Category Archives: Asia

Asia is the largest and most populous continent with a blend of many different climates. It varies greatly across and within its regions concerning ethnic groups, cultures, environments, economics, historical ties and government systems. Many of the world’s major religions have their origins in Asia.

Boosting Public Transport Supply to Meet Needs of India’s Aging Population

India’s elderly population is expected to rise by 360% between 2000 and 2050 and contributes to 20% of the total population. Due to population growth, infrastructure in India has to keep up with the demographic change by providing accessible and affordable public transportation, which is vitally important. India boasts of a well-connected transportation system with trains, buses, metro systems, auto rickshaws and taxis in urban as well as, to a lesser extent, rural areas. Despite the plethora of transportation options, many of these services are beyond the reach of the elderly population.

Mumbai
The large number of people utilizing public transportation is a major hindrance for the elderly. For example, in Chennai, a south Indian city, the elderly complain of how government buses are always crowded. While there are seats reserved for the elderly in these buses, it is hard to avail of these services. In Mumbai, another metropolis, trains are the preferred means of transport because they are fast, cheap and reliable. However, they are extremely crowded which makes it really difficult for senior citizens to get in the train. Like the buses in Chennai, these trains too have reserved seating for the elderly.

Another major issue is affordability. As Ravi Samuel of Vision Age India states, “If elderly people cannot afford private transport, it is very difficult for them to commute or attend social, religious and family functions.” Those who can afford it use the relatively expensive modes of transportation which include rickshaws and taxis. They can be hailed from anywhere, depending on the city.

There are national guidelines for age-friendly transportation in place. These include 2 reserved seats for the elderly in the front of the bus, fare concessions and subsidized bus passes, 30% concessions on trains, separate counters for senior citizens, ramps at stations for greater accessibility, disability-friendly train coaches and fare concessions by several major public and private airlines. It is heartening to see that many cities and/or states go above and beyond these guidelines.

For instance, Mumbai is currently petitioning for elderly-only compartments in all trains at the Bombay High Court. New Delhi, the country’s capital, has introduced low-floor buses. Since their introduction, the number of senior citizen bus passes has increased from approximately 255,000 in 2007-08 to 1,100,000 in 2013-14. These buses also display ticker messages on aboard buses, reminding passengers to not occupy or block the seats meant for the elderly.

Initiatives like these are great first steps towards accommodating the elderly population. Yet, it is important to remember that transportation is but one aspect of infrastructure that needs to be worked on. A cross-sectional approach, incorporating sectors such as housing, education, roads, law-enforcement and town planning, is necessary to provide an easier and holistic lifestyle for the elderly population in India.

Namratha Rao is currently pursuing her MSPH in International Health in Social and Behavioral Interventions at the Johns Hopkins University Bloomberg School of Public Health. 

 

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The Need to Address Chronic Conditions in Timor-Leste

Dili_Timor_Leste
Timor-Leste or East Timor is a small low income country in Southeast Asia with a population of 1,114,000. It has years of conflict, violence and brutality, and a tumultuous past with Portuguese and Indonesian forces. The conflict and political upheaval have left its marks on all aspects of development in the country. In 2002, Timor-Leste became an independent nation.

Being one of the newest countries in the world, Timor-Leste’s current WHO Country Cooperation Strategic Agenda 2009-2014 is primarily focused on developing a robust health system and improving capacity building. Key health issue focus areas are infectious diseases, maternal and child health and nutrition. There is an immediate need for data and adequate focus on chronic conditions, especially among the adult and elderly population. Although Timor-Leste has the lowest number of publications in medicine, available preliminary data particularly on cardiovascular diseases and diabetes highlights the growing burden of chronic conditions among the elderly. With increased urbanization and improved economic conditions, there is a need to address this growing burden among the elderly population.

Among the 50-96 year population, cardiovascular and circulatory diseases account for approximately a 25% of the total disability adjusted life years (DALYs). For the population aged 70 years and above, these diseases account for approximately 36% of the total DALYs. Specifically, ischemic heart disease in 2010 accounted for approximately 12% and 16% of the total DALYs for 50-69 year and 70+ year population respectively. The disease burden of diabetes mellitus (in terms of DALYs) among the 50-69 and 70+ year population has also increased from 3.6% to 4% of the total disease burden affecting this population. The overall diabetes prevalence in Timor-Leste is currently low at 2.9%. Available data indicates that 7 out of 10 cases occur in those over 40 years. Furthermore, there is very low awareness of diabetes in the country which is a risk factor for increased diabetes prevalence. Urbanization and economic development have the potential to rapidly increase the prevalence rate. Currently, Timor-Leste does not have a national strategy in place to address the diabetes.

