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

2010年至2050年期间，60岁及以上的人口预计将增加2.5亿，达到世界人口的22%。其中，81%将生活在低收入和中等收入国家。迫切需要确定能够有效促进这些国家老年人的健康、经济安全和生活质量的政策。我们不应假设，在高收入国家运行良好的政策，也适用于较贫穷国家的情况。迄今为止，由于缺乏可靠的数据，对中低收入国家老年人的研究受到限制。为了填补这一空白，世界卫生组织在六个中低收入国家（中国、加纳、印度、墨西哥、俄罗斯联邦和南非）开展了一系列关于老年人健康和福祉的大型调查。这些国家加起来已经占世界60岁以上人口的36%。这是一个前所未有的数据来源，有望为政策制定者和研究人员提供非常重要的见解。研究小组已经对数据进行了初步分析，这项研究将使他们能够扩展他们的工作。我们建议将分析重点放在三个关键主题上。(i)领取养恤金福利对老年人的健康和福祉有什么影响？针对中低收入国家老年人的政策主要侧重于提供养老金。人们认为，除了确保他们的经济安全外，这将有助于他们支付保健服务费用，从而改善他们的健康。然而，这方面的证据并不总是很清楚。例如，南非有一个慷慨的养老金计划，但老年人的健康状况不佳。我们将对养老金、健康和福利进行系统分析，评估它们在不同SAGE国家中的关联程度。这将使决策者了解养恤金和其他政策（如提高基本保健服务水平）的相对重要性。㈡高血压是导致中风、心脏病和痴呆等严重疾病的主要原因。对世卫组织新数据库的初步分析显示，中低收入国家的高血压患病率存在很大差异。人们对这些疾病的认识程度和接受有效治疗的程度也存在很大差异。我们的研究将探讨这些国家在认识和治疗方面的差异，以及国家内部差异的原因。这将通过对世卫组织数据进行更详细的分析，结合从文件来源获得的额外信息和对SAGE国家主要举报人的访谈来实现。我们将特别关注这些变化对政策的影响。（iii）人们如何经历晚年生活受到前世影响的强烈影响，但我们对这些影响的确切了解有限。世卫组织SAGE包括有关老年人过去生活的大量信息，包括其父母的教育和职业状况。我们将使用这些数据来分析生命历程影响，并比较SAGE国家之间的影响。这将提高人们对早期生活干预如何提高老年幸福感的认识。该研究项目将包括大量的传播和与决策者的接触，包括在每个研究国家举行会议。

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.