Distr. LIMITED E/ESCWA/SDD/2004/WG.1/2 11 February 2004 ORIGINAL: ENGLISH ECONOMIC AND SOCIAL COMMISSION FOR WESTERN ASIA
AGEING IN THE ARAB COUNTRIES: REGIONAL VARIATIONS, POLICIES AND PROGRAMMES
04-0072
CONTENTS Page Abbreviations and explanatory notes.................................................................................................. Introduction .......................................................................................................................................
v 1
Chapter I. AGEING TRENDS ................................................................................................................ A. B. C. D.
2
Conceptual frameworks .................................................................................................... Size of population............................................................................................................. Fertility rates .................................................................................................................... Mortality rates ..................................................................................................................
2 3 6 8
II. FUTURE PROSPECTS IN THE ARAB REGION ..............................................................
11
A. B. C. D. E. F.
Percentage of the old population ....................................................................................... Rate of growth of the old population................................................................................. Median age of the population............................................................................................ Dependency burden .......................................................................................................... Ageing index .................................................................................................................... Rate of population ageing .................................................................................................
11 14 16 17 19 19
III. CONSEQUENCES OF POPULATION AGEING ...............................................................
24
A. B. C. D.
Socio-economic consequences .......................................................................................... Health consequences ........................................................................................................ Social security for the elderly in Arab States..................................................................... Conclusions and recommendations ...................................................................................
24 25 25 27
LIST OF TABLES 1. 2. 3. 4. 5. 6. 7. 8.
Annual growth rate of populations of Arab countries in 2000-2050 .......................................... Trends in CBR and TFR in Arab countries in 1950-2050.......................................................... Trends in CDR and life expectancy at birth in Arab countries in 1950-2050 ............................. Population aged 60 years and older in Arab countries in 2000 and 2050 ................................... Population aged 80 years and older in Arab countries in 2000 and 2050 ................................... The rate of growth of the old populations in Arab countries in 2000-2050 ................................ Ageing indicators in Arab countries in 2000 and 2050.............................................................. Estimated rate of population ageing in the Arab region.............................................................
5 6 8 11 12 15 16 20
LIST OF FIGURES I. II. III. IV. V. VI. VII. VIII. IX. X. XI.
A conceptual framework of the ageing process......................................................................... A modified conceptual framework of the ageing process .......................................................... Low, medium and high variants of population projections for the Arab region in 1950-2050 .... Total population of Arab countries in 2000 .............................................................................. Total projected population of Arab countries in 2050 ............................................................... Trends in CBR in selected Arab countries in 1950-2050........................................................... Trends in TFR in selected Arab countries in 1950-2050 ........................................................... Trends in CDR in selected Arab countries in 1950-2050........................................................... Trends in life expectancy at birth in selected Arab countries in 1950-2050 ............................... Demographic trends in the Arab region in 1950-2050............................................................... Gender ratios of the population aged 60 years and older in Arab countries in 2000 and 2050 .... c
2 3 4 4 5 7 7 9 9 10 13
CONTENTS (continued) Page XII. XIII. XIV. XV. XVI. XVII. XVIII. XIX.
Gender ratios of the population aged 80 years and older in Arab countries in 2000 and 2050 .. The rate of growth of the old populations in Arab countries in 2000-2050 .............................. Median age in Arab countries in 2000 and 2050 ..................................................................... Old-age dependency ratio in Arab countries in 2000 and 2050................................................ Oldest old-age dependency ratio in Arab countries in 2000 and 2050...................................... Ageing index in Arab countries in 2000 and 2050 .................................................................. Age pyramids of Arab countries in 2000 ................................................................................ Age pyramids of Arab countries in 2050 ................................................................................
d
14 15 17 18 19 20 21 22
ABBREVIATIONS AND EXPLANATORY NOTES bpw CBR CDR DESA GDP ICPD LAS TFR
Births per woman Crude Birth Rate Crude Death Rate Department of Economic and Social Affairs Gross domestic product International Conference on Population and Development League of Arab States Total Fertility Rate
e
INTRODUCTION Population ageing is the outcome of demographic transition. Reductions in infant, child and maternal mortality in addition to decreases in fertility rates during the second half of the past century have resulted in an increase of older populations across the world with the concomitant impact on socio-economic development.1 While this growth of the old population is a global phenomenon, there are significant regional disparities. Typically, developed countries have experienced higher growth rates of their older populations given comparatively low mortality rates, which stabilized in the early 1970s, and lower fertility, which have reached or have been below replacement level since the 1990s. By contrast, the decline of fertility rates is relatively a new trend in the Arab region and, therefore, the process of ageing is at an earlier stage. However, this process is expected to accelerate in Arab countries given a number of factors that compound demographic ageing and which are largely absent in developed countries. Most prominent among these is the age-selective migration of labour that arises from the political uncertainty and prevailing economic conditions in the region, particularly high unemployment rates. The interplay of the emigration of young adults with the ongoing fertility and mortality transition accelerates demographic ageing and increases the dependency burden on the State in the areas of health, housing and social security for a growing number of senior citizens. Unfortunately, the majority of Arab countries have underestimated the importance of this issue and are not anticipating the future repercussions on national economies caused by such a demographic transition. Consequently, there is an urgent need for renewed thinking on this matter and for strategies to tackle the challenges posed by a growing elderly population. This study aims to highlight those challenges by exploring relevant policies and programmes that have been formulated by Arab countries, and by presenting some alternative strategies.2 Chapter I underscores the ageing trends in the Arab region, whose future prospects and consequences are further developed in chapters II and III, respectively.3
1
In this study, the old are defined as persons aged 60 years and older.
2
This study covers all 22 members of the League of Arab States (LAS).
3
The data on population ageing presented in this paper have been derived from three publications by the Population Division of the Department of Economic and Social Affairs (DESA) of the United Nations, namely: World Population Prospects – The 2000 Revision, Vol. I: Comprehensive Tables (United Nations, New York, 2001); World Population Prospects – The 2000 Revision, Vol. II: The Sex and Age Distribution of the World Population (United Nations, New York, 2001); and World Population Ageing 1950-2050 (United Nations, New York, 2002).
I. AGEING TRENDS IN THE ARAB REGION A. CONCEPTUAL FRAMEWORKS Population ageing and individual ageing are concepts of ageing at, respectively, the macro and micro levels. The former refers to ageing of populations in an aggregate sense whereby the age-sex structure of a population, represented by an age pyramid, undergoes a change as a result of ageing. Population ageing is equally referred to as demographic ageing and is affected by changes in mortality, fertility and migration flows. By contrast, individual ageing is solely influenced by a reduction in mortality rates. In an instrumental study on the ageing process, Golini provided a conceptual framework that explicitly describes the dynamics and consequences of such a process and is an excellent teaching aid to distinguish between population ageing and individual ageing.4 Additionally, a third module of ageing exists that has both macro and micro-level characteristics. Referred to as “ageing of households”, this module is considered a macro-level concept for the purpose of analysing the age-sex structure of households; and a micro-level concept when calculating the mean age of households. Consequently, the ageing of households largely depends upon the objectives of any given analysis. Figures I and II, respectively, illustrate the conceptual framework of the ageing process and the modified framework that incorporates the third module at both micro and macro levels. The principal difference between these two frameworks relates to the sub-national units, which comprise members of families and households. Figure I. A conceptual framework of the ageing process DETERMINANTS
DEMOGRAPHIC TRANSITION
REDUCTION IN BIRTHS (mainly attributed to a decline in fertility)
AGEING OF INDIVIDUALS
AGEING OF FAMILIES AND HOUSEHOLDS
Consequences on the following:
AGEING OF POPULATIONS AND ALL SUBPOPULATIONS − Labour force − Women of reproductive age − Elderly − Sub-national administrativ
Macro Level
MIGRATION FLOWS
CONSEQUENCES
Micro Level
REDUCTION IN MORTALITY RATES
AGEING
1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
Population Psychology Culture Value system Ethics Society Economy Education Health Family
Attitudes towards migration 12. Environment 13. Policy 14. International relations
POLICIES POLICIES
4 Golini, A. “Teaching demography of ageing”, which was presented at the Seminar on Demographic Training in the Third Millennium (Rabat, 15-18 May 2001).
