Paul Andrew Bourne[1]

Department of Community Health and Psychiatry

Faculty of Medical Sciences

The University of the West Indies at Mona

Kingston, Jamaica

 

 

Introduction

 

            Traditionally, demographers have sought to analyze and provide information on health from the perspective of mortality. From the mortality tenet, they have captured and measure health status, by using life expectancy and diseases. Life expectancy may be an adequate indicator of length of life and from a biomedical perspective a yardstick for health status, but such a construct is not in keeping with the conceptual definition furnished by the World Health Organization – that “health is a state of complete physical, mental and social wellbeing and not merely the absence of diseases or infirmity”.  It should be noted that this conceptual definition which is in the Preamble to the constitution of the WHO which was signed in July 1946 and became functional in 1948, according to one scholar, from the Centre of Population and Development studies at Harvard University, it is mouthful of sweeping generalization, that is difficult to attain, and at best it is a phantom. (Bok 2004).  This paper recognizes this debate, and understands its importance but unfortunately will not be providing information hereafter thereon as it is not the purpose of this study. Is there a shift taking place in demography, as the journal ‘Demography’, 1997, has published an article by Smith and Kington who looked at health status from biopsychological conditions?  Is this an indicator of shift taking place as some universities do have one department called epidemiologic and population studies, population and development studies, population and public health studies?

 

            With the increased ageing of the world’s populations even in the developing regions (“a new paradigm of aging” PAHO and WHO 1997, 1), its implications are multi-fold as it means changes, shifts and new direction in (i) dependency ratios; (ii) employability and labour force; (iii) pension packages; (iv) mortality patterns and hospitalization care; (v) longevity – life span and life expectancy; (vii) health status and family health-care – as the elderly have a wide spectrum of health challenges, and the health costs faced by this age cohort are normally higher, (viii) social and economic development (including building and other infrastructure) and (ix) demographic and epidemiological transition. Thus, there is a need for demographic information, as it is vital for studying the characteristics of older adults as the discipline of demography speaks to the scientific study of population that focuses on broad groupings within which specific population can be studied.  Thus in order to affect the appropriate policies for the aged population, demographers in those geographic areas must provide policy makers with answers to the shift in scientific inquiry brought about by this new paradigm, which is biopsychosocial model in the study of health status. However, why should we study any particular sub-group within the general population, or for that matter the aged?

 

The issue of the ageing of a population cannot be simply overlooked as such; a situation will affect labour supply, pension system, health care facilities, products demanded, mortality, morbidity, and public expenditure among other events.  It is not simply about mortality, fertility and/or morbidity.  The phenomenon is about people, their environment and how they must coexist in order to survive, and how institutions that do exist to enhance longevity. Ageing, therefore, is here to stay.  In order to grasp the complexities of this phenomenon, Lawson’s monograph adequately provides a summative position on the matter.  She noted that:

 

Actually, it is predicted (U.N) that developing countries are likely to have an older generation crisis about the year 2030, that is about the same time as most developed countries (Lawson 1996, 1)

 

 

This demographic transition is not only promulgated by Lawson, but is concurred on by Cowgill (1983) who believed that come the next half-century (2030), there is strong possibility this transition will plague developing nations. This is no different for the developed nations (Lawson 1996). Three centuries ago, the issue of ageing would not constitute one out of twenty-five of the total population (Lawson 1996, 1), or even more than this as is the case in the 21^st Century.  According to Lawson, “The world is going to have to learn to live with populations containing a much higher proportion of older people…” (Lawson 1996, 5).  The speed at which a population will age (60 years and over) in countries in the Latin America and the Caribbean (i.e. shift from 8 to 15 %) will be shorter than two-fifths the duration of time it took the United States and between one-fifth and two-fifths for Western European country to attain similar levels (McEniry et al. 2005; Palloni et al. 2002).  The rate of growth in the ageing populace in Latin America and the Caribbean is not only realty, but the issue is; will the elderly’s care and wellbeing reside squarely on the shoulders of the young?

