International Longevity Centre–South Africa (ILCSA) is a not-for-profit research, policy and education organisation which focuses on the promotion of healthy and productive ageing, and older persons’ full participation in society. It is affiliated to The Albertina and Walter Institute of Ageing in Africa in the Faculty of Health Sciences at the University of Cape Town, South Africa.

ILSCA was admitted to the International Longevity Center (ILC) Global Alliance, headquartered in New York City, USA, in June 2005. Founded in 1990 by President and CEO Dr Robert Butler, ILC is an international group dedicated to the study of longevity, and the political, social and economic integration of older persons in society. The group’s mission is to help societies to address issues, and to respond to challenges and opportunities of population ageing and longevity in positive and constructive ways.

The ILC Global Alliance has centres in the United States, the United Kingdom, Japan, France, the Dominican Republic, India, Argentina, the Netherlands and Israel. ILCSA is the only ILC in the Africa region.

Mission

The mission of ILCSA is to understand processes, implications and situations of individual and population ageing in South Africa and sub-Saharan Africa (SSA), and to help African societies to accommodate an expanding older population and to enhance the quality of life of older citizens. ILCSA carries out its mission through research, training and advocacy, and the dissemination of knowledge for decision support. Its programmes view population ageing and longevity positively, and aim to facilitate the optimisation of individuals’ capacity for active, healthy and productive ageing.

Ageing in South Africa and sub-Saharan Africa

ILCSA activities focus on population ageing and longevity in South Africa, but take cognisance of related trends and situations elsewhere in sub-Saharan Africa (SSA), with an aim to achieve a sub-regional understanding and to transfer technology and expertise in the sub-region. Sub-Saharan Africa is the world’s poorest and least developed sub-region; all but two of 30 countries with low human development world-wide are in SSA (UNPD, 2006). Numerous social ills beset the sub-continent, challenge nations, and retard or reverse development, which ills include rural stagnation, the proliferation of urban slums, the HIV/AIDS crisis and armed conflict. Fertility and mortality rates remain high: 65 per cent of the population is younger than 25 years and only 5 per cent is 60 years or older (projected to rise to 8 per cent by 2050). The absolute number of older persons will however rise dramatically: from 36.6 million in 2005, to 140 million by 2050. Life expectancy at age 60, currently 16 years, does not differ markedly from that of other world regions. South Africa’s population aged 60 years and over constitutes 7.2 per cent of the total population, projected to rise to 13.1 per cent by 2050. Life expectancy at age 60 will increase from 16.5 years to 19.5 years by 2050 (UN/DESA, 2007).

Hence, SSA countries have fairly youthful populations, although a longevity trend is under way. The concerns of the governments are however primarily those of the young. Nevertheless, consequences of key issues and trends in the sub-region impact not only younger persons, but the welfare and well-being of older persons as well. Such trends and issues include chronic poverty, weak infrastructure, high youth unemployment, rural to urban migration of young adults, changing family structures and kin support systems, inadequate social protection, persisting infectious diseases – especially HIV/AIDS, poor access to health care, gender inequality, and human rights violations. Specific issues and their consequences, or their impact on older persons are considered briefly.

Governments of SSA countries must still eradicate infectious diseases (especially malaria, tuberculosis, waterborne disease and HIV/AIDS) and few resources are available to manage a growing burden of chronic disease. Health care for older persons is unsatisfactory widely, through poor access, or barriers to services and marginalisation of older clients in health care delivery. Given widespread poverty, virtually all older Africans are reliant on public health services for treatment; very few are able to pay for private health care. The concept of long-term care is virtually non-existent in SSA. Frail and sick older persons rely on family members to care for them in domestic settings without help from formal agencies. Very few residential care facilities exist for older persons; institutionalisation of elders is unacceptable culturally, and mainly socially indigent and frail elders who have no kin to care for them live in such a facility.

Only six SSA countries (Botswana, Lesotho, Mauritius, Namibia, Senegal and South Africa) thus far operate a social pension programme; elders in the other countries depend on family for income support, or continue to earn a livelihood. South Africa’s non-contributory (but means tested) social pension programme, along with that of Brazil, is the most expansive in the developing world (Barrientos, Ferreira et al., 2003). Studies show that beneficiaries (women aged 60 and over, men aged 65 and over – the age of eligibility for men is to be lowered to 60 by 2010) share pension income with family and household members, and contribute to development in this way. Beneficiaries are entitled to free treatment at public health care facilities and placement in a state subsidised residential care facility, where needed and if a facility is available. However, a downside of the pension programme is a requirement that beneficiaries are economically inactive, which effectively removes older workers who are poor from the labour force, limits their capacity for productive ageing, and increases an economic burden on the state.

African society is patriarchal and characterised by deep gender divides. Older women, in particular, are discriminated against and disadvantaged in numerous social, economic and political arenas. In South Africa, customary law is practised alongside Western law, especially in rural areas and largely under the authority of tribal chiefs. Under customary law women may not inherit their deceased husband’s property (only males have rights to inheritance). Older widows in these areas are particularly vulnerable to exploitation, abuse and destitution. Nonetheless, South Africa’s Constitution prohibits discrimination on several grounds, especially gender and race, and the government conducts aggressive campaigns to ensure that women’s rights to equality are honoured. The government is less clear though on the eradication of age discrimination; most institutions continue to enforce mandatory age based retirement rules. Older persons tend neither to enjoy equal application of the law in practice.