2
Figure II. A modified conceptual framework of the ageing process AGEING
REDUCTION IN MORTALITY RATES
AGEING OF INDIVIDUALS
DEMOGRAPHIC TRANSITION
REDUCTION IN BIRTHS (mainly due to reduction in fertility)
CONSEQUENCES
CONSEQUENCES ON: Micro Level
DETERMINANTS
AGEING OF FAMILIES AND HOUSEHOLDS
2.
Psycholo gy
4.
Culture Value System
5.
Ethics
6.
Society
7.
Econom y
• Subnation al
8.
Educatio n
AGEING OF POPULATIONS AND ALL SUBPOPULATIONS • Labour force • Women of reproduct ive ages
Macro Level
POLICIES
Populati on
3.
i
MIGRATION FLOWS
1.
9.
Health
10.
Family
11.
Migratio n attitude
12.
Environ ment
13.
Policy
14.
Internati
POLICIES
B. SIZE OF POPULATION At a regional level, the population rose from 76.5 million in 1950 to 284.4 million in 2000, which translates as an annual growth rate of 2.6 per cent over that period.5 While this annual growth rate is predicted to decline to 1.99 per cent in the first 25 years of this millennium, and to 1.67 per cent in the subsequent 25 years, the most conservative estimates of the population of the Arab region is set at some 437 million and 550 million in 2025 and 2050, respectively (see figure III for the low, medium and high variants of population projections).
Figure III. Low, medium and high variants of population projections 5
DESA. World Population Prospects – The 2000 Revision, Vol. I: Comprehensive Tables (United Nations, New York,
2001).
3
for the Arab region in 1950-2050 (Thousands)
٨٠٠٠٠٠
٧٦٦٠٦٢
Population
٧٠٠٠٠٠
٦٥٤١٤١
٦٠٠٠٠٠
٤٦٨٥٧٨ ٤٩٨٤٤٧
٥٠٠٠٠٠ ٤٠٠٠٠٠ ٢٠٠٠٠٠ ١٠٠٠٠٠
Medium
٤٣٧١٢١
٢٨٤٣٧٢ ٢٨٤٣٧١ ٢٨٤٣٧١
٣٠٠٠٠٠
High
٥٤٩٩٤٧
Low
٧٦٥٢٢
٠ ١٩٥٠
٢٠٠٠
٢٠٢٥
٢٠٥٠
Years
Source: DESA. World Population Ageing 1950-2050 (United Nations, New York, 2002).
At a national level, there are significant differences between Arab countries in terms of size and growth rates of their populations. Figures IV and V illustrate the populations in 2000 and subsequent projections in 2050.6 Figure IV. Total population of Arab countries in 2000 (Thousands) Egypt Sudan Algeria Morocco Iraq Saudi Arabia Yemen Syrian Arab Republic Tunisia Somalia Libyan Arab Jamahiriya Jordan Lebanon Palestine Mauritania United Arab Emirates Oman Kuwait Comoros Bahrain Djibouti Qatar ٠
١٠٠٠٠
٢٠٠٠٠
٣٠٠٠٠
٤٠٠٠٠
٥٠٠٠٠
Population
Source: DESA. World Population Ageing 1950-2050 (United Nations, New York, 2002).
6
Within that context, the medium variants of population projections have been used. Ibid.
4
٦٠٠٠٠
٧٠٠٠٠
Figure V. Total projected population of Arab countries in 2050 (Thousands)
Egypt Yemen Sudan Saudi Arabia Iraq Algeria Morocco Somalia Syrian Arab Repulic Tunisia Palestine Jordan Libyan Arab Jamahiriya Oman Mauritania Lebanon Kuwait United Arab Emirates Comoros Djibouti Bahrain Qatar ٠
٢٠٠٠٠
٤٠٠٠٠
٦٠٠٠٠
٨٠٠٠٠
١٠٠٠٠٠
١٢٠٠٠٠
Population
Source: DESA. World Population Ageing 1950-2050 (United Nations, New York, 2002).
A comparison of these figures reveals interesting population dynamics in the Arab region. Egypt and Qatar are expected to maintain the highest and lowest populations in the region, respectively, during the period 2000-2050. Moreover, the annual growth rate of the population over that period is predicted to exceed 3 per cent in Somalia and Yemen, and to remain in the range of 2-3 per cent in Comoros, Oman, Palestine, Mauritania and Saudi Arabia (see table 1). The lowest annual growth rate in the narrow range of 0.7-0.8 per cent is expected in four Arab States, namely, Lebanon, Qatar, Tunisia and United Arab Emirates. This could be attributed to a comparatively higher decline in fertility of these countries. TABLE 1. ANNUAL GROWTH RATE OF POPULATIONS OF ARAB COUNTRIES IN 2000-2050 (Percentages) Country or territory
Annual growth rate 0.7 0.7 0.8 0.8 0.9 1.0 1.0 1.0 1.0 1.3 1.4 1.5
United Arab Emirates Lebanon Qatar Tunisia Bahrain Egypt Morocco Algeria Djibouti Libyan Arab Jamahiriya Sudan Kuwait
5
TABLE 1 (continued) Country or territory
Annual growth rate 1.6 1.7 1.7 2.0 2.2 2.3 2.5 2.6 3.1 3.4 1.5
Syrian Arab Republic Iraq Jordan Comoros Saudi Arabia Mauritania Oman Palestine Somalia Yemen Arab region
Source: Calculated from data provided in DESA. World Population Ageing 1950-2050 (United Nations, New York, 2002).
C. FERTILITY RATES At a regional level, the drop in the growth rate of the population is largely attributed to a decline in the crude birth rate (CBR).7 While both fertility and mortality are projected to decrease over the period 20002050, the decline in fertility in absolute terms is expected to be greater than the drop in mortality. The CBR for the Arab region dropped by approximately 18 points from 1950-1955 to 2000-2005, and is estimated at 16.2 births per 1,000 people in 2045-2050 (see table 2). TABLE 2. TRENDS IN CBR AND TFR IN ARAB COUNTRIES IN 1950-2050 CBR Country or territory 1950-1955 1975-1980
2000-2005
TFR 2025-2030 2045-2050 1950-1955 1975-1980 2000-2005 2025-2030 2045-2050
Algeria
51.0
45.0
23.5
16.0
13.5
7.3
7.2
2.8
2.1
2.1
Bahrain
45.1
34.4
15.7
13.2
12.7
7.0
5.2
2.3
2.1
2.1
Comoros
47.3
48.7
37.7
23.3
17.1
6.3
7.1
5.0
2.8
2.1
Djibouti
46.7
56.2
38.0
32.5
19.2
7.1
6.7
5.8
3.9
2.1
Egypt
48.6
38.9
23.3
16.3
13.9
6.6
5.3
2.9
2.1
2.1
Iraq
49.4
41.9
33.9
18.4
15.8
7.2
6.6
4.8
2.3
2.1
Jordan
46.7
45.0
32.8
19.4
15.7
7.4
7.4
4.3
2.4
2.1
Kuwait
45.2
40.1
19.2
13.3
13.1
7.2
5.9
2.7
2.1
2.1
Lebanon
41.0
30.1
19.0
13.6
11.7
5.7
4.3
2.2
1.9
1.9
Jamahiriya
48.0
47.3
26.8
16.9
13.6
6.9
7.4
3.3
2.1
2.1
Mauritania
46.5
44.7
43.7
30.8
18.6
6.5
6.5
6.0
3.8
2.1 2.1
Libyan Arab
Morocco
50.4
39.4
24.8
16.5
13.7
7.2
5.9
3.0
2.1
Palestine
46.7
47.8
39.0
28.7
17.4
7.4
7.4
5.6
3.7
2.1
Oman
50.9
46.1
36.0
27.9
18.1
7.2
7.2
5.5
3.5
2.1
Qatar
46.3
29.9
17.4
14.0
13.3
7.0
6.1
3.3
2.1
2.1
Saudi Arabia
49.0
45.9
33.8
23.5
16.3
7.2
7.3
5.5
3.2
2.1
Somalia
53.4
51.7
51.8
39.9
27.7
7.3
7.3
7.3
5.1
3.3
Sudan
46.1
43.7
33.6
19.3
16.0
6.5
6.3
4.5
2.3
2.1
Syrian Arab Republic
46.6
46.0
29.9
17.0
14.7
7.1
7.4
3.7
2.1
2.1
Tunisia
46.4
36.4
18.6
14.1
13.2
6.9
5.7
2.1
2.1
2.1
United Arab Emirates
47.8
30.5
15.7
12.8
12.4
7.0
5.7
2.9
2.1
2.1
Yemen
52.2
53.7
48.8
39.0
27.6
7.6
7.6
7.6
5.4
3.4
Arab region
47.8
42.9
30.1
21.2
16.2
7.0
6.5
4.2
2.8
2.2
Source: DESA. World Population Ageing 1950-2050 (United Nations, New York, 2002). 7
That rate measures the number of live births per 1,000 people in a population in a given year.
