Understanding quality of life and well-being of older people - Case studies of China, India, Pakistan and Bangladesh

Lead Research Organisation: University of Southampton
Department Name: School of Social Sciences


Policy responses to challenges linked with rapid population ageing, especially in middle and low income countries, require a clear understanding of the factors that influence the well-being and quality of life of older people. Comparative analysis of secondary data has the potential to highlight outcomes of good policy practices and illuminate what policy reforms and data improvements are essential for this purpose.
The study proposed will undertake secondary data analysis of older people living in China, India, Pakistan and Bangladesh. The choice of these countries is driven by the fact that the speed of ageing in these countries will be considerably fast: the proportion of the population aged 60 and over will be more than double by 2050. Also, these countries represent different policy regimes and, given past legacies, there is strong potential for mutual learning in policy making to address the issues of ageing and the aged.

The research will build upon the work undertaken by the PI and HelpAge International in constructing the Global AgeWatch Index 2013, and will make a unique contribution that will achieve not just the promotion of scientific comparative research on issues of ageing and older people, but also (through joint production of knowledge) it will achieve high levels of policy and practitioners impact, through engagement of experts and stakeholders and through web and media dissemination at various stages of the research.

The Global AgeWatch Index in its current form captures only the national levels of well-being of older people with data that is available in international databases. The project will shed further light on differentials within these countries, and what additional indicators can be computed from the national datasets providing further insights about the measurement of concepts of capabilities and vulnerabilities of older people. Through disaggregation of these indicators using the six most pertinent demographic and socio-economic attributes (age, gender, educational attainment, living arrangements, and regions such as rural/urban distinction), the study will highlight which of these attributes are particularly important for specific aspects of the quality of life and well-being of older people. By analysing key features of different policies operating in these countries, particularly with respect to social protection, health, social care and the enabling environments, the analysis will show how different policy settings can be linked to differential outcomes pointing to good policy practices that can be emphasised for the consideration of these four and other countries.

The above analyses of secondary data will be undertaken jointly with HelpAge International, which has substantive experience of engagement with the national governments for research and programming (see, for instance, Khondker et al. 2013; Erb 2011; Vilela 2013). National stakeholder consultations as well as presentation of the results in international conferences will deliver the key findings to academic and non-academic beneficiaries, to national and international stakeholders, and to researchers as well as statistical communities. The dissemination of key findings from this study will also help experts and stakeholders in other regions to guide their discussion with governments regarding policies on ageing; data collection and improvements; cooperation among national and international institutions to collate and share existing data; and how the evidence generated can be used effectively for policy implementation.

The future development of the GAWI and its wider use, arising from the project, will also shed a light on dimensions of growing concern to policy makers engaged in the post 2015 sustainable development framework, such as inequalities, eliminating persistent poverty, achieving universal health coverage and extending social protection through the social protection floor.

Planned Impact

Who will benefit from this research?
By comparing micro data from four countries with high numbers of older people and with varying policy regimes, the project will highlight gaps and best practices in areas of academic research, as well as for policies on ageing and in data collection activities. A strategic programme of dissemination and impact will involve four layers of impact:

- Members of the advisory group: The study will be supported by an international advisory group, which will include at least one expert representative from each country; already, we have made contacts with the following experts in the four countries: Prof. Du Peng, Institute of Gerontology, Renim University, Beijing, China; Mathew Cherian Chief Executive, HelpAge India, Delhi; Ajeeba Aslam, Country Director HelpAge International, Pakistan; Mr Abid Ghafoor Chaudhry, PMAS-Arid Agriculture University, Rawalpindi, Pakistan; Ms Nirjharinee Hasan, Country Director, HelpAge International, Bangladesh.

- Policy makers at the national/sub-national level, by engaging with national academic, civil society and policy making stakeholders, at the national and sub-national level in the four countries in question - i.e. such as the China National Committee on Ageing, HelpAge in India, and HelpAge Affiliates and partners in Pakistan and Bangladesh. Likewise, the project team will also engage with key government departments such as the Chinese Ministry of Human Resources and Social Security, the Indian Ministry of Statistics & Programme Implementation, and the Federal Planning Commission in Pakistan and Bangladesh.

- Statistical communities, who are involved in the data collection and analysis, i.e. by engaging with national statistical institutes (such as the Chinese National Bureau of Statistics; Indian Central Statistical Organisation; Pakistan Bureau of Statistics and Bangladesh Bureau of Statistics), and

- International organisations, with particular interest in issues of ageing and (human) development (such as World Bank, UNFPA, WHO, UN-DESA, UNDP), and in the four countries in question, by engaging particularly with the regional/local offices of the international organisations.

How will they benefit from this research?
An advisory group will be formed, to function along the lines of the expert group that advised at various stages of the Global AgeWatch Index project. The advisory group will include representatives of national policy making bodies and statistical communities and national and international civil society. Consultations will be undertaken, during various stages of the proposed ESRC research so as take on-board the advice of these experts in maximizing the impact of the research.

A meeting with stakeholders will be organised around the end of the project (in the capital city of one of the four countries), so as to convey key findings of the research and policy analysis undertaken by the project; this meeting will also ensure that the findings will be used for the maximum benefits of welfare of older people in all four countries. The web portal, to be developed by HelpAge, will further ensure that the findings of the project are available also for all other countries included in the framework of the Global AgeWatch Index. In addition, the findings will be disseminated through a package of materials (such as PowerPoint, Question and Answer documents) to practitioners in 103 countries where HelpAge is active.

The most tangible global impact will be realised through the development of future editions of the GAWI. The refinements in the conceptual and measurement framework, that will become possible through in-depth micro-data study of China, India, Pakistan and Bangladesh, will be realised in the future editions of the GAWI for countries around the world, to make it a more credible source of comparative information on issues of ageing and older people.


