Table Of ContentAbout this book
Accelerated population ageing is a global trend. It has long been a significant
issue for developed countries, and it is now becoming one in the developing
world. There is a tendency to depict population ageing as a threat to the future.
Rather, it should be recognised as one of the great achievements of the past
century – albeit one which also generates a range of social, economic, political
and cultural challenges. The wellbeing and quality of life of older people are
strongly conditioned by their capacity to manage opportunities and risks. Social
protection, both formal and informal, can play a key role in mediating these
processes. This book examines relationships between the wellbeing of older
people and processes of development, taking examples from a diverse range of
low-, middle- and high-income countries. A key message is the danger of
generalisation: older people are an extremely heterogeneous group, with
varying needs, capabilities and expectations.
The book is divided into three sections. The first explores the wellbeing of
older people in selected, very different development contexts – the UK, Brazil,
Ukraine and China. The second section focuses on formal social protection for
older people. It includes evaluations of pension schemes in four middle-income
countries, an assessment of Japan’s new long-term care insurance fund, and a
comparison of health care financing for pensioners in the USA and Argentina.
The third section considers informal social protection and the care economy.
This is explored with reference to intergenerational relationships in Ghana,
informal care in Mexico, the impact of HIV/AIDS on older people in
Thailand, and a wider philosophical discussion of care and social justice.
Taken together, these chapters highlight the complexity of relationships
between development and the way later life is experienced. They identify key
priorities for policymakers, and map out an urgent research agenda.
About UNRISD
The United Nations Research Institute for Social Development (UNRISD) is
an autonomous agency engaging in multidisciplinary research on the social
dimensions of contemporary problems affecting development. Its work is
guided by the conviction that, for effective development policies to be formu-
lated, an understanding of the social and political context is crucial. The
Institute attempts to provide governments, development agencies, grassroots
organisations and scholars with a better understanding of how development
policies and processes of economic, social and environmental change affect
different social groups. Working through an extensive network of national
research centres, UNRISD aims to promote original research and strengthen
research capacity in developing countries.
Current research programmes include: Civil Society and Social Movements;
Democracy, Governance and Human Rights; Identities, Conflict and Cohesion;
Social Policy and Development; and Technology, Business and Society.
A list of UNRISD’s free and priced publications can be obtained by
contacting the Reference Centre, UNRISD, Palais des Nations, 1211 Geneva
10, Switzerland; Phone: (4122) 917 3020; Fax: (4122) 917 0650; E-mail:
Living Longer
Ageing, Development
and Social Protection
edited by
Peter Lloyd-Sherlock
UNRISD
UNITED NATIONS RESEARCH INSTITUTE
FOR SOCIAL DEVELOPMENT
Zed Books
LONDON & NEW YORK
Living Longer: Ageing, Development and Social Protection
was first published in 2004 by
Zed Books Ltd, 7 Cynthia Street, London N1 9JF, UK and
Room 400, 175 Fifth Avenue, New York, NY 10010, USA
www.zedbooks.co.uk
On behalf of the United Nations Research Institute for Social Development
(UNRISD), Palais des Nations, 1211 Geneva 10, Switzerland
Copyright © United Nations Research Institute for Social Development, 2004
Cover designed by Andrew Corbett
1
Set in 10 ⁄2/12 pt Bembo
by Long House, Cumbria, UK
Printed and bound in Malta
by Gutenberg Ltd
Distributed exclusively in the USA by Palgrave Macmillan, a division of
St Martin’s Press, LLC, 175 Fifth Avenue, New York, NY 10010
All rights reserved
A catalogue record for this book
is available from the British Library
US Cataloging-in-Publication Data
is available from the Library of Congress
ISBN 1 84277 356 9 Hb
1 84277 357 7 Pb
ACKNOWLEDGEMENTS
This book was largely derived from an UNRISD workshop on Ageing,
Development and Social Protection held in Madrid in April 2002 as part of the
Second World Assembly on Ageing. UNRISD provided full financial and
organisational support for this event. The editor would like to extend his appre-
ciation to the chapter contributors who always responded positively to the
numerous rounds of revision that were requested. In particular, he would like
to thank Caroline Danloy and Shahra Razavi of UNRISD for their support and
encouragement throughout this project.