As Timor-Leste works on creating a robust and comprehensive health system, it will be imprudent if chronic conditions affecting older populations are not taken into account. With increased economic growth, access to health services and urbanization, the rising burden of chronic conditions can lead to the high prevalence of communicable and non-communicable diseases i.e. the double burden of disease. Collection of valuable data and surveillance, and strategies to improve awareness and reduce the current burden of chronic diseases are ideas for sustainable good health in Timor-Leste.

Namratha Rao is currently pursuing her MSPH in International Health in Social and Behavioral Interventions at the Johns Hopkins University Bloomberg School of Public Health.

 

 

Affected, not Infected – HIV/AIDS and the Elderly in Thailand

The HIV virus is known to affect men and women in their reproductive age, between 15-49 years, leaving behind a large dependent population – children, the elderly, etc. The elderly play an important role in the epidemic although they are the invisible victims of this epidemic. They may not necessarily be infected with HIV, but are certainly affected by it.

The various roles of the elderly in the HIV pandemic include care-giving to the infected children, co-residence with the infected, providing financial and material support, fostering grandchildren, experiencing the suffering and ultimate loss of a child, and facing negative community reactions. HIV can place a huge physical, emotional and financial burden on the elderly population of a country.

Thailand, in South East Asia, reported its first case of AIDS in 1984. The latest UNAIDS estimates (2013) suggest a 1.1% national adult HIV prevalence. Like many developing countries, Thailand maintains a relatively high involvement of older parents in the lives of the adult children. Seven out of ten elderly people over 60 years live with, live near, or receive some form of material support from their adult children. Corresponding figures show that over two-thirds of HIV+ adults lived with or near their parents. Additionally, a similar proportion of HIV+ adults reported to receiving parental care at the terminal stage of illness.

Caregiving to a HIV+ adult child places a significant burden on the elderly. They lose the material, financial and emotional support from children that they are counting on. In Thailand, a study reported that over 50% elderly HIV caregivers experience fatigue, insomnia and anxiety. However, this information is before the provision of antiretroviral therapy (ART) in Thailand. With the improved access to ART, HIV is increasingly looking like a chronic disease. The lifespan of HIV/AIDS patients is increasing, and those under ART can lead a ‘normal’ life. HIV/AIDS is no longer the death sentence it used to be.  Consequentially, the use of ART greatly reduces the responsibilities placed on the shoulders of the elderly population.

A big advantage of ART for the elderly is economic stability. Parents of HIV/AIDS children need no longer use their limited resources on the health of their children. Additionally, they can continue to rely on their adult children with HIV+ for financial support since ART can allow those children to lead a closer to ‘normal’ life. Parents’ psychological well-being has also improved due to fewer worries about the health of their children with HIV/AIDS. Thailand incorporated older people affected by HIV/AIDS as a target group in their 10th National AIDS Plan (2007-2011) for the first time. This not only demonstrates a sensitized understanding of the victims who are infected and affected of HIV/AIDS, but also marks a significant step forward in understanding and providing holistic care for the elderly population in Thailand.

Similar models of HIV care, with the elderly looking after the HIV/AIDS adult children, have been reported in countries including Cambodia and Tanzania. Even with the increasing use of ART, the elderly may play a role, albeit a modified one, in HIV care. There is a strong need for updated and comprehensive data to shed light on the issue to better inform current public health and HIV/AIDS campaigns.

Namratha Rao is currently pursuing her MSPH in International Health in Social and Behavioral Interventions at the Johns Hopkins University Bloomberg School of Public Health.

Women in India – Longevity, Health Disparities and Empowerment

Being over 65 years and living in India is an increasingly common phenomenon. The Indian population over 65 years is steadily on the rise, totaling to a whopping 90 million people in 2011. Estimates suggest that this number will exceed 227 million by 2050. Within this giant aging population, there is a unique sub-section of disadvantaged people who are women. Women in India live longer than men, but consistently report poor health, higher disabilities, lower cognitive function and lower utilization of health services.

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A study in 2008 showed wide health disparities between elderly men and women. Even after controlling for demographics, medical conditions and known risk factors, the gap still existed. Controlling for economic independence, however, reduced the gaps significantly. This emphasizes the necessity for financial empowerment among older women for them to enjoy a healthier life. Financial empowerment may be the key to improving health outcomes of elderly women. However, the barriers of gender discrimination and poor education are hard to overcome.

The Longitudinal Aging Study in India (LASI), the first of its kind in the country, found that elderly women have lower cognitive function than elderly men, and linked this discrepancy to gender discrimination. This study was conducted in two southern states, Karnataka and Kerala, and two northern states, Rajasthan and Punjab. In the southern states, the gender difference was accounted for by poorer education, health and social engagements. However, the disparity in the two northern states existed even after controlling for these known risk factors, indicating a high level of discrimination against women.

