measuring quality of life of older people lessons from the analysis of national datasets in asia
TRANSCRIPT
Measuring quality of life of older people Lessons from the analysis of national datasets in Asia
By Asghar ZaidiUniversity of Southampton and
London School of Economics and Political Science
The Economic Implications of AgeingHelpAge Asia-Pacific Regional Conference 2016
Hanoi, 6-8 September 2016
Overview
1. Context and the ESRC-SDAI project
1.1 The context of global ageing and country coverage (BD, CH, IN, PK)
1.2 Key objectives and deliverables of the ESRC-SDAI project (2015-2016)
2. The Analytical framework
2.1 Four domains of the Global AgeWatch Index
2.2 Extensions: Emphasis on ‘Healthy ageing’, ‘Social engagement’,
‘Housing’, and overall life satisfaction
3. Key findings and policy insights
3.1 Insights from our country-specific data summary report (China)
3.2 Key findings from the research papers
4. Identifying challenges and learnings
4.1 Identifying data gaps and challenges (e.g. in the implementation of the SDGs)
4.2 Learnings and recommendations
Part 1
Context and the ESRC-SDAI
project
ESRC Economic and Social Research Council (the UK)
SDAI Secondary Data Analysis Initiative
Duration: January 2015 – December 2016
1.1 The Context of global ageing
Speed and scale of population ageing is profound in the selected countries
Source: HelpAge International, Global AgeWatch Index website.
I. Development strategies to empower older people by
improving their well-being and quality of life
Two bold pledges made in the Post-2015 SDGs
‘no one will be left behind’ and
‘we endeavour to reach the furthest behind first’
II. The healthy, secure and empowered older people in turn
contribute not just to their own wellbeing but also to the
overall development of the society in which they live.
The SDG Context: Ageing linked to development
Source: Zaidi, A. (2015). Ageing and Development. GSDRC Professional Development Reading Pack
no. 25, developed for DFID, the UK.
http://www.gsdrc.org/wp-content/uploads/2015/11/Ageing-and-Development_RP1.pdf
1.2 Key objectives and deliverables of
the ESRC-SDAI project (2015/16)
1. Objectives
To undertake in-depth analysis of the existing surveys
- to improve our understanding of the QOL and wellbeing of older people
- to feed the evidence into national and international policymaking debates
- to provide unique insights about the data gaps and evidence deficits
- to support future editions of the Global AgeWatch Index
- to trigger stronger coordination of key stakeholders in the region
2. Deliverables
- Various research papers, with policy insights
- A ‘Policy Report’ on data and evidence
- Stakeholders’ event and the advisory group consultations
- Webpage illustrations of the key findings of the project
- Development of guidelines for future editions of Global AgeWatch Index
Datasets used
1. India and China
- WHO Study on global AGEing and adult health (SAGE), Wave 1,
2007
Timeliness issue, but rich information on health, and other aspects of
lives of older people
Access expected for the 2nd wave of SAGE surveys (for 2014)
2. Bangladesh and Pakistan
- Bangladesh’s Household Income and Expenditure Survey (HIES),
Year 2010
- Pakistan Social and Living Standards Measurement (PSLM), Year
2013
Accessibility restricted for later years, but they are also not expected to
provide any better policy-relevant information
Access required for Survey on Population Ageing in Bangladesh, 2014
Data expected for Pakistan Human Rights Survey of Older Persons, 2016
Part 2
The Conceptual / Analytical
framework
2.1 Four domains of the Global AgeWatch Index
Source: Zaidi, A. (2013). Global AgeWatch Index 2013: Purpose, Methodology and Results. Report
prepared for HelpAge International, http://www.helpage.org/download/52949b561453d/
Well-being
Income security
Health
CapabilitySubjective well-being
Enabling environ.
Material deprivation
Equivilised consumption
Social engagement
Functioning assessment
Self-rated health
Health difficulties
Trust in people
Elder abuse
Access and utilisation of healthcare
Highest education level of the father
No of hours worked
Preventive health measures
Satisfaction with life domains
Problems with coping with things
Overall quality of life
Happiness
Control over life
2.2 The extensions – Emphasis on ‘Healthy ageing’, ‘Social engagement’, ‘Housing’, and overall life satisfaction
Lifelong learning
Housing
Civic freedom
Family transfers
Part 3
Key findings and policy
insights
(from the work completed so far)
3.1 Insights from the summary report (for China)
1. Pension income coverage and pension income adequacy serious concerns
for low educated and rural residents;
2. Self-reported health also point to rural-urban differentials, possibly due to
unequal healthcare coverage (the same for educated/non-educated groups)
3. Negative relationship between education and mental well-being
indicators.
4. Employment activities lowest among those with secondary or higher
education and highest among those persons with less than primary
education – employment is therefore providing a safety net for those who
have less pension income
5. In terms of enabling environment, someone to trust indicator point to a
greater deprivation among older persons, although self-perceived safety is
not much different between the younger and older age groups
6. Access to healthcare is suspiciously high – only 5% struggle on this (must
investigate the rural/urban distinction in this)
1. Age is a significant factor for active engagement as very old people less
often meet friends and relatives and are involved in public meetings, but
level of trust and self-perceived safety do not change when people get older
(in both countries). This implies that a greater effort by local level public
policy bodies can generate additional engagement of oldest old of the society
in both India and China.