 

            Now, there is a need not to subjectively qualify the health status of older people, but to provide a demographic study of this group’s wellbeing. As demographic information is paramount in the analysis of the health status of the elderly, it is highly probable that such a study will provide the bedrock upon which invaluable information can be garnered on this group.  In the past,  demographers such as Shryock, Siegal and Associates (1976) did not see it fitting to study and provide information on health in their textbook ‘The Methods and Materials of Demography’ primarily because they were more concerned about issues such as – mortality, life expectancy, fertility, projections and estimations, population composition and distribution.  Nevertheless, the issue of health, health status and wellbeing has increasingly become an important issue to demographers so much so that in the second edition of the text “The Methods and Material of Demography” edited by Siegal and Swanson; the authors included an entire chapter on health (Chapter 14, 341-370).  Our world is always evolving, and with this comes a new set of questions that the old paradigm may be unable to address.  This is one of the dynamics of science, addressing new issues that cannot be fitted within the old epistemology of the paradigm, which is there to explain particular phenomenon.  Demographers have been for years assessing life expectancy and diseases as indicators of health status of people (see for example Elo 2001) - believing that it is the best measure to evaluation a people’s general wellbeing, - but with the increases in non-communicable ailments it is obvious that longevity does not pronounced quality lived years (see for example Jamshidi et al. 1992, 172).  In keeping with the science of the disciplines, demographers like Siegel and Swanson and Professor Emily Grundy have recognized the importance of the study of ageing, quality of life of the lived person, and other issues surrounding health of a population in keeping with the shift in population ageing across the globe.  The old paradigm was not able to account for distinction between the lived years and the quality of lived years, hence, this is one of the primate reason begin the paradigm shift in health focus by demographers.  Evidence in paradigm shift is so clear today that Professor Emily Grundy is not only a demographer but she is a demographic gerontologist.  She have done extensive work on ageing, quality of lived experience of the aged, demography and public health and ageing policy studies.

 

            Among the many challenges of contemporary societies is the reality of demographic transition.  This implies that the human population is living longer but that this is within the context of reduced mortality and fertility along with increases in diseases from the epidemiologic transition.  Accompanying the changes in the population structure is not only the shifts which are likely to present populations but the delay demographic shift that will continue if they are not reversed.  Professor Grundy is keeping with the challenges of health woes which are likely to befall contemporary societies if policy makers do not act today as a precursor for this tomorrow’s problem.  Knowing that demography studies population dynamics, in particular mortality, morbidity, fertility and migration, it would be simplistic if they do not venture in the study of ageing from the perspective of characteristics of the age-cohorts 65 and beyond years, as well as the interrelation between population change and human health.  Those issues had to be resolved, and so who are more competent than demographers and/or demographic gerontologists to examine population issues – with which health and ageing falls.  In attempt to understand the determinants of the population ageing, health must be brought within the existing model.  So by introducing health within the old model, a number of discourses have begun to emerge which include (i) differential of longevity and quality lived years; (ii) public health and longevity; (iii) the feminization of population ageing, (iv) health issues– physical limitation and frailty, wellbeing, nutritional deficiencies- and health care costing of population ageing, and (v) health transition – the composite of epidemiologic transition and ‘response of society to health and disease processes’.

 

            These shifts are in keeping with the world population ageing. Their implications include fertility transition (decline), mortality decline, old-age dependency ratios, challenges to public health, along with the economic development indictors such as labour force participation rates, and lowered savings.  Thus, population ageing is not simply an indicator of demographic transition but that it speaks to a whole shift in the socio-economic indicators and health consequences.  With this said, demographers have twinned health and demography.  Demography is concerned with understanding population dynamics, which include fertility, mortality, migration and life expectancy.  From all indications, with demography being concerned about how population changes occur, health is one such consequence. 

