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Understanding and Advancing the Health of Older Populations in sub-Saharan Africa: Policy Perspectives and Evidence Needs

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Background: Debate on policy challenges associated with the health of older populations in sub-Saharan Africa (SSA) has intensified in recent years, centering on a concern about older persons’ vulnerability to ill-health and their exclusion from health services. Despite international policy calls and formal expressions of commitment on the part of SSA governments, comprehensive policy action has remained scant. The impasse reflects a lack of political will and an uncertainty about required policy approaches, engendered by wide gaps in understanding of old age-related health in the region.

Purpose: The purpose of the paper is to pinpoint major approaches and areas of evidence needed as a priority to overcome the impasse in policy on ageing and health in SSA.

Methodology: A critical review of relevant SSA and international scientific, policy and development literature conducted as part of a research project on Dimensions and determinants of health in old age in Kenya and Nigeria: implications for policy.

Results: Six major areas of evidence and a spectrum of approaches are required to (i) strengthen the case on why action on old age-related health should be pursued in the SSA setting and (ii) clarify what concrete forms such action should take.

Conclusion: A systematic research endeavour on the six areas is needed to advance policy and practice on the health of older populations in SSA. If accompanied by an explicit international comparative perspective such research also has the potential to significantly advance scientific debate on ageing and health globally.


  1. 1.

    Velkoff VA, Kowal PR. Population ageing in sub-Saharan Africa: Demographic dimensions 2006. U.S. Census Bureau, Current Population Reports, P 95/07-1. Washington (DC): U.S. Government Printing office; 2007.

  2. 2.

    United Nations Population Division. World population prospects: the 2008 revision. 2010. Available from URL: (Accessed 6 January 2010).

  3. 3.

    World Bank. Country classification. 2010. Available from URL: (Accessed 4 January 2010).

  4. 4.

    United Nations Development Programme. Human development report 2010. The real wealth of nations. Pathways to human development. New York (NY): Palgrave Macmillan; 2010.

  5. 5.

    Aboderin I, Ferreira M. Linking ageing to development agendas in sub-Saharan Africa: Challenges and approaches. J Popul Ageing. 2009;1:51–73.

  6. 6.

    Ofstedal MB, Zimmer Z, Hermalin A, Chan A, Chuang YL, Natividad J, Tang Z. Short-term trends in functional limitation and disability among older Asians: A comparison of five Asian settings. J Cross Cult Gerontol. 2007;22:243–61.

  7. 7.

    Robine JM, Michel JP. Looking forward to a general theory on population aging. J Gerontol Med Sci. 2004;59A:590–7.

  8. 8.

    Martin LG, Freedman VA, Schoeni RF, Andreski PM. Trends in disability and related chronic conditions among people aged fifty to sixty-four. Health Affairs. 2010;29:725–31.

  9. 9.

    United Nations. Madrid International Plan of Action on Ageing (MIPAA). New York (NY): United Nations; 2002.

  10. 10.

    African Union/HelpAge International. Policy framework and plan of action on ageing. Nairobi: HAI Africa Regional Development Centre; 2003.

  11. 11.

    Kalache A, Aboderin I, Hoskins I. Compression of morbidity and active ageing: Key priorities for public health policy. Bull World Health Organ. 2002;80:243–4.

  12. 12.

    Daar AS, Singer PA, Persad DL, Pramming SK, Matthews DR, Beaglehole R, et al. Grand challenges in chronic non-communicable diseases. Nature. 2007;450:494–6.

  13. 13.

    Lloyd-Sherlock P. Population ageing and development. From generalisation to evidence. Bristol (UK): Policy Press; 2010.

  14. 14.

    Amuyunzu-Nyamongo M. Need for a multi-factorial, multi-sectorial and multi-disciplinary approach to NCD prevention and control in Africa. Glob Health Promot. 2010;1757–9759; Suppl: 31–2.

  15. 15.

    World Health Organization. 2008–2013 Action plan for the global strategy on the prevention and management of noncommunicable disease. Geneva: WHO; 2008.

  16. 16.

    Ebrahim S. Chronic diseases and calls to action. Int J Epidemiol. 2008;37:225–30.

  17. 17.

    World Bank. Public policy and the challenge of noncommunicable diseases. Washington (DC): World Bank; 2007.

  18. 18.

    De-Graft Aikins A, Unwin N, Agyemang C, Allotey P, Campbell C, Arhinful D. Tackling Africa’s chronic disease burden: From the local to the global. Global Health. 2010;6:5.

  19. 19.

    African Union. Africa health strategy 2007–2013. Addis Ababa: African Union; 2007.

