Jamaica’s Ageing population

Paul Andrew Bourne


Introduction

In the earlier centuries, pandemic and pestilence destroyed millions of lives. One such pandemic was the Oriental or bubonic plague (a rate-based disease, fleas that lived on humans and rats). In early 1330s, it exterminated many lives in Hong Kong and later spread throughout China, the continent of Asia and then to Europe. In October 1347, the pestilence was brought to Europe by a group of Italian merchants who had traveled to China on business. On their return to the ports of Sicily, many of them were found suffering from the plague and some were dead. The pestilence had traveled all the way Northern Europe to England. In August of the fourteenth century (1348), the people of England named it the ?'Black Death'. It eradicated approximately 40 million people worldwide. Some scholars argue that this disease ?'wiped out' about one-third to one-half of European's and Asian's human population (Rowland 2003), and five years it slaughtered 25 million Europeans. The disease stayed with people until it disappeared in the 1600s. Then during the 1700s, smallpox slew an estimated 100 peoples worldwide.

Following those pandemics and plagues, the discoveries of peninsulin along with proper sanitation and public health have seen a significant reduction in mortality. Whereas low mortality is not synonymous with all nations - because of warfare and famine- low death rates have been the experience of a plethora of the developed societies. This reality is also happening in many developing and emerging nations. Accompanying mortality decline is the issue of the fertility transition that began in the France in the 19th century. This has spread throughout Europe, America and Canada, Japan, China, Barbados and Jamaica to name a few countries. Many developed societies are now experiencing what is referred to as ?'below replacement level fertility. This is where the society automatically replenishes itself by approximately 2.1 births per women of child-bearing age (i.e. 15 - 49 years). There are societies like Barbados, Trinidad and Tobago, Japan, France, Sweden, and Canada among others that have a total fertility rate of approximately 1.6 children per woman of child-bearing age, which is an indicator of below replacement level fertility. This coupled with declining mortality further explains the next inevitable population challenge, old ages. Population ageing is not simply longer live, but is the health challenges that face not only the individual but the cost of health, the possibility of reduced economic growth, shifts in disease patterns and prevalence and the increasing pressure that it is likely to place on the working age population. The question that few Jamaicans have been asking themselves is ?'what are the scope, implications and challenges of population ageing' within our declining state (i.e. increasingly less resources).

Indicators of population ageing

Demographers refer to ageing of world population as demographic ageing (or population ageing, or ageing population). There are a few yardsticks that are used in this process. One, they use the median age of the population. This is where one-half of population within a geographic space is either above or below a certain age (i.e. median age). Two, some use the proportion of the human population that is 65 years (some say 60 years) and older, which is 8 - 10 %. For the purpose of this paper, I will use the latter (i.e. 8 -10% of the population 60 and 65 years and older). As a demographer, the chronological valuation for old age (or ageing population) is 65 years and beyond; and so, this will be used throughout this paper except in a further cases, and when this is the case, I will specify to this end.

Population ageing means longer life and not necessarily quality living. In this article, I use ageing totally in the sense of longer life. With this said, there is an indication that Jamaica's population have been ageing, and when did this began? Another germane question that is of significance is ?'Is there a gender disparity in longer life, and which sex is likely to live longer in Jamaica?' I will begin with life expectancy as the symbolic representation of population ageing.

Table 1.1.1: Expectation of Life at Birth by Sex, 1880-1991, Jamaicans
Period Average Expected Years of Life at Birth
Male (in %) Female (in %)
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* 75.58*
Sources: Demographic Statistics (1972-2004), and Statistical Yearbook of Jamaica, 1999.
* Economic and Social Survey, Jamaica 2005.

From the data above (Table 1.1.1), in Jamaica, population ageing began in the early twentieth century (1920s). In the 1800s, Jamaica life expectancy (i.e. years of life) was 39 years and 10 months for women and 37 years for men. The disparity in lived years was about 3 years in favour of women. In the late 1800s, the lived years fell for both sexes (i.e. 36 yrs and 9 months for men and 38 years and 4 months for women, which mean that men gained approximately 2 years on their lived years compared to their women counterparts). The lived years have continued to increase ever since the 1920-1922. The latest statistics (1991-2001) reveal that females outlive their male counterparts on average by approximately 4 years (i.e. 71 years for men and 75 for women). Another indicator of population ageing is the percentage points of aged with regards to the total population. Hence, ?'what is the proportion of the population 65 years and older?'