 

            In “The Methods and Material of Demography”, Lamb and Siegel commence the chapter on Health Demography with the following statement: “Health is a leading characteristic of the members of a population, akin other demographic and socioeconomic characteristics” (Lamb and Siegel 2004, 341).  They did not cease there but continue that “...increased life expectancy, …has shifted the focus of population health from quantity of life to the quality of life, …”  Embedded in this thesis is the importance that demographers must now place on quality of life as against the quantity of life (life expectancy).  Thus, the length of life expectancy cannot be used as an indicator of health as the absence of ailments is not necessarily an indicator of a ‘good’ quality of life experienced by an individual.  As shown in the JSLC (1997-2002), that the aged populace have the highest rate of number of days spent in health care, and they share the highest proportion of illnesses and ailment with the children (less than 5 years. These are clearly indicators that longer life is not necessarily spent as healthier days. With the measures related to functioning being increasingly an issue for the elderly, the wellbeing of this group must be studied from a demographer’s vantage point. 

 

            Spiegelman (1980) outlines the importance of health in demography, which explains his rationale for the inclusion of ‘Health Statistics’ in chapter 7 of the text ‘Introduction to Demography’. In this, the author furnishes definitions, and he emphasizes the significance of ‘attitude toward health maintenance.’ Still little attention was given to ‘quality of health-care’ outside of morbidity. One of the ironies of this text is the author’s recognition that

 

            ..Health statistics encompasses not only morbidity statistics, but also data relating to its socio-economic correlates including health attitudes and to utilization of health services (Spiegelman 1980, 171)

 

Nevertheless, despite his acceptance of the importance of socio-economic variables including those two to which he refers, the text’s primary focus is on morbidity, which is keeping with a uni-directional approach to the study of health.  Hence, this study is timely. It will be able to provide a new focus in the study of health demography in Jamaica as well as providing a more holistic understanding of the state of the elderly. 

 

            One scholar who works with the London School of Hygiene and Tropical Medicine, University of London, Professor Emily Grundy, have coined both medical demography and social gerontology in order to study ageing, ageing and wellbeing, demography and health, life cycle influences on migration, fertility annals and health in later years, and primarily on the demography of ageing with a public health and policy focus.  Her professorial status is in demographic gerontology, which speaks to the linkage that has created between social gerontology and medical demography.  By the merging the two fields into one, Professor Grundy has sought to highlight the need to understand population ageing, demographic transition, mortality and morbidity patterns, health outcomes, and determinants which explain the state of people who happen to have had escape many of the challenges of mortality’s battles.

 

            Embedded in Professor Grundy’s works is the recognition that the negative functionality’s consequences of ageing are vital; and so is ageing from demographic vantage points, which include a detailed analysis of longevity beyond mortality and fertility while incorporating all the likely conditions that may influence this demographic transition.  Other focuses of Professor Grundy’s demographic gerontology are – (i) questioning the differential between longevity and quality life; (ii) understanding the implications of present population ageing and the role that it will play on future population age structure; (iii) recognizing that population ageing must be met with a coordinated effort to play for its future socio-economic challenges such as lowered labour force participation, Medicare expenditure, and (iv) the burden that the working class will need to absorbed in order to afford the aged population.  Despite the paved way that has been set for Caribbean demographers, limited works exist on the aged from a demographic perspective.  From a demographic gerontology view point, increasingly fewer works exist in the Caribbean and more so Jamaica from demographers.  Therefore, the time is right for a demographer to explore demographic gerontology as the discipline is a multidimensional drawn from economics, sociology, geography, epidemiology, and gerontology.  Hence, this work is a move afoot in this direction of integrative demography – the use of demographic gerontology within the Jamaican context.

