Islamset - Rights of Ageing People: Threats to health and well-being in Africa

Dr Darnton-Hill's article is an excellent reminder of the challenges of aging globally, and of the interdependence of life satisfaction, health, psychosocial well-being and economic security in successful aging. These factors are as relevant for Africa as anywhere else, but they are overshadowed by the continent's socioeconomic fragility. Africa is expected to experience one of the world's largest increases in this age group: current projections suggest that by 2025 the elderly population will be 4.4 times as great as it is now. This is often ignored by planners who are already overwhelmed by the large increases in the younger population; in many countries people under 17 years of age account for more than half the population.

The effect of AIDS

Average life expectancy is 52 years in sub-Saharan Africa, and efforts to increase it and make aging healthier are put at risk by the AIDS pandemic. The extended family has been a very resilient agent of support for the elderly, and studies show that most rural elderly have traditional tasks, such as caring for children, which are mutually beneficial Extended family members, mainly the women, usually care for the elderly. However, AIDS threatens the viability of this system.

Grandparents are often left with few financial resources when their economically active sons and daughters die, but they are compelled to try and act as a complete substitute for the parents in caring for their orphaned grandchildren. Instead of reaching the time they had looked forward to, of being looked after by their children, they are faced with the arduous task all over again of raising children and finding money for clothes, food and school and clinic fees.

Surveys in southern Africa show that more than half of the elderly, and sometimes as much as 80%, receive remittances from their employed sons and daughters; but this is the age group most affected by the AIDS pandemic. No African economy except South

Africa has a national state pension scheme, and the elderly recognize the need to remain active and self-sufficient for as long as possible. Typically they fall back on subsistence agriculture, but this is flimsy protection, especially in times of drought. In many African rural societies, mutual support is provided through traditional agricultural activities in which the elderly can actively contribute (for instance by brewing beer) and receive labour in return. The effects of structural adjustment

Structural adjustment programmes are in place everywhere in Africa, and their impact on health has yet to be assessed, but the evidence so far offers little cause for satisfaction. Figures on child mortality, nutritional deficiencies, and the incidence of tuberculosis and malaria, for instance, are static or rising. Few data are collected on the quality of life of the elderly in Africa, but it is well known that the daily tasks of living (such as washing, walking, collecting water and fuel) are strenuous. This means that once mobility is restricted there is a rapid loss of viability. In addition, health services, especially at the district and local levels, are not well attuned to the needs of the elderly.

A study made in West Africa shows serious nutritional deficiency among the rural elderly, especially for women. Elderly refugee women in the Sudan and Zimbabwe were also found

At a time when national health systems are collapsing for lack of funds and infant mortality and disease incidence are rising, programmes designed to ascertain and meet the needs of the elderly are not seen as a priority.

to have a lower nutritional status than men. However, at a time when national health systems are collapsing for lack of funds and infant mortality and disease incidence are rising, programmes designed to ascertain and meet the needs of the elderly are not seen as a priority.

Questions of well-being

Surveys indicate that in Africa women feel lonely more than men do, and are less likely than men to have friends outside the extended family. One such study found that 47% of the women in the survey felt lonely "always or often", whereas only 29% of the men did. Perhaps to compensate, more women than men report finding comfort in religious beliefs and practices. Elderly women who live on their own are particularly vulnerable, as they are not likely to be looked after by either the family or the state. The law sometimes provides them with some protection, but it is rarely used. Most elderly people live in extended family households, but in nearly all African societies significant numbers of elderly women live alone in isolation and poverty.

It is often observed that Africans regard their elders with reverence and respect. Because the elderly are closer to die ancestors (some languages use the same word for both) they are seen as repositories of wisdom and authority from the past. However, nowadays they are challenged in that role by the new order which favours education and youth, and gradually makes being old or a chief or a headman seem irrelevant.

National planning must attempt to counteract this trend towards die marginalization of the elderly in Africa, and find ways to meet their emerging needs. One example of what can be done is a scheme in Zimbabwe which incorporates elderly women in the midwifery programme, thus combining traditions with modem hygienic practices. Both the elderly midwives and the mothers they serve report considerable satisfaction with this system.

Surveys show that more elderly women feel excluded from family decisions than elderly men, and that the older elderly are more excluded than the younger elderly. However, the majority of the elderly still enjoy considerable status and involvement in the family. They still play important religious and ritualistic roles at funerals, wedding negotiations and ceremonies and other such events.

To sum up, Dr Darnton-Hill gives us a valuable perspective, but in Africa the problems of "successful aging" are exacerbated by AIDS and structural adjustment programmes. Africa's rich cultural traditions offer unique ways to increase elderly people's sense of involvement and well-being. At the same a time, however, one must beware of assuming that all of the elderly can be treated in the idealistic ways stipulated by tradition. It will be necessary to focus on those most in need of social support.