Pensions, health and wellbeing of older people in developing countries: insights from the WHO SAGE survey

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Between 2010 and 2050, the number of people aged 60 and over is expected to increase by one and a quarter billion, reaching 22 per cent of the world's population. Of these, 81 per cent will be living in low and middle income countries (LMICs). There is an urgent need to identify policies that are effective in promoting the health, economic security and quality of life of older people in these countries. We should not assume that policies working reasonably well in high income countries will suit the circumstances of poorer ones. To date, research on older people in LMICs has been limited by a lack of reliable data. The World Health Organisation has sought to fill this gap by conducting a set of large surveys of older people's health and wellbeing in six LMICs: China, Ghana, India, Mexico, the Russian Federation and South Africa. Together, these countries already account for 36% of the world's 60+ population. This is an unprecedented data source, which promises to generate highly significant insights for policy-makers and researchers. The research team have conducted preliminary analysis of the data and this study would enable them to extend their work. We propose to focus our analysis on three key themes. (i) What effect does receiving a pension benefit have on older people's health and wellbeing? Policy for older people in LMICs is heavily focussed on providing pensions. It is assumed that, as well as ensuring their economic security, this will help them pay for health services and consequently improve their health. Yet the evidence for this is not always clear. For example, South Africa has a generous pension scheme but poor health outcomes for older people. We will conduct a systematic analysis of pensions, health and wellbeing, assessing the extent to which they are linked in the different SAGE countries. This will inform policy-makers about the relative importance of pensions and other policies, such as the upgrading of basic health services.(ii) Hypertension is a major cause of serious illness, including stroke, heart disease and dementia. Preliminary analysis of the new WHO data base has revealed large variations in the prevalence of hypertension across LMICs. There are also large variations in the extent that people are aware of these conditions and are receiving effective treatment for them. Our study will explore the reasons for these national variations in awareness and treatment, as well as for variations within countries. This will be done by more detailed analysis of the WHO data, combined with additional information obtained from documentary sources and interviews key informants in the SAGE countries. We will pay particular attention to the policy implications of these variations.(iii) How people experience later life is strongly influenced by previous life effects, but our precise knowledge of these effects is limited. WHO SAGE includes large amounts of information about older people's past lives, including their parents' education and occupational status. We will use this data to analyse life course effects and compare them across the SAGE countries. This will improve knowledge about how earlier life interventions may enhance wellbeing in old age.The research project will include a large element of dissemination and engagement with policy-makers, including meetings in each of the study countries.