 

Seniors cannot be neglected as they will constitute an increasingly larger percentage of total population and sub-populations in different topography than in previous centuries (UN 2005; WHO 2005; Chou 2005; STATIN 2004; Apt 1999; Caribbean Food and Nutrition Institute1999a; Randal and German 1999; US Census Bureau 1998; Eldemire 1995a, 1994; Mesfin et al. 1987; Grell, 1987). Furthermore, from all indications, in the developing world, the elderly population will continue to increase as a proportion of the globe’s population (Lawson 1996; Eldemire 1995a; PAHO 1990) which is in keeping the world’s ageing statistics. According to Randal and German (1999), the number of aged living in developing countries will more than double by 2025, “reaching 850 million”.  The Caribbean is not different as according to Grell (1987), the English-speaking Caribbean from the 1970 census revealed that between 8.8 and 9.8 percent of the populace were 60 years and older. A matter Lawson noted began in Jamaica since the 1900 (Lawson 1996, 1-37).

 

In 2004, the life span of people 60 years and older in Trinidad and Tobago, Barbados and Jamaica increased between 7.9 and 10 years.  Using information for 2003 from the World Development Indicators report showed that life expectancy at birth in Trinidad and Tobago, and Jamaica were 70 and 76 years respectfully.   Does an increase in life expectancy translate into quality of life for the elderly?  One author commented that health matters influence all other areas of life of the elderly, inclusive of their social roles (Lawson 1996).  The aged in Jamaica play an active role in family functioning.  Hence, the aged is highly likely to seek support from within this agent of socialization.  Some authors claimed that with modernization, the elderly will increasingly become dependent on the state and not on the family (Cowgill and Holmes 1972) for survivability.

 

Studies revealed that the elderly population accounts for 20 percent of the population of Trinidad and Tobago, 21.5 percent in Barbados and 14.6 percent in Jamaica. STATIN (2004, iii) in “Demographic Statistics, 2004” reported that 10 percent of Jamaica’s population are 60 years and older, which is supported by Eldemire (1995) contrary to the viewpoints of Gibbings.  Despite the indecisiveness to reach consensus on a definition of ageing from the United Nations’ perspective on the elderly, ‘old age’ begins at 60 years while demographers conceptualize this variable as ages 65 years and older (See for example Lauderdale 2001; Elo 2001; Manton and Land 2000; Preston et al. 1996; Smith and Kington 1997; Rudkin 1993).  “Where ‘Old age’ begins is not precisely defined, the unset of older age is usually considered 60 or 65 years of age” (WHO 2002, 125).  Nevertheless, this project is a partial fulfilment of a demography degree, and so will subscribe to demographic conceptualizations, primarily.

 

Table 1.1.0: Expectation of Life at Birth by Sex, 1880-1991, Jamaicans

Period	Average Expected Years of Life at Birth
	Male	Female
	e0	e0
1880-1882	37.02	39.80
1890-1892	36.74	38.30
1910-1912	39.04	41.41
1920-1922	35.89	38.20
1945-1947	51.25	54.58
1950-1952	55.73	58.89
1959-1961	62.65	66.63
1969-1970	66.70	70.20
1979-1981	69.03	72.37
1989-1991	69.97	72.64
1999-2001	70.94*	7558*
2002-2004	71.26

 

Statistics on the world population in particular to the Caribbean showed that fertility and adult mortality have been steadily declining (See for example Hambleton et al. 2005; STATIN 1999, 2002, 2004, 2005; United Nations 2005). This implies that life expectancy for Caribbean nationals is increasing and this reality will result in an increased demand for fastidious services, which is in keeping with global trends (See for example, UN 2003; CAJANS 1999a), which is further aptly explained by the United Nations in a document titled World Population Prospect: The 2004 Revision, that:

 

The twentieth century witnessed the most rapid decline in mortality of human history. By 1950-1955, life expectancy at the world level was 47 years and it had reached 65 years by 2000-2005. Over the next 45 years, life expectancy at the global level is expected to rise further to reach 75 years in 2045-2050. (United Nations 2005, 10)

 

Some writers revealed that an ageing population is a challenge to the world, as the major issues in ageing are not only mortality or morbidity but also the total man that include – the social, medical, psychological and economic conditions (Hambleton et al. 2005; Pacione 2003; Baro 1985). According to Hagley in Multiple Medical disorders in the Elderly Patient  forwarded a statements that encapsulates the tenets of the aged by saying that “The physician involved in the care of the elderly must therefore be constantly alert to the possibility of the presence of multiple pathology in the individual patient” (Hagley 1987, 138).

