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Health Barriers Faced by the Elderly in JamaicaIn line with the global aging population trend, Jamaica has seen a rapid increase in its elderly population. This increase is now calling for continued action to address the health barriers faced by the elderly in Jamaica.

An Aging Population

In 1995, Jamaica reported having 110,430 males and 130,020 females in the 60 years and older group. This represented 9.42% of the total population in the country. By 2001, Jamaica’s elderly population consisted of 122,844 males and 141,869 females. A decade later in 2011, the census reported that the number of individuals who were 60 years or older had risen to 145,204 males and 159,979 females. These numbers indicated a 15.2% increase in the total number of people who were 60 years or older from 2001 to 2011.

Additionally, by 2011, those in this age group accounted for a greater share of the dependency ratio, a ratio measuring the number of young (0-15 years) and old (60 years or older) people in a population compared with that of the working population.

The World Health Organization has stated that this older population is mostly affected by chronic non-communicable diseases, such as cardiovascular diseases, diabetes, arthritis, hypertension and cancers. In 2018, Jamaica reported that 72% of elderly people had at least one chronic illness, with hypertension and diabetes being the most common. This contributes to the high percentage of people taking medication as well. Furthermore, persons over 60 years of age were much more likely to experience protracted illnesses in comparison to the rest of the population.

Healthcare Barriers

With recent progress in Jamaica’s life expectancy, the elderly are living longer. According to the World Health Organization, in 2018, the life expectancy for Jamaicans was 76.2 years. It is expected that these individuals will require more long-term care and rehabilitation services as they become increasingly vulnerable to diseases and lose physical or mental capacities.

However, there is limited access to local long-term care services in Jamaica and the number of caregivers has decreased throughout the country. Traditionally, younger Jamaicans would stay home and help care for older family members, but with the recent fall in family size resulting from a drastic drop in the fertility rate, the number of family members available to care for these individuals has significantly declined. The issue is worsened by the increasing number of young Jamaicans migrating abroad, typically to the United States, and leaving their older family members behind who frequently encounter difficulties in accessing rehabilitation services independently.

Financial Barriers to Healthcare

Many older Jamaicans also face financial barriers in accessing much needed medical treatment and services. While Jamaica has established a wide and extensive network of public primary care centers and hospitals offering free or low-cost services, the cost of medications and other health care resources has risen as most of these products are imported and the nation’s currency has undergone severe devaluation.

These financial burdens are especially felt by the country’s older population who rely on pensions to cover their living and health expenses. The Old Age Pension provided to qualifying retired Jamaicans is usually insufficient to cover the additional health costs associated with old age as the pensions do not adjust to meet the yearly changes in the cost of living.

Lack of Access to Healthcare in Rural Areas

Additionally, older Jamaicans living in rural areas experience significantly higher barriers to health as there is a lack of overall access to medical care, health and treatment services and transportation. A study conducted in 2012 found that people living in rural areas tend to have more “uncontrolled and undiagnosed disease,” evidenced by the fact that 27.5% of those surveyed who were diagnosed with high blood pressure had not previously received a diagnosis from a doctor. Furthermore, among those who had received a prior diagnosis, 72.2% had signs of the disease as being poorly controlled.

Also, health barriers are intensified by the fact that only 30% of the elderly population living in rural areas are pension recipients as compared to 44.4% in the Kingston Metropolitan Area. The elderly in rural areas also report having greater issues with food availability and adequacy as 53% stated not having easy access to the food they need.

Researchers Eldemire-Shearer, K Mitchell-Fearon and DL Holder-Nevins stated in 2014 that these difficulties in accessing treatment and food emphasize the health challenges that older Jamaicans face as the current health system is primarily engaged in reducing chronic disease and maintaining functional ability. They say a different approach is needed to better meet the new demands of older Jamaicans who suffer from prolonged mental or physical conditions.

Addressing Barriers

In 2018, the Jamaican government revised the National Policy for Senior Citizens, created in 1997, to introduce new measures for supporting and improving the quality of life for the elderly. The plan outlines a multi-stakeholder approach designed to address social, economic and health barriers faced by this fast-growing population.

