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Income, health and abuse data is inadequate and risks leaving older people behind

03 Feb 2017

Pedro receives healthcare in Colombia (c) Jonas Wresch/HelpAge International

The Sustainable Development Goals (SDGs), agreed by the United Nations in September 2015, present a major challenge to national and international statistical systems. While they are inclusive of older people, there are serious gaps in global data on ageing. Too often, we fail to count older people in surveys, or to adequately analyse and describe findings about older people in survey reports. When this happens, we are failing to measure the inclusion of older people in the SDGs.

Following the first UN World Data Forum, which took place in Cape Town in January 2017, I look at three areas where data on older people needs to be improved: income security, health and wellbeing, and violence and abuse.

Income security is complex, poverty surveys must appreciate this

The development of policies on income security of older people and the monitoring of progress on poverty reduction relies heavily on analysis of "old age poverty".

In household surveys, the typical methodology takes the total income of a household in which an older person lives and divides it by the number of people living within that household. This figure is then compared to a given poverty threshold.

The limitations are clear: it does not assess the individual situation of an older person, but that of his or her household. It supposes that older people get an equal share of the income and that their needs are the same as everyone else in the household. However, these assumptions may be false. Needs change across people's lives, and it may be the case that children's needs are prioritised over those of older people. Therefore, through this form of poverty analysis we cannot understand older people's situation as distinct from that of the wider household.

Results on old age poverty have been shown to be highly sensitive to changes in assumptions used in household surveys. This issue has been explored in HelpAge International research due to be published on wellbeing and quality of life in Bangladesh and Pakistan. The findings demonstrate that when alternative assumptions are used, for example in relation to economies of scale and different levels of consumption among children, the results show higher levels of poverty among older people. What this means is that we have to interpret old age poverty data with care.

An older man and woman in Kenya make soap to sell - a way of ensuring they have an income (c) Benj Binks/HelpAge International

To overcome these limitations, poverty data analysis must take into account the broad nature of old age income security. Older people have a diverse range of income sources, including work, pensions, money transfers from family, and savings and assets. These must be assessed to find out if overall income is adequate, sufficiently regular and predictable. We must understand how sources of income interact with and complement each other, and take into account the cost of services older people are likely to access, such as healthcare.

Health indicators and targets fail to monitor progress on older people

The Sustainable Development Goals have a clear call for universal health coverage (UHC) worldwide. But without the right data on the obstacles people face, it is impossible to measure progress towards this goal.

There are shortcomings in the data sources typically used to measure the indicators of progress on the health SDG for older people. For example, current SDG indicators to measure UHC include a coverage indicator that tracks access to a number of key prevention and treatment services.

Treatment for hypertension and diabetes is included here, yet older people's access may not be measured. Where the data is drawn from Demographic and Health Surveys (DHS) and WHO's STEPS NCD Risk Factor Surveys (STEPS), limited information will be available for older people.

DHS surveys normally exclude women aged 50 and over, and men aged 55 or 60 and over; and WHO guidance suggests the inclusion of people up to age 69 in the case of STEPS.

Though older people are part of the SDGs health framework, it is clear that current indicators do not adequately monitor progress in accessing healthcare across all ages. The consequence is that we risk leaving behind the most vulnerable older people.

National surveys are missing opportunities to close the data gap on violence and abuse

Every person, regardless of race, sex, age, disability or socio-economic status, has a right to lead their life free from violence and abuse. The SDGs call for the elimination of this kind of discrimination in all its forms. However, the data is not there to fully understand how it impacts older people - only 17% of 133 countries have conducted a national survey on elder abuse, and this is primarily in high-income states (pg 23).

Where evidence is available, it suggests elder abuse is a significant problem globally. In the EU, the rate of violence and abuse against women aged 60-97 is 28%. In low and middle-income countries, reports of prevalence vary. In Peru 83% of men and women aged 50+ have reported at least on form of abuse, while in Kyrgyzstan it is 35%. Yet we do not have the full picture. 

Nzingo has been attacked by her relatives in Kenya (c) Roopa Gogineni/HelpAge International

We need to know about the different types of violence and abuse experienced in later life, which groups of older men and women are most at risk, who is perpetrating the crimes, the frequency and length of time they have been happening, and the channels through which victims seek help. One way to address this data gap is to gather information on elder abuse through ageing-specific and general surveys. Yet there is no consistency in the inclusion of questions on violence and abuse, and the amount of information requested varies by survey.

The Demographic and Health Survey, for example, offers a great opportunity to close the data gap. It is carried out across 90 low and middle-income countries and has a stand-alone module on violence and abuse. However, it does not currently incorporate older people's experiences. There is an upper age limit on participation and it is at each country's discretion whether to include the module. Even if they do include it, the template can be altered to omit the more sensitive questions, such as those on sexual violence.

Developing internationally agreed guidelines on violence and abuse data in later life would stimulate better inclusion of core questions on elder abuse in national surveys, and lead to greater availability of comparable statistics across countries.

I have outlined data gaps affecting older people in the areas of income security, universal health coverage and experience of violence and abuse. Yet there are many other gaps, and no single agency can close the gaps on their own.

One of the key outcomes of the first UN World Data Forum was the clear recognition that a wide range of data stakeholders - national statistical offices, multilateral agencies, academics, civil society organisations and the private sector - can and must work together to close these major data gaps. In two years time, at the second forum in Dubai, we will have the opportunity to review this progress, and the inclusion of older people must be improved. 

Find out more about our work on the Sustainable Development Goals.

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Alex Mihnovits
Country: Estonia/UK
Job title: Global Agewatch Programme Assistant

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