April 2004

Rural population ageing in developing countries: issues for consideration by FAO

by Libor Stloukal
Population and Development Service
FAO Gender and Population Division

Abstract

This paper discusses the implications of rural population ageing for agriculture, food security and sustainable rural development in low-income countries. It argues that agencies such as FAO must respond to the various challenges and opportunities arising from rural ageing by incorporating ageing-related matters into their activities. At the same time, more information needs to be generated about the exact nature of the linkages between population ageing and social, economic and environmental issues in concrete settings.

Introduction

Population ageing – the increase in the proportion of ‘older people’, i.e. 60 years and over, in the population – has emerged as one of the most significant and universal demographic processes of the present time. This paper demonstrates the role of rural population ageing in demographic and socio-economic change and examines its possible effects on sustainable rural development, with the aim of highlighting issues that are specifically relevant to FAO. The paper was originally prepared as background document for a one-day brainstorming workshop on rural ageing held in FAO on 12 December 2003.

Demography of population ageing

At present, population ageing is much more advanced in Europe, North America and Japan than in the less developed countries of Asia, Africa and Latin America. The temptation might be to dismiss ageing as an issue that need not be addressed until some point in the future. To do so would be a mistake.

• In the years to come, developing country populations will be undergoing unprecedented changes in their age composition (Table 1). While the proportion of the total population under 20 years will drop from its 2000 level of 43 per cent to 37 per cent in 2025, the proportion aged over 60 years will increase from 8 per cent to 14 per cent. By mid-century developing countries will probably have an age structure similar to that of today’s more developed regions.


• Populations of developing countries are still growing. However, in the coming years the overall tempo of population growth is predicted to slow down, but the growth in the over 60 age group is expected to increase (Figure 1). Thus, a period of more rapid ageing lies ahead.


• Population ageing is occurring much faster in developing countries than has been the case in Europe and North America. For example, while France took 115 years to increase the proportion of its older population from 7 to 14 per cent (WHO 2001), in many developing countries the same increase will be achieved in 20 years or less, and it will have happened by 2030 (UN 2003a).


• Developing countries are home to the majority of the world’s older people. At present, about two thirds of the global number of persons aged over 60 years live in developing regions. By 2025 this proportion is likely to increase to 71 per cent (Figure 2).


• Not only will developing countries have less time to prepare for ageing, but most will have to face the ageing-related problems at much lower levels of development than the industrialized world. Many developing countries are already struggling to provide minimum levels of education, health care and income support for the needy. Population ageing in these countries will create adjustment pressures far more insistent than those experienced in Europe or North America.

Population ageing is a consequence of the continuing demographic transition, particularly the unprecedented decline in fertility levels experienced over the past 30 years. As a result, children and youth have come to represent a smaller proportion of the total population, while older people – the survivors of large birth cohorts – account for a greater proportion. This trend has been accelerated by marked falls in mortality rates and a transformation in both the age and cause structure of deaths – the so-called epidemiological transition from infectious diseases, such as diarrhoea and pneumonia, to chronic and degenerative diseases. Although HIV/AIDS is dramatically changing demographic structures of some countries, the overwhelming majority of people living in developing regions are not infected with HIV. In fact, many more people are surviving into old age than are being infected with HIV and dying of AIDS. Population ageing, therefore, will not be halted by the HIV/AIDS pandemic. On the contrary, in high prevalence countries, HIV/AIDS will accelerate population ageing through the increased mortality of younger adults, combined with declines in fertility among HIV-positive women who die before completing their reproductive trajectories, and increased mortality of children who die because of HIV infection. Elevated levels of AIDS-associated mortality will thus produce ‘chimney-like’ population pyramids characterized by comparatively low proportions of younger adults and high proportions of older persons (Figure 3).

The shift towards an older age structure has multiple consequences for population composition. The most important effects include:

• The greatest relative increases occur in the older segments of the old-age group, in particular the old-old (70+ years). Over time, population ageing leads to increased accumulation of particularly frail people suffering from age-associated physical and mental disabilities and dependencies.
• In virtually all countries women experience lower mortality levels than men. As a result, older women outnumber older men, hence the expression ‘feminization of older life’.
• Another consequence of lower female mortality is the increasing proportion of older women who are widows living without the social and economic benefits of spousal support. Their situation can be particularly difficult if widowhood is associated with the loss of assets.
• Population ageing also causes changes in living arrangements, resulting in shifts in the household structure, particularly increases in the proportion of older people heading households or living alone.
• Because older people have usually lower incomes, population ageing increases vulnerability to poverty. As a consequence, the proportion of persons living below the poverty line can escalate, especially in the least developed countries.