  20. 20.

    Aboderin I, Gachuhi, M. First East African policy-research dialogue on ageing. Identifying information gaps. AFRAN Policy-Research Dialogue Series, Report 01-2007. African Research on Ageing Network. Oxford Institute of Ageing; 2007.

  21. 21.

    Aboderin I. Advancing health service provision for older persons and age-related non-communicable disease in sub-Saharan Africa: Identifying key information and training needs. AFRAN Policy-Research Dialogue Series, Report 01-2008. Oxford Institute of Ageing; 2008.

  22. 22.

    Kenya Ministry of Health. National Health Sector Strategic Plan II 2005–2012. Nairobi, Kenya: KMoH; 2005

  23. 23.

    World Health Organization. The health of the people. The African regional health report. Brazzaville: WHO Regional Office for Africa; 2006.

  24. 24.

    Clausen T, Wilson AO. Twenty-five years of expectation. Where are the services for older people with mental illness in Africa? Int Psychiat. 2010;7:32–4.

  25. 25.

    Kowal P, Kahn K, Ng N, Naidoo N. et al. Ageing and adult health status in eight lower—income countries: the INDEPTH WHO—SAGE Collaboration. Global Health Action. 2010:Suppl2;11–22.

  26. 26.

    Kimokoti RW, Hamer DH. Nutrition, health and aging in sub-Saharan Africa. Nutr Rev. 2008;66:611–23.

  27. 27.

    Clausen T, Charlton KE, Holmboe-Ottesen G. Nutritional status, tobacco use and alcohol consumption of older persons in Botswana. J Nutr Health Aging. 2006;10:104–10.

  28. 28.

    Gureje O, Kola L Afolabi E. Epidemiology of major depressive disorder in elderly Nigerians in the Ibadan Study of Ageing: A community-based survey. Lancet. 2007;370:9591:957–64.

  29. 29.

    Clausen T, Romoren TI, Ferreira M, Kristensen P, Ingstad B, Holmboe-Ottensen G. Chronic diseases and health inequalities in older persons in Botswana (Southern Africa): A national survey. J Nutr Health Aging. 2005;9: 455–61.

  30. 30.

    Bekibele CO, Gureje O. Self-reported visual impairment and impact on vision-related activities in an elderly Nigerian population: Report from the Ibadan Study of Ageing. Ophthalmic Epidemiol. 2008;15:250–6.

  31. 31.

    Bekibele CO, Gureje O. Fall incidence in a population of elderly persons in Nigeria. Gerontol. 2010;56:278–83.

  32. 32.

    Lasisi AO, Abiona T, Gureje O. The prevalence and correlates of self-reported hearing impairment in the Ibadan Study of Ageing. Trans R Soc Trop Med Hyg. 2010;104:518–23.

  33. 33.

    Gureje O, Ogunniyi A, Kola L. The profile and impact of probable dementia in a sub-Saharan African community: Results from the Ibadan Study of Aging. J Psychosom Res. 2006;61:327–33.

  34. 34.

    Gureje, O, Ogunniyi A, Kola L, Afolabi E. Functional disability in elderly Nigerians: Results from the Ibadan Study of Ageing. J Am Geriatr Soc. 2006;54:1784–9.

  35. 35.

    Clausen T, Wilson AO, Molebatsi RM, Holmboe-Ottesen G. Diminished mental- and physical function and lack of social support are associated with shorter survival in community dwelling older persons of Botswana BMC Public Health. 2007;7:144–52.

  36. 36.

    Gureje O, Ademola A, Olley BO. Depression and disability: Comparisons with common physical conditions in the Ibadan Study of Aging. J Am Geriatr Soc. 2008;56:2033–8.

  37. 37.

    Kyobutung C, Egondi T, Ezeh A. The health and well-being of older people in Nairobi’s slums. Glob Health Action. 2010;S2:45–53.

  38. 38.

    Debpuur C, Welaga P, Wak G, Hodgson A. Self-reported health and functional limitations among older people in the Kassena-Nankana District, Ghana. Glob Health Action. 2010;S2:54–63.

  39. 39.

    Gómez-Olivé, FX, Thorogood M, Clark BD, Kahn K, Tollman S. Assessing health and well-being among older people in rural South Africa. Glob Health Action. 2010;S2:23–35.

  40. 40.

    Mwanyangala MA, Mayombana C, Urassa H, Charles J, Mahutanga C, Abdullah S, Nathan R. Health status and quality of life among older adults in rural Tanzania. Glob Health Action. 2010;S2:36–44.

