Spring 2011

Aging in Africa


Jason L. Powell, Ph.D.

University of Central Lancashire, UK

Introduction: From Global Aging to aging in Africa

The rapid increase in population aging across the globe signals one of the most important demographic changes in human history. In the latter half of the last century, the world's developed nations completed a long process of demographic transition (Phillipson, 1998). We can see demographic transition as a shift from a period of high mortality, short lives, and large families to one with a longer life expectancy for an aging population and far fewer children (Powell, 2005). This transformation has taken many years across the globe but particularly in Europe and North America as small unit families moved from agrarian mode of production to urban cities; basic public health measures steadily reduced the risk of contagious disease; and modern medicine has prolonged lives to unprecedented lengths (Giddens, 1993). In developing countries, this demographic transition is certainly underway, though these countries vary widely at their places along the spectrum. Low birth rates and the resultant population decrease have received considerable media attention, particularly in Europe and parts of eastern Asia (Bengston and Lowenstein 2004). Historically, when demographers projected national and global populations, the projections commonly assumed that birth rates would decline globally but only to the "two-child" family, i.e., two children per woman or per couple on average (Phillipson, 1998). An assumption that fertility would fall below this rate would have some consequences: a decrease in population size and an aging population who would depend upon a dwindling number of younger workers. Today, the global population has come to what we may call a great “demographic divide”. Very low birth rates have inflicted long-lasting alterations upon the age structure of populational aging (Phillipson, 1998). Yet, when one attempts to research ageing in Africa there is only a tiny handful of research that has been done. One has to try to situate Africa in the context of aging populations in other parts of the world to get a feel for comparative analysis.

In order to examine such complex and vast demographic changes, academic researchers use a variety of methodological tools to find, collate and interpret such changes. The forecasted rise in the number of older people aged 75+ over the next 20 years will lead to an expansion of demand for health care services, housing accommodation and pensions for aging populations.  Direct statistical data about aging populations come from vital statistics registries that track all births and deaths as well as certain changes in legal status such as marriage, divorce, and migration (registration of place of residence) (Phillipson 1998). In developed countries with good registration systems (such as the United States and much of Europe), registry statistics are the best method for measuring the number of births and deaths in populations (Bengtson and Lowenstein 2004). A Census is also usually conducted by a national government and attempts to enumerate every person in a country (Gavrilov and Gavrilova 1991). However, in contrast to vital statistics data, which are typically collected continuously and summarized on an annual basis, the American Community Surveys typically occur only every 10 years (Phillipson 1998). Analyses are conducted after a Census to estimate how much over or undercounting took place. Censuses collect information about families or households, as well as about such individual characteristics as age, sex, marital status, literacy/education, employment status and occupation, and geographical location (Giddens 1993). They may also collect data on migration (or place of birth or of previous residence), language, religion, nationality (or ethnicity or race), and citizenship. In nation states in which the vital registration system may be incomplete, Censuses are also used as a direct source of information about fertility and mortality; for example the censuses of the People's Republic of China gather information on births and deaths that occurred in the 18 months immediately preceding the census (Cook and Powell, 2007).


We can usually consider various dimensions to measure global aging such as demographic, socio-economic, health, intergenerational support, activities in later life, social security, dependency rates and human right issues (Phillipson 1998). The datasets or statistics that are used to measure the global aging are basically demographically and medically oriented. For example, low birthrates, life expectancy and dependency rates. While the proportions of older people in a population are typically highest in more developed countries because of measurement data of low birth rates and high life expectancies which are used to understand global aging, the most rapid increases in older populations are actually occurring in the less developed world (Cook and Powell, 2007). Between 2006 and 2030, the increasing number of older people in less developed countries is projected to escalate by 140% as compared to an increase of 51% in more developed countries (Krug, 2002). A key feature of population aging is the progressive aging of the older population itself.  Demographers contrast the “old” (65+) with the “oldest old” (85+) and that the oldest old population is growing at an even more rapid pace than the overall old population. Over time, more older people survive to even more advanced ages. Around the world, the 85-and-over population is projected to increase 151% between 2005 and 2030, compared to a 104% increase for the population age 65 and over and a 21% increase for the population under age 65 (Bengtson and Lowenstein 2004). The most striking increase will occur in Japan: by 2030, nearly 24% of all older Japanese are expected to be at least 85 years old (Kim and Lee 2007). As life expectancy increases and people aged 85 and over increase in number, four-generation families may become more common. Dependency rates, that is the number of dependants related to those of working age have altered little over the twentieth and twenty first centuries.  The reason there has been so little change during a period of so-called rapid aging populations is that there has been a fall in the total fertility rate (the average number of children that would be born to each woman if the current age-specific birth rates persisted throughout her child-bearing life).


