Plan of Action on Ageing (AU-Plan),10 urge the development of strategies to enhance health service provision for Africa's older persons as a way to realize their right to health and to encourage their valuable contributions to families and societies. The Plans call for two main types of measures: (i) multi-faceted health promotion strategies to prevent disease and disability among successive cohorts of older persons, and (ii) policies to ensure full access to adequate curative and rehabilitative care for older persons who already suffer from disease or disability. Such responses, as MIPAA and AU-Plan assert, are to be forged as part of core national health and development agendas and to serve the ultimate goal of enhancing older persons' quality of life.5 The recommendations overlap with intensifying calls on Africa's governments to prevent and manage their countries' rising burden of CNCD, such as cardiovascular disease (CVD), chronic respiratory disease, diabetes and cancers, which overwhelmingly affect adults in their middle and older ages.12,14-18

As signatories to MIPAA and AU Plan and prompted by the calls on CNCD, SSA countries formally acknowledge the need for policy responses on old age-related health needs. Collectively, African governments propose action to address these needs in the African Union Africa Health Strategy 2007-2013.19 Individual states (including, for example, Burundi, Kenya, Nigeria, Senegal, South Africa and Tanzania) pledge relevant measures as part of national health sector plans and, in some cases, broader national policy frameworks on ageing.20,21 Typically, countries propose (to varying degrees of detail) one or both of two kinds of responses: (i) steps to develop preventive and/or curative primary healthcare services for major CNCD and, in some cases (e.g., Kenya) other degenerative diseases,22 and/or (ii) social protection measures to redress the exclusion of older persons (and other vulnerable groups) from health services, by removing financial barriers. …

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