Health and ageing in low, middle and high-income countries (1)

Western populations are facing two major challenges today: The integration of the aging population and the increasing amount of immigrants into society. Indeed, this has never been as pertinent as today (e.g. Castles & Miller, 2009; Deutsche Bundesregierung, 2007). Given the current state of globalization with the emergence of new institutions and new forms of migration, the pressure on societies to deal with these unexpected changes is rising. For instance, the establishment of the European Union and the free boarders within it allows for increasing job mobility. As a result, not just the number of immigrants increases, but also the composition of all demographic cohorts, resulting in new consolidated minorities: elderly and race groups.
An increase in the number of minority groups can raise prejudice against them based on the majority’s fear of the increasing importance of the minority which in turn can lead to greater discrimination against the minorities (Becker, 1971).
This project aims at comparing different approaches to measure age and race discrimination in health care: Therefore 3 methods were used: a survey to measure the perceived age and race discrimination in medical treatment, a field experiment to compare the objective race and age discrimination and a lab experiment based on the game theory.

Western populations are facing two major challenges today: The integration of the aging population and the increasing amount of immigrants into society. Not just the number of immigrants increases, but also the composition of all demographic cohorts, resulting in new consolidated minorities: elderly and race groups. An increase in the number of minority groups can raise prejudice against them based on the majority’s fear of the increasing importance of the minority which in turn can lead to greater discrimination against the minorities.Given that the forms of discrimination manifested by different groups will depend on perceived cultural norms acquired through personal experience and socialization, developing countries may experience discriminatory behavior towards usthe elderly and migrants quite differently, than Western countries. Discrimination in health care is one of the worst, since health is directly related to mortality. Thus, this project aimed at comparing ageism and racism in medical treatment between Germany, The Netherlands (as Western countries) and Indonesia (as a developing country). Video-based experiments were conducted with 480 physicians, who were evaluating the video showing a physician-patient conversation. As expected patients were evaluated differently depending on their age and race.

Data from a longitudinal follow up of 14,000 elderly Costa Ricans 1990-2011 show that the death rate ratio (DRR) among males of the Nicoya region is 0.72 (95% CI: 0.62 – 0.82) compared to the rest of Costa Rican males. The DRR for Nicoyan women is not significantly different from one. Accordingly, life expectancy at age 55 for Nicoyan men would be 31.1 years compared to the 26.0 years in Japan, the country with the highest life expectancy. We further explore genetic versus environmental determinants by examining differential effects by migration status: DRR of men born and living in Nicoya (relative to other Costa Ricans) is 0.56 (CI: 0.45 – 0.69), compared to the DRR of 0.87 of immigrants and of 1.10 of out-migrants. The Nicoyan advantage is concentrated in cardio-vascular mortality, with a DRR of 0.50 for non-migrant Nicoya men. Nicoyans do not show significant advantages in most traditional risk factors such as blood pressure or lipids, but do show advantages in three potential markers of stress: overnight urinary cortisol, serum Dehydroepiandrosterone sulfate (DHEAS), and Leukocyte Telomere Length. They also have significantly lower body weight, waist circumference, fasting glucose and disability (physical and cognitive) levels.

This study focuses on a comparative analysis of attitude towards ageing among people aged 40-59 living in Korea and Japan. The purpose of this study is to investigate whether people’s perceptions on one's own future life vary in two countries. We also describe leading factors that make Korean and Japanese middle-aged adults more or less concerned about their ageing. The data for this study are collected from the 2010 Korea General Social Survey (KGSS) and Japanese General Social Survey (JGSS). Three scales of attitude towards ageing were examined as our dependent variables: anxiety about poor health, loss of life and financial independence. Our hypothesis was that Koreans will have more negative attitude towards ageing due to relatively weak social welfare for the elderly compared to Japan and strong family ties which make the elderly dependent on their offspring. However, the findings show that Japanese middle-aged adults are significantly more concerned about their future life than Koreans. After adjusting for socioeconomic characteristics, the difference between two countries became even greater. This study will attempt to address this result as following socioeconomic aspects: characteristics of Korean and Japanese middle-age, different social perceptions on education level and living area (urban/rural) in Korea and Japan.