  41. 41.

    Gureje O, Kola L, Afolabi E, Olley BO. Determinants of quality of life of elderly Nigerians: Results from the Ibadan Study of Ageing. Afr J Med Med Sci. 2008;37:239–47.

  42. 42.

    Bekibele CO. Gureje O. Impact of self-reported visual impairment on quality of life in the Ibadan Study of Ageing. Br J Ophthalmol. 2008;92:612–5.

  43. 43.

    BeLue R, Okoror TA, Iwelunmor J, Taylor KD, Degboe AN, Agyemang C, Ogedegbe G. An overview of cardiovascular risk factor burden in sub-Saharan African countries: A socio-cultural perspective. Global Health. 2009;5:10–22.

  44. 44.

    Mbanya J-CN, Motala AA, Sobngwi E, Assah FK, Enoru ST. Diabetes in sub-Saharan Africa. Lancet. 2010;375:2254–66.

  45. 45.

    Addo J, Smeeth L, Leon DA. Hypertension in sub-Saharan Africa. A systematic review. Hypertension. 2007;50:1012–8.

  46. 46.

    Uwakwe R, Ibeh CC, Modebe AI, Bo E, Ezeama N, Njelita I, et al. The epidemiology of dependence in older people in Nigeria: Prevalence, determinants, informal care, and health service utilization. A 10/66 Dementia Research Group cross-sectional survey. J Am Geriatr Soc. 2009;57:1620–7.

  47. 47.

    McIntyre D. Health policy and older people in Africa. In: Lloyd-Sherlock P, editor. Living longer. Ageing, development and social protection. London and New York: Zed Books; 2004. p. 160–183.

  48. 48.

    Xu K, Evans DB, Kadama P, Nabyonga J, Ogwal PO, Nabukhonzo P, Aguilar AM. Understanding the impact of eliminating user fees: Utilization and catastrophic health expenditures in Uganda. Soc Sci Med. 2006;62:866–76.

  49. 49.

    Cohen B, Menken J. Report — Aging in sub-Saharan Africa: Recommendations for furthering research. In: Cohen B, Menken J, editors. Aging in sub-Saharan Africa: Recommendations for furthering research. Washington (DC): The National Academies Press; 2006. p. 7–45.

  50. 50.

    United Nations/International Association of Gerontology and Geriatrics. Research agenda on ageing for the 21st century. New York (NY): United Nations; 2008.

  51. 51.

    World Health Organization. World health statistics 2009. Geneva: WHO; 2009.

  52. 52.

    United Nations. Millennium Development Goals. 2010. Available from URL: (Accessed 19 December 2009).

  53. 53.

    International Monetary Fund. Factsheet. Poverty Reduction Strategy Papers (PRSP). 2009. Available from URL: (Accessed 8 January 2010).

  54. 54.

    African Development Bank. African development report 2006. Aid, debt relief and development in africa. Oxford (UK): Oxford University Press; 2006.

  55. 55.

    Nigeria Federal Ministry of Health. Revised national health policy. Abuja, Nigeria: Federal Ministry of Health; 2005.

  56. 56.

    World Bank. World development report 2006: Equity and development. Washington (DC): orld Bank; 2005.

  57. 57.

    World Health Organization. closing the gap in a generation: Health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. Geneva: WHO; 2008.

  58. 58.

    World Health Organization. WHO STEP wise approach to surveillance. 2010. Available from URL: (Accessed 20 April 2010).

  59. 59.

    Kuhn R, Rahman O, Menken J. Survey measures of health: How well do self-reported and observed indicators measure health and predict mortality. In: Cohen B, Menken J, Editors. Aging in sub-Saharan Africa: Recommendations for furthering research. Washington (DC): The National Academies Press; 2006. p. 314–342.

  60. 60.

    Ahenkora K. The contribution of older people to development. The Ghana study. Ghana, Accra: HelpAge International and HelpAge; 1999.

  61. 61.

    Mohatle T, deGraft Agyarko R. The contribution of older people to development. The South Africa study. UK: HelpAge International; 1999.

  62. 62.

    World Health Organization. WHO guide to identifying the economic consequences of disease and injury. 2009. Geneva: WHO. Available from URL: (Accessed 4 June 2010).

  63. 63.

    Obrist B, Iteba N, Lengeler C, Makemba A, Mshana C, Nathan R, et al. Access to health care in contexts of livelihood insecurity: A framework for analysis and action. PLoS Med. 2007;4:1584–8.

  64. 64.

    Gilson L, McIntyre D. Removing user fees for primary care in Africa: The need for careful action. BMJ. 2005;331:762–5.