The Size and Growth of the World’s Older Population


In every society in the world, there is concern about population aging and its consequences for nation states, for sovereign governments and for individuals. The global population is aging. Aging itself is a triumph of our times – a product of improved public health, sanitation and development. Yet over 100 million older people live on less than a dollar a day. In 1950, 8 out of every 100 people were over 60. By 2050, 22 out of every 100 people will be over 60. By 2045, the global population of people aged 60 years and over will likely surpass, for the first time in history, the number of children under age 15 (Powell, 2005). The increasing share of older people in the world’s population results from a combination of hugely increased life expectancy and reduced fertility. Total fertility is expected to decline from 2.82 children per woman in 1995-2000 to 2.15 children per woman in 2045-2050. Life expectancy worldwide is expected to increase by 11 years, from 65 in 1995-2000 to 76 in 2045-2050, despite the impact of HIV/AIDS (Phillipson 1998). Most of the world's older people live in developing countries (Krug, 2002).


Even in the poorest countries, life expectancy is increasing and the number of older people is growing. In 2000, there were 374 million people over 60 in developing countries – 62% of the world's older people. In 2015, there will be 597 million older people in developing countries – 67% of the world's older people (Bengston and Lowenstein 2004). In 2005, one in twelve people in developing countries are over 60. By 2015, one in ten people in developing countries will be over 60 and, by 2050, one in five people in developing countries will be over 60. In every region, the rate of population increase for the 65-and-over age group is higher than for the under-14 age group and the 15-64 age group (Bengston and Lowenstein 2004).

There are more older women and they are more likely to be poor. The majority of older persons globally are women. In 2006, there are 82 men for every 100 women over 60 worldwide (Powell, 2005).  In developing countries, the gap is less wide: there are 85 men for every 100 women over 60. However, with age this gap increases – for over 80s, there are only 73 men for every 100 (Bengston and Lowenstein 2004).


The following patterns illustrate a growing picture of aging developing in nation states to reveal a clear pattern of global aging:




The United Nations (UN) estimates that by the year 2025, the global population of those over 60 years will double, from 542 million in 1995 to around 1.2 billion people (Krug, 2002:125). The global population age 65 or older was estimated at 461 million in 2004, an increase of 10.3 million just since 2003.


Projections suggest that the annual net gain will continue to exceed 10 million over the next decade—more than 850,000 each month. In 1990, 26 nations had sizeable older populations of at least 2 million, and by 2000, older populations in 31 countries had reached the 2 million mark (Cook and Powell, 2007). UN projections to 2030 indicate that more than 60 countries will have at least 2 million people age 65 or older. By 2030 the world is likely to have one billion older people, accounting for 13% of the total global population today (Krug, 2002).


If these issues capture the statistical increases of global aging, the next section interrogates the causes of global aging.



The Cause of Global Aging 


[d8] Eight causal factors illustrate the nature and extent of population aging across the globe.   First, the overall population is aging. For the first time in history, and possibly for the rest of human history, people age 65 and over will outnumber children under age 5. Second, life expectancy is increasing. Most countries, including developing countries, show a steady increase in longevity over time, which raises the question of how much further life expectancy will increase.  Third, the number of oldest old is rising. People age 85 and over are now the fastest growing portion of many national populations. Fourth, the leading causes of death now are those diseases that typically affect older adults. Non-communicable diseases, such as cancer or cardiovascular disease, are becoming a growing burden.  Fifth, family structures are changing. As people live longer and have fewer children, family structures are transformed, leaving older people with fewer options for care.  Sixth, social insurance systems are evolving. As social insurance expenditures escalate, an increasing number of countries are evaluating the sustainability of these systems.  Seventh, new economic challenges are emerging. Population aging will have dramatic effects on social entitlement programs, labor supply, trade, and savings around the globe and may demand new fiscal approaches to accommodate a changing world.  Eighth patterns of work and retirement are shifting. Shrinking ratios of workers to pensioners and people spending a larger portion of their lives in retirement increasingly challenge existing health and pension systems (Bengtson and Lowenstein 2004; Krug 2002; Estes 2001).