The image of old age in Bangladesh is associated with graying of hair, wrinkling of skin, with poor physical health, and decreased ability to work. The common expression “bura hoechi”, to be aged, means to be limited in terms of performing economically productive activities, known as ‘work’. For ‘old-old’ age, there is a saying, “uthan akhon onek dure”, which literally means “even the courtyard is like a very distant place.” This takes the notion: even a courtyard becomes a place hard to reach by an old person. A common proverb in the form of rhyme is “jokhon hobe sathi hate porbe lathi.” This translates as “when you are sixty you are likely to need a stick in your hand.” The deterioration of the physical state associated with ageing is reinforced in saying “jokhon hobe ashi tokhon sob basi,” which means “when you are eighty you feel everything in past”.

This study aimed to explore the relationship of perceived health with all-cause mortality among the older persons in Thailand. The data from the National Health Examination Survey III (NHES III) conducted in 2004 were linked to 2004-2008 death records from vital registration system using a unique personal identifier which existed in both data sources. The total samples of 17 439 older persons aged 60 years and older were analyzed using the Cox proportional hazard model. Survival time was calculated as the interval between interview date and date of death or until the date of 31st August 2008 if those older persons were still alive.

The findings indicated that mortality increased across bad health status. The older persons who had fair perceived health were 1.21 (95% CI 1.10-1.34) times more likely to die than very good/good health counterparts and the bad/very bad perceived health older persons were 1.66 (95% CI 1.46-1.88) times more likely to die than the very good/good health older persons.

Indonesia is expected to face rapid population aging in the near future, yet most the expected elderly population are still vulnerable to poverty. In order to economically survive in the prolonging old-age life , health is vital for the elderly. One popular method of maintaining health is to do self-medication. This paper tries to analyze the nature of self-medication for the elderly Indonesians, using inferential and empirical method. The inferential method uses observations of IFLS 2007 data for respondents aged 45 years above, regressed by Heckman selection bias (two-step) model. Using several controlling variables, the regression result indicates self-medication is almost perfectly inelastic for the elderly Indonesians. And an empirical result done in 2012 showed that self-medication is favorable for elderly Indonesians, yet an increase in income will lead elderly Indonesians to change the most favored medication. The results indicate that self-medication is an inferior good for maintaining health of the elderly Indonesians.

While the relationship between self-rated health and mortality is well established in industrialized country settings, there is little evidence from developing countries. This study seeks to further our understanding of the relationship between self-rated health and mortality in a developing country, through the use of a unique longitudinal dataset from Matlab, Bangladesh. Using panel data from two rounds of the Matlab Health and Socioeconomic Survey and the Matlab Health and Demographic Surveillance System, the study first examines correlates of self-reported health, then the relationship between self-reported health and mortality using logistic regression and Cox proportional hazards analyses. To the extent that people are aware of their health condition regardless of whether they have access to health care, this study is expected to find that self-rated health is a good predictor of subsequent mortality and morbidity. However, the high prevalence of infectious diseases and injuries may mean that previous self-rated health status have little relations to subsequent mortality. The results from this study will provide new insights to a scarcely explored topic on the relationship between self-rated health, mortality, and functional disability in a low-income setting.

With the global paradigm shift in disease burden, behavioural change has been identified as one the major drivers of effective disease management. This study examines risk and preventive health behaviour in Ghana controlling for chronic disease status and socio-demographic factors. Data from the Study on Global Ageing and Adult Health (SAGE) conducted in an adult population 18 years and older with significant focus on those aged 50 years plus were analysed. The study focuses on healthy lifestyle behaviour (HLB) estimated using factor analysis and regression modelling to investigate the association between chronic disease, socio-demographic factors and HLB. An overall higher level of HLB among chronic disease persons was found with age, sex education, employment and wealth still being significant predictors of HLB. The study argues that the significant differential in HLB in favour of chronic disease persons will chart a new pathway for the epidemiological transition with longevity.

The aim of this study is to identify the relation between mental and physical subjective and physical health measures across countries. Self-reported health measures are commonly used in ageing surveys, although its problems with respect to the accuracy of self-reported measures are known. These may be explained by cross-cultural differences in response styles. Recent ageing surveys are used to compare objective and subjective health (both mental and physical) for more than 20 countries all over the world. Here, samples of those aged 50 and above were asked about self-reported physical and mental health.
Each respondent had to assess ones general health and ones perceived memory function. Additionally, each interviewee was visited by health personnel, who measured grip strength, lung function and blood pressure as well as BMI and the waist-hip-ratio. Finally, cognitive performance tests, including memory tests, were conducted.