Global Aging Is a Local Issue

A Q&A with Prof. Kavita Sivaramakrishnan on her new book, As the World Ages

April 2, 2019

Around the world, populations are aging, and in some places, very quickly. The fraction of adults age 60 or older in Sub Saharan Africa will more than triple by 2050. By comparison, the number of seniors in Europe, already an old population, will inch up a relatively modest one-third. What took wealthy countries 150 years will happen in the global south in 20 years, and at a lower level of economic development and little in the way of a social safety net. How the global community has responded to this demographic “gray tsunami” is the subject of a new book by Kavita Sivaramakrishnan, As the World Ages: Rethinking a Demographic Crisis (Harvard University Press).

In the following Q&A, Sivaramakrishnan, interim co-director of the Columbia Aging Center, argues that, in addressing these demographic trends, Western experts too often extrapolate their models and experiences of aging to low- and middle-income countries. Retirement, costs of long-term care, and welfare have been the main focus in Europe and the U.S. But in the global South, adequate access to social benefits is often not universal, and historically, policy debates have focused on the responsibilities of family. The response to longevity in the global South should consider the context—societies where there are simultaneous demands made for the work life, care, and health of both the young and the old, and where policymakers struggle with limited resources. In many ways, she says, global aging would be better thought of in terms of local health. 

Is the crisis of population aging overblown?

The panic over a “gray tsunami” frames aging as extremes of dependency or self-sufficiency. The truth lies somewhere in between. Some older people are able to postpone disability, but there will always those who depend on intergenerational solidarity from younger people and some kind of care. Increasingly, young people are being asked to do more for older generations, but many of them are unable to find jobs and are under stress. We also see support happening in the other direction: if you offer older people an income, they share it with younger generations. And it is more than strictly financial. I’m conducting a study with a Presidential Innovation Grant to examine life in urban slums in Nairobi and Mumbai, to see how older people there offer cultural capital to younger people, and how young and older persons respond to sharing resources. I want to understand their expectations in contexts that are deprived and stressful for both. Migration from rural to urban areas, especially considering the lack of jobs in the countryside and stressful living in urban slums, is challenging traditional roles.

You write that there isn’t a one-size-fits-all approach to aging. Can you explain?

The first international meeting on aging, in 1982, framed the issue of global aging based on the western experience of a social safety net and retirement. Developing countries responded by saying this model of aging doesn’t fit with their experience. They argued that aging wasn’t a problem because their old people were looked after by family members. At the same time, these countries were beginning to see some of these traditional supports weakened, as young people migrated to the cities. In recent years, the idea of successful aging has gained currency. Basically, this means you’re responsible for your own health. It’s an idea that is really only workable in a wealthy context when you have had dependable salaries that can ensure savings in old age, or pensions or access to nutrition and healthcare through your lifespan. You can’t age successfully if you’ve been through acute poverty or famine or civil war. Poor people don’t retire and do volunteer work in places like Asia and Africa. You work until you die.

Are there any lessons for the West in the experience of aging in the developing world?

Countries in the global South have a long history of population aging without welfare and pensions. In our current period of globalization, the world is looking more and more similar. The social, health, environmental, and financial risks and exposures in underserved and marginalized areas of the world are similar. The West, too, has deprivation and poor neighborhoods and older people who fall outside the social safety net. In this way, there is a need for approaches to aging that see overlapping and shared questions and interests.

I have recently been part of initiatives that have brought together experts on aging in India and China, and there is a growing sense that countries with the largest aging populations should share their experiences with aging programs and policies that have been mobilized successfully by local communities so that they can be scaled up or be relevant to other settings. For instance, in cities such as Chennai in South India, there are neighborhood-level networks of geriatric checkups and care by older people who take care of those older than they are, the oldest of the old. This is an approach that is low cost and encourages social cohesion. We need to look to the “local” for traditions of care. At the same time, state support, especially for older, frail, and vulnerable persons in rural India and China is indispensable, and families cannot offer care to parents and relatives among deprived populations without state-led support.