Figure 1.1: Proportion of the population 60 years and 65 years and older
Source: Figures taken from Demographic Statistics (STATIN) various years


If we are to use the benchmark of 60 years and older as indicating ageing, Jamaica's population has been ageing for some time now (i.e. at least 10% of the total population 60 years and beyond). (See Figure 1.1 - the blue coloured quadrilateral). On the other hand, if we are to use 65 years and beyond as the symbol of ageing, then proportion of the total population that is 65+ years, since 1991 are as follows: 7.51, 7.44, 7.46, 7.49, 7.51, 7.54, 7.54, 7.56, 7.59, 7.59, 7.61, 7.63, 7.64, 7.66, 7.77, 7.76 (ends 2001). The demographic reality is, Jamaica's population is undoubtedly ageing; and this will continue because of fertility declines. Data from the Statistical Institute of Jamaica show that in the 1960s, the crude birth rate (CBR) was 40 per 1000 of the population and this fell to 25 per 1000 of the population in 1990, and in 2006 the figure reads 17.0 per 1000 of the population. In addition, the country's total fertility rate (TFR) has fallen from approximately 6 children per women of child-bearing ages in the 1970 to 2.45 in 2006. If this trend continues in the foreseeable future, population ageing is here to stay. My rationale for this is obvious as in 1970 5.4% of the total population was 65+ years and in 2004 the figure reads 9.0%. Fertility declines coupled with the reduction in mortality rates along with the increases in live years are all indicators of demographic transition in Jamaica, but is this different for other Caribbean states?

Population ageing: Nationally, Regionally and Globally

Demographic transition in the Caribbean is in keeping with the rest of the world. In that, total fertility for 1970-1975 for the world was 4.49 and for 2000-2005, it fell to 2.65. Whereas in Latin America and the Caribbean between 1970 and 1975 it was 5.05 and this was further reduced to 2.55 in 2000-2005. Concurrently, in 2005, total fertility in Bahamas is 2.2, in Barbados it is 1.5, for Jamaica 2.3 and for Trinidad and Tobago, 1.6 (United Nations 2006:87-89). Barbados and twin islands of Trinidad and Tobago are experiencing below replacement level fertility, a problem presently faced by many developed nations such as those in Southern and Easter Europe and the United States and Canada, to name a few countries. In addition, mortality in the Caribbean has been falling coupled with increased life expectancies that are comparable with those in developed nations, beyond 71 years, which according to Rowland (2003:18) are components within the demographic transition model. I will present a pictorial representation of Jamaica's population pyramid, which will show the state of population ageing come 2050. I will repeat, the reality is demographic ageing is here to stay.

Pictorial of the population ageing in Jamaica, 2000 - 2050: Population pyramid

From the U.S. Census Bureau, International Data Base, Jamaica's population in 2000 showed a relatively young population, which is because of the broad base. This triangular age profile is an indication of the high proportion of children, which means that Jamaica in 2000 had a high fertility and high mortality.



However, the young population that was observed in 2000 from all indication is shifting as the base of the age profile narrows and the middle expands. Within the demographic transition, this is a representation where the young population is falling and shifting toward the middle ages, and old type of profile.



While the demographic transition is not necessarily obvious in the 2025, Jamaica's age type population profile will definitely be contracting at the base and expanding at middle and old ages. Such a profile denotes is as indication of low fertility and death rates. A careful look at the diagram reveals that the come 2050 and beyond, Jamaica's oldest elderly will substantially more females. The "greying" of the Jamaica's population is coming, and has already made its way within the society. From records of the Population Division of the United Nations, Jamaica's population 60 years and older in 2050, using the medium variant, is likely to be 24% of the entire population, with 18.1% being 65 years and older, compared to approximately 5% being 80+ years. These shifts mean more degenerated conditions at older ages, increased disability and diminished quality of life. The disparity in gender composition speaks to the higher morbidity in women and higher mortality for men. With this inevitable pending socio-economic and political challenge ahead, should demographers be bothered with studying ageing and wellbeing of the aged?
Implications of population ageing

Furthermore, Jamaica like Montserrat and Barbados are experiencing the return of some of those people who migrated in the 1950s-1960s, who are elderly along with the continuous negative migration of young people, thereby increasingly expanding the population ageing in those societies. This is an explanation of the population ageing occurring within many of the Caribbean nations. Therefore, many Caribbean countries began experiencing population ageing in 1960s but it has recently begun to be of concern because of the emphasis of this matter on the world stage.