 

In general, improved nutrition and living standards were responsible for the widespread mortality declines in the beginning of the 20th century. Death rates began to decline throughout the world because of better personal hygiene and public sanitation projects that removed garbage and sewage from city streets and provided safer drinking water. Improvements in health and medical breakthroughs have also greatly contributed to gains in life expectancy at birth. In Jamaica, the elderly population is growing at the fastest pace since the1970s (Eldemire 1997), and this primarily is due to bio-technological advancement over the last century. However, this still has not translated into many discourses on the phenomenon. Caribbean Food and Nutrition Institute (1999a) commented that increased life expectancy from mortality theory may be as a result of freedom from diseases.  They noted that this theory has been challenged and that there is substantial evidence that disproves it.

 

Research on the elderly in the developing world suggested that the elderly face an increasing need of medical care, social and economic conditions (McEniry et al. 2005; Eldermire 1997; Posner 1995; Eldemire 1992; Palmore 1981; International Association of Gerontology 1955) more than the younger folks because of degeneration of the human body as it ages.  The issue of wellbeing is progressively becoming a popular area of discourse in contemporary social sciences but the foci are still predominantly from the perspective of biomedical studies.  Quality of life is indeed multidimensional and spatio-temporal, and so it is simplistic to research the manner in a single space. 

 

Globally, regionally and especially domestically, the most popular space in research concerning wellbeing is the biomedical approach; its popularity is fuelled by the combination of the traditional operational definition of health (good physical health) and the dominance of the medical sciences in this field of enquiry.  The number of studies on mortality, structural alterations and functional declines in body systems, genetic alterations induced by exogenous and endogenous factors, prevalence and incidence of diseases, and certain diseases as determinants of health, clearly justify an established leniency to the medical science in the study of health and health care.  Engel (1977, 1980) accredited the biomedical model that governs health care to the practice of pundits for over the last 300 years.  This model assumes that psychosocial processes are independent of the diseases process.  Engel argued for the bio-psychosocial model that includes biological, psychological, and social factors, which is a close match to the multi-dimensional aspect of man. With this as the base, it can be construed from Engel thrust behind the bio-psychosocial model that the previous mode is a reductionist model. Engel’s bio-psychosocial model in analyzing health emphasizes both health and illness, and maintains that health and illnesses are caused by a multiplicity of factors.  Engel’s theorizing, therefore, is better fitted for the definition of health coined by the World Health Organization.

 

There are numerous studies on hypertension, arthritis, diabetes, cancer, and sickle cell and their effect on health (Pedersen and Saltin 2006; McGinnis and Foege 1993; Nicholson 1987; Mesfin et al. 1987) and that those studies have established that there is a causal relationship between cancer, HIV/AIDS infection, cardiovascular diseases, and low birth weight and health status. In addition to those areas previously mentioned, there are studies that have revealed that an association exists between diabetes and health status and in particular chronic diseases and mortality and by extension, quality of life.

 

Traditional studies on various diseases and their influence on health were stressed in the medical research but the inconclusiveness of sociological and psychological determinants are responsible for the secondary nature of socioeconomic and psychological variables in health research.  One researcher attributes this perception squarely to the socialization of people, when he wrote “…aging is widely regarded by professionals and the general public alike as a condition requiring medical intervention” (Cattell 1996). 

