Aging in Sub-Saharan Africa
Recommendation for Furthering Research
THE NATIONAL ACADEMIES PRESS
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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.
This study was supported by Contract No. N01-OD-4-2139, TO#119 between the National Academy of Sciences and the National Institutes of Health and the National Institute of Aging. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project.
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Suggested citation: National Research Council. (2006). Aging in Sub-Saharan Africa: Recommendations for Furthering Research. Panel on Policy Research and Data Needs to Meet the Challenge of Aging in Africa. Barney Cohen and Jane Menken, Eds. Committee on Population, Division of Behavioral and Social Sciences and Education. Washington, DC: The National Academies Press.
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PANEL ON POLICY RESEARCH AND DATA NEEDS TO MEET THE CHALLENGE OF AGING IN AFRICA
JANE MENKEN (Chair),
Institute of Behavioral Science and Department of Sociology, University of Colorado
ALEX EZEH,
African Population and Health Research Center, Nairobi, Kenya
EDWELL KASEKE,
School of Social Work, University of Zimbabwe
BARTHÉLÉMY KUATE-DEFO,
Department of Demography, University of Montreal, Canada
DAVID LAM,
Department of Economics, University of Michigan
ALBERTO PALLONI,
Department of Sociology, Institute for Environmental Studies, University of Wisconsin at Madison
STEPHEN TOLLMAN,
School of Public Health, University of theWitwatersrand, Johannesburg, South Africa
ROBERT J. WILLIS,
Institute for Social Research, University of Michigan
BARNEY COHEN, Director, Committee on Population
ANTHONY S. MANN, Senior Project Assistant
COMMITTEE ON POPULATION
KENNETH W. WACHTER (Chair),
Department of Demography, University of California, Berkeley
ANNE C. CASE,
Woodrow Wilson School, Princeton University, New Jersey
EILEEN M. CRIMMINS,
Department of Sociology, University of Southern California, Los Angeles
BARBARA ENTWISLE,
Carolina Population Center, University of North Carolina
JOSHUA R. GOLDSTEIN,
Woodrow Wilson School, Princeton University, New Jersey
BARTHÉLÉMY KUATE-DEFO,
Department of Demography, University of Montreal
CYNTHIA B. LLOYD,
Policy Research Division, Population Council, New York
THOMAS W. MERRICK,
Center for Global Health, George Washington University, Washington, DC
RUBÉN G. RUMBAUT,
Department of Sociology and Center for Research on Immigration, Population, and Public Policy, University of California, Irvine
ROBERT J. WILLIS,
Institute for Social Research, University of Michigan
BARNEY COHEN, Director
Acknowledgments
This report adds to the empirical and conceptual knowledge of the situation of older people in sub-Saharan Africa and makes practical suggestions for further research in this area. The report is based on a workshop organized by the Committee on Population in collaboration with the Health and Population Division, School of Public Health, University of the Witwatersrand in Johannesburg, South Africa, in July 2004. The report draws on a number of papers commissioned for the workshop, on the comments made by a panel of distinguished discussants, and on the discussion by workshop participants.
Many people made generous contributions to the workshop’s success. We are grateful to our colleagues, Alex Ezeh, Edwell Kaseke, Barthélémy Kuate-Defo, David Lam, Alberto Palloni, Stephen Tollman, and Robert Willis, who served on the panel that was charged with organizing the workshop and preparing a document that outlined the priority research areas in relation to aging in sub-Saharan Africa. Belinda Bezzoli, deputy vice-chancellor for research of the University of the Witwatersrand, and Richard Suzman, of the National Institute on Aging, supported the planning of the workshop and participated throughout. We are also especially grateful to the various authors and discussants who prepared papers or presentations in advance of the meeting: Mary Amuyunzu-Nyamongo, African Population and Health Research Center; Ayaga Bawah, Navrongo Health Research Center; Peter Byass, Umeå University; Samuel Clark, University of Colorado at Boulder and University of Washington; Gloria Chepngeno, University of Southampton; Mark Collinson, University of the Witwatersrand; Myles Connor, University of the Witwatersrand; Rob Dorrington, Univer-
sity of Cape Town; Alex Ezeh, African Population and Health Research Center; James Fairburn, University of KwaZulu-Natal; Michel Garenne, French Institute for Research and Development (IRD); Victoria Hosegood, London School of Hygiene & Tropical Medicine; Gillian Hundt, University of Warwick; Kathleen Kahn, University of the Witwatersrand; Benoit Kalasa, United Nations Population Fund; Edwell Kaseke, University of Zimbabwe; Abdhalah Ziraba Kasiira, African Population and Health Research Center; Paul Kowal, World Health Organization; Barthélémy Kuate-Defo, University of Montreal; Rodreck Mupedziswa, University of the Witwatersrand; Randall Kuhn, University of Colorado at Boulder; David Lam, University of Michigan; Murray Leibbrandt, University of Cape Town; Frances Lund, University of KwaZulu-Natal; M. Giovanna Merli, University of Wisconsin; Tavengwa Nhongo, HelpAge International; Alberto Palloni, University of Wisconsin; Karen Peachey, consultant; Dorrit Posel, University of KwaZulu-Natal; M. Omar Rahman, Independent University, Bangladesh; Vimal Ranchhod, University of Michigan; Kalanidhi Subbarao, The World Bank; Negussie Taffa-Wordofa, African Population and Health Research Center; Ian M. Timaeus, London School of Hygiene & Tropical Medicine; Margaret Thorogood, University of Warwick; Stephen Tollman, University of the Witwatersrand; Eric Udjo, Human Sciences Research Council; Servaas van der Berg, University of Stellenbosch; Victoria Velkoff, U.S. Census Bureau; Robert Willis, University of Michigan; Martin Wittenberg, University of Cape Town; and Zewdu Woubalem, African Population and Health Research Center.
