Rural Communities and the Elderly
Following the death of Violet Brown, the world’s then oldest centenarian on September 15th, there has been increased conversation surrounding this strong woman, her life and the fact that despite her age, she hardly had any illnesses. In an April 2017 interview with a Jamaican local newspaper, Ms. Brown teased that she was healthier than her five remaining children and had no ailments.
Unlike Ms. Brown however, many of the elderly in Jamaica suffer from a host of conditions particularly in rural Jamaica, where poverty is estimated to be twice as high when compared to urban areas. In recognition of the United Nations International Day for older persons, it is important to highlight some of the issues and challenges impacting the health of our elderly citizens and to echo some of the suggestions being proposed to improve their current situations.
Violet Brown, Jamaican supercentenarian who was the oldest verified living person in the world for five months (15 April 2017-15 September 2017) died at the age of 117 years, 189 days.
Source: Caribbean360, 2017
The proportion of Jamaicans greater than 60 years of age has been rapidly increasing with the most recent census data depicting that this cohort is expected to grow from 10.49% (2005) to over 14%(2025). This increasing longevity of the population has however sought to bring to the forefront some of the underlying challenges affecting the country, especially the rural population. Based on statistics published in the Jamaica Survey of Living Conditions (JSLC) it was revealed that in 2002, 12.6% of citizens had reported having an illness compared to 39.4% of rural elderly. This health disparity further widened in 2007 with 15.5 % of Jamaicans reported having an illness compared to 44.9 %of the rural elderly. These statistics highlight that the rural elderly are 3 times more likely to report having an illness when compared to the wider population.
The health of these elderly folk may be contextualized based on underlying issues of poverty and socio-economic challenges that are often characteristic of rural communities. Poverty aggravates the health conditions of rural aged residents, as they are incapable of accessing the required health care services, medication, and nutrition necessary to maintain a healthy lifestyle. In 2010, poverty in Jamaica was an estimated 20% compared to 23.2 % among the rural elderly. Older females have further been identified as being at greater risk for poverty and vulnerability, as such gender considerations become important.
The World Health Organisation (2005) has discussed that poverty often shows strong correlations with illness, chronic diseases and premature death and it has been reiterated by scholars that income is positively associated with better health, as poverty often means poor nutrition, water and food supply. Within Jamaica, the poor often seek less medical care and this offers some justification for the increased probability of contracting chronic illnesses as they are less likely to have health insurance.
Often seen as a ‘way out’ for those experiencing ill-health, health insurance proves important as the cost of medication is described as one of the major challenges of health care. With the introduction of the Jamaica Drugs for the Elderly Programme (JADEP), which is a public health insurance coverage for aged Jamaicans, the cost of medication was significantly reduced. Health care costs were however still a burden as only an estimated 22% of rural aged Jamaicans had access to personal health insurance. These highlight the vulnerabilities of the poor and showcase that for them to access health care, the majority of funding has to be out of pocket or funded by the government.
Since 2007, a ‘no user fees’ policy has been implemented for public health care in Jamaica. Despite the effort, it has been found that only 54% of the rural elderly accessed the services as delays, poor customer service and issues between medical practitioners and clients related to treatment, have reduced effective operations of these institutions.
Poverty continues to contribute to the ill-health of the rural elderly. It is important to recognize that the socio-economic conditions of the elderly are not the same as the conditions for the general population and this creates an urgency to improve the current health status of the old. With poverty on the rise and being most prevalent among rural residents, the rural elderly must become focal points of discussions in issues of health care and poverty alleviation. Targeted public health interventions and measures for the elderly are therefore critical to alleviating the economic health care costs being experienced. While efforts have been made to alleviate these challenges, more needs to be done especially in rural communities where the impacts of poverty are most prevalent.
Bourne PA (2008) Medical sociology: modelling well-being for elderly people in Jamaica. West Indian Med J 57: 596-604.
Bourne PA, Solan I, Sharpe-Pryce C, Campbell-Smith J, Francis C (2013) The Rural Aged and their Health: A Poverty-Health Viewpoint. Epidemiol 4: 140. doi:10.4172/2161-1165.1000140
Marmot M ( 2002) The influence of Income on Health: Views of an Epidemiologist. Does money really matter? Or is it a marker for something else? Health Affairs.21:31–46.
World Health Organization (2005) Preventing Chronic Diseases a vital investment. Geneva: WHO.
About the author: Jhannel Chloe Tomlinson