6
Within the context of current CBR, the Arab region can be divided into three broad categories of fertility as follows: (a) Mauritania, Somalia and Yemen, where CBR was found to be higher than 40; (b) Comoros, Djibouti, Iraq, Jordan, Oman, Palestine, Saudi Arabia and Sudan, with CBR in the range of 30-40; and (c) Algeria, Bahrain, Egypt, Kuwait, Lebanon, Libyan Arab Jamahiriya, Morocco, Qatar, Syrian Arab Republic, Tunisia and United Arab Emirates, where CBR was in the comparatively low fertility range of 15.7-29.9. While all the Arab countries follow a declining trend in CBR in the period 1950-2050, the selection presented in figure VI highlights those countries with extreme values of CBR in 1950-1955 or with atypical trends of CBR during 2000-2005 and 2045-2050. Consequently, the trends in CBR for the remainder of Arab States lie within these extremes. Figure VI. Trends in CBR in selected Arab countries in 1950-2050 (Number of live births per 1,000)
٦٠
CBR
٥٠ ٤٠
Somalia
٣٠
Yemen Algeria
٢٠
Kuwait
١٠
Bahrain
٠ 1950-1955
1975-1980
2000-2005
٢٠٢٥-٢٠٣٠
Lebanon
٢٠٤٥-٢٠٥٠
Year
Source: DESA. World Population Ageing 1950-2050 (United Nations, New York, 2002).
Similarly, the total fertility rate (TFR) for the Arab region decreased from approximately 7 births per woman (bpw) in 1950-1955 to the current level of 4.2 bpw, and is projected to continue this downward trend to reach the near-replacement level of 2.2 bpw in 2050 (see table 2).8 With the notable exception of Somalia and Yemen, all the Arab States are predicted to reach the near-replacement level of 2.1 bpw by 2050. In Lebanon, this rate is projected to fall below replacement level at 1.9 bpw (see figure VII). Figure VII. Trends in TFR in selected Arab countries in 1950-2050 ٨ ٧ ٦ Yemen
TFR
٥
Palestine
٤ ٣
Jordan
٢
Lebanon
١ Comoros
٠ ١٩٥٠-١٩٥٥
1975-1980
٢٠٠٠-٢٠٠٥
٢٠٢٥-٢٠٣٠
٢٠٤٥-٢٠٥٠
Sudan
Year
Source: DESA. World Population Ageing 1950-2050 (United Nations, New York, 2002).
8 TFR represents the average number of children that would be born to a woman throughout her lifetime given that the agespecific fertility rates still prevail at that time.
7
D. MORTALITY RATES There was a substantial decline in mortality in the Arab region during the second half of the past century. The crude death rate (CDR), which was estimated at 24.3 per 1,000 people in 1950-1955, dropped to the current level of 7.1 per 1,000 and is expected to remain at approximately that level until 2050 (see table 3). 9 At a national level, a number of countries and territories experienced a steep decline in mortality during the period 1950-2000, including Algeria, Comoros, Egypt, Iraq, Jordan, Libyan Arab Jamahiriya, Morocco, Palestine, Oman, Qatar, Saudi Arabia, Syrian Arab Republic, Tunisia, United Arab Emirates and Yemen. However, most of these countries are expected to see a reversal in this trend with rising death rates in the subsequent 50 years. This rise is expected to be most apparent in four Arab States, namely, Bahrain, Kuwait, Qatar and United Arab Emirates, where CDR in those countries is expected to reach approximately three times the current levels. However, this rise does not necessarily translate into an increase in the level of mortality and, instead, could be attributed to ageing of the population of these countries resulting from drops in fertility and mortality. TABLE 3. TRENDS IN CDR AND LIFE EXPECTANCY AT BIRTH IN ARAB COUNTRIES IN 1950-2050 (Births per woman) CDR
Life expectancy at birth
(Number of deaths per 1,000) Country or territory
1950-1955 1975-1980
2000-2005
(Years)
2025-2030 2045-2050 1950-1955 1975-1980 2000-2005 2025-2030 2045-2050
Algeria
23.9
13.4
5.3
5.6
8.4
43.1
57.5
70.3
75.7
Bahrain
16.4
6.3
3.7
7.5
11.1
51.0
65.9
73.8
77.7
78.4 79.9
Comoros
24.2
15.3
8.8
4.9
5.2
40.7
50.9
60.8
70.8
76.3
Djibouti
29.6
22.2
20.8
16.0
8.1
33.0
43.0
40.6
48.2
63.3
Egypt
24.0
14.2
6.1
6.3
8.2
42.4
54.1
68.3
74.7
77.8
Iraq
21.9
8.8
7.0
4.8
6.1
44.0
61.1
64.9
74.3
77.6
Jordan
26.0
9.6
4.3
4.0
5.9
43.2
61.2
71.0
76.2
78.8
Kuwait
11.2
4.2
2.7
5.9
8.1
55.8
69.6
76.5
79.2
81.1
Lebanon
18.7
8.7
5.4
6.4
10.0
56.0
65.0
73.5
77.0
79.2
Jamahiriya
22.5
12.7
4.8
5.3
7.5
42.9
57.7
70.3
76.6
79.1
Mauritania
28.7
20.0
14.2
7.0
5.6
35.5
45.5
52.5
65.5
72.1
Morocco
25.7
13.0
6.0
6.0
8.3
42.9
55.8
68.7
74.8
77.9
Palestine
26.0
13.5
4.3
3.1
3.8
43.2
60.8
72.4
76.4
79.0 78.5
Libyan Arab
Oman
31.9
12.4
4.1
3.8
4.0
36.4
54.8
71.5
75.5
Qatar
22.2
9.4
4.1
9.7
11.4
48.0
65.6
70.3
75.3
78.3
Saudi Arabia
25.9
10.7
4.1
4.0
4.6
39.9
58.8
72.2
76.9
79.4
Somalia
31.8
22.9
17.0
9.5
5.7
33.0
42.0
48.9
59.4
68.3
Sudan
26.1
17.9
11.4
7.3
7.7
37.7
46.6
57.0
67.1
72.9
Republic
21.4
8.9
4.0
3.9
6.2
46.0
60.1
71.8
76.6
79.1
Tunisia
22.6
10.0
6.4
6.5
9.4
44.6
60.0
70.9
76.2
78.8 80.5
Syrian Arab
United Arab Emirates
22.8
7.4
4.0
8.8
11.5
48.0
66.8
75.4
78.4
Yemen
31.7
20.7
8.3
3.8
3.1
32.1
44.1
61.9
71.4
75.5
Arab region
24.3
12.8
7.1
6.4
7.3
42.7
56.7
66.5
72.9
76.9
Source: DESA. World Population Ageing 1950-2050 (United Nations, New York, 2002).
9
That rate measures the number of deaths per 1,000 people in a population in a given year.
8
Figure VIII. Trends in CDR in selected Arab countries in 1950-2050 (Number of deaths per ١,٠٠٠) ٣٥ ٣٠
CDR
٢٥ ٢٠
Oman
١٥
Somalia Yemen
١٠
Lebanon
٥
Bahrain
٠ ١٩٥٠-١٩٥٥
١٩٧٥-١٩٨٠
٢٠٠٠-٢٠٠٥
٢٠٢٥-٢٠٣٠
Kuwait
٢٠٤٥-٢٠٥٠
Year
Source: Compiled from data in table 3.