The above considerations indicate that the global action on ageing needs to embrace developed as well as developing countries. However, it must be stressed that ageing in developing regions is characterized by vast regional and inter-country differences (for more information about geographic differentials, see Marcoux 2001 and Stloukal 2001) as well as variations related to factors such as socio-economic status, gender, and differences between rural and urban settings.

Rural dimension of population ageing

It is often assumed that in developing countries, ageing proceeds faster in urban areas where fertility and mortality declines are typically more advanced than in rural settings. In reality, ageing in rural communities usually manifests itself earlier and advances more rapidly than in the cities (Marcoux 1994, 2001; Skeldon 1999). By far the most important determinant is rural-to-urban migration which comprises mainly younger adults and thus increases the proportion of older persons ‘left behind’ in the villages. In some rural areas, ageing is further accelerated by factors such as the return of older persons, often upon retirement from the urban workforce, or the increased mortality among younger adults due to HIV/AIDS. Thus, in the majority of poorer countries, ageing is predominantly a rural phenomenon and it is in the villages where the consequences of ageing are most felt (Stloukal 2001).

Rural-to-urban migration has major implications for rural elderly as many are left by their adult children, often with the responsibility for grandchildren. In these circumstances the productive opportunities for older men and women may become very limited, particularly if they are left to cultivate land that is beyond their physical capacity and have no possibility to hire labour, use animal power or mechanization. Rural outmigration, combined with falling fertility rates and increasing longevity, thereby increases the strain on older rural people, which can have negative consequences for their wellbeing as well as for their participation in rural development. Nevertheless, migration does open up opportunities for those migrants who are able to find paid employment, as well as for those rural residents who receive remittances.

Agriculture and older people

Older people fulfil multiple roles within the community, as workers, subsistence farmers, land owners, household members and breadwinners. Many are resourceful survivors and contribute to the well-being of their families and communities. However, research on the linkages between ageing and development in resource-poor countries (Heslop 1999, HAI 2002) has identified that the majority of older persons living in rural areas:

• have physical disabilities resulting from years of hardship and deprivation,
• are in poor health and experience high levels of anxiety and stress,
• are amongst the poorest in the community because of their diminished capacity to earn an income,
• are not covered by any pension scheme,
• are unable to access basic services: health care, potable water, energy, proper sanitation,
• live in physically demanding environments, but continue to work, often into very old age.

Most rural elderly do not retire from the labour force in the way urban workers do. Typically, their withdrawal from economic activities is gradual and is completed only when they become physically unable to work. Studies in Africa showed that, in 1993, between 74 per cent and 91 per cent of people over 65 continued to work, most in agriculture (HAI 1999). Some elderly, usually men, are able to continue in paid jobs, especially if they can shift to work which is less physically demanding. But most are likely to be doing home-based work such as farming, housework or childcare, often making essential contribution to household survival. The fact that older people are more likely to be involved in informal and/or part-time employment means that their work is generally under-reported in official surveys.

Environmental degradation, climate change and limited agricultural technology tend to affect older farmers more than their younger, healthier and better educated counterparts. This is compounded by discrimination against older people in accessing credit, training, and other income-generating resources. Processes such as diffusion of new agricultural technologies and introduction of improved seeds and tools often bypass older farmers as many have neither the spare cash to buy additional inputs, nor the skills (i.e. literacy) and energy to invest in adopting new practices. Because of gender divisions in agricultural production – with regard to opportunities to obtain credit and training, or participate in market exchanges – older women are particularly disadvantaged. Customary property practices, and in some settings even formal legislation, add to the discrimination faced by older women. For instance, in many parts of the developing world, women’s direct access to land through purchase or inheritance is still limited (FAO 2003).

Rural population ageing inevitably leads to changes in the quantity and quality of agricultural labour force. It can be expected that in many areas the supply of agricultural labour will become increasingly tight as the relative numbers of those age-groups whose activity rates are highest will diminish due to the combined effects of migration to cities, fertility decline and, especially in African settings, increases in adult mortality rates because of HIV/AIDS. This means that there may be serious obstacles to expanding agricultural production, or even maintaining the existing production patterns, particularly if these depend on manual labour as is the case in most of Africa.

