Is Africa aging? Especially when fertility in Africa has been historically high? With continued focus on maternal and child health policies, an increasing proportion of children are now surviving and entering adulthood, which contributed to a bulge in the young population (ages 1-15 years). Africa is also making progress on checking the spread of HIV and other communicable diseases and widespread use of anti-retroviral treatment (ART) is helping adults to lead a comparatively longer life. The combined effect of early childhood survival and lower mortality in adulthood is likely to increase elderly (aged 65 and above) population in the future. Current projections show that in the next twenty years the number of elderly will almost double to 58 million. Eastern and Western Africa will have the fastest growth in elderly population while Southern Africa will have the highest proportion of elderly (14%). While the proportion in Africa is unlikely to reach the levels in other aging countries/regions like USA, Japan, Europe any time soon, aging does pose a challenge to African economies and health care system.
Projections from the World Health Organization (WHO) indicate that deaths due to non-communicable diseases (NCDs) will rapidly increase among the adults in the Sub-Saharan Africa and reach the levels in other aging regions. NCDs like Diabetes and cardiovascular conditions are on the increase not only in elderly but also in adults and exceed the levels prevalent in USA, UK, India and China. Risk factors like hypertension and alcohol consumption are also higher in SSA while obesity and smoking are at comparable levels as other developed and aging regions.
Africa's Demographic Transition: Planning for the Future of Africa's Youth
Increasing Youth Cohorts Sub Saharan Africa
The early onset of chronic conditions, increasing prevalence among adults is likely to reduce labor force participation. Labor force participation in SSA is 65% and is already lower than other regions. Although elderly are more actively involved in labor force, they are mostly employed in informal sector like agriculture with low wages. These two factors contribute to lower level of personal savings which could be used for prevention and treatment of diseases.
Aging is associated with higher medical expenditure and in Kenya, for example, the increase was 26% in the age group 65-69 as compared to 60-64. Those with chronic conditions have higher out-of pocket costs and the proportion increases with the increase in conditions one is suffering from. WHO estimates that in countries with less than $1000 per capita income, out of pocket expenses are more than 40% of the health expenditure. With the increasing prevalence of chronic conditions in SSA, a larger proportion of the poor is expected to pay for their healthcare through out-of-pocket spending. This system of payment is unsustainable as a study in Nigeria showed that over 60% of participants who used out-pocket spending for healthcare reported difficulty in accessing health services due to financial constraints.
Although the pace of aging in Africa is relatively slow, it will still face an increasing burden of chronic conditions. To reap the potential demographic dividend African countries would have to pay attention to this issue and adequately strengthen the health system.