At a regional level, the life expectancy at birth rose from 42.7 years in 1950-1955 to 66.5 years in 2000-2005 and is expected to reach approximately 77 years by 2045-2050 (see table 3).10 With the exception of Djibouti, the Arab States have witnessed a steady rise in life expectancy. By 2050, this rate is projected to reach a maximum of 81.1 years in Kuwait and minima of 63.3 years and 68.3 years in Djibouti and Somalia, respectively. During the period 2000-2050, Djibouti and Somalia are expected to witness among the highest gains in life expectancy at birth with increases of approximately 22.7 years and 19.4 years, respectively (see figure IX). Figure IX. Trends in life expectancy at birth in selected Arab countries in 1950-2050 (Years) ٩٠
Life expectancy at birth
٨٠ ٧٠ ٦٠
Lebanon
٥٠
Kuwait
٤٠ ٣٠
Bahrain
٢٠
Somalia
١٠
Djibouti
٠ ١٩٥٠-١٩٥٥
١٩٧٥-١٩٨٠
٢٠٠٠-٢٠٠٥
٢٠٢٥-٢٠٣٠
٢٠٤٥-٠٥٠
Yemen
Year
Source: Compiled from data in table 3.
10 The life expectancy at birth is defined as the average number of years a group of people born in the same year can be expected to live if mortality at each age remains constant in the future.
9
Figure X. Demographic trends in the Arab region in ١٩٥٠-٢٠٥٠ ٩٠ ٨٠ ٧٠ ٦٠ ٥٠
٤٠ ٣٠ ٢٠ ١٠ ٠
1950-1955
1975-1980
٢٠٠٠-٢٠٠٥ Years CBR
CDR
Source: Compiled from data in tables 2 and 3.
10
٢٠٢٥-٢٠٣٠ TFR
Life expectancy at birth
2045-2050
II. FUTURE PROSPECTS The five principal indicators used to investigate future prospects of population ageing are as follows: (a) percentage of the old population; (b) rate of growth of the old population; (c) median age of the population; (d) dependency burden; and (e) ageing index. Based on these indicators, the relative position of the 22 Arab countries in the region are reviewed and discussed below. A. PERCENTAGE OF THE OLD POPULATION This study examines the following two old-age brackets: the population aged 60 years and older; and the population aged 80 years and older, commonly referred to as the “oldest old” population. Within the context of the latter, comparisons are equally made with the marginally younger population aged 60-79 years, referred to as the “young old”. 1. The percentage of the population aged 60 years and older At a national level, Egypt was found to have the highest number of people aged 60 years and older, at 4.3 million or 6.3 per cent of the total population in 2000, which is set to rise to some 23.7 million or 20.8 per cent by 2050 (see table 4). Within the context of absolute populations, that age bracket is projected to exceed 10 million in Algeria and Morocco, and 5 million in five other countries, namely, Iraq, Saudi Arabia, Sudan, Syrian Arab Republic and Yemen. However, in terms of evaluating the ageing of a population, the percentage of that age bracket to the total population is a more revealing measure. In 2000, this percentage was found to be comparatively even, ranging from a low of 3.1 per cent in Qatar to 8.5 per cent in Kuwait. By stark contrast, in 2050, approximately a quarter of the populations in five countries are expected to be aged 60 years and older. These are as follows: Bahrain, at 24.0 per cent; Kuwait, at 25.7 per cent; Lebanon, at 25.4 per cent; Tunisia, at 24.6 per cent; and United Arab Emirates, at 26.7 per cent. However, there are significant regional disparities that can be attributed to the varying stages of demographic transition and, more specifically, to differences in fertility and mortality rates. TABLE 4. POPULATION AGED 60 YEARS AND OLDER IN ARAB COUNTRIES IN 2000 AND 2050 2000
Country or territory Algeria Bahrain Comoros Djibouti Egypt Iraq Jordan Kuwait Lebanon Libyan Arab Jamahiriya Mauritania Morocco Palestine Oman Qatar Saudi Arabia Somalia Sudan Syrian Arab Republic Tunisia United Arab Emirates Yemen
Population aged 60 years and older (Thousands) 1 817.5 30.1 29.6 34.8 4276.7 1 055.5 221.1 84.2 297.2 290.9 125.2 1 912.2 1 56.4 106.6 17.5 976.6 342.3 1 710.2 760.9 794.5 1 32.9 660.5
2050
Population aged 60 years and older (Percentage of total population) 6.0 4.7 4.2 5.5 6.3 4.6 4.5 4.4 8.5 5.5 4.7 6.4 4.9 4.2 3.1 4.8 3.9 5.5 4.7 8.4 5.1 3.6
Population aged 60 years and older (Thousands)
Population aged 60 years and older (Percentage of total population)
11 361.9 250.9 231.8 61.9 23 678.7 8 089.7 1 826.6 1 028.4 1 274.5 2 103.5 752.2 10 374.4 1 170.3 918.9 172.0 7 699.1 2 333.3 9 148.3 6 542.2 3 462.6 990.4 5 426.1
Source: Compiled from DESA. World Population Ageing 1950-2050 (United Nations, New York, 2002).
11
22.2 24.9 12.2 5.8 20.8 15.1 15.6 25.7 25.4 21.1 8.9 20.6 9.9 10.5 20.7 12.9 5.7 14.4 18.0 24.6 26.7 5.3
2. The percentage of the population aged 80 years and older Given the increase in the life expectancy at birth during the period 2000-2050, both the percentage and absolute size of the oldest old populations are set to increase in all the Arab States. Specifically, the percentage of the oldest old population to total population is projected to rise from the narrow range in 2000, at a low of 0.1 per cent in Qatar to 0.8 per cent in Tunisia, to an estimated range of 0.5 per cent in Somalia and Yemen to 6.4 per cent in the United Arab Emirates in 2050 (see table 5). Moreover, by 2050, the percentage of the population aged 80 years and older is expected to exceed 3 per cent of the total populations of six countries, namely, Algeria, Bahrain, Kuwait, Lebanon, Qatar and Tunisia. Furthermore, in order to study the structural changes among the elderly, the population aged 60 years and older is decomposed into two age groups, namely, the “young old” in the 60-79 years age-bracket; and the “oldest old” aged 80 years and older. In 2000, the percentage of the oldest old to the young old ranged from a low of 3.3 per cent in Qatar to13.9 per cent in Palestine, where, by implication, for every 100 people aged 60-79 years there were approximately 14 individuals aged 80 years or older. While the increase in the share of the oldest old is unlikely to be substantial at a regional level, at a national level, a number of countries are expected to undergo some structural changes in their elderly populations by 2050. These include the United Arab Emirates, at 31.5 per cent; Bahrain, at 29.7 per cent; and Qatar, at 29.4 per cent. Conversely, the percentage of the oldest old to the young old is expected to remain below 12.0 per cent in Djibouti, Mauritania, Somalia and Yemen (see table 5). TABLE 5. POPULATION AGED 80 YEARS AND OLDER IN ARAB COUNTRIES IN 2000 AND 2050 2000
Country or territory Algeria Bahrain Comoros Djibouti Egypt Iraq Jordan Kuwait Lebanon Libyan Arab Jamahiriya Mauritania Morocco Palestine Oman Qatar Saudi Arabia Somalia Sudan Syrian Arab Republic Tunisia United Arab Emirates Yemen
2050
Population aged 80 years and older (Thousands)
Population aged 80 years and older (Percentage of total population)
Population aged 80 years and older (Percentage of population aged 60-79 years)
181.5 1.9 2.1 1.3 3 339.4 68.8 19.6 3.8 24.5
0.6 0.3 0.3 0.2 0.5 0.3 0.4 0.2 0.7
11.1 6.8 7.7 3.8 8.6 7.0 9.8 4.8 9.0
1 586.6 57.4 20.9 6.6 3 073.7 1 071.5 257.6 144.1 230.8
3.1 5.7 1.1 0.6 2.7 2.0 2.2 3.6 4.6
16.2 29.7 9.9 11.5 14.9 15.3 16.4 16.3 22.1
21.2 8.0 149.4 19.1 7.6 0.6 61.0 17.6 124.4
0.4 0.3 0.5 0.6 0.3 0.1 0.3 0.2 0.4
7.8 6.8 8.5 13.9 7.7 3.3 6.7 5.4 7.8
289.1 76.1 1 410.1 141.9 105.0 39.0 895.2 204.7 1 016.5
2.9 0.9 2.8 1.2 1.2 4.7 1.5 0.5 1.6
15.9 11.3 15.7 13.8 12.9 29.4 13.2 9.6 12.5
64.8 75.7
0.4 0.8
9.3 10.5
799.6 534.9
2.2 3.8
13.9 18.3
10.4 36.7
0.4 0.2
8.5 5.9
237.4 511.9
6.4 0.5
31.5 10.4
Population aged 80 years and older (Thousands)
Population aged 80 years and older (Percentage of total population)
Source: Compiled from DESA, World Population Ageing 1950-2050 (United Nations, New York, 2002).