The document promotes universal access to quality health care for all senior citizens and acknowledges the varying medical needs within this age group. It also calls for a greater expansion of health insurance coverage since only 23% of elderly people are insured.

Furthermore, the plan outlines steps for improving income security for all senior citizens and tasks the government with providing food assistance when necessary. It also provides detailed initiatives for expanding access to health resources, including mental health services, home and respite care, physiotherapy and other rehabilitation services. All these health resources for the elderly are to be carried out under the supervision of the National Council for Senior Citizens, which monitors and evaluates the progress of senior citizen programs at both the national and regional levels.

While the existing health care system will require the full implementation of all these measures in the coming years to combat the health barriers faced by the elderly in Jamaica, this policy plan offers a comprehensive guide to start addressing some of these challenges.

– Emely Recinos
Photo: Flickr

Elder Poverty in JapanWith a robust elderly population that only continues to grow, Japan faces an unconventional problem concerning its impoverished elder populations. Food security and homelessness have resurfaced as an increasing number of Japan’s older residents find themselves strapped for money and without access to basic needs. The number of those reliant on public assistance had been steadily decreasing since the mid-90s; however, recent socio-economic issues like COVID-19 have increased elderly poverty in Japan.

Home to an elderly population of 18.1%, Japan boasts one of the highest life expectancies in the world, at 81 and 87 years for men and women respectively. According to the Organisation for Economic Cooperation and Development (OECD), Japan is expected to maintain and grow this high life expectancy. Since 2008, when Japan’s population peaked, it’s gradually been decreasing and aging as the number of elderly increases and the rate of births slow. Those older than 65 comprise 28.4% of the population—a number that’s projected to reach 35.3% by 2040.

Japan’s Welfare System

Japan’s public pension system ensures at least all citizens are covered to a certain standard, and as such, has improved securing basic daily needs for their elderly population. After a 1994 bill passed to reform public pensions in Japan, the amount of the population on public assistance rose from 1.6% in 1995 to 2.9% in 2015. While some attribute a slowing economy to this, nuances of poverty that can’t be fixed by the income security Japan’s public pension program provides seems to be prevalent among the elderly.

One such issue that can’t be addressed by the pension system, is the amount of elderly in Japan that live alone—a number that’s much higher in Japan than in other countries.

Poverty and Dependence

Elderly poverty is particularly a concern among adults older than 75 years old with severe income disparities observable starting at the age of 65 years, and many of them live alone.

At this age, many are retiring or unable to work, while some who may have been married to the provider in the family find themselves without an income when the provider passes. While it used to be custom for the elderly to move in with their children, who could care for their aging parents, the slowing rate of births means that an increasing number of the aging population do not have kids who can take care of them, and even those who do might be reluctant, not wanting to impose on the life their children have made for themselves.

A study conducted on the living conditions of Japan’s elderly population showed several factors associated closely with mortality, including no air conditioning, no refrigerator and the cut-off of several essential services due to costliness. Out of the 7614 participants in the study, 12% struggled with one of these factors while 3.3% struggled with at least two.

The elderly are one of the more vulnerable populations that fall under the poverty umbrella as they’re more likely to have health conditions and income disparities. Moreover, the poor and elderly who get sick or injured don’t have any means of being helped; not only is there no one to attend to them and make sure they get access to the healthcare they need, but those who can’t afford to meet their daily needs—which makes them more susceptible to illness and injury—will also struggle to pay for healthcare. A deficiency in being able to maintain their lifestyle resulted in 27,000 early deaths among elderly Japanese every year.

Women and Elder Poverty

A study of Japan’s pension anticipates that 25% of elderly women in Japan will be living below the poverty line, with this rate rising to 50% in never-married and divorced women. Additionally, 10% of elderly men are predicted to live below the poverty line.