 

In Jamaica, only a miniscule number of studies have sought to analyze death of a family member or close friend, violence, joblessness, psychological disorders and sexual abuse on wellbeing, or social change on health, area of residence on quality of life and perception of ageing and its influence on health conditions.  Morrison alluded to a transitory shift from infectious communicable diseases to chronic non-communicable diseases as a rationale for the longevity of the Anglophone Caribbean populace. This was equally endorsed by Peña (2000), the PAHO/WHO representative in Jamaica. They argued that this was not the only reason for the changing life expectancy. Morrison summarized this adequately, when he said that:

 

 “Aiding this transition is not only the increased longevity being enjoyed by our islanders but also the changing lifestyle associated with improved socioeconomic conditions (Morrison 2000, 61)

 

 

With the post-1994 widened definition of health as forwarded by the World Health Organization (WHO), people are becoming increasingly cognizant that socio-cultural factors such as geographic location, income, household size and so on, as well as several psychological factors explain wellbeing; hence the new definition of health has coalesced biomedical variables and socio-cultural and psychological variables in the new discourse on wellbeing.

 

In many societies, there is an official age limit on retirement. Such a limit ranges between 60 and 65 years, and varies depending on gender, socioeconomic status, and the typologies of the industry. When one compares the difference in life expectancy of the sexes - age differential, perception, cultural factors and socialization- those issues provide an in-depth avenue of understanding wellbeing.  With social biases stocked against the elderly, retirement is another social change to which the aged takes some time to become accustomed as the body at a certain age provides a completely new set of conditions. Retirement is not a problem that the elderly will face but the social departure in particular, the removal from the social setting, provides another set of issues for seniors. People who retire frequently are removed from the social setting of work and this become exclusionary, and it is this setting that affects their quality of life of those persons.

 

Many unemployed aged are dependent on the state and the family for assistance. Although prior to this age they may have invested in stocks, bonds, and other investment options, this does not necessarily adequately cater for future existence, as illnesses in old age may quickly reduce all investments.  The situation is not any easier for the employed aged as old age sometimes means that employer’s offer reduced salaries. With respect to the employed aged, with an average life expectancy post-retirement being 15 years (WHO 2004), they must bear the exorbitant cost for curative health care as well as preventative care and these must sometimes be met from reduced salaries. This process becomes even more burdensome for non-pensioners. 

 

Coupled with the cost of health care in contemporary societies, poverty is a social reality for many aged folks. Poverty of itself provides social exclusion from the availability of scarce resources for seniors.  Another social exclusion is the perception of the various public concerning the roles of the elderly.  The psychosocial byproduct of poverty of the aged further complicates the increased dependency of this group on younger folk.  This may not come across as positive to the once independent elderly, and so poor retirees are likely to become frustrated or unhappy, which influence their heath conditions. 

 

Additionally, there is the likelihood of insufficient planning for old age as many old people face the daunting challenge of life in post-year retirement while caring for other sick relatives.  Even with adequate preparation for retirement within the context of an additional fifteen years and the cost of care to maintain a particular quality of life, all planning for this stage in the life of the aged is almost impossible. For instance, how do you plan for chronic diseases such as cancer and any other such conditions while planning for retirement, or for that matter for HIV of a family member? This reality sometimes is different from the ideal, the elderly with a possible weaken physical state must plan for those eventualities while contemplating a life post-65 years.  

 

Additional years of life do not denote positive changes in lifestyle practices. It should be noted that health speaks to the quality of life experienced by the individual.  With the increased probability of survivorship, seniors await a number of conditions.  There is voluminous research in biomedical sciences (cancer, hypertension, heart attack - cardiovascular diseases, mental disorder, arthritis, stroke, diabetes, asthma, genetics, and so on) that conclusively show that there are a number of diseases that arise with ageing but those areas are single-focused.  Eldemire (1997) forwarded a view that was expressed by the United Nations in 1992 that “life expectancy at age 60 years is now approximately 20 years”. This is the additional years of life that the elderly is expected to live within particular economic status, health conditions, social, psychological and cultural experiences.  With the increased quantitative change in life expectancy of the elderly, the aged are now vulnerable to chronic disabilities, gradual removal from many areas of their social roles and subsequently, a reduction in wellbeing.  Many researchers have revealed that there is a difference in the life expectancy of the sexes, where females generally outlive their male counterparts. This social reality posed new experiences for older women, and may be complicated by the death of their children. Therefore, the health status of the elderly must be affected as this social change provides a new set of experiences.  