The Committee on Population was extremely fortunate to be able to enlist the help and cooperation of the staff and faculty of the Health and Population Division, School of Public Health, University of the Witwatersrand, in Johannesburg, South Africa. Particular thanks are due to Stephen Tollman for his invaluable assistance facilitating the meeting and to Dereshni Ramnarain for her assistance in ensuring that the meeting ran smoothly and successfully.
In Washington, DC, several members of the staff of the National Academies made significant contributions to the report. We thank Kirsten Sampson Snyder for her help guiding the report through review, Christine McShane for her skillful editing, and Yvonne Wise for managing the production process. The project took place under the general direction of Jane L. Ross and Barney Cohen. On behalf of the panel, we thank them for their efforts.
This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making the published
report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process.
We wish to thank the following individuals for their participation in the review of the report: Ronald Angel, Department of Sociology, University of Texas at Austin; Channing Arndt, Department of Agricultural Economics, Purdue University; Yael Benyamini, School of Social Work, Tel Aviv University; Peter Byass, Department of Public Health and Clinical Medicine, Umeå University; Benjamin Campbell, Department of Anthropology, Boston University; David Canning, Department of Population and International Health, Harvard School of Public Health; Julia Dayton, consultant; Gary V. Engelhardt, Center for Policy Research, Syracuse University; Bibi Essama, Westat; Monica Ferreira, The Albertina and Walter Sisulu Institute of Ageing in Africa, University of Cape Town, South Africa; Gary Fields, Department of Economics, Cornell University; Kathleen Ford, Department of Epidemiology, University of Michigan; Lucy Gilson, School of Public Health, University of the Witwatersrand; Mark Gorman, Department of Economic and Social Affairs, HelpAge International; William T.S. Gould, Department of Geography, University of Liverpool; Ellen Idler, Institute for Health, Rutgers, State University of New Jersey; Benoit Kalasa, advisor, United Nations Population Fund; Peter Lloyd-Sherlock, Faculty of Social Sciences, University of East Anglia; Monde Makiwane, Child, Youth, Family and Social Development, Human Sciences Research Council, Pretoria, South Africa; Douglas L. Miller, Department of Economics, University of California, Davis; Akim Mturi, School of Development Studies, University of KwaZulu-Natal; Sendhil Mullainathan, Department of Economics, Harvard University; Laura Rudkin, Department of Preventive Medicine and Community Health, University of Texas; Joshua Salomon, Department of Population and International Health, Harvard University; Gigi Santow, independent researcher; Doreen Tempo, Department of Social Policy and Social Work, University of Oxford; Joseph R. Troisi, II, Department of Psychology, Saint Anselm College; Etienne van de Walle, Department of Sociology, University of Pennsylvania; Stig Wall, Department of Public Health and Clinical Medicine, Umeå University; Alan Whiteside, Health Economics and HIV/AIDS Research Division, University of KwaZulu-Natal; Alun Williams, Centre for Human Ageing, University of Queensland, Australia; Martin Wittenberg, School of Economics, University of Cape Town; Zewdu Woubalem, African Population and Health Research Center; and Zachary Zimmer, Policy Research Division, Population Council.
Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions
or recommendations nor did they see the final draft of the report before release. The review of this report was overseen by Allan G. Hill, Department of Population and International Health, Harvard School of Public Health. Appointed by the National Research Council, he was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final context of this report rests entirely with the authoring committee and the institution.
Jane Menken, Chair
Panel on Policy Research and Data Needs to Meet the Challenge of Aging in Africa
Barney Cohen, Director
Committee on Population
Contents
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Aging in Sub-Saharan Africa: Recommendations for Furthering Research |
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Aging in Sub-Saharan Africa: The Changing Demography of the Region |
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The HIV/AIDS Epidemic, Kin Relations, Living Arrangements, and the African Elderly in South Africa |
Older Adults and the Health Transition in Agincourt, Rural South Africa: New Understanding, Growing Complexity |
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The Situation of Older People in Poor Urban Settings: The Case of Nairobi, Kenya |
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Labor Force Withdrawal of the Elderly in South Africa |
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HIV/AIDS and Older People in South Africa |
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Interactions Between Socioeconomic Status and Living Arrangements in Predicting Gender-Specific Health Status Among the Elderly in Cameroon |
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Survey Measures of Health: How Well Do Self-Reported and Observed Indicators Measure Health and Predict Mortality? |
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