CONTENTS
List of Acronyms x
Preface xi
1 Ageing, Development and Social Protection:
Generalisations, Myths and Stereotypes
PETER LLOYD-SHERLOCK 1
PART I Development Trajectories, Social Change and
Wellbeing in Later Life
Introduction 19
2 Long-term Historical Changes in the Status of Elders:
the United Kingdom as an Exemplar of Advanced
Industrial Economies
PAUL JOHNSON 22
3 Social Policy and the Wellbeing of Older People
at a Time of Economic Slowdown: the Case of Brazil
ANA AMÉLIA CAMARANO 44
4 The Impact of Transition on Older People in Ukraine:
Looking to the Future with Hope
VLADISLAV V. BEZRUKOV AND NATALIA A. FOIGT 71
5 Potential Consequences of Population Ageing
for Social Development in China
DU PENG AND DAVID R. PHILL IPS 97
PART II Formal Social Protection and Older People
Introduction 117
6 Comparing Pension Schemes in Chile, Singapore,
Brazil and South Africa
ARMANDO BARRIENTOS 122
7 Ageing in Japan: An Issue of Social Contract
in Welfare Transfer or Generational Conflict?
TETSUO OGAWA 141
8 Health Policy and Older People in Africa
DI MCINTYRE 160
9 Social Health Insurance for Older People:
A Comparison of Argentina and the United States
NÉLIDA REDONDO 184
PART III Older People and the Care Economy
Introduction 205
10 Intergenerational Family Support and Old Age
Economic Security in Ghana
ISABELLA ABODERIN 210
11 Ageing in Mexico:
Families, Informal Care and Reciprocity
CRISTINA GOMES DA CONCEIÇÃO AND
VERONICA MONTES DE OCA ZAVALA 230
12 AIDS and Older Persons: The View from Thailand
JOHN KNODEL AND CHANPEN SAENGTIENCHAI 249
13 Care, Dependency, and Social Justice: A Challenge to
Conventional Ideas of the Social Contract
MARTHA C. NUSSBAUM 275
Notes on Contributors 300
Index 304
Tables
1.1 Population ageing and per capita wealth for selected countries 3
1.2 Population ageing in more and less developed regions 3
1.3 Subnational variations of population ageing
(population aged 65 or over), circa 1991 4
2.1 Main components of UK pensioner incomes (%) 29
2.2 State pension payments in the UK, 1910–1993 32
2.3 The cost of public pensions as % of GDP in selected OECD
countries in 2000 and 2050 (projected) 39
3.1 Some economic characteristics of Brazilian regions 45
3.2 Brazilian demographic trends, 1995–2000 47
3.3 Some characteristics of Brazilians aged 60+ 49
3.4 Self-reported health problems of people aged 60+, 1998 (%) 51
3.5 Average income of people aged 60+, by source 54
3.6 Some characteristics of the Brazilian cohort aged 40–59 in 1981 56
3.7 Some characteristics of the 60+ population by region
and rural/urban location, Brazil 58
3.8 Adult children living in families headed by people 60+, by sex
of head, Brazil (%) 64
3.9 Other relatives under 14 years living in families headed by
people 60+, by sex of head, Brazil (%) 64
3.10 Poverty prevalence data, 1981 and 2001, Brazil (%) 65
4.1 Economic performance in the European NIS 72
4.2 Population age structure and potential support ratio by
generation in Ukraine, 1989 and 1998 75
4.3 Income structure for families with different average
per capita household income, Ukraine, 1992–98 (%) 80
4.4 Older people who report limitations in buying basic
consumption goods and in using services as a consequence
of falling incomes, Ukraine 82
5.1 Age composition of China’s population 97
5.2 Projected population ageing in China (thousands) 98
5.3 Regional differences in China (1997) – the Human
Development Index and its components 102
5.4 Regional differences in the percentages of persons
aged 65+, China 2000 103
6.1 Main features of pension schemes in Chile, Singapore, Brazil
and South Africa 128
6.2 Some indicators of older people’s livelihoods 132
6.3 Pension scheme coverage 135
7.1 State expenditure on pensions, health care for older people
and elder care in Japan, compared with total social security
expenditure 149
7.2 The development of the LTCIS and the situation of older
people in Japan (1999–2001) 150
7.3 Estimates of the needs of older people and service users under
the new LTCIS social care system in Japan 155
8.1 Reported illness by age group (% reporting illness in
preceding two weeks in South Africa and in preceding four
weeks in Côte d’Ivoire and Tanzania) 164
9.1 Persons over 65 years of age as a percentage of total
population: Argentina and United States, 1960–2000 185
9.2 INSSJP accrued revenue, by source, 2000 and 2001 ($Arg millions) 194
9.3 Accrued expenditures on services and inputs, by type of service,