 

The situation of social change that affects the elderly is simply not exclusively linked to mortality but adjustments concerning relocation from family households to nurses-care and the movement from living alone to residing with children. This reduces the accustomed autonomy of the senior. The change in lifestyle because of those transitions added to crime and violence modify the wellbeing of the aged-populace.  This social change is can be a difficult one for many aged-folks; and the panacea is not to ameliorate obdurate typologies of severe illnesses but the enjoyment of life.

 

In Jamaica, studies, which examined the health of the elderly, do so mostly from within the context of causes of mortality from a disease perspective and even so, they are limited. This paper seeks to address the insufficient data on the subject as well as enriching the body of knowledge that exists within the context of the World Health Organization’s (WHO) new approach to health.  This is recorded in WHO a press release in 2000 that stated:

 

            Disability Adjusted Life Expectancy (DALE) summarizes the expected number of years to be lived in what might be termed the equivalent of "full health." To calculate DALE, the years of ill health are weighted according to severity and subtracted from the expected overall life expectancy to give the equivalent years of healthy life. (WHO 2000b)

 

The World Health Organization and a plethora of research organizations have worked assiduously to develop and launch particular perspectives on health, and measures on population conditions in combination with measures on populace mortality, and morbidity.  Prior to the slant taken by WHO on health, the conceptualization of this variable was focused on a particular physiological state of the individual. However, with the introduction of new operational definition of the construct, health has been expanded to mean much more than the absence of diseases to include measures of healthy life expectancy, happiness, utility, personal preference, and self-reported quality of life. With this extension of population health, new genres of studies are forthcoming. Those studies highlight the space of population health in respect to socio-economic conditions of the elderly. This paper considers a number of the aspects within the multidimensional space of health.  These are socioeconomic, environmental and psychological factors and will provide answers to the question of what contribution these make to the measurement of wellbeing.

 

            This study responds to the underlining concerns of the continuous increase in population ageing. The fast ageing of populations, unless managed in a proactive manner, could impose serious challenges for policy makers in the Caribbean and Jamaica. Noteworthy is that a particular level of economic development is needed in order to deal with the challenges of this demographic transition. The demographic composition and structure of future world population and subpopulation must be understood within policy framework.  The challenges that are likely to arise from an ageing population on public expenditure, on pensions and health care, particularly in the absence of reforms in pensions and health services, could lead to a build-up of public debt in developing countries in specific Caribbean islands.

 

The United Nations projections indicate that the world’s elderly populace is likely to be approximately 25 percent of the world population by 2050, which has a number of socioeconomic and demographic consequences.   The impending demographic change in population structure and the limited number of studies on the non-biomedical perspective on the elderly within the Jamaican space compels the researcher to analyze this phenomenon in an attempt to ascertain whether Jamaica is typical within the impending space of demographic transition.

 

In 2004, Jamaica’s old-aged population stood at 7.7 percent. This is not atypical; according to WHO/SEARC (1999), India’s elderly population was 7.7 percent.  During 2004-1991, the elderly population of Jamaica rose by 3.28 percent (see Table 1).  When the elderly is strictly operationalized within a demographer’s space (65 years and beyond), on an average the elderly population grew by 3.62 percent (see Table 2).  The data in Table 2 reveal that for every 100 working-aged of the population there are approximately 13 elderly that is dependent on them.  This is within approximately 30 percent of the population being children.  Over the same period, the number of child-to-total-population grew by - 4.4 percent and by -10.08 percent for the youth.  Without effective population planning for the elderly, come the next four decades, the old-aged population will become a burden to the working aged-populace in respect to medical care, nursing care, pension, other social insurance and survivability cost.  With this impending social reality, there is a high probability that the old-aged will be called on to provide increasingly more of their needs for themselves within the construct limited resources from developing societies.  The physiological changes with ageing such as loss of hair, wrinkling of the skin, decrease in height, and loss of teeth are not the only issue of old age but other critical factors that affect their wellbeing.