The government designed the original pension system under the assumption that many women quit their jobs to take care of their children after marrying, and as such, the pension takes care to cater to women. However, divorce and never-married populations have become more prevalent since, leaving women who are not married to receive only a small portion of what a married woman would receive, which isn’t enough to maintain a sustainable living standard. Currently, the poverty rate of women over the age of 65, is 22%.

Long-term Care Insurance

Introduced to the public in 2000, this brand of socialized medical care deploys mandatory health coverage to everyone in Japan older than 65, according to their mental and physical health needs.

Due to the mandatory nature of this coverage, its flexibility and accessibility are its key components, with the coverage extending to a variety of types of healthcare according to an individual’s needs in both the public and private sectors. Long-term Care Insurance also tries to focus on cultivating community support, attributing to the ease of isolation many of the elderly find themselves in, to alleviate premature deaths.

While elderly poverty in Japan is expected to increase due to the country’s rising life expectancy rate and declining birth rate, the government is taking steps to ensure elderly poverty is addressed, such as implementing the public pension plan and the Long-term Care Insurance.

Catherine Lin
Photo: Flickr

The Growing Concern of Elderly Poverty in FranceSince the early 1970s, the mean standard of living for senior citizens above 65 years old in France has significantly improved. Complying with the guidelines that the second U.N. World Assembly on Aging (WAA) in 2002 and the Madrid International Plan of Action on Aging (MIPAA) brought up, France keeps implementing aging policies that focus on the health and well-being of elderly people, their participation and benefits in the social development and a more enabling and supportive environment. However, elderly poverty in France remains a socioeconomic issue. As of 2012, 17.5% of French people are over 65 years old, whereas working-age people between 15 and 64 take up 63.8% of the total population. A 2019 study reported that around one out of 10 elderly people in France lives in poverty, which is to say, there are now more than one million French people of old age living below the poverty threshold.

Wealthier than the Younger Population

Although elderly poverty in France is a significant issue, senior French citizens are not the most susceptible group to poverty. The elderly population is far behind young adults, females and immigrants in terms of one’s risk of poverty. The French National Institute of Statistics and Economic Studies (INSEE) reported that in 2015, elderly people over 65 years old are not only half as likely to fall into the lowest-earning 10% as their counterparts between the ages of 25 and 64, but their proportion among the lowest-earning 20% also decreases in the 21st century.

Such situations are the comprehensive outcome of more continuous career and higher wages, higher retirement pensions, mandatory supplementary schemes and so on. They also have more time and opportunity for inheritance and savings, and their forms of resources are less sensitive to economic fluctuations. As such, it is not too hard to understand why the mean standard of living for elderly people is 3% higher than that for the younger generations in France.

Health Status

Yet despite accumulated wealth, health status deteriorates remarkably with age, which may cause extra expenses that Social Security does not cover and lead to elderly poverty in France. In 2015, 43% of French people over 65 years old endured at least one long-term illness, and the percentage keeps rising over the years.

When the deterioration in health causes a partial loss of autonomy and home care is no longer suitable, the elderly people have to live in an institutional setting such as a nursing home, and this would be another large expense that many are not able or not willing to afford. Only fewer than 2% of people aged below 75 live in a nursing institution, and for those over 85 years old, the number climbs to ten times higher.

The Incoming Challenge of Population Aging

As the problem of population aging is becoming increasingly serious in Europe, it is too early for the elderly to be too optimistic. In 2012, there were 15 million French people aged over 60 years old, and this number is expected to reach 24 million in 50 years, alongside the extended life expectancy. Over the last decade, more people went into retirement, and there were 5% of elderly people aged between 65 and 74 still in employment, many of whom were part-time employees with low qualifications, shopkeepers and older farmers.

The French government has to adjust the retirement pension and health care policies to ensure the well-being of old age. So far various actions are underway, but the results are far from satisfying. For instance, a large national strike began in December 2019 to protest against President Macron’s pension system reform. The government must take into consideration the growing elderly poverty in France and actively work to alleviate poverty rates with policies and financial support.