In addition to the effect on labour supply, increases in the proportion of older farmers whose physical and economic resources are often limited can have significant long-term consequences for agricultural communities, including:

• household livelihood strategies may become more subsistence-oriented,
• production options may evolve towards less labour-demanding activities, leading to reductions in cultivated area, declines in crop variety, or switches to less nutritious crops,
• intensity of measures with long gestation periods – e.g. soil and water conservation, use of fertilizers, construction and maintenance of irrigation systems, or tree planting – may decline,
• the proportion of agricultural land available for rent or sale may increase,
• saving and investment behaviour may become more conservative,
• uptake of technological innovations may diminish.

So far, little research effort has been made to systematically asses the importance of these possible effects. However, the linkages seem to be intuitively plausible, and their implications for sustainable rural development might be indeed crucial. The sketchy evidence available indicates that, if socio-economic circumstances are favourable, rural ageing can contribute to agricultural intensification – for instance by facilitating property transfers that lead to land consolidation and the creation of more economically rational holdings, as was the case in the Republic of Korea between 1980 and 1996 (Skeldon 1999).

Poverty in old age

In many developing countries, poverty is the key enemy of older people, with profound long-term impacts on their families and themselves. Many older people lack the basic requirements – food, water and shelter – and are chronically poor. Low levels of education, gender inequality and poor health are important determinants of poverty in old age. Social exclusion – the distancing of older people from their families and communities – can further separate older persons from sources of wealth. In its consequences, social exclusion can lead to outcomes that go beyond income and wealth into poor housing, malnutrition and personal insecurity (May 2003).

Poverty among the elderly differs from that of other categories of poor people for two principal reasons (Heslop and Gorman 2002):

• Old age is the late part of the human life span and as such it is associated with irreversible declines in physical capacity and adaptability to change. Consequently, relatively few old people can fully support themselves through existing earnings, and many have to depend on other sources: personal savings, family transfers, or community support. Social assistance programmes for older citizens are available in only a few developing countries – and where they exist, they are often less likely to reach rural areas.
• Traditional arrangements that guaranteed status and material well-being in old age – such as the primary role of the elderly in kinship relationships, religious life, or property transactions – are often among the first ones to be eroded by socio-economic modernization. Changes such as the establishment of labour market mechanisms or land reform serve to undermine these traditional arrangements, forcing older persons into a marginal status.

Debates about poverty in old age usually concentrate on older women – because they live longer than men and face greater disadvantages and discrimination due to widowhood, lower social status and fewer opportunities to earn an income. However, given that their contribution is typically focused on family, household and informal sector work, older women may often be able to retain their social and economic roles longer than older men. By contrast, men are often seen mainly as economic providers, and the age-associated loss of earning power can significantly worsen their social status and self-respect. Privileges associated with being the family breadwinner and successful farmer in earlier years do not automatically transfer to older men. In addition, men may face considerable difficulties in shifting their activities into family- and household-oriented functions, owing to lack of confidence or cultural barriers associated with performing ‘women’s work’. The consequences can be drastic. For instance, survey evidence from Africa shows that older men are more likely than older women to lose the support of their children and become beggars (Heslop and Gorman 2002).

Food insecurity of the elderly

Insufficient nutrition can be expected to be a frequent problem among older persons. Frail older people living alone appear most at risk from malnutrition because they may be unable to purchase, grow, or gather the food they need. Elderly living in households affected by HIV/AIDS are likely to be doubly vulnerable as the epidemic is decimating the middle generation of breadwinners, frequently reducing already poor families to extreme poverty. Even those older persons who live in well-off households may not get enough to eat, because of cultural practices or age-related abuse. During food shortages, older people are usually among the worst hit. In natural and political disasters, older people are frequently neglected and little effort is made to meet their needs for food, shelter, sanitation, health care or security (HAI 2001).

Not much empirical evidence is available about the nutritional status of older people in developing countries. For obvious demographic, epidemiological and political reasons, most research on nutrition among older people has, to date, been carried out in developed countries. The large survey databases that cover developing regions – WHO, UNICEF, DHS – tend to focus on children under five years of age and their mothers, without taking representative samples among other age groups. In addition, conventional anthropometric measurements of nutritional status are less applicable to older persons because of age-related changes in body composition.