  65. 65.

    Kristiansson C, Gotuzzo E, Rodriguez H, Bartoloni A, Strohmeyer M, Tomson G, Hartvig P. Access to health care in relation to socioeconomic status in the Amazonian area of Peru. Int J Equity Health. 2009;8:11.

  66. 66.

    Larson CP, Unnati RS, Rafiqul I, Nikhil R. Childhood diarrhoea management practices in Bangladesh: Private sector dominance and continued inequities in care. Int J Epidemiol. 2006;35:1430–9.

  67. 67.

    Chuma J, Gilson L, Molyneux C. Treatment seeking behaviour, cost burdens and coping strategies among rural and urban households in coastal Kenya: An equity analysis. Trop Med Int Health. 2007;12:673–86.

  68. 68.

    Rispel LC, de Sousa CA, Molomo BG. Can social inclusion policies reduce health inequalities in sub-Saharan Africa? A rapid policy appraisal. J Health Popul Nutr. 2009;27:492–504.

  69. 69.

    Guarnizo-Herreño CC, Agudelo C. Gender-related equity/inequity in gaining access to health services. Rev Salud Publica (Bogota). 2008;10Suppl:44–57.

  70. 70.

    Pokhrel S, Snow R, Dong H, Hidayat B, Flessa S, Sauerborn R. Gender role and child health care utilization in Nepal. Health Policy. 2005;74:100–9.

  71. 71.

    Sauerborn R, Berman P, Nougtara A. Age bias but no gender bias in the intra-household resource allocation for health care in rural Burkina Faso. Health Transit Rev. 1996;6:131–45.

  72. 72.

    Larme, A. (1997) Health Care Allocation and Selective Neglect in Rural Peru Social Science and Medicine 44: 1711–1723.

  73. 73.

    Phillipson C. Aging and globalization: Issues for critical gerontology and political economy. In: Baars J, Dannefer D, Phillipson C, Walker A, Editors. Aging, globalization and inequality. Amityville (NY): Baywood; 2006. p. 43–58.

  74. 74.

    Scharf T, Phillipson C, Kingston P, Smith AE. Social exclusion and older people: Exploring the connections. Educat Ageing. 2001;16:303–20.

  75. 75.

    Labonté R, Schrecker T. Globalization and social determinants of health: Introduction and methodological background (Part 1 of 3) Global Health. 2007;3:5–15.

  76. 76.

    de Graft Aikins A. Healer-Shopping I Africa: New evidence from a rural-urban qualitative study of Ghanaian diabetes experiences. BMJ. 2005;331:737.

  77. 77.

    Kolling M, Winkley K, von Deden M. ’For someone who’s rich it’s not a problem’. Insights from Tanzania on diabetes health-seeking and medical pluralism among Dar es Salaam’s urban poor. Global Health. 2010;6:8.

  78. 78.

    Mendis S, Fukino K, Cameron A, Laing R, Filipe A Jr, Khatib O, et al. The availability and affordability of selected essential medicines for chronic diseases in six low- and middle-income countries. Bull World Health Org. 2007;85:279–88.

  79. 79.

    van Mourik MSM, Cameron A, Ewen M, Laing RO. Availability, price and affordability of cardiovascular medicines: a comparison across 36 countries using WHO/HAI data. BMC Cardiovasc Disord. 2010;10:25.

  80. 80.

    Lagarde M, Palmer N. The impact of user fees on health service utilization in low- and middle-income countries: How strong is the evidence? Bull World Health Org. 2008;86:839–48.

  81. 81.

    Chuma J, Musimbi J, Okungu V, Goodman C, Molyneux C. Reducing user fees for primary health care in Kenya: Policy on paper or policy in practice? Int J Equity Health. 2009;8:15.

  82. 82.

    Bakeera SK, Wamala SP, Galea S, State A, Peterson S, Pariyo GW. Community perceptions and factors influencing utilization of health services in Uganda. Int J Equity Health. 2009;8:25–37.

  83. 83.

    Chawla M, Ellis RP. The impact of financing and quality changes on health care demand in Niger. Health Policy Plan. 2000;15:76–84.

  84. 84.

    Dillip A, Hetzel MW, Gosoniu D, Kessy F, Lengeler C, Mayumana I, et al. Socio-cultural factors explaining timely and appropriate use of health facilities for Degedege in south-eastern Tanzania Malar J. 2009;8:144.

  85. 85.

    Chibwana AI, Mathanga DP, Chinkhumba J, Campbell CH Jr. Socio-cultural predictors of health-seeking behaviour for febrile under-five children in Mwanza-Neno District, Malawi. Malar J. 2009;8:219.