12
Population aged 80 years and older (Percentage of population aged 60-79 years)
With regard to the absolute population of the oldest old, a number of countries in the Arab region could face a growing challenge in terms of providing social security and health facilities to this segment of their populations. Within that context, Egypt is expected to have more than 3 million oldest old individuals by 2050, followed by Algeria, Iraq, Morocco and Sudan, where the oldest old populations in those countries are set to exceed 1 million individuals. 3. Gender ratios in the old population In those countries where cultural factors have contributed to lower female life expectancy, reductions in mortality have been substantially higher among females than males in practically all age groups. This has resulted in reducing the gender gap between males and females. Additionally, given the comparatively higher life expectancy at birth of women to men in some countries, the number of widows is expected to rise by 2050. This increase can be evaluated by investigating the gender ratios of the old and oldest old populations.11 In 2000, old men aged 60 years and older outnumbered their female counterparts in eight countries, namely, Bahrain, Jordan, Kuwait, Libyan Arab Jamahiriya, Oman, Qatar, Saudi Arabia and United Arab Emirates (see figure XI). In the other countries of the region, the gender ratio was found to be less than 100. Generally, this population is projected to move towards greater gender equilibrium by 2050. Figure XI. Gender ratios of the population aged 60 eras and older in Arab countries in 2000 and 2050 Yemen United Arab Emirates Tunisia Syrian Arab Republic Sudan Somalia Saudi Arabia Qatar Oman Palestine Morocco Mauritania Libyan Arab Jamahiriya Lebanon Kuwait Jordan Iraq Egypt Djibouti Comoros Bahrain Algeria ٠
٥٠
١٠٠
١٥٠
٢٠٠
٢٥٠
Gender ratio ٢٠٠٠
٢٠٥٠
Source: Compiled from DESA, World Population Ageing 1950-2050 (United Nations, New York, 2002).
11
The gender ratio is calculated as the number of men to every 100 women.
13
By stark contrast, in 2000, old men aged 80 years and older outnumbered their female counterparts in only two countries, namely, Qatar and the United Arab Emirates (see figure XII). At a regional level, the gender ratio for this population was found to be approximately 80, thereby implying 80 oldest old men for every 100 female counterparts. While this gender imbalance in favour of women is projected to persist in 2050 for the region as a whole, there are expected to be a number of notable exceptions at a national level, including Qatar, with a ratio of 160; and the United Arab Emirates, at approximately 195 oldest old men for every 100 oldest old women. Figure XII. Gender ratios of the population aged 80 years and older in Arab countries in 2000 and 2050 Yemen United Arab Emirates Tunisia Syrian Arab Republic Sudan Somalia Saudi Arabia Qatar Oman Palestine Morocco Mauritania Libyan Arab Jamahiriya Lebanon Kuwait Jordan Iraq Egypt Djibouti Comoros Bahrain Algeria ٠
٢٠ ٢٠٠٠
٤٠
٦٠
٨٠
١٠٠
١٢٠
١٤٠
١٦٠
١٨٠
٢٠٠
Gender ratio
٢٠٥٠
Source: Compiled from DESA, World Population Ageing 1950-2050 (United Nations, New York, 2002).
B. RATE OF GROWTH OF THE OLD POPULATION Within the context of the rate of growth of the population aged 60 years and older during the period 2000-2050, Kuwait is expected to have the highest rate at 5.0 per cent, followed by Qatar and Oman at 4.57 per cent and 4.31 per cent, respectively (see table 6). Additionally, this rate was found to be in the range of 4-5 per cent in a total of 12 Arab countries, which is significantly higher than the equivalent rate of growth for the total populations.12 Moreover, in that period, the average annual rate of growth of the oldest old populations is projected to exceed 5 per cent in a total of 11 Arab countries, including Kuwait and Qatar both with rates of more than 7 per cent.
12 For instance, while the total population in Bahrain is set to grow at an annual rate of 0.9 per cent, the population aged 60 years and older in that country is projected to grow at 4.24 per cent during the same period (see tables 1 and 6).
14
TABLE 6. THE RATE OF GROWTH OF THE OLD POPULATIONS IN ARAB COUNTRIES IN 2000-2050 (Annual percentages) Rate of growth of the population aged 60 years and older 3.76 4.24 4.11 1.16 3.42 4.07 4.22 5.00 2.91 3.96 3.59 3.38 4.03 4.31 4.57 4.13 3.84 3.35 4.30 2.94 4.02 4.21
Country or territory Algeria Bahrain Comoros Djibouti Egypt Iraq Jordan Kuwait Lebanon Libyan Arab Jamahiriya Mauritania Morocco Palestine Oman Qatar Saudi Arabia Somalia Sudan Syrian Arab Republic Tunisia United Arab Emirates Yemen
Rate of growth of the population aged 80 years and older 4.33 6.80 4.58 3.25 4.41 5.49 5.15 7.26 4.49 5.23 4.51 4.49 4.01 5.25 8.47 5.37 4.91 4.20 5.03 3.91 6.25 5.27
Source: Compiled from DESA, World Population Ageing 1950-2050 (United Nations, New York, 2002).
Figure XIII. The rate of growth of the old populations in Arab countries in 2000-2050 (Percentages)
Qatar Kuwait Bahrain United Arab Emirates Iraq Saudi Arabia Yemen Oman Libyan Arab Jamahiriya Jordan Syrian Arab Republic
80 years and older
Somalia
60 years and older
Comoros Mauritania Morocco Lebanon Egypt Algeria Sudan Palestine Tunisia Djibouti 0
1
2
3
4 5 Rate of growth
6
7
8
Source: Compiled from table 6.
