Social Determinants of Elderly Health in Developing Countries
I. Introduction
The world is undergoing an unprecedented shift in the age of its population. According to Tyagi and Paltasingh (2017), the elderly population, ages 65 and above, only composed around 524 million individuals during 2010 in the entire world. However, the number of the elderly population is expected to increase to around 1.5 billion by the year 2050. This phenomenon is described as global population aging where the relative size of the older population as a share of the total population increases over time (Powell and Khan, 2013). Due to the innovations of modern science and technology, humanity can extend its life expectancy through improvements in the accessibility and affordability of healthcare, sanitation, and quality of life (World Health Organization, 2012). Moreover, this sudden increase in the elderly population has broader implications to society such as greater opportunities for the elderly in other domains of social life, the concentration of resources to fewer individuals, and the accumulation of more human capital for development (Davidson and Hagedorn, 2012; Laboul, 2012; Olhansky 2012; Zahidi, 2012).
For these reasons, elderly health is becoming an increasingly salient issue in the discourse of public health. The health status of the elderly is important to ensure that other dimensions of well-being such as social and economic engagement are maintained (Bakshi and Pathak, 2015). Nonetheless, global population aging has unequal distributions of risks and burdens over different countries of the world. Developing countries — countries with emerging and underdeveloped economies —, must grapple with precarious social conditions such as poverty, illiteracy, and weak medical systems. Furthermore, there is a dearth of literature that tackles elderly health in the context of these impoverished countries (Higo and Khan, 2015). Hence, it is necessary to understand these social factors that could potentially impact elderly health in the context of the developing regions of the world.
II. Contextualizing Elderly Health in Developing Countries
Health is a multidimensional concept that is shaped by different factors such as socioeconomic status, environment, diet, income, and education (Rout, 2008). Similarly, elderly health is multifaceted but differs from other age groups such as children and adolescents. To contextualize elderly health in developing countries, it is important to categorize them into three domains: individual, intermediate, and remote determinants of elderly health (Gutierrez-Robledo, 2002). These social factors significantly determine the quality of elderly health in developing countries where a myriad of social issues can potentially affect the healthcare systems for the aged.
Firstly, the individual determinants of elderly health refer to individual attributes such as gender, age, affluence, education, nutrition, and co-morbidity that affect the health status of old people (Gutierrez-Robledo, 2002). To illustrate this aspect, the relationship between gender and elderly health can be further explained. Developing countries tend to lag in progress in terms of gender equality and have more rigid gender roles compared to developed countries in the West. Consequently, these gender norms and constructs can affect the individual health of the elderly (Ghosh and Husain, 2010). In one study of Mini (2009), data suggests that there is a higher occurrence of multiple health problems in women compared to men in developing contexts. Findings explain that as women approach old age, their health needs get neglected due to gender related-issues such as having a lower-economic status due to the lack of opportunities, widowhood, and the burden of reproductive labor such as caring for other family members (Devi et al., 1999). Thus, gender along with other individual determinants of elderly health can significantly affect the elderly in developing countries.
On the other hand, intermediate determinants of elderly health refer to meso-factors such as family, environment, poverty, housing, health and social services, and employment that impact the health status of the elderly (Gutierrez-Robledo, 2002). In the context of developing countries, these intermediate determinants become more salient due to the risks and burdens that they entail for the health of elderly people. A relevant scenario to this factor is change in family size and structure. According to Treas and Macum (2011), the global shift in the population of aging individuals has altered traditional family size and structures. Statistics predict that individuals will have fewer siblings in the future as the number of people who only have one or two children steadily increase (Agree and Glaser, 2009). The reduction of family size entails different living arrangements that may affect the availability of resources for informal care, particularly of support that family members contribute to older people in the household (Higo and Khan, 2015).
In developing countries, elderly people rely on other family members for social support and economic survival such as Bangladesh, Indonesia, Singapore, and Taiwan (Ghuman and Ofstedal, 2004), This cultural preference of living with other family members is a prevalent living arrangement of the elderly in developing countries. Moreover, the dismal development of financial security systems such as public pension programs in the developing world compels the elderly to live with their families because of the lack of government support (Higo and Williamson, 2011). Due to the decline in family size and conventional living arrangements, the elderly in developing countries are less likely to receive quality healthcare from the absence of social welfare programs (Lloyd-Sherlock, 2010). In addition, the dwindling family size means that elderly people in developing countries would have fewer informal resources to help them with their deteriorating health (Higo and Khan, 2015). The elderly in developing countries may be left with few social resources and nowhere to live in the absence of extended family members.
Finally, the remote determinants are macro-structures that influence elderly health such as development trends, population policies, urbanization, and migration (Gutierrez-Robledo, 2002). These refer to expansive social forces that have bearing on the health of elderly people in developing countries. A pertinent social force that affects elderly health is migration patterns due to the global care drain (Bettio, 2012). Over the past decades, healthcare workers have been in demand for home and community-based long-term care (LTC) for the disabled and frail elderly. Hence, the majority of developed countries such as Canada, the United Kingdom, and the United States of America have encountered human resource shortages for LTC workers in their rapidly growing elderly population (Browne and Braun, 2008).
To address the scarcity of the LTC workforce, developing countries have been integrated into the global market. The governments of these developing countries have encouraged their labor force to migrate to developed countries to become LTC workers. For example, the Philippine government has heavily invested in the education and training for the export of LTC workers. Filipino nurses and nurse-aids are sent to developed countries to earn financial benefits and remittances that are sent back to the country (Ball, 2008).
However, this trend has resulted in a global care drain where the LTC workforce of the developing regions of the world is excessively siphoned by developed countries. On one hand, the export of LTC workers has benefited developing countries through economic gains but it poses long-term costs and even risks to the health of the elderly population in their home countries (Aboderin, 2012). As developing countries are further integrated into the global LTC market, younger healthcare workers are compelled to migrate to developed countries. This in turn results to the loss of scarce human resources for the developing countries who also need LTC workers to serve their rapidly expanding elderly population (Higo and Khan, 2015).
III. Summary and Conclusions
The phenomenon of global population aging represents the monumental success of society to improve the longevity of human life. Along with this trend, it is equally important to shed light on the discourse of elderly health. Ensuring the well-being of the elderly allows society to efficiently allocate its resources and enhance the quality of life. Nonetheless, these changes have unequal distributions of risks and burdens particularly for developing countries (Bass, 2011; Culter et al., 2011). Hence, it is necessary to further study the different social determinants of elderly health to differentiate poor societies from affluent ones.
In the case of Developing countries, they must confront the different layers of social determinants on elderly health that range from micro, meso, and macro structures. These factors represent the intersectionality of elderly health that are usually inadequately addressed in mainstream public health approaches. Thus, further research and collaboration amongst policymakers are crucial to understanding the relationship of social factors with elderly health (Higo and Williamson, 2011). With the rise of the elderly population, humanity must ensure that every human being will live with dignity and fulfilling long lives.
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