Yes, there's a youth bulge, but the global south is also getting older

Henry Mbene in Nigeria receives food and health checks from NGOs. Luisa Pelamo in Argentina keeps active by volunteering in a local community center. An NGO taught Chandra Devi Kafle in Nepal how to use a mobile phone. These people all have different lives in different environments, but upon reaching an older age, each of them has experienced life-changing challenges requiring additional support. While development practitioners have given the so-called youth bulge much attention in recent years, particularly in Africa, less notice has been paid to the impact of improved global life expectancy. The World Health Organization says that expectancy increased by more than six years between 2000 and 2019 from 66.8 years to 73.4. As a result, between 2022 and 2050, low- and middle-income countries will account for 85% of the population growth of people aged 65 and older worldwide, according to aging-focused nonprofit AARP International. By 2050, roughly 4 in 5 older adults will live in these countries, which is also where aging inequity — the cumulative effect of inequalities experienced throughout a person’s lifespan — tends to be more acute, compared to high-income countries. Moreover, gender-based disparities in education, large informal economies, and a lack of pension coverage also contribute to aging inequities in LMICs, according to an AARP International report published last year, which profiled the three senior citizens named above. The report, “Achieving equitable healthy aging in low- and middle-income countries,” written by think tank Economist Impact, warns that aging inequity is becoming an increasingly urgent issue in LMICs. ‘Surviving is not thriving’ Demographic aging will not happen uniformly across LMICs. AARP International predicts the greatest growth will be among lower- and upper-middle income countries, rather than low-income countries. Sub-Saharan African countries will experience the fastest growth, while Asian countries will contribute to over 70% of the global increase of the older population. World Bank Vice President for Human Development Mamta Murthi said development professionals need to acknowledge that an increased human survival rate is a “good part of the story.” However, she stressed: “Surviving is not thriving.” “Life expectancy has grown in developing countries because of the investments made in sanitation, in nutrition and in access to health care, etc.,” she said. “But increasing survival rates are not enough to guarantee a life free of poverty.” To address these challenges, development professionals need to integrate an understanding of aging into policy, Murthi suggested. Investments should be viewed through the whole length of people’s potentially longer lives. The fact that people are going to live and work longer strengthens the case for building strong foundations early on, Murthi argued. “Preventive health care — things that prevent the emergence of chronic disease or bad health outcomes over the long term … should be strengthened,” she said. Overcoming structural barriers Murthi emphasized the role of development professionals in helping countries prepare for this demographic transition. This includes lower-middle-income countries developing or introducing schemes like social insurance, affordable health care, or savings plans, as in many middle-income countries. The World Bank has helped develop a pension scheme for informal sector workers in Kenya. It set up a similar scheme in Rwanda, where more than 80% of the labor force works in the agricultural sector, is self-employed, or works informally, and is at risk of experiencing poverty in older age. In Egypt, the bank is helping the government expand universal health insurance. Whereas in China, where the percentage of people aged 65 and older is growing rapidly, the focus is on improving elderly care. In the coming months, the bank will publish a new report addressing the aging challenge which will cover issues including long-term care, behavior change, gender gaps in access to care, social protection, and government solutions to support healthy longevity. Falling into the gaps Kafle’s story is just one example of how gender gaps in education and employment experienced by women throughout their lives result in poorer outcomes in old age. Because of social taboos, she was not allowed to go to school. She was then married at the age of 13. It was only in her 70s that Kafle learned how to write her name, rather than signing with a thumbprint, thanks to a class provided by nonprofit Ageing Nepal. Like many women, who tend to live longer than men, Kafle has outlived her partner. After her husband died, she had to raise four children while digging roads for a living. The AARP report cites Malawi as an example of this gender dynamic. There, 34% of women over 60 years old are married compared to 85% of men, meaning fewer have the material, social, or emotional support a spouse can provide. Monica Ballesteros, senior manager for policy and insights at Economist Impact, said her research on interventions supporting older women in LMICs reveals that few of them combine both gender and aging equity lenses. Such approaches are important, particularly to promote formal work for women.“Women are usually working in the informal economy that doesn't have the same benefits in terms of pensions and access to health care,” she explained. “This is something that accumulates and makes them more economically vulnerable at an older age.” The report also highlights the huge disparities in services available for people living in rural areas compared to urban areas. Globally, 56% of rural populations lack access to health care services, which is more than double the proportion of urban populations. The gap between rural and urban informal employment is larger in LMICs than in high-income countries: 84% of rural workers and 53% of urban workers in LMICs are in informal employment, while the proportions in HICs are 22% and 17%, respectively. Attitude adjustment Wade Islan, manager for policy and insights at Economist Impact, pointed out that while aging is addressed within separate United Nations agencies, there is not one overarching department focused on the demographic, as there is for children. Murthi echoed this suggestion, calling for the creation of an “index ministry or apex agency” inside countries to coordinate policies on healthy aging. Islan also wants attitudes to shift, to mean older people are viewed as contributors to society, rather than a burden. “Even in countries where older people are more highly respected, or that is the stereotype or perception, there still can be fairly high rates of incidence of age-related discrimination and anti-aging sentiments,” he said. AARP CEO Jo Ann Jenkins told Devex that global professionals could not afford to ignore older people’s needs, and suggested every multilateral development bank and foreign assistance agency should create internal working groups to focus on the implications of population aging. “It’s simply smart planning and smart investing to take into account the shifting context in different countries if we are working for long-term success,” she said.