There may also be increasing stigma and aging stereotypes of older adults due to population aging. For example, some public services are thought to be paid for by ‘younger’ working people.  Thus, the increasing proportion of older adults in a population signifies burden on the younger population (Estes, Biggs and Phillipson 2003). Most of the more developed nations have had decades to adjust to this change in age structure. For example, it took more than a century for France 's percent of population age 65 and over to increase from 7% to 14% of the total population. In contrast, many less developed countries are experiencing rapid increases in the number and percentage of older people, often within a single generation. The same demographic aging process that unfolded over more than a century in France  will occur in two decades in Brazil (OECD 2007). In response to this demographic transition , institutions must adapt quickly to accommodate a new age structure. Some less developed nations will be forced to confront issues, such as social support and the allocation of resources across generations, without the accompanying economic growth that characterized the experience of aging societies in the West. In other words, some countries ‘may grow old before they grow rich’ (Cook and Powell, 2007: 17).


Globalisation has also produced a distinctive stage in the social history of population aging, with a growing tension between nation state-based solutions (and anxieties) about growing old and those formulated by global institutions (Phillipson, 1998). Globalisation, defined here as the process whereby nation-states are influenced (and sometimes undermined) by trans-national actors (Powell 2005), has become an influential force in shaping responses to population ageing. Growing old has, itself, become relocated within a trans-national context, with international organisations (such as the World Bank and International Monetary Fund) and cross-border migrations, creating new conditions and environments for older people (Phillipson, 1998). 
Aging can no longer just be viewed as a 'national' problem but one that affects trans-national agencies and communities. Local or national interpretations of aging had some meaning in a world where states were in control of their own destiny.[CS13]  They also carried force where social policies were being designed with the aim or aspiration of levelling inequalities, and where citizenship was still largely a national affair (and where there was some degree of confidence over what constituted 'national borders'). The crisis affecting each of these areas, largely set in motion by different aspects of globalisation, is now posing acute challenges for understanding ‘global aging’ in the twenty-first century.[CS14] 
If these examples illustrate the complexity and impact of global aging – then it may be pertinent to highlight how population aging has impacted on one region of the world: Africa. Africa is the least researched continent when it comes to researching ageing and effect on ageing identity in Africa.

Aging in Africa

Economic security, health and disability, and living conditions in later life are policy concerns throughout the world, but the nature of the problem differs considerably from continent to continent and between and within countries – especially within Africa. 

In Africa older people make up a relatively small fraction of the total population, and traditionally their main source of support has been the household and family, supplemented in many cases by other informal mechanisms, such as kinship networks and mutual aid societies. In 2005, Nigeria ranked among the top 30 countries in the world on the basis of the size of its population age 60 and over. Nigeria had the largest older population in sub-Saharan Africa, with over 6 million people age 60 and over ; South Africa had just over 3.4 million. Congo and South Africa are projected to have nearly 5 million older people in 2030. Burkina Faso, Cameroon, Cote d’Ivoire, Madagascar, Mozambique, Niger, Senegal, and Uganda are all projected to have their older populations grow to over one million people by 2030 (Building Blocks 2004). There is very little careful empirical research has been undertaken on long-term trends in the welfare of older people, there are a number of reasons to believe that traditional caring and social support mechanisms in Africa are under increasing strain (OECD 2007).


African economies, among the poorest in the world, are still heavily dependent on subsistence agriculture, and average income per capita is now lower than it was at the end of the 1960s. Consequently, the region contains a growing share of the world’s poor. In addition, reductions in fertility and child mortality have meant that, despite the huge impact of the HIV/AIDS epidemic across much of the region, both the absolute size and the proportion of the population age 60 and over have grown and will continue to grow over the next 30 years (Estes, Biggs and Phillipson 2003).