  86. 86.

    Hetzel M, Iteba N, Makemba A, Mshana C, Lengeler C, et al. (2007) Understanding and improving access to prompt and effective malaria treatment and care in rural Tanzania. The ACCESS Programme. Malar J. 2007;6:83–98.

  87. 87.

    Siegrist J, Marmot M, Editors. Social inequalities in health: New evidence and policy implications. Oxford (UK): Oxford University Press; 2007.

  88. 88.

    McMunn A, Breeze E, Goodman A, Nazroo J, Oldfield Z. Social determinants of health in old age. In: Marmot M, Wilkinson RG, editors. Social determinants of health. Oxford (UK): Oxford University Press; 2006. p. 267–96.

  89. 89.

    Smith K, Golman N. Socioeconomic differences in health among older adults in Mexico. Soc Sci Med. 2007;65:1372–85.

  90. 90.

    Nguyen CT, Couture M-C, Alvarado BE, Zunzunegui M-V. Life course socioeconomic disadvantage and cognitive function among the elderly population of seven capitals in Latin America and the Caribbean. J Aging Health. 2008;20:347–62.

  91. 91.

    Zimmer Z. Poverty, wealth inequality and health among older adults in rural Cambodia. Soc Sci Med. 2008;66: 57–71.

  92. 92.

    Ferraro K, Shippee TP. Aging and cumulative inequality: How does inequality get under the skin? Gerontologist. 2009;49:333–43.

  93. 93.

    Crystal S. Dynamics of late-life inequality: Modeling the interplay of health disparities, economic resources and public policies. In: Baars J, Dannefer D, Phillipson C, Walker A, Editors. Aging, globalization and inequality. The new critical gerontology. Amityville (NY): Baywood; 2006. p. 205–14.

  94. 94.

    Brunner E, Marmot MG. Social organization, stress and health. In: Marmot M, Wilkinson RG, (Editors). Social determinants of health. Oxford: Oxford University Press; 2006. p. 6–31.

  95. 95.

    Stansfield SA. Social Support and Social Cohesion. In: Marmot M, Wilkinson RG, (Editors). Social determinants of health. Oxford: Oxford University Press; 2006. p. 148–171.

  96. 96.

    Monteverde M, Noronha K, Palloni A. Effect of early conditions on disability among the elderly in Latin America and the Caribbean. Popul Stud. 2009;63:21–35.

  97. 97.

    Kinra S. Commentary: Beyond rural-urban comparisons: Towards a life course approach to understanding health effects of urbanization. Int J Epidemiol 2004;33:777–8.

  98. 98.

    Ogunniyi AO, Osuntokun BO. Determination of ages of elderly Nigerians through historical events: Validation of Ajayi-Igun. West Afr J Med. 1993;12:189–90.

  99. 99.

    Falkingham J, Namazie C. Measuring health and poverty. A review of approaches to identifying the poor. London (UK): DFID Health Systems Resource Centre, Department for International Development (DFID); 2002.

  100. 100.

    Expert Group on Poverty Statistics (Rio Group). Compendium of best practices in poverty measurement. 2006. Available from: (Accessed 8 February 2011)

  101. 101.

    Nguyen CT, Couture M-C, Alvarado BE, Zunzunegui M-V. Life course socioeconomic disadvantage and cognitive function among the elderly population of seven capitals in Latin America and the Caribbean. J Aging Health. 2008;20:347–62.

  102. 102.

    Blazer DG, Sachs-Ericsson N, Hybels CF. Perceptions of unmet basic needs as a predictor of mortality among community-dwelling older adults. Am J Public Health. 2005;95:299–304.

  103. 103.

    Blazer DG, Sachs-Ericsson N, Hybels CF. Perceptions of unmet basic needs as a predictor of depressive symptoms among community-dwelling older adults. J Gerontol A Biol Sci Med Sci. 2007;62:191–5.

  104. 104.

    Wilkinson RG. Ourselves and others — For better or worse: social vulnerability and inequality. In: Marmot M, Wilkinson RG, Editors. Social determinants of health. Oxford (UK): Oxford University Press; 2006. p. 341–358.

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Correspondence to Isabella Aboderin PhD.

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Recommended Citation: Aboderin I. Understanding and Advancing the Health of Older Populations in sub-Saharan Africa: Policy Perspectives and Evidence Needs. Public Health Reviews. 2010;32:357–76.

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Key Words

  • sub-Saharan Africa
  • aging
  • older adults
  • health policy