Jingyan Zhang
Photo: Flickr

Elderly Care in Bosnia and Herzegovina
Bosnia and Herzegovina has been slowly recovering from the conflict that took place in the country during the late 1990s. The war took a toll on the country economically, politically, socially and physically. On top of its high levels of poverty, the country is also becoming a victim of the aging population epidemic and elderly care in Bosnia and Herzegovina is a huge concern. The country is facing issues of a dip in fertility rate and an increase in the rate of the elderly people, leaving a large number of older population with a small population of working-age people to support them. This issue coming from the uneven age distribution grew due to a fall in birth rates, a decrease in population from deaths during the war years and an increase in life expectancy.

The Increase of Elderly Population

Currently, people over the age of 65 make up 17 percent of the total population. Moreover, the United Nations Department of Economic and Social Affairs estimated that the number of persons aged 65 and more than 65 will reach 30 percent of the population in 2060, comparative with the 15 percent it sat at in 2010. With a population of only 3.5 million, this is a daunting number.

The older population in Bosnia and Herzegovina is extremely vulnerable for many reasons. Some of the issues they face include low income and increased living expenses. Obtaining employment is difficult as well. Due to the high unemployment rate the country faces, many employers prefer younger workers. This means that many of the elderly face poverty and have been unemployed since before retirement age, leaving them with subsequently less to provide for themselves as they age.

The situation for elderly women is worse than it is for men, as women lose rights with the loss of a husband. They also face higher rates of poverty as they are usually unable to economically provide for themselves alone. The elderly are ailed by illnesses such as cardiovascular and malignant diseases, neurological and mental disorders like Alzheimer’s, as well as sensory and physical disabilities. Many of these diseases and the lack of care for them result in a higher rate of depression amongst the elderly.

The Exodus of Medical Workers

On top of all this, Bosnia and Herzegovina is facing an exodus of its medical workers. Many young doctors and medical professionals are leaving the country after their schooling is complete and migrating toward Germany and other Western countries because these countries offer better job opportunities and more competitive salaries. More than 10,000 nurses, doctors, caregivers have gone to Germany alone. Only about 6,000 doctors work in Bosnia, meaning for every six doctors, one works in Germany. Not only is this leading to a lack of medical professionals, but the country is also losing money as they put millions into medical training facilities that students use and then leave behind as they migrate their services.

Bosnia is being forced to send patients abroad for care, so in the last two years, the country has spent around $37 million on patients that were sent outwards. Not only is this epidemic draining the country’s money, leaving it with less available funding to put towards elderly care in Bosnia and Herzegovina, it also means there are not enough doctors to perform geriatric care. It’s a negative feedback loop that hinders the country’s ability to care for its citizens, especially the elderly ones.

The Solutions for the Problems

The growing number of the elderly population in combination with the exodus of medical workers leaves the country with many people suffering and few resources to help them. Thankfully though, Bosnia and Herzegovina has not turned a blind eye towards these issues and instead has begun to search for solutions. Members of the United Nations adopted the Madrid International Plan of Action on Ageing that aims to address the issues of aging in the 21st century. The plan focuses on three main aspects: older persons and development, advancing health and well-being into old age and ensuring enabling and supportive environments.

With support from the United Nations Population Fund, United Nations Department for Economic and Social Affairs and the Swiss Cooperation in Bosnia and Herzegovina, the country has developed its own strategies, inspired by the structure of the Madrid International Plan of Action on Ageing. It plans to improve social and health protections, promote activism and volunteerism in local communities, as well as inter-generational support. The country aims to improve access to public services, especially for those in rural areas and prevent violence, neglect and abuse against older persons. The execution of this initiative will require a great deal of money and resources, but the government is dedicated to the improvement of elderly care in Bosnia and Herzegovina.

This plan of action shows that the government is making this issue a focal point in national policy and beginning to address the problems that will address the aging population. Elderly care in Bosnia and Herzegovina has a long way to go before the older population is secure and comfortable. With initiative from the government to care for the elderly, social attention will be turned towards this problem that will encourage the younger generation to aid the older and make room for various organizations to provide help and resources to the country’s older population.

– Mary Spindler
Photo: Flickr