In Africa, older people have traditionally been viewed in a positive light, as repositories of information and wisdom. And while African families are generally still intact, social and economic changes taking place can weaken traditional social values and networks that provide care and support in later life. Africa has long carried a high burden of disease, including from malaria and tuberculosis; today it is home to more than 60% of all people living with HIV—some 25.8 million in 2005. The vast majority of those affected are still in their prime wage-earning years, at an age when, normally, they would be expected to be the main wage earners and principal sources of financial and material support for older people and children in their families. Many older people have had to deal with the loss of their own support while absorbing the additional responsibilities of caring for their orphaned grandchildren. Increasingly, then, it appears that African societies are being asked to cope with population aging with neither a comprehensive formal social security system nor a well-functioning traditional care system in place (Building Blocks 2004).


The big issue is that a majority of the world's population of older people (61 per cent, or 355 million) live in poorer African countries. This proportion will increase to nearly 70 percent by 2025. For many countries, however, population aging has been accompanied by reductions in per capita income and declining living standards. Epstein (2001) notes that between 1950 and the late 1970s, life expectancy increased by least 10 percent in every developing country in the world, or on average by about 15 years. However, at the beginning of the twenty-first century, life expectancy remains below fifty in more than ten developing countries , and since 1970 has actually fallen, or has barely risen in a number of African countries (Phillipson 1998). The AIDS epidemic is certainly a major factor here, but development loans requiring the privatization of health care have also had an impact. Epstein (2001) reports, for example, that by the mid- 1990s the African continent was transferring four times more in debt repayment than it spent on health or education. More generally, Help Age International (2000: 8) argue that:


‘Older people's poverty is still not a core concern in the social, economic and ethical debates of our time. Their right to development is routinely denied, with ageing seen as a minority interest or case for special pleading. Poverty and social exclusion remain the main stumbling blocks to the realisation of the human rights of older people worldwide.’


The Consequences: Africa, aging, World Bank and IMF 


In the developed world, the magnitude and absolute size of expenditure on programs for older people has made these the first to be targeted with financial cuts. In less developed countries, older people (women especially) have been amongst those most affected by the privatization of health care, and the burden of debt repayments to the World Bank and the IMF (Estes 2001). Additionally, globalization as a process that stimulates population movement and migration may also produce changes that disrupt the lives of older people (Phillipson, 1998). And one must not forget either that they may comprise up to one-third of refugees in conflict and emergency situations - a figure which was estimated at over 53 million older people worldwide in 2000 (Estes 2001).


It is interesting that the World Bank (1994) foresees growing ‘threats’ to international stability with the consequence of pitting different demographic-economic regions against one another (Phillipson, 1998). The United Nations (2002) view the relationship between aging populations and labor force participation with panic recognizes important policy challenges, including the need to reverse recent trends toward decreasing labor force participation of workers in late middle and old age despite mandatory retirement in certain western countries such as the UK (Powell, 2005). Social welfare provisions and private-sector pension policies influencing retirement income have a major impact on retirement timing. Hence, a major concern for organizations such as United Nations and World Bank centers on the number of such 'dependent' older people in all developing societies. Furthermore, nation states with extensive social programs targeted to the older population—principally health care and income support programs—find the costs of these programs escalating as the number of eligible recipients grows and the duration of eligibility lengthens due to global pressures (Bengtson and Lowenstein 2003). Further, few countries have fully funded programs; most countries fund these programs on a pay-as-you-go basis or finance them using general revenue streams. Governments may be limited in how much they can reshape social insurance programs by raising the age of eligibility, increasing contribution rates, and reducing benefits. Consequently, shortfalls may need to be financed using general revenues. Projections of government expenditures in the United States and other OECD countries show increases in the share of gross domestic product devoted to social entitlements for older populations. In some cases, this share more than doubles as a result of population aging (OECD 2007). Different countries’ age groups have different levels of pace of growth (Phillipson, 1998; Estes, Biggs and Phillipson, 2003).

 As a consequence of the global demographics of aging, the changing societies of the post millennia are being confronted with quite profound issues relating to illness and health care, access to housing and economic resources including pension provision. The past several years has witnessed an unprecedented stretching of the human life span. This aging of the global population is without parallel in human history (Bengston and Lowenstein 2004). If these demographic trends continue to escalate, by 2050 the number of older people globally will exceed the number of young for the first time since formal records began raising questions of the power of the nation state in the context of global aging.


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Spring 2011