Ageing inevitable means longer life, that affects the population composition and structure. In that as the population ages, the base of the population pyramid narrows, while the upper portion expands. If reduced fertility continues without any major catastrophe in the future, what we are likely to experience is people living longer, and the death rates at older ages will begin to naturally increase thereby changing the population age structure further. Another result of this demographic ageing is increased disability that will result. Whereas technological advances have added years to people's lives, it has not reduced ailments. So people will be living longer, but with more disability. Global life expectancy has risen from 47 years in 1950-1955 to 65 years and beyond in 2000-2005 and 2005-2015, which is similar for Jamaica, Trinidad and Tobago, Bahamas and Barbados (United Nations 2006:87-89; United Nations 2005: xxii: STATIN 2003). One of the probabilistic results of ageing is the reduction on the working aged and the youthful population. These provide shifts in the population pyramid as it contracts at younger ages and expand at older ages. This is reiterated in a publication of the Caribbean Food and Nutrition Institute (1999:191) that stated, "By the year 2050, there will be older persons than children in the world, the majority of whom will be females and widowed or without a partner. The Caribbean is likely to mirror this phenomenon…". The Statistical Institute of Jamaica pointed out that those societies that were at the early stage of the demographic transition in which fertility remains high and mortality decline are now experiencing increasing in younger population. However, for those that at the late stage, where fertility is declining and mortality is stationary, the younger sector of the population is smaller than the segment 60 years and older (STATIN 2003). This is in keeping with the global perspective on demographic transition.

Within the 21st century, population ageing and shifts in health status of the population are synonymous constructs, along with the deviations between living longer and living healthier. Notwithstanding these realities, scientific study on the aged population is more recent than the construct itself. Erber credited a Belgian mathematician and astronomer, Adolphe Quetelet, in 1835, for studying the different stages that men pass through during their lifetime. The work is a pivotal landmark in the study of the ageing process. As population ageing is reality in the Caribbean, Jamaica and other developed nations that have begun in earnest to project the like socio-economic of "greying" populations within the general setting of aged dependency, support ratios and many issues associated with demographic transition.

In 1884, an Englishman named Francis Galton who was both a mathematician and medical doctor researched ?'physical and mental functioning' of some 9,000 people between the ages of 5 and 80 years (Erber 2005:4). As mathematician like his predecessor, Adolphe Quetelet, Galton want to measure human life span, physical and mental functioning of people. Therefore, he sponsored a health exhibition that would allow him to have data for analysis. This begs the question - what explains that fascination of man in seeking to understand ageing, and in particular, his/her intrigue with the aged and their wellbeing?

Even though, the ageing process is lifelong and though this may be constructed within each society differently, many decades have elapsed since Galton's study on the health status of people. Despite changes in human development and the shifts in world population toward demographic ageing - people living beyond 65 years (see ILO 2000; Wise 1997), the issues of the aged and their health status, in particular general wellbeing, have not taken front stage on the radar of demographers unlike many other demographic issues. This is especially true for the Caribbean.

There are signs indicating that population ageing in the 21st century is affecting many industrialized societies. These societies are affected through low fertility, which speaks to the future problems of - high age dependency ratios, high support ratio, and future changes in population size and structure. Among the challenge of low fertility in industrialized nations are the difficulties that it posses for population replacement, reduced juvenile dependency, lower potential fertility, and increased old-age ratio. There are some non-demographic issues that spill offs of population ageing such as the consequences for future pension allocations, hospitalization expenditure for the aged.

A demographer, Alain Marcoux, measured population ageing in an article titled ?'Population ageing in developing societies: How urgent are the issues?' as a specified valuation of the general population being 60 years and older. The benchmark that was used to establish this situation is the proportion of the population who are aged 60 years and over exceeds 10%) whereas another group of scholars Gavrilov and Heuveline used 65 years and beyond that exceeds 8-10%. These include for example - Germany, Greece, Italy, Bulgaria and Japan; U.S.A; Sweden - see Figure 1.1.1, below). Interestingly, Greece and Italy's aged population (people 60 years and older) in 2000 stood at least 24% of the total population, which indicate completion of the fertility and mortality transition, and the high burden being placed on the working population. Those societies' fertility decline began early and their mortality at older ages has been declining; this justifies their ageing population. This is not only confined to developed societies as it is spreading to the entire world.

