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

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.

This impact summary is intended to be read in conjunction with the detailed impact plan. Here we summarise the main audiences for the research and the nature of impacts to be achieved.

1. Intergovernmental policymaker engagement. Key divisions of the World Health Organisation (WHO) will be directly involved throughout the research process, from preliminary analysis to final dissemination. As well as influencing WHO, this will enhance our engagement with national health ministries and other organisations, as part of WHO's own dissemination and influencing networks. Members of other key organisations, including the World Bank and ILO, will participate in the advisory group.

2. Engagement with national policymakers and other key stakeholders in the SAGE countries and elsewhere. Engagement with national key informants is a key element of the research design. Key informants will be kept informed about the project and will be invited to participate in national dissemination meetings.

3. NGOs and civil society organisations, both nationally and internationally. HelpAge International will be involved throughout the research process and have agreed to support the dissemination activities, both through their international office and through their 70 affiliates in 50 countries.

4. The study will identify particular aspects of findings of potential interest to the general public and will develop specific strategies to communicate these, using press releases, blogs and media engagement.

5. The research will be of specific interest to DFID's interests in social protection, life course and non-communicable disease. PLS is currently seconded (40%) to DFID to support its research strategy in these areas.