The very few studies that do provide the required age-specific breakdown indicate that older people are often nutritionally vulnerable and frequently consume diets that are poor in both quality and quantity (Ismail 1999, FAO 2000, Dangour and Ismail 2003). Determinants of malnutrition in old age include a variety physiological, social and economic factors, ranging from lifetime exposure to diseases and poverty, to illiteracy, reduced social contact and poor functional ability (WHO 2001). Given the projected trends in ageing, the public health and socio-economic effects of this state of affairs are likely to be considerable. For instance, there is accumulating evidence that malnutrition in old age contributes to declines in immune function, morbidities such as bone fractures, and mental deterioration (Dangour and Ismail 2003). Increases in population ageing, if combined with old-age malnutrition, can thus worsen the health profile of rural communities, and hence their social and economic prospects as well.

It is important to note that the elderly can positively influence the nutritional status of co-residing relatives, particularly grandchildren. For instance, a recent study in rural Gambia demonstrated significantly improved nutritional status and survival among those children who had a living maternal grandmother (Sear et al. 2000). This indicates that interventions to improve nutrition of the elderly, and thereby their health and ability to perform household tasks, can have beneficial effects extending far beyond the original target group.

HIV/AIDS and older persons

At least for a certain period, AIDS contributes to population ageing by killing younger adults and thus increasing the proportion of elderly in the population. The implication of HIV/AIDS for older persons is that they have to:

• bear the pain of losing adult children and other relatives,
• bear the loss of breadwinners, and thus the loss of support in old age,
• redirect their remaining energy and resources to care for the sick,
• deplete their resource base in quest for medical treatment and funerals,
• assist orphaned children, at a time when they themselves may need assistance,
• risk exposure to infectious diseases by being in close contact with sick household members,
• risk contracting HIV through sexual intercourse if they are sexually active.

HIV/AIDS has far-reaching economic, social and psychological effects on older people, destroying their hopes for the future and bringing new burdens as breadwinners and carers. The epidemic deepens poverty of people who are usually already poor. Collapse of household income, time spent caring for the sick, and the struggle to cover expenses such as drugs or burials can bring economic devastation. Of the African countries hardest hit by the epidemic, only South Africa and Namibia have old-age pension coverage, but even there pensions seem to be unable to alleviate poverty in households affected by HIV/AIDS (Legido-Quigley 2003). Evidence from Thailand shows that, although nearly 60 percent of elderly parents benefit from government health insurance in the payment of care and treatment cost for an ailing adult child, poor parents are far more likely than better off parents to suffer from financial hardship if a main household income provider dies (Knodel and Im-em 2003).

Widespread orphanhood also bodes badly for older persons in AIDS-affected countries, since grandparents often become surrogate guardians when parents are not able to raise their own children (Table 2). This role of the elderly is often associated with feelings of frustration as how to adequately cope with bringing up surviving orphans at a time when resources have dried up and other forms of support are no longer available (WHO 2002, HAI/IHAA 2003). The risk is that without external assistance, such as remittances or community support, many elderly will not be able to fulfil their considerable potential as carers of orphaned children, sources of agricultural and nutritional knowledge, and protectors of the rights of these vulnerable children to their land and other household assets (du Guerny 2002).

Challenges and opportunities of population ageing

While population ageing represents, in one important sense, a major success for humankind – a massive survival to old age has become possible – it also poses profound challenges to policies and public institutions that must adapt to changing age structures.

The principal challenge is associated with increases in the older population relative to the population of working ages (Table 3), which creates social and political pressures on social support and health care systems. These effects of population ageing can undermine sustainable development and economic growth, and burden already strained family and community support systems, as well as public institutions, national health budgets and other resources. Possible policy approaches to respond to these problems include (EWC 2002):

• policies to enhance traditional systems of family support,
• policies to encourage the elderly who are still capable to remain in the work force,
• institutions and systems to support high levels of personal saving to draw on in old age, and
• public programmes, including pension schemes and national health care systems.

It needs to be pointed out that hitherto only a minority of developing countries have enacted policies on ageing. Many lack the necessary institutional basis, such as efficient pension and healthcare schemes, capital markets, and accounting or regulatory systems. A study conducted in 2002 revealed that out of 64 countries in Africa, Asia-Pacific and Latin America for which relevant data was available, only 24 had a national policy on older persons, although a further 16 were in the process of developing such a policy (HAI 2002). It is therefore not surprising that development policies for rural areas seldom recognize the needs of older members of rural communities.