 

Conclusion

With the ageing of the world population of which many developing countries have become a party to and to which some become participants to come 2020 and beyond within the general contextual of the shift in diseases from infectious to chronic diseases, the old adult populations are likely to living longer but may be experiencing low quality of life.  Based on the PIOJ and STATIN’s publication (i.e. Jamaica Survey of Living Conditions), while the general health status of the world is ‘good’ there is a remarkable increase in chronic diseases such as cancers, diabetes, heart diseases to name a few which affect the working population, more so the elderly. Thus, even with the lived reality of the increases in life expectancies of Jamaicans over the last century, the old adults are growing older in more ailments. Hence, this research seeks to broaden an examination of the wellbeing of the old adult populations in Jamaica from the perspective of psychosocial model of looking a health status.  Such a model expands the present biomedical model (i.e. report of sicknesses and/or ailments and their care) to include psychosocial, environmental, and economic conditions. This is in keeping with the holistic definition advocates by the World Health Organization’s constitution.

 

            Scholars argue that the social discipline has undergone a type of calamity in purpose (Lincoln and Denzin 2003, 6), which some thoughtful pundits daring to question - “what is the purpose of social research and who does it or should it serve” (Waller 2006, 23). Hence, this section of the thesis outlines the rationale (i.e. significance) of the study, along with its scope, primarily because of this social reality that:

 

            The speed of demographic aging in Latin America and the Caribbean will be unprecedented. The time it will take a typical country in Latin America and the Caribbean to attain a substantial fraction of people above age 60, say around 15 percent, from current levels of around 8 percent is less than two fifths the length of time it took the US, and between one fifth and two fifths of the time it took an average Western European country to attain similar levels … (McEniry, Polloni, Wong, and Pelaez 2005, 2)

 

 

When the above (McEniry et al 2005) situation is deconstructed within the context of the health status of these people, it warrants more significance for a social science inquiry. As health is a multi-faceted variable (Portrait et al. 2001) that looks beyond bio-medical conditions. When wellbeing is mentioned, it goes beyond many of the established operational definitions of health (i.e. physical functioning).  Wellbeing is a state of psychological, social and economic state and this refers specifically to the worth of this condition in the discourse of social sciences.  There is already a social exclusion of the elderly from many activities and research is one such neglect. 

 

A substantial number of studies on wellbeing of the elderly have analyzed the variable through the purview of diseases and physical functioning.  Firstly, when the issue is approached from a socio-cultural perspective, the numbers of studies are few.  There is a lacuna in the social sciences in the study of the elderly to which this body of knowledge will bridge the gap and offer an in-depth understanding the determinants of the wellbeing among the elderly in Jamaica.

 

Secondly, according to Waller (2006), “Mills (1959) tell us that as academics, we need to critically analyze social phenomenon and ascertain their effects on societies, groups and individuals in order to understand and make better sense of phenomena, and to describe and explicate them...” (Waller 2006, 3), which forms the next rationale for this project. This is to provide information on wellbeing among the Jamaican elderly in order to forward a better understanding of the epistemological properties of this phenomenon.  Simple put, this thesis must supply information that can be used by all publics nationally, regionally and internationally, by identify pertinent variables and the associations between these variables. As a basis for making available to researchers, policy makers and the average reader empirical and representative research aimed at analyzing the cause and effects of particular determinants on the quality of life of senior citizens in Jamaica.

 

Reference

 

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