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Zaidi A (2017) The Policy Discourse of Active Ageing: Some Reflections in Journal of Population Ageing

Description Embracing the positive aspects of longevity and to portray older persons as a resource to the society, they need to be supported to fulfil their fullest potential, among others through active participations consistent with their abilities and aspirations. One of the first papers produced focusses on older people's economic, political and social participation in two of the most populous countries of the world: India and China. The approach adopted uses the advanced statistical modelling methods to create a composite measure of various components of social engagements and then analysed the socio-economic factors influencing the composite social engagement and its components in the two countries.

Healthy ageing is defined by WHO as the "process of developing and maintaining the functional ability that enables wellbeing in older age." (WHO, 2015). Previously, at the occasion of the 2nd World Assembly on Ageing in Madrid 2002, the Madrid International Plan of Action on Ageing (MIPAA) and its Political Declaration by the 159 governments adopted "Advancing health and wellbeing into old age" as one of its three priority directions. In economic terms, investment in promoting healthy ageing contributes to not just the labour supply for workers, but also in increasing the productivity of older people in their work places and in their social roles. It is therefore emphasised that healthy ageing is vital for the social and economic development of countries around the world. The paper on comparison of healthy ageing across India and China outline what different factors contribute to healthy ageing of older population in the two countries. Can they learn something from it?

The experience of preparing and publishing three editions of the Global AgeWatch Index has exposed significant gaps in internationally comparable data on ageing
and older people. The analysis funded in this project has shown that the journey towards fulfilling the objective of making high quality data indispensable to policy making for ageing
societies will be long and arduous. A particular concern is that the complexities of old age are rarely adequately captured by data sets. Issues of health, income and personal security in older age are complicated by the impact of factors such as gender and ethnicity. The complex interactions of these dimensions of identity in old age cannot be reflected in single aggregate indicators. However, when disaggregated and analysed in greater depth, as has been done in this project, the data now being collected has the potential to shed new light on our understanding of ageing in different jurisdictions.
around the world, and the policies needed to support this growing sector of the
Exploitation Route These findings help the policy making communities in the two countries in identifying the importance of social engagement and healthy ageing of older people in improving their wellbeing. The comparative picture of China and India implies that the two countries can learn from policy experiences with respect to reducing the risk of loneliness in old age.
The data report highlights what gaps need to be filled to meet the demands of evidence-informed policymaking in these countries.
Sectors Healthcare,Leisure Activities, including Sports, Recreation and Tourism,Government, Democracy and Justice

Description Key findings of the research were presented to key stakeholders in Pakistan and in China, during August 2016 (Islamabad) and in December 2016 (Beijing). In both countries, the target audience were specifically high-level policy officials and other key stakeholders (such as the British Council, DFID, UNFPA, HelpAge International and other domestic NGOs). In Pakistan, the event was organised jointly in association with the National Council of the Elderly and HelpAge International, and in China with the Renmin University and UNFPA-Beijing. A large key stakeholder event was organised in Hanoi, where key stakeholders from India and Bangladesh. The impact generated at this stage can be categorised cultural affecting the beliefs of a society about the quality of life and well-being of the older population. For example, in Pakistan, the results provided a great sense of negligence of the issues of older people in public policymaking, particularly by the ministry of Human Rights but also by Planning Commission. The absence of appropriate data was one of the standout findings, especially in comparing the situation with India. It is too early to link any policy changes with our research.
First Year Of Impact 2016
Sector Healthcare,Government, Democracy and Justice
Impact Types Cultural,Societal

Description Dementia in Low and Middle Income countries
Amount £99,978 (GBP)
Organisation Help Age International 
Sector Charity/Non Profit
Country United Kingdom
Start 03/2017 
End 02/2018
Description Work with JC Institute of Ageing 
Organisation Chinese University of Hong Kong
Country Hong Kong 
Sector Academic/University 
PI Contribution - To help the researchers understand better the work underway in this project to improve the Global AgeWatch Index. - To help JC Institute of Ageing to construct Global AgeWatch Index for Hong Kong
Collaborator Contribution They estimated several indicators on the well-being of older people in Hong Kong. These allowed us to appreciate how the national level analysis for China suffer from aggregation bias.
Impact http://www.cpr.cuhk.edu.hk/en/press_detail.php?1=1&1=1&id=2356&t=cuhk-jockey-club-institute-of-ageing-ranks-hong-kong-as-19th-in-the-world-in-terms-of-elderly-well-being-in-2015&s=
Start Year 2016
Description Aiming high: achieving the Global Goals to end poverty, inequality and climate change 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact It provided an explanation of the post-2015 Global Sustainable Development Goals in simple language and with a reference to older people.
Year(s) Of Engagement Activity 2015
URL http://www.helpage.org/global-agewatch/blogs/asghar-zaidi-20076/aiming-high-achieving-the-global-goa...
Description Professional Development Reading Pack: Ageing and Development 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Reading packs are commissioned by the UK Government's Department for International Development (DFID) for independent study and professional development use. They are intended to be thought-provoking introductions to emerging issues and debates within the subject areas they cover. The views expressed are those of the author, and do not necessarily reflect the opinions of GSDRC, its partner agencies or DFID.

This reading pack was requested to me for my lead in the ESRC-SDAI project and it addressed the specific issue of ageing and development.
Year(s) Of Engagement Activity 2015
URL http://www.gsdrc.org/professional-dev/ageing-and-development/
Description Sustainable Development Goals have put ageing back onto the agenda 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact It is a contribution to the blog series of Global AgeWatch Index. It is a widely read blog series accessed by a wide variety of audience.
Year(s) Of Engagement Activity 2016
URL http://www.helpage.org/global-agewatch/blogs/member/asghar-zaidi-20076/