A major crisis in the sub-region that impacts older persons severely are the effects of the HIV/AIDS epidemics. Poor and affected older persons face a loss of support and care from kin in old age when their adult children succumb to the disease. In addition, they must assume responsibility for raising grandchildren orphaned as a result of the disease. Older women, in particular, bear a heavy material, physical and emotional care burden, and in most cases receive no formal support. Older persons themselves are increasingly at risk of infection with the HI virus, which infection is typically neither suspected nor diagnosed, and goes untreated.

Such is a thumb-nail sketch of the status and situations of older persons in the sub-region and gives background to the thrusts and aims of ILCSA's various programmes and activities. The situation of older persons in South Africa is similar to that in other SSA countries, except that South African elders, as in a handful of other Southern African countries, enjoy virtually universal and relatively generous, regular social pension benefits.

Barrientos, A., Ferreira, M., Gorman, M. et al. 2003. Non-contributory pensions and poverty prevention: A comparative study of Brazil and South Africa. London: Institute of Development Policy and Management (Manchester) and HelpAge International.

United Nations Population Division (UNPD). 2006. Population ageing 2006. Wallchart. New York: UNPD.

United Nations Department of Economic and Social Affairs (UN/DESA). 2007. World Population Ageing 2007. New York: UN.

Research

The Institute of Ageing in Africa (IAA) and affiliate ILCSA are leading research centres of excellence on ageing and older persons in South Africa and indeed the SSA sub-region. Priority areas for research identified in recent international and national research agendas for the sub-region (e.g. the AFRAN agenda (2005), the updated UN/IAGG agenda (2008), and the US National Academies of Science (NAS) agenda (2007)), and guide ILCSA’s research programme. The areas include health conditions, health care, social protection and poverty reduction, and to this end, ILCSA is currently 1) participating in a six-year follow-up of the collaborative bi-national (South Africa and Brazil) Non-Contributory Pensions and Poverty Study (NCPPS) conducted in 2002/03, now known as BRAZZA2 and focused on ageing, well-being and development, and 2) continuing subsequent phases of the collaborative Study to Understand and Foster the Functioning and Involvement of Contributive Elders (SUFFICE) project, which will include a) a health intervention at two key geriatrics sites, b) a generalisation survey in three provinces, and c) comparative research with New York based collaborators and a US database. Other research intervention projects under way deal with a) falls, their prevention and management; b) community stroke rehabilitation practices; c) the diagnosis and management of, and risk factors for dementia in specific cultural settings; and iv) the quality of geriatric care.

Training

Enhanced training programmes in Gerontology and Geriatrics are needed nationally and sub-regionally. At present, training in multidisciplinary Gerontology is not offered as a degree course at any sub-regional institution; graduate students may work in Gerontology but are required to graduate in their mother discipline. ILCSA is working with national and sub-regional stakeholders to develop and formalise multi-disciplinary education in this field. .

Training in Geriatric Medicine in the sub-region is far from optimal. Thus far, health professionals and teaching institutions have tended to view Geriatrics as a Cinderella sub-speciality; consequently, the clinical care of older patients is hardly included in medical training curricula and attracts little interest as an area of specialisation. Training of health professionals allied to medicine in ageing and the care of older persons equally needs a stronger focus. Similarly, training is needed for a range of workers in the non-formal sector (non-profit organisations (NPOs)). Once again, ILCSA is working with national and sub-regional stakeholders to expand and training in Gerontology and Geriatric Medicine, and thus improve geriatric care broadly.

Policy

Policy on ageing in South Africa and the sub-region is under developed in general. What policies on ageing there are tend to be fragmented and uneven, and to have a sectoral bias. Given SSA governments’ focus on youth development, poverty reduction, job creation and the eradication of infectious diseases, the formation and implementation of policy to benefit older persons is not a priority.

In South Africa, a major schism exists between policies and programmes for older persons provided separately by the ministries of Health and Social Development (or Welfare), and the strategies and programmes are unco-ordinated. The Social Development ministry assumes primary responsibility for older persons, but interprets its mandate narrowly; it focuses on the provision of old age grants, the subsidisation of certain facilities and services, and the prevention of elder abuse. The Health ministry has no specific policies on older persons, but operates a Geriatrics sub-directorate, which mainly develops geriatric care protocols. No other ministries have policies that benefit older persons specifically.

Nonetheless, new landmark legislation in South Africa in the form of the Older Persons Act No. 13 of 2006 is aimed at protecting older citizens’ rights, regulating facilities and services, and empowering older persons to live a life in dignity and security. ILCSA participated in the drafting of the legislation as well as the establishment of the South African Older Persons’ Forum (SAOPF); the forum assumes a policy implementation watchdog role.

ILCSA engages moreover with stakeholders, through advocacy and knowledge production and dissemination, to develop or reform policy. Special efforts it is making include 1) advocacy for the formulation and adoption of a national plan of action on ageing, and 2) participation in review and appraisal activities of progress made in the implementation of recommendations in the UN’s Madrid International Plan of Action on Ageing (MIPAA) and the African Union’s Policy Framework and Plan of Action on Ageing.

Key areas relating to the well-being of older persons in South Africa in need of policy reform include a) improved health care provision and delivery; b) expanded community based care and support services; c) eradication of all forms of age discrimination; and d) empowerment of older persons to know and exercise their rights, and to participate in social, economic and political processes fully, especially those that affect them. These areas are underscored in the UN’s Strategic Implementation Framework (forthcoming) and constitute a set of goals for ILCSA’s activities.