2. People living in rural areas meet friends more often than urban dwellers in
both countries, they feel more safe and have more trust on others. Thus, the
move towards making cities and urban communities more age friendly will
generate higher quality of life and wellbeing of urban older population.
3. Income level is significant factor of social engagement and in general, more
affluent older people are more engaged, with some exceptions. Again,
income provides a buffer against other forms of deprivation.
3.2 Insights from the research papersa. social engagement paper
a. social engagement paper
4. Despite cultural differences, the same groups of older people are more often
engaged in India and China (but with differences in basic components of
social engagement). This implies that the two countries can learn from policy
experiences with respect to reducing the risk of loneliness in old age.
5. Almost every type of social engagement is related to subjective well-being
and health status of older people. Therefore, vulnerable groups (women, very
old) should be supported to enhance their engagement.
6. The metric of social engagement developed point to specific actions towards
vulnerable groups, for example very old people in India have problems with
participation in public meetings (which is an most important aspect of social
engagement, to behold one’s rights).
Source: Zaidi, A. and R. Antczak (2016), ‘Engaging older people: A comparative analysis of China and India’,
paper prepared in consultations with M. Evandrou and J. Falkingham, University of Southampton, the UK
1. Housing conditions vary significantly between the two countries analysed. Older
population in China experienced much better conditions than those observed for
India. There are potentials learnings for both countries.
2. The key findings confirmed the importance of housing conditions for the subjective
well-being indicators of older persons. Thus, housing is a critical aspect of living
conditions in later life. Older persons experience decreasing functional capacities and
require greater public support in their times of rising frailty and vulnerability.
3. However, surprisingly, this relationship is stronger in the case of the life satisfaction
measure, and rather limited for the self-rated health measure, leading to conclusion
that housing features do not have influence on all aspects of well-being.
4. Additionally, notable differences are found in these relationships across India and
China, which implies that perception of housing and its importance may be
dependent on other external public services as well as on the context of culture and
environment.
3.2 Insights from the research papersb. ‘Housing, health and well-being of older persons in
China and India’
Source: Zaidi, A. and R. Antczak (2016), ‘Housing, Health and wellbeing of older
persons in China and India’, Journal of Gerotechnology, forthcoming.
Part 4
Identifying challenges and
learnings
4.1 Identifying data gaps and challenges
India and China richer in datasets on older people
- WHO’s SAGE surveys have provided rich datasets on health and
functioning of older people (the data for the 2nd wave required)
- Data on social engagement also very rich in the SAGE surveys, allowing
analysis of its benefits for the health and well-being of older people
- The harmonised method of the SAGE surveys facilitate comparative
analysis, and the HRS type surveys are a ‘data revolution’ in this respect
- Sample size restrictions for smaller subgroups (the new Chinese survey
for rural and urban households offer a greater improvement in this
respect)
4.1 Identifying data gaps and challenges
Bangladesh and Pakistan requiring special surveys
- The existing sources are mainly surveys for persons of all ages, with
little or no special effort made in the enumeration of older persons
(especially those who may have mental health issues)
- Limited information on pension income components and health and
functionings
- Little or no information on age friendly environments
- Individual-level data access remains an issue, as specialised
permissions are required prohibiting a timely availability of these surveys
- Current surveys not adequate to capture the baseline position in the
SDG monitoring of progress for subgroups (especially for older people
with disabilities)
- Lack of census data in Pakistan raises serious doubts about the
representativeness of the existing survey data
4.2a Learnings
1. Group-specific evidence insightful
- The disaggregated information with respect to gender, educational
attainment and rural/urban status provide great insights
2. Distinctions between individual attributes and those
of their communities very useful
- In particular, the data should allow us to make the distinctions between
intrinsic capacities and functional abilities (WHO’s 2015 report)
4.2a Learnings
3. Access to individual-level data essential
- e.g. The subgroup analysis (say between rural and urban residents)
requires controlling for other factors, through multivariate analysis
4. Insights for future versions of Global AgeWatch Index
- The disaggregation between men and women vital; and for age groups
- Many additional indicators required, which have been missing in the
international datasets (1) access to and utilisation of healthcare service;
(2) lifelong learning; (3) physical and mental health status; (4) elder
abuse; and (5) social engagements (6) Housing condition
4.2b Recommendations
1. Specialised surveys on older persons required
- The survey questionnaire and the enumeration procedures should be
designed to capture the special needs and aspirations of older people;
- Greater information on health and functionings required (for Pakistan
and Bangladesh)
- The new UN-DESA initiative of surveys on ageing in Africa is a good
practice example
2. Greater information vital on age-friendly enabling environments
- In particular, rights to affordable and decent healthcare, housing and
social engagement is essential in the evidence on QOL of older people
3. Data required on early life course experiences and their impact
on the quality of life of older people
- In particular, to generate evidence how to break the accumulation of
deprivations from early life to old age
- Can the existing longitudinal surveys be expanded for this purpose? A
good example is the Indonesian Family Life Survey
4.2b Recommendations
4. Greater consultations required with national-level experts
- In particular, in raising our understanding of supplementary evidence
available, e.g. with the help of admin data; qualitative ifocus group
nterviewing
5. Collection of data on human rights of older persons essential
- In particular, the information about the awareness of rights holders and
their capacities to claim those rights are missing from most datasets