Some developing states such as Barbados, and Trinidad and Tobago, and Jamaica are currently experiencing the shifts in population age (see Table 1.1.2).

Table 1.1.2: Percentage of estimated or projected Populations of different Caribbean nations, 1980, 2000, and 2020


Country 1980 2000 2020

0-14 yrs
60+ yrs
0-14 yrs
60+ yrs
0-14 yrs
60+ yrs
Barbados 29.6 14.1 22.5 14.1 19.4 19.3
Guyana 40.9 5.7 30.2 6.3 23.0 11.3
Jamaica 40.3 9.3 28.3 9.0 20.4 12.4
Suriname 39.8 6.3 32.4 7.9 24.2 9.8
Trinidad & Tobago 34.3 8.1 28.6 8.4 23.5 13.3
Caribbean 38.4 6.3 26.7 8.4 22.0 15.2
Source: United Nations. 2005c: World Population Prospects: The 2004 Revision

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 [ageing] 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 promogated by Lawson, but is concurred on by Cowgill 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. Three centuries ago, the issue of ageing would not constitute one out of twenty-five of the total population, or even more than this as is the case in the 21st Century. According to Lawson, "The world is going to have to learn to live with populations containing a much higher proportion of older people…" . 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 well-being reside squarely on the shoulders of the young?

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. Furthermore, from all indications, in the developing world, the elderly population will continue to increase as a proportion of the globe's population which is in keeping the world's ageing statistics. According to Randal and German, the numbers of aged living in developing countries will more than double by 2025, "reaching 850 million". The Caribbean is not different as according to Grell, 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.

From a study commissioned by the Planning Institute of Jamaica, it was noted that the globe's population grew at a rate of 1.7 percent per annum, with the population of the seniors (60 years and older) growing at 2.5 percent. A point of emphasis was the monthly growth rate for the elderly in developing countries (3.3 %), with a projected population forecast of seniors for Jamaica for 2020 to be 15 percent. From the World Development Indicators report, in 2003, 6.9 percent of Jamaicans were 65 years and older. Eldemire noted that the increased aged populace in Jamaica began in the 1960's. From statistical reports, the percent has continued to increase post-2000.

STATIN in ?'Demographic Statistics, 2004' reported that 10 percent of Jamaica's population are 60 years and older, which is supported by Eldemire 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. "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 fulfillment of a demography degree, and so will subscribe to demographic conceptualizations, primarily. Whereas, some developing countries will begin to experience this come 2030 most societies would have been exposed to this by 2050.

Figure 1.1.1: Selected regions and their percent of pop. 65+ years
Source: United Nations 2005: World Population Prospects: The 2004 revision (page 20)

Conclusion

Globally, with changes in Public Health - namely sanitation - and nutrition, have added a substantial number of years to people's life expectancies, which is captured in Figure 1.1.1. Remarkably, the majority of the world's population come 2050 will be experiencing population ageing because they would have had more people 65 years and older. Thus, there is a demographic transition toward an aged population. In addition, this is attributed to the introduction of vaccination, in particular to the discovery of peninsulin. Prior to its development and implementation, pestilence and pandemic would have limited life expectancy to below 50 years, in many instances. During the pre 20th- centuries, death statistics were used to measure health status and mortality along with quality of life, which explains why physicians would be preoccupied with illnesses and diseases as a measure of how to effectively address wellbeing of people.

The 20th century has brought with it massive changes in typologies of diseases where deaths have shifted from infectious diseases such as tuberculosis, pneumonia, yellow fever, Black Death (i.e. Bubonic Plague), smallpox and ?'diphtheria' to diseases such as cancers, heart illnesses, and diabetes. Although diseases have shifted from infectious to degenerate, chronic non-communicable illnesses have arisen and are still lingering within all the advances in science, medicine and technology. One demographer showing the extent of human destruction due to the Black Death mentioned that this plague reduced Europe's population by one-quarter (Rowland 2003:14). Accompanying this period of the ?'age of degenerative and man-made illnesses' is life expectancies that now exceed 50 years. So while people aged 70 years and beyond in many developed and a few developing states, the question is - Are they living a healthier life - how is their wellbeing within the increases in life expectancy? Alternatively, is it that we are just stuck on life expectancies and diseases as primary predictors of wellbeing - or health status?