15
C. MEDIAN AGE OF THE POPULATION At a national level, the minimum and maximum median ages in 2000 were found in Somalia, at 16.0 years, and in Qatar, at 32.1 years, respectively (see table 7).13 By 2050, the median ages are expected to rise significantly in the majority of Arab States. This increase is set to be most apparent in Lebanon, at 41.1 years, followed by the United Arab Emirates, at 40.5 years. By contrast, the lowest increases in the median ages in 2050 are projected in Qatar, Somalia and Yemen. However, in the case of Qatar, the projected incremental rise from 32.1 years to 37.9 years in 2000-2050 does not represent a significant indicator, given that Qatar had the highest median age in the Arab region in 2000. TABLE 7. AGEING INDICATORS IN ARAB COUNTRIES IN 2000 AND 2050 2000 Country or territory Algeria Bahrain Comoros Djibouti Egypt Iraq Jordan Kuwait Lebanon Libyan Arab Jamahiriya Mauritania Morocco Palestine Oman Qatar Saudi Arabia Somalia Sudan Syrian Arab Republic Tunisia United Arab Emirates Yemen
2050
Median age (Years)
Old-age dependency ratio
Oldest old-age dependency ratio
Ageing index
21.8 29.6 17.9 18.2 21.9 18.8 19.5 22.7 25.1
10.2 7.0 8.0 10.7 10.8 8.5 8.1 6.8 14.1
1.0 0.4 0.6 0.4 0.9 0.6 0.7 0.3 1.2
21.4 17.7 22.3 16.8 17.7 32.1 18.4 16.0 19.7
9.1 9.2 10.8 10.1 8.1 4.4 9.2 8.1 10.1
18.7 24.6 31.3 15.0
Median age (Years)
Old-age dependency ratio
Oldest old-age dependency ratio
Ageing index
17.4 16.7 9.8 12.8 17.8 11.0 11.4 14.1 27.4
38.2 40.3 31.2 25.4 37.4 34.4 33.8 39.2 41.2
38.2 43.8 19.1 8.8 35.2 24.2 25.2 47.0 44.5
5.3 10.0 1.7 0.9 4.6 3.2 3.6 6.6 8.1
113.0 137.2 51.1 20.6 103.5 67.0 69.1 130.4 145.2
0.7 0.6 0.8 1.2 0.6 0.1 0.6 0.4 0.7
16.2 10.7 18.4 10.6 9.6 11.7 11.2 8.1 13.6
37.7 27.0 37.6 27.6 27.8 37.9 31.3 21.5 33.5
35.9 13.9 34.7 15.6 16.7 34.8 20.2 9.8 22.9
4.9 1.4 4.7 1.9 1.9 7.9 2.3 0.9 2.5
105.0 32.7 102.4 37.2 39.1 104.7 55.8 15.7 63.5
8.6 13.6
0.7 1.3
11.5 28.4
35.6 38.9
29.9 44.0
3.7 6.8
82.7 125.6
7.4 7.8
0.6 0.4
19.7 7.3
40.5 21.1
48.7 9.2
11.7 0.9
143.7 14.3
Source: Compiled from DESA, World Population Ageing 1950-2050 (United Nations, New York, 2002).
13
The median age of a population is defined as the midpoint age that separates the younger half of the population from the
older half.
16
Figure XIV. Median age in Arab countries in 2000 and 2050
Lebanon United Arab Emirates Bahrain Kuwait Tunisia Algeria Qatar Libyan Arab Jamahiriya Morocco Egypt Syrian Arab Republic Iraq Jordan Sudan Saudi Arabia Comoros Oman Palestine Mauritania Djibouti Somalia Yemen ٠.٠
٥.٠
١٠.٠
١٥.٠
٢٠.٠
Median age in 2000
٢٥.٠
٣٠.٠
٣٥.٠
٤٠.٠
٤٥.٠
Median age in 2050
Source: Compiled from table 7.
D. DEPENDENCY BURDEN 1. Old-age dependency ratio The dependency ratio is a measure of the portion of a population that is composed of dependents who are too young or too old to work. 14 It provides a valuable tool in assessing the financial burden of dependents on the working population. At a regional level, this ratio ranged from a low of 4.4 in Qatar to 14.1 in Lebanon in 2000 (see table 7). However, the challenge posed by ageing populations is expected to assume alarming proportions by 2050, particularly in those Arab countries where dependency ratios are projected to rise above 40. These include, by order of magnitude, United Arab Emirates, at 48.7; Kuwait, at 47.0; Lebanon, at 44.5; Tunisia, at 44.0; and Bahrain, at 43.8 (see figure XV).
14
Traditionally, the dependency ratio is taken to be equal to the number of individuals aged 14 years and younger and 65 years and older divided by the number of individuals aged 15-64 years. For the purposes of this study, however, the old-age dependency ratio is defined as the number of individuals aged 60 years and older divided by the working population aged 15-59 years.
17
Figure XV. Old-age dependency ratio in Arab countries in 2000 and 2050 (Percentages) United Arab Emirates Kuwait Lebanon Tunisia Bahrain Algeria Libyan Arab Jamahiriya Egypt Qatar Morocco Syrian Arab Republic Jordan Iraq Sudan Saudi Arabia Comoros Oman Palestine Mauritania Somalia Yemen Djibouti ٠.٠
٥.٠
١٠.٠
١٥.٠
٢٠.٠
٢٥.٠
٣٠.٠
٣٥.٠
٤٠.٠
٤٥.٠
٥٠.٠
Old-age dependency ratio in 2050 Old-age dependency ratio in 2000
Source: Compiled from table 7.
2. Oldest old-age dependency ratio Similarly, while the oldest old-age dependency ratio showed modest variation in 2000, it is set to rise significantly in a number of Arab States by 2050.15 Those countries where this ratio is projected to rise above 5 include, by order of magnitude, United Arab Emirates, at 11.7; Bahrain, at 10.0; Lebanon, at 8.1; Oman, at 7.9; Tunisia, at 6.8; and Algeria, at 5.3. The oldest old-age burden is not expected to pose a serious challenge in the other countries of the Arab region.
15 In this case, the oldest old-age dependency ratio is defined as the number of individuals aged 80 years and older divided by the working population aged 15-59 years.
18
Figure XVI. Oldest old-age dependency ratio in Arab countries in 2000 and 2050 (Percentages) United Arab Emirates Bahrain Lebanon Qatar Tunisia Kuwait Algeria Libyan Arab Jamahiriya Morocco Egypt Syrian Arab Republic Jordan Iraq Sudan Saudi Arabia Oman Palestine Comoros Mauritania Yemen Somalia Djibouti ٠.٠
٢.٠
٤.٠
٦.٠
٨.٠
١٠.٠
١٢.٠
Oldest old-age dependency ratio in 2050 Oldest old-age dependency ratio in 2000
Source: Compiled from table 7.
E. AGEING INDEX The ageing index provides another important tool to evaluate the ageing of a population.16 With the exception of Lebanon and Tunisia, the ageing process was generally slow in the Arab region until 2000 (see figure XVII). However, this index is expected to increase substantially by 2050, particularly in those States that are comparatively more advanced in their demographic transitions. These include, by order of magnitude, Lebanon, at 145.2; United Arab Emirates, at 143.7; Bahrain, at 137.2; Kuwait, at 130.4; and Tunisia, at 125.6 (see table 7). F. RATE OF POPULATION AGEING While population ageing in the Arab region is not currently of the order of magnitude witnessed in some developed countries, the process of ageing has already begun in a number of Arab States. This process, which is expected to gather pace in the subsequent 50 years, could grow into alarming proportions. Consequently, there is a need to quantify the pace of population ageing in individual Arab countries, thereby laying the foundations for the formulation of sound policies and programmes aimed at tackling the future challenges.
16 In this case, the ageing index is defined as the number of individuals aged 60 years and older divided by the number of children aged 14 years and younger.
19
Figure XVII. Ageing index in Arab countries in 2000 and 2050 Lebanon United Arab Emirates Bahrain Kuwait Tunisia Algeria Libyan Arab Jamahiriya Qatar Egypt Morocco Syrian Arab Republic Jordan Iraq Sudan Saudi Arabia Comoros Oman Palestine Mauritania Djibouti Somalia Yemen ٠.٠
٢٠.٠
٤٠.٠
٦٠.٠ Ageing index in 2000
٨٠.٠
١٠٠.٠
١٢٠.٠
١٤٠.٠
Ageing index in 2050
Source: Compiled from table 7.
