Global Aging and International Social Work Practice: A Developing Country Perspective

Dhrubodhi Mukherjee, MSW, Ph.D
Assistant Professor, Social Work
Southern Illinois University Carbondale

 Abstract

This article explores the challenges that an aging population poses to developing countries. It also argues that the future of aging among industrialized nations is intertwined with the management of the aging policies across developing countries. Existing literature and population trends are examined to show how globalization has created several fundamental changes in the cultural practices and traditional social norms across developing societies that have contributed to a weakening social status of older adults. The article takes a task centered social work approach in its attempts to describe the vulnerabilities of these older adults. Policy recommendations that have far-reaching consequences for industrialized countries are included.

Keywords: older adults, developing countries, cultural capital, social network, international social work, aging, and globalization.

 Contents

Introduction
Population Aging in Developing Countries
Aging and the Moral Economy
Globalization, Social Capital, and Aging in Developing Societies
Declining Potential Support Ratio
Implications for Global Social Work Policy Practice
Conclusion and Future Directions
References

 Introduction

The aging population within industrialized countries is expected to surge in the next 30 years. The long-term financing challenges of adequate insurance and healthcare for the burgeoning number of older adults have accentuated policy concerns regarding the aging population in industrialized countries. These concerns are statistically rooted. In 2000, people over 60 years of age composed roughly 10% of the world's population. By 2050, that percentage is projected to increase to 21% (Sowers & Rowe, 2007). Moreover, the worldwide life expectancy is expected to rise by eleven years. Sowers and Rowe (2007) further reported that in 2005, 1 out of every 12 people in developing countries was over 60; by 2050, that number will be raised to 1 out of every 5 people. Developing countries will experience almost two thirds of this growth spurt in the aging population (Dhar Chakraborti, 2004). This phenomenon is simply known in the literature as global aging (Healy, 2008). However, the current state of gerontological social work practice, especially in the developing world, lacks the training of social workers and adequate funding to attend to the great challenges of aging population (HelpAge India Foundation, 2008). Therefore, it is important to assess the challenges that such a demographic splurge will entail on global social work practice as it relates to the developing world. There are several key questions that seek answers: How will global aging affect the international donor agencies' capacity to meet the demand of gerontological social workers in developing nations? What kind of strategies should global policy practice adopt to influence national and international approaches to global aging? This article explores the implications of global aging on social work practice in developing countries.

Academic and practice literature tend to focus singularly on strategic discourse on future challenges to population aging within developed countries, without taking into consideration the simultaneous impact it might have on developing countries. This article compares aging trends in developing countries to those in developed nations through the use of available literature and the United Nations international data on aging. The article argues that economic globalization has necessitated global interdependence, which must be acknowledged and taken into consideration when researching the effects of an aging population. The article asserts that an exclusion of developing countries' perspectives on research and strategies regarding this demographic deluge can create limitations in the approaches taken by developed nations concerning this issue. The article also examines the role of international gerontontological social work practice as a possible conduit between aging research in developed and developing countries.

The need for an international consensus on gerontological social work was first felt during the World Conference on Aging in Vienna, organized in 1982 by the United Nations. The conference identified several key variables contributing to the increased longevity in society, including advances in preventive medicine and controls on human fertility (Dhar Chakraborti, 2004). The baby boom generation (born between 1946 and 1968) is expected to live longer than their predecessors, which could put enormous pressure on the state infrastructure in the United States and several Western European countries (Arun & Arun, 2001; Baars, Dannefer, Phillipson, & Walker, 2006; Dhar Chakraborti, 2004; Dixon, 2002).

Alongside this projected age inflation in developed countries are the predictions by population scientists that the growth in the percentage of the elderly population in relation to that of working adults could have long-term implications on international immigration policies. Working-age immigrants from population-rich countries, such as China and India, are expected to swamp the shores of those developed nations with dwindling working populations and a burgeoning number of dependent older adults (Friedman, 2006). Notably, the argument above is predicated on an inherent assumption that the developing countries are generally characterized by a growing number of high-skilled young adults. The purpose of this article is to challenge this notion and to argue that population aging is as much a challenge for developing countries as it is for developed ones. Because of globalization, there have been some fundamental changes in the cultural practices and traditional social norms and values across many developing societies, thereby weakening the social status of older adults. The article traces these social vulnerabilities and establishes the need for international social work intervention to specifically address the protection of at risk older adults across developing regions.

 Population Aging in Developing Countries

Developing nations have witnessed sustained economic growth, yet have consistently scored low on the Human Development Index (HDI), have relatively low per-capita income, and have underdeveloped tertiary or service sectors within their economy (Nilsson, Rana, & Kabir, 2006). Developing countries are experiencing a geometric growth in the service industries and per capita income due to a surge in the Business Processing Outsourcing (BPO) contracts between developed countries, such as the United States, United Kingdom, Germany, and Australia, and developing countries such as India, Brazil, China, and the Philippines. However, the gross domestic contribution from the service sector is nominal at best (Friedman, 2006; Yusuf, 2001). It is important to note that many developing countries are also emerging economies, which means that, not too long ago, they made the transition from regulated to open market economies (Bhagwati, 2004).

Along with the economic changes, developing countries are witnessing a significant increase in the proportion of the older population (Takamura, 2007). In 2007, 66% of the total population of developing nations were over 55 years old, which is a 59% increase from 2000 (Kinsella & Velkoff, 2001). Table 1.1 shows the United Nations' report on "World population aging 2000-2050," which predicts that the underdeveloped regions in Asia, Africa, and Latin America will constitute 81 percent of the worlds' elderly population by 2050, with 53% of that increase taking place in Asia alone. This would make developing countries such as India, Pakistan, Bangladesh, Nepal, the Philippines, and Myanmar especially vulnerable to the looming socio-economic challenges of aging (Dhar Chakrabarti, 2004).