INSSJP, Argentina, 2000 and 2001 ($Arg millions) 195
9.4 Expenditure on health services and inputs, by type of service
MEDICARE, USA, 2000 196
10.1 Demographic trends: projected population ageing in Ghana 212
11.1 Demographic trends in Mexico, 1950–2025 231
11.2 Percentages of household types, by age, gender and marital status
of the head of household, Mexico 1994 234
11.3 Distribution of support from older people to relatives,
Mexico City, 1999 239
12.1 Potential pathways through which the AIDS epidemic may
adversely impact the wellbeing of AIDS parents, and their
possible specific consequences 251
12.2 Parental care givers and instrumental helpers, by gender, Thailand 258
12.3 Parental care-giving duration, by return migration status of adult
child who died of AIDS, Thailand 258
12.4 Percentage of parents performing specific tasks of care giving
and instrumental help among parents who gave either type of
assistance to their adult child with AIDS in Thailand 260
12.5 Health problems experienced during care-giving by parents who
gave care to an adult child with AIDS in Thailand 261
12.6 Percentage distribution of self-reported change in health over
the previous three years in Thailand: a comparison between
parents who lost a child to AIDS and parents who did not 262
12.7 Percentage of AIDS parents in Thailand involved in the care
and living arrangements of AIDS orphans 263
12.8 Potential influences on economic impact on AIDS parents
in Thailand, by care-giving and economic status 265
12.9 Community reaction in Thailand to AIDS parents during the
illness and after the death of their adult child, by
care-giving status (%) 268
Figures
2.1 Labour force participation rates of males aged 60–64 in some
European countries 38
3.1 Map of Brazilian regions 45
3.2 Proportion of people aged 60+ with difficulties in daily
functioning, Brazil 51
3.3 Proportion of people aged 60+ living in poverty in Brazil 53
3.4 Proportion of people aged 60+ classified as ‘other relatives’ in Brazil 55
3.5 Some characteristics of the Brazilian cohort aged 40–59 in 1981 56
3.6 Social security benefits paid to older people, Brazil (millions) 59
3.7 Number of social assistance benefits paid to older people, Brazil 61
3.8 Contribution of people aged 60+ to family budgets in Brazil, 2001 63
3.9 Average monthly value of Brazilian social security benefits,
2000 (US$) 66
4.1 Estimated earned incomes (PPP US$) in the European
NISs by gender, 1999 73
4.2 The proportions of population aged 65+ and birth rates
in the European NISs, 1980–98 74
4.3 Annual changes in mortality rates at age 0–64 and 65+
in Ukraine, 1990–98 76
4.4 Age structure of deaths from AIDS in Ukraine by gender, 1987–99 77
4.5 The deviation from recommended norms of actual daily food
intake among older, non-working dependent persons, Ukraine 82
4.6 Economic activity of older people in the European NISs, 1970–99 83
4.7 Social status of persons who have lost hope of finding
jobs in Ukraine, 1995 84
4.8 Male and female mortality at age 60+ due to socially
determined causes of death in Ukraine in 1989 and in 1999 86
4.9 Potentially lost years of life from birth until age 65, by major
causes of death in Ukraine in 1990 and in 1996, and by gender 87
4.10 The structure of older (60+) workers’ employment,
by gender and branches of the economy, Ukraine 88
4.11 An evaluation of provision by the older generation
of material and functional assistance to young families, Ukraine 91
II.1 The state-centred model of social protection 120
II.2 The neoliberal model of social protection 120
II.3 The quasi-market model of social protection 121
6.1 The golden age 125
6.2 The ‘age of insecurity’ 125
7.1 Outline of the Long-Term Care Insurance System in Japan 146
7.2 Overview of measures for the Gold Plan 21, Japan 148
7.3 Diversification of service providers in elder care services in Japan 152
8.1 Change in utilisation of public sector primary care services
in KwaZulu–Natal, after user fees were removed 168
9.1 Population covered by INSSJP in Argentina and MEDICARE in
the US as a percentage of the total over-65 population in those
countries in 2000 192
9.2 Persons under 65 year of age as a percentage of all INSSJP clients
in 2001 and all MEDICARE users in 1999 193
12.1 Living and care-giving arrangements at terminal stage of illness
for adults who died of AIDS in Thailand 256
12.2 Mean combined care and net funeral costs to AIDS parents, and
percentage for whom costs were a serious burden 267