Within that context, the five principal indicators used to investigate future prospects for each country, which were reviewed and discussed above, can be processed cumulatively and arranged in descending order of magnitude. This provides national characteristics with regard to ageing populations that can be categorized into countries whose populations are set to experience rapid, medium or slow rates of ageing (see table 8). TABLE 8. ESTIMATED RATE OF POPULATION AGEING IN THE ARAB REGION
Rapid rate of ageing
Medium rate of ageing
Country or territory Algeria Bahrain Kuwait Lebanon Tunisia United Arab Emirates Egypt Iraq Jordan Libyan Arab Jamahiriya Morocco Qatar Saudi Arabia Syrian Arab Republic Sudan
20
TABLE 8 (continued) Country or territory Comoros Djibouti Mauritania Oman Palestine Somalia Yemen
Slow rate of ageing
Governments of countries with rapidly ageing populations need to devise adequate strategies and plans on a priority basis in order to meet the needs of their growing elderly populations. While there is lesser sense of immediacy for those countries whose populations are ageing at a medium rate, there is still a strong need to provide basic amenities to the old and oldest old segments of society, particularly in Egypt, which, in absolute numbers, has the highest elderly population in the region. The remaining seven Arab countries, whose populations are ageing at a comparatively slower rate, are not expected to experience significant challenges in this area until 2050. Consequently, the issue of ageing populations is not a priority for these countries. The age pyramids of the above three groups of countries in 2000 and their likely age-sex structure in 2050 are provided in figures 14 and 15, respectively. Figure XVIII. Age pyramids of Arab countries in 2000
Age
A. ARAB COUNTRIES WITH RAPID RATES OF POPULATION AGEING 85+ 80-84 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4
Female Male
18 16 14 12 10 8
6
4
2
0
2
4
6
8 10 12 14 16 18
Percentages
Age
B. ARAB COUNTRIES WITH MEDIUM RATES OF POPULATION AGEING
85+ 80-84 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14
Female Male
18 16 14 12 10
8
6
4
2
0
2
Percentages
21
4
6
8
10 12 14 16 18
Age
C. ARAB COUNTRIES WITH SLOW RATES OF POPULATION AGEING 85+ 80-84 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4
Female Male
18
16
14
12
10
8
6
4
2
0
2
4
6
8
10
12
14
16
18
Percentages
Source: Compiled from DESA, World Population Ageing 1950-2050 (United Nations, New York, 2002).
Figure XIX. Age pyramids of Arab countries in 2050
Age
A. ARAB COUNTRIES WITH RAPID RATES OF POPULATION AGEING 85+ 80-84 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4
Females Males
12
10
8
6
4
2
0
2
4
6
8
10
12
Percentages
Age
B. ARAB COUNTRIES WITH MEDIUM RATES OF POPULATION AGEING 85+ 80-84 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4
Females Males
12
10
8
6
4
2
0 Percentages
22
2
4
6
8
10
12
Age
C. ARAB COUNTRIES WITH SLOW RATES OF POPULATION AGEING 85+ 80-84 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4
Females Males
12
10
8
6
4
2
0
2
4
6
8
10
12
Percentages
Source: Compiled from DESA, World Population Ageing 1950-2050 (United Nations, New York, 2002).
23
III. CONSEQUENCES OF POPULATION AGEING This chapter focuses on the consequences and impacts of population ageing in the areas of socioeconomic development, health and social security for the elderly. These are reviewed below. A. SOCIO-ECONOMIC CONSEQUENCES Researchers have tended to study the consequences of ageing and the various challenges arising from such a process from different perspectives. While sociologists deal with the gradual unfolding of the social development of individuals, including changes in their social status, roles and social security, economists are generally concerned with the impact of ageing on such purely economic factors as financial dependency.17 Studies conducted in developing countries largely reflect financial insecurity among the elderly, particularly among old women. While individuals who work in the informal sectors of the economy earn progressively less with growing age and rely more on financial assistance, their counterparts in the formal sectors are equally dispossessed of income and economic independence past the fixed retirement age. This is particularly the case in those countries where there are little or no retirement benefits and where inadequate or inexistent social security schemes prevail. 18 Moreover, at an individual level, mandatory retirement or withdrawal from work due to old age provokes a number of negative impacts, including alienation from society, loss of purpose, reduced productivity, loss of social roles and other psychological problems.19 In most developed countries, the elderly receive some income as social security.20 This form of welfare assistance is largely absent in developing countries. Where such provisions exist, they generally extend only to retired employees of the public or formal sectors through pension and contributory provident funds. The majority of the population in those countries are therefore compelled to rely exclusively on private savings or donations from families and charities. Population ageing has the direct consequence of raising the dependency burden whereby a growing percentage of retirees and elderly are being supported by a diminishing percentage of the economically active population. Concomitantly, the growing old and oldest old populations increase the demand on national health and social service systems, which in turn augment the cost of retirement pensions and medical care.21 This has negative repercussions on the standard of living of the population. 22 Moreover, the “composite impact of ageing and the rising dependency ratio… have adverse effects on household savings” and on the per capita income of households.23 A negative cycle is therefore set in motion given that a decline in household savings results in a drop in investment, which in turn decreases the aggregate supply of goods and services and, consequently, a fall in national income. Furthermore, in terms of
17 Saxena, P.C. and Kumar, D. “Differential risk of mortality among pensioners after retirement in the State of Maharashtra, India”, which was presented at the 13th World Congress of Sociology (Bielefeld, Germany, 18-23 July 1994); and Rajan, I.S., Mishra, U.S. and Sarma P.S. “A survey of elderly in India” (Centre for Development Studies, Trivandrum, India, April 1994). 18
Soldo, B.J. and Manton, K.G. “Demographic challenges for socioeconomic planning”, Journal of Socio-Economic Planning Sciences, Vol. 19 (1985). 19
Kiuranov, C. “Society, work and aging”, Social Aspects and Country Reviews of Population Ageing, G.J. Stolnitz ed. (United Nations, New York, 1994). 20
For instance, the United States of America practises a system of intergenerational transfer whereby young people contribute funds to the State, which in turn is allocated to the elderly through social security. 21
Azim, P. “The ageing population of Brunei Darussalam: trends and economic consequences”, Asia-Pacific Population Journal, Vol. 17, No. 1 (March 2002). 22
Anderton, A.G. Economics (Causeway Press Ltd, June 2000).
23 Azim, P. “The ageing population of Brunei Darussalam: trends and economic consequences”, Asia-Pacific Population Journal, Vol. 17, No. 1 (March 2002), p. 51.
24
gross domestic product (GDP), the increasing percentage share of national budgets needed to meet the growing demands of the elderly restricts the capital available for other developmental projects.24 Within the context of the changing age-sex structure of the population due to ageing, industries are expected to modify their patterns of production in order to accommodate and respond to new and nascent demands.25 B. HEALTH CONSEQUENCES Demographic transition and epidemiology are directly related. The latter, which refers to the branch of medicine that deals with the incidence, distribution and control of disease in a population, is a function of changing patterns of health and, therefore, varies with demographic trends.26 Reductions in fertility and mortality rates translate into declines of childhood diseases and increases in degenerative diseases in the elderly, who are more susceptible to both infectious and chronic diseases due to the deterioration of their immune responses from old age. In this age group, the leading causes of mortality include hypertension, cardiovascular diseases, cancer and diabetes. 27 Equally prevalent among the elderly are such maladies as pneumonia, kidney and chronic renal diseases, and Parkinson’s disease. 28 Additionally, multiple chronic diseases are common in old ages that affect the health and the quality of life of the elderly. 29 Within that context, arthritis and orthopaedic, visual and auditory impairments are some of the commonly observed ailments of the elderly. 30 In cases of acute conditions, these diseases and ailments can be protracted and can even lead to death.31 Consequently, with demographic ageing on the agenda of most Arab countries, there is a growing need to take stock of the changing health requirements of the population. In particular, those countries whose populations are expected to age at a rapid rate must prepare themselves to meet the health requirements of the elderly by formulating short- and long-term plans and policies that can adequately address the issue of population ageing.32 C. SOCIAL SECURITY FOR THE ELDERLY IN ARAB STATES The International Plan of Action on Ageing adopted by the first World Assembly on Ageing (Vienna, 26 July – 6 August 1982) was the first official document that underscored the challenges and issues related to population ageing. These issues were further developed by the Programme of Action of ICPD (1994), which conduced to national strategies aimed at reforming social security programmes across the world. Several 24
Pursuant to the Programme of Action of the International Conference on Population and Development (ICPD) (Cairo, 513 September 1994), member States are committed to mobilize their resources aimed at meeting the demands of their elderly populations. 25
Tabbarah, R. “Demographic trends E/ESCWA/SD/2002/WG.1-I/3.
of ageing in
the
Arab
countries”
(ESCWA,
31
January 2002),
26
Sibai, A.M. “The elderly in Lebanon: their demographic, socio-economic, social and health aspects” (in Arabic) (American University of Beirut, Faculty of Health Sciences, September 1998). 27
Public Health Service (PHS). Current estimates from the National Health Interview Survey: United States, 1990 (Department of Health and Human Services (DHSS), PHS, 1991). 28
Boulghourjian, C.M. “Psychosocial, health, and economic aspects of an elderly Armenian population in Lebanon”, which is an unpublished thesis submitted to the American University of Beirut, Faculty of Health Sciences (June 1997). 29
Cavanaugh, J.C. Adult development and aging, second edition (Brooks/Cole Publishing Company, 1993).