However, population ageing has to be viewed as both a sustainable development challenge and an opportunity. On the positive side, in many countries the health status of older people of a given age is improving over time, because more recent generations have a lower disease load. Many older persons can thus live active lives until a much later age than in the past. If they are encouraged and assisted to be productive, they can be important economic contributors as well. Further benefits of ageing include the wealth of skills and experience that older people can bring to the workplace, to public life, families and households. In particular, rural elderly often have considerable knowledge in farming practices, in plants and their various uses for nutritional and medicinal purposes. The elderly frequently act as guardians of traditions in farming and management of natural resources, many of which may be more ecologically sound than modern techniques (du Guerny 1997). In order to protect biodiversity, such knowledge must not be lost. Older people are also crucial in the inter-generational transmission of cultural identity and social cohesion. In AIDS-affected settings, they play a key role as carers of the sick and guardians of orphans. Furthermore, return migration of older persons to rural areas may represent a significant input for the rural economy in terms of human and financial capital (IOM 2001). The challenge for governments, therefore, is to move beyond traditional social protection approaches to invest in the productive capacities of older persons, in order to make the most of their potential for social benefit.

Implications for FAO

There is a growing recognition throughout the developing world that population ageing needs to be incorporated into national development strategies (HAI 2002). This is complicated by the fact that population ageing creates multiple problems for national economies, in particular for social support systems that must also satisfy the different needs of younger people. Governments will thus face increasingly difficult choices of how to use available funds without benefiting one group at the expense of others. Given the expected demographic dynamics, rural development in poorer countries will be increasingly dependent on older persons. Therefore, a growing demand for technical assistance on how to adjust rural development policies to the realities of population ageing can be expected.

Population ageing is a global phenomenon that requires both national and international action. The UN system has developed a number of recommendations intended to assist countries in responding to the challenges and opportunities brought about by population ageing. Prominent among these is the Madrid International Plan of Action on Ageing (UN 2003b), adopted at the Second World Assembly on Ageing in April 2002. The Madrid Plan includes several recommendations that are directly relevant to FAO’s field of action:

• encouraging employment opportunities for all older persons who want to work (paragraph 28),
• improving living conditions and infrastructure in rural areas, including ensuring equal access to and control of economic resources by older rural women (paragraph 32),
• diminishing the marginalization of older persons in rural areas, with particular focus on empowering older rural women through access to financial and infrastructure services (paragraph 33),
• reducing poverty among older persons, particularly older women, the oldest old and other disadvantaged groups (paragraph 48),
• promoting access to food and adequate nutrition for all older men and women (paragraph 68).

The agricultural and rural sectors are in a strong position to assist in addressing ageing-related issues. FAO, with the UN mandate for improving nutrition and food security, agriculture and rural development, has a major responsibility to contribute to tackling the effects of rural ageing. The Organization’s technical expertise, neutrality and global outreach represent important strengths in this regard. Specifically, FAO could make a substantial contribution to the debate and action on population ageing in developing countries by:

• continuing to examine the ageing-related issues from a holistic socio-economic perspective, thereby contributing to the approaches focusing on social protection and health,
• strengthening efforts to understand the implications of ageing for food security, labour supply, agricultural production, management of agricultural land and other productive resources, transmission of agricultural knowledge etc., while at the same time building awareness of the importance of these implications,
• mainstreaming the consideration of gender aspects of rural ageing into relevant development activities,
• assisting decision-makers in developing effective policy responses, particularly by highlighting the potential role of agricultural and rural development interventions and by identifying the sub-groups within the rural population that are most in need of old-age assistance.

It seems appropriate for FAO to intensify work on these issues because measures to establish appropriate responses – rural development programmes and policies sensitive to the needs and abilities of older persons – require a considerable amount of lead-time. As stated in the Madrid International Plan of Action on Ageing, ‘forward thinking calls us to embrace the potential of the ageing population as a basis for future development’ (UN 2003b, p. 13).

Table 1: Projected population aged 60 and above, selected major regions

Figure 1: Projected population growth rates

Figure 1: Projected numbers of persons aged 60 and above

Figure 3: Population composition by sex and age in the medium variant (“with AIDS”) and in the no-AIDS scenario (“without AIDS”), seven most highly affected countries in sub-Saharan Africa*

Note: * Botswana, Zimbabwe, Swaziland, Lesotho, Namibia, Zambia, South Africa. Source: UN 2003c.

Table 2: Who is caring for orphans?

Table 3: Projected old-age dependency ratios (aged 60+ per 100 aged 20-59), selected major regions

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