Gender bias is evident in all life stages of a woman – female infanticide, poor education facilities, dowry practices, stereotypical roles of women as home-makers and discrimination against widows. It is exceptionally hard for elderly women to have good health and quality of life. Stigma needs to the fought at the grassroots level. The existing government initiatives for the girl child are commendable, but they do little for the current generation of elderly women who continue to face discrimination, poor health, poor education and economic dependence. While the ongoing LASI study will continue to provide a comprehensive understanding of geriatric health in India, targeting elderly women will go a long way in improving health outcomes among the elderly population. The provision of medical, financial and social support for elderly women is empowering, and can improve their overall health and quality of life.

Namratha Rao is currently pursuing her MSPH in International Health in Social and Behavioral Interventions at the Johns Hopkins University Bloomberg School of Public Health. 

A Comparative View of Elder Abuse in Israel and the United States

Photo Credit: Hamed Masoumi

I spend every Tuesday morning visiting a dear friend at a local nursing home. My friend is a Holocaust survivor and at 90 years old, her mind is sharp since she easily recounts the story of her life – from the horrors of the camps to the beauty of Israel and finally to the hard work, freedom, and challenges of America. As I am ready to leave her and return to school each week, a look of loneliness washes over the smile on her face and I am reminded that her only other visitors are nurses and her daughter who can visit once a week.

The elderly comprise a significant amount of the U.S. population and statistics indicate that 10,000 baby boomers will turn 65 each day for the next 15 years. As the U.S. population ages, older adults are often viewed in a negative light, and hence a target group for all kinds of abuse: physical, sexual, verbal and financial exploitation. It is estimated that a shocking 500,000 older adults are abused each year in the United States, with family members as the overwhelming majority of abusers (mainly partners and children of the individual). Most of these cases go unreported because the victim does not have the physical capability or mental capacity to inform an official of the mistreatment.

Elder abuse is a major issue currently plaguing Israel as well. A report by the University of Haifa indicated that 18 percent of elderly participants were subject to some form of abuse. The most common form is verbal abuse, indicating a potential problem in interpersonal relationships as people age. Verbal abuse may also be used as a method to instill terror and power in a relationship, lending the way to more types of abuse.

Many religions teach people to respect and revere the elderly. In short, an individual’s exterior does not properly convey the depth of its contents. My dear friend appears to be a frail old woman with a failing body but her mind is very active. The elderly are people above all else and they deserve to be treated as such.

It is impossible to ignore the fact that everyone will grow old one day. With this in mind, I urge you to take some time and think about giving back by volunteering with a senior in your area. You may be the only contact the person has with the outside world beside the caregiver, and can advocate on their behalf if you suspect abuse. For U.S. residents, visit Give Back to Seniors to search for volunteer opportunities in your community.

Linda Nakagawa is a rising senior at Brandeis University. She is a double major in Psychology and Politics with a minor in Social Justice Social Policy. Linda is originally from Newburgh, New York and is a member of Temple Beth Jacob. As a Machon Kaplan participant, Linda was a public policy intern at the National Association of States United for Aging and Disability.

Singapore: Prevention is Better Than Cure

As we all know, in today’s world, people have longer life expectancies. In fact, 75% of the world’s population is older than 60 years of age (WHO). We live longer but the fact is the fact is that we are not aging very well. Once we reach a certain age, chronic diseases occur and hinder us from living a healthy long life; two out of three global deaths are due to chronic diseases such as heart disease or stroke. Due to the aging population, these chronic diseases and necessary expensive treatments put a financial burden on nations’ healthcare systems. As Dr. Lim states in the video, “the healthcare system in Singapore has worked well the last few decades, but was not built for such an aging population and a population that struggles with chronic diseases.”

                                                                                          Photo Credit: Niall Kennedy

Singapore has responded to the trend and puts emphasis on preventative health strategies rather than on just treating or curing the diseases. In Singapore, many fitness parks with workout stations have been built, which not only help the elderly to get active and stay physically healthy, but also to meet and get to know one another. With the increasing aging population possibly living alone, the social aspect of these fitness parks is important and improves the mental state of the elderly.

Public Health professionals can only hope that such preventative initiatives towards healthy living situations for the elderly, or better yet all age groups, will be continued not only in Asia. If we can persuade the entire family to get involved in these types of physical activities, we will have healthier children, adults, and elderly and can lessen the financial burden on the healthcare system. Other community organizations may get involved by offering exercise classes and promoting fitness among seniors.

In addition, local governments need to be convinced that building fitness parks has a positive impact not only on the elderly, but all residents’ physical and mental health. Governments overall need to rethink and focus on disease prevention, and not only treatment and cure.

What else can WE do to improve the health of our community members?

Martina Lesperance is a Health Educator and Screening Technician in El Paso, Texas.