30
Brody, J. “Changing health needs of the aging population”, Research and the Ageing Population – No. 134 (CIBA Foundation Symposium, February 1988). 31
Dooghe, G. “Social and health aspects”, Social Aspects and Country Reviews of Population Ageing, G.J. Stolnitz ed. (United Nations, New York, 1994). 32
These countries include Algeria, Bahrain, Kuwait, Lebanon, Tunisia and United Arab Emirates (see chapter II).
25
developing countries have integrated social security and other welfare programmes for the elderly in their developmental agenda. Generally, there are many commonalities in the social security programmes of Arab countries, which are largely traditional social insurance, rather than defined benefit programmes and contribution systems. This common approach to social security is unusual given that the Arab region constitutes a widely disparate group of States in terms of GDP and per capita income, and comprises some of the wealthiest and poorest countries of the world.33 The per capita incomes of the three wealthiest Arab countries, namely, Kuwait, Qatar and the United Arab Emirates, exceed those of several European countries. Additionally, the per capita incomes of Jordan and the Syrian Arab Republic are comparable to those of Poland and Romania; and of Yemen to that of India.34 Historically, Iraq was the first Arab country to establish a social security programme. Formulated in 1950, the Law on the Provident Fund was promulgated in 1956, which was subsequently converted to a social insurance plan in 1971. Similar plans were implemented in a number of countries, including Bahrain, in 1976;35 Kuwait, in 1976; Oman, in 1991; Saudi Arabia, 1962; Syrian Arab Republic, in 1959; and Yemen, in 1991. While social security coverage rates are comparatively higher in the Arab region than in sub-Saharan Africa and Asia, this coverage extends to less than 25 per cent of the population. In Saudi Arabia and Kuwait, a modest 21 per cent and 23 per cent of the labour force, respectively, enjoys such coverage. In some Arab countries, this low rate can be attributed to foreign workers who constitute a higher percentage of the national labour force and who are not provided for under the national social security schemes. 36 Moreover, the coverage can be a function of the size of the companies and the type of work.37 Within the context of the former, social security coverage is restricted to enterprises with a minimum of ten employees in Bahrain and Saudi Arabia, and a minimum of five employees in Jordan. Below those numbers of workers, participation in national security plans is deemed voluntary. Consequently a lack of mandatory inclusion contributes to low coverage rates. With the exception of Lebanon, where only the employers contribute to social security, employees tend to contribute 5-7 per cent of their wages for the coverage, while the contribution by the employers is in the range of 7-14 per cent.38 Additionally, some States provide subsidies towards social security funds as a percentage of total wages. These include Kuwait, at 10 per cent; Oman, at 5 per cent; and Yemen, at 6 per cent for workers in the public sector, and 9 per cent for other employees. While the majority of Arab States pay benefits to their employees as annuities, Lebanon and Yemen disburse lump sum payments on termination of employment. Moreover, while most countries calculate the benefits according to the average earnings of the final two years of employment, the benefits in Kuwait are
33
Turner, J. “Social security development and reform around the world”, The Three Pillars of Wisdom? A Reader on Globalization, A. Tausch ed. (World Bank Pension Models and Welfare Society, Nova Science Publishers, New York, 2003). 34
Turner, J. and Lichtenstein, J.H. “Social security reform in the Middle East”, Journal of Aging and Social Policy, Vol. 14
35
In the case of Bahrain, while the programme was introduced in 1976, benefits began to be disbursed in 1986.
(2002). 36
Within that context, Jordan and Yemen are notable exceptions given that migrant workers in those two countries enjoy the same entitlements in the area of social security as nationals. Turner, J. and Lichtenstein, J.H. “Social security reform in the Middle East”, Journal of Aging and Social Policy, Vol. 14 (2002). 37
In Jordan, approximately three-quarters of total spending on public pensions is allocated to military pensions. Palacios, R. and Pallares-Miralles, M. “International patterns of pension provision”, Social Protection Discussion Paper No. 0009 (World Bank, April 2000). 38
Turner, J. and Lichtenstein, J.H. “Social security reform in the Middle East”, Journal of Aging and Social Policy, Vol. 14
(2002).
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based on the final monthly wage, and in Lebanon they are given on the basis of the final monthly wage or the average of the final 12 months, whichever is higher. The majority of the countries in the Arab region give replacement rates of 60 per cent or higher for 30 years of service. In Kuwait, which enjoys one of the most generous schemes, retiring employees are entitled to 65 per cent of their final monthly wage in addition to 2 per cent of that final income multiplied by the number of years of service above 15 years. Moreover, they are eligible for this benefit from the age of 50 years and can receive up to 25 per cent of total benefit as a lump sum. In Saudi Arabia, benefit is computed as 2 per cent of the average covered wages multiplied by the number of years of service, thereby providing a replacement rate of 60 per cent for 30 years of work. In the Syrian Arab Republic, the percentage of the average covered wages rises marginally to 2.22 per cent with a maximum benefit of 75 per cent of average earnings. In Yemen, benefit equals 2.5 per cent of average earnings multiplied by the number of years of service. D. CONCLUSIONS AND RECOMMENDATIONS The old and oldest old populations are projected to grow to alarming proportions by 2050 both in terms of absolute numbers and percentages of total populations. There is therefore an urgent need for policymakers to focus on the challenges arising from population ageing. Moreover, relevant strategies must aim at the following: (a) to promote the quality of life of the elderly and enable them to work and live independently in their own communities; (b) to provide healthcare systems and social security in old age; and (c) to develop a social support system, both formal and informal, with a view to enhancing the abilities of relatives to take care of the elderly within the familial environment. The models and concepts set forth in this study relate to population ageing as a result of changes in fertility and mortality. However, other factors can play an equally important role in transforming national and regional demographics. Prominent among these are migration of labour, which affects the younger segments of a population and can contribute significantly to the rate of population ageing. Consequently, ageing could be accelerated in a number of countries, particularly those where the populations are already ageing at rapid and medium rates. This emigration from the Arab region of the young, in addition to any immigration of the old from other regions, further exacerbates an already high dependency burden. Governments in the region must therefore act to monitor the emigration of their economically active population and provide employment opportunities and better future prospects to retain their populations of young adults. Furthermore, the lack or limited coverage of the formal social security plans in the Arab region has several implications on the economic well being of the elderly. One of the implications is that a significant proportion of the population past retirement age continues to work even when their health conditions deteriorate.39 In many cases, this participation in the labour force by the elderly results from a lack of adequate coverage under social security schemes, which compels the old to persist with their daily livelihoods. While there is no uniform policy across the region with regard to social security schemes, coverage and retirement age, most Arab States fully recognize the need to “develop social security systems that ensure greater intergenerational and intra-generational equity and solidarity and that provide support to elderly people through the encouragement of multigenerational families, and the provision of long-term support and services for growing numbers of frail older people”.40 Additionally, ongoing social changes in the Arab region due to the proliferation and diffusion of Western culture could have an adverse effect on the traditional social support system. While the elderly in Arab societies currently enjoy a great degree of care and support in their families, an increase in nuclear 39 In Lebanon, where the retirement age is 64 years, one-third of elderly men continued participating in the labour force beyond this age. Sibai, A.M. “The elderly in Lebanon: their demographic, socio-economic, social and health aspects” (in Arabic) (American University of Beirut, Faculty of Health Sciences, September 1998). 40
ICPD Programme of Action, para. 6.18.
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living arrangements among the young diminishes the extended family system and weakens this care and support to the elderly. Without such familial care, the elderly could be compelled to relocate to nursing and old age homes. Consequently, Arab Governments need to strengthen the formal and informal support systems for the elderly with the collaboration of non-governmental organizations and the private sector. The old can continue to participate fully in society and lead self-determined, healthy and productive lives. Their self-reliance and sense of purpose need only the support of Governments, non-governmental organizations and families.
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