Before the establishments of the American Gerontology Association in the 1930s and their many scientific studies on the ageing process (Erber 2005), many studies were done based on the biomedical model (i.e. physical functioning or illness and/or disease-causing organism), (see also Brannon and Feist 2004:9). Many official publications used either (i) reported illnesses and/or ailments, or (ii) prevalence of seeking medical care for sicknesses. Some scholars have still not move to the post biomedical predictors of health status. The dominance of this approach is so strong and present within the twenty first century, that many doctors are still treating illnesses and sicknesses without an understanding of the psychosocial and economic conditions of their patients. To illustrate this more vividly, the researcher will quote a sentiment made by a medical doctor in ?'The Caribbean Food and Nutrition Institute Quarterly, 1999. A public health nutritionist, Dr. Kornelia Buzina, says that "when used appropriately, drugs may be the single most important intervention in the care of an older patient … and may even endanger the health of an older patient …" (quoted in the editorial of Caribbean Food and Nutrition Institute 1999:180).

Dr. Buzina admits that wellbeing is fundamentally a biomedical process. This conceptual framework is coming from the Newtonian approach of basic science as the only mechanism that could garner information and that empiricism was the only apparatus establish truth or fact. It is still a practice and social construction that numerous scholars and medical practitioners have and continue to advocate the way ahead. Simply put, physical health is equated to wellbeing (or health, or wellness). If such a viewpoint holds any dominance in contemporary societies, then are saying that conditions such as the death of an elderly's life long partner; a senior citizen taking care of his/her son/daughter who has HIV/AIDS; an aged person not being able to afford his/her material needs; someone older than 64 years who has being a victim of crime and violence and continue to be a victim; seniors who reside in violate areas who live with a fear of the worst happening, the inactive aged, and generally those who have retired with no social support are equally sharing the same health status as elderly who have not on medication because they are not suffering from biomedical conditions to be given drugs?

In a titled article, Drug Therapy in the Elderly, the author says, "The elderly are the major drug users both because they need specific drugs for control of chronic diseases and because they may excessive use of over-the-counter drugs" (Buzina 1999:194). This goes further to reiterate the point that the, while the author is a nutritionist and understand the importance of lifestyle practices and equally is acquainted with psychosocial and cultural conditions as important predictors of health, she places more emphasis on the physiologic conditions of the aged by looking at the linkage between diseases and health status. Such a position places significant importance on biological ageing, with minimal understanding of the social, ecologic and psychological conditions of ageing and their influence on health status. Another nutritionist argues that analyzing the material wellbeing and socioeconomic conditions of the elderly afford an understanding of their general wellbeing. She writes that "many elderly person who live alone are affected by loneliness as a result of the loss of a spouse, family members or close friend" (Anthony 1999:213); another point that the author raises is "social data can provide an indication of the quality of life of the elderly and some of the reasons for the nutritional state that is manifested" as well as "it is important to ascertain the financial situation of the elderly as it allows the dietitian/nutritionist to assess their ability to adequately provide nutrients needed to maintain optimum nutrition" (Anthony 1999:212). Hence, ?'where are the policies to address to socio-economic this challenge of developing states?' With Jamaica's declining economy, how will we be able to afford - (1) the pension and social programmes cost for the elderly, (2) the falling share of the population loss due to retirement, (3) the lowering of the number of youths population in the future to meet the increasing elderly population, and (4) waiting will only further increase the challenge of addressing the issues of the aged.


Notes

Epidemiologic Transition. Omran labeled the shift from pandemic, pestilences and famine to chronic and degenerate diseases as epidemiological transition. There were period in human history when plagues such as the Black Death, killed at least one-quarter of Europe's human population and 50 million Europe and Asia (Rowland 2003, 14). With the advent of the peninsulin, sanitation and better hygiene, man has seen the reduction of pandemics and pestilences to an increase in non-communicable and degenerate illnesses such as diabetes, heart diseases, mellitus, respiratory infections, cardiovascular diseases, cancers and so on. While the developed nations like North America, Europe, Australia and Western Pacific states already have undergone this some time ago, developing and emerging states such as Barbados, Trinidad and Tobago and Jamaica are experience the same epidemiologic transition like many developed societies. In that the leading causes of death in developed countries were primarily cardiovascular diseases and cancer followed by respiratory diseases and this is the same situation in the stated developing and emerging societies.

Paul Andrew Bourne
email: [email protected]