Among the developing regions, Asia would witness the largest increase of older adults, and countries like China and India - with more than 2 billion people between them - would have a combined 600 million people over the age of 60 by 2020 (U.S. Administration on Aging, 2005). Moreover, within different cohorts of older persons, the number of individuals who are 80 years of age or older has been predicted to grow faster than any other cohort, raising additional challenges for long-term care facilities. Developing countries like Singapore, Costa-Rica, Colombia, and Malaysia would each witness more than a 200% increase in their aging population (Kinsella & Velkoff, 2001).

Table 1.1 above shows the distribution of aging population across the world. As we can clearly see, the aging population in the less developed regions is expected to multiply. Developed countries play a crucial role in funding the civil society initiatives for welfare of the aged across less developed regions of the world. The practice of welfare to the aged by either civil society or the federal government has had a history; the section below traces this historical precedence in the context of global social work practice.

 Aging and the Moral Economy

Initially, there were three factors that influenced the global aging population during the 19th Century: the Industrial Revolution, the rural-urban migration and the development of the working class (Bhagwati, 2004). The industrial revolution was initially fueled by the wealth amassed by the Western European countries through their economic occupation of Asian and African regions during the colonial era. As a result, Western European countries, along with their 'new land' in the Americas, were well positioned to invest in mass-scale industries and simultaneously encouraged migration from rural to urban areas, creating a working class concentrated in the cities. These developments during the early 1800s joined social status with economic productivity and associated older adults with economic unproductiveness, leading to a decline in their social status (Yusuf, 2001).

The rise of urban, industrialized societies gave birth to the social and cultural value systems that bestow more importance to individual needs and aspirations over those of the family and community (Cole, Achenbaum, & Carlin, 2008). By the third quarter of the 20th century (1950-1975), the patterns of social expectation in the Western democratic societies required publicly funded state institutions to ensure that elderly populations did not become dependent on their families during retirement. In response to such expectations, the state within many industrial societies implemented policies to provide employment based and publicly funded retirement benefits for older adults (Finer, 2000). Martin Kohli (1987) called this state involvement with the fiscal responsibility of the aged the beginning of a moral economy.

Aging, in a moral economy, is divided into two phases. The first phase is active retirement supported by Social Security, pensions, and private insurance, while the second phase is characterized by frailty, with financial support being provided by Medicare, Medicaid, and other publicly funded health insurance programs (Cole, Achenbaum, & Carlin, 2008). During the latter half of the 20th century (1950-2000), federal funding for entitlement programs which targeted the elderly had already been institutionalized in the social policy infrastructures of industrialized nations, including the United States. Though economic protection for older adults had dramatically improved in moral economies, they still had to face the rapid pace of urban industrialized lifestyles and cultural resistance to professional social work intervention. As a result, the traditional values of social respect given to the aged and emotional support provided by the family system were dealt a blow by the increasingly fragmented families and the rapid migration to urban areas. Consequently, the elderly population experienced an increase in social isolation, a decline in social support networks, a higher rate of depression and anxiety, and a susceptibility to elder mistreatment or abuse. In other words, the moral economy, in its attempt to institutionalize economic support, had failed to increase social capital for the elderly.

However, towards the close of the 20th century, the initial shock of industrialization and the rapid melting down of the old order had begun to settle down for the elderly living in developed regions (Yusuf, 2001). Still, modernization has resulted in a loss of identity and social status for older adults and eroded the cultural view that has traditionally supported societal norms of respect for seniors. In response, a new generation of older adults in developed countries organized around group interests through advocacy organizations, such as the American Association of Retired People (AARP) and SeniorNet. They fought against policies that called for mandatory retirement, age-caps on issuing driver licenses, and high costs of senior healthcare. Strong civil rights groups representing the elderly in developed nations have been working to preserve the rights of older adults, while federal support for older adult welfare has dwindled over time.

On the other hand, the developing countries have had a history of weak or non-existent moral economies. The institutionalization of welfare for the elderly has been limited in these regions. The benefits of industrialization came to developing countries almost half a century after that of more developed countries. As a result, the dominant value structures in these regions remained more traditional, with older adult populations enjoying considerable social status and cultural capital. Because of this traditional mindset, the role of national government funded initiatives remained minimal throughout developing countries, and the socio-economic and medical responsibilities of the elderly were borne primarily by family members and the local community.

 Globalization, Social Capital, and Aging in Developing Societies

Historically, in developing countries, agrarian economies and family-owned production of goods necessitated a shared lifestyle and collective responsibilities, which instilled norms and values that helped maintain a higher social status for the aging population (Mukherjee, 2008). The family, kinship, and friendship networks played a vital role in sustaining the elderly population within a "joint" or "co-resident" family structure, where older adults lived in the same house with the families of their children (Lubben & Gironda, 1996). Co-resident families provided support, dignity, and security for the elderly. These families assumed care giving responsibilities without expecting financial compensation from the state (Prakash, 1999; Sudhir, 2000; Thara Bhai, 2002). Thus, the onus of providing minimum social security and medical care had primarily rested on the family, kinship, and friendship networks. Although a small minority of older adults, who were employed by the federal and state government, have benefited from a small monthly state pension, the number was minimal, compared with the overall spectrum of older adults living in developing countries (Dixon, 2002; Kumar, 2003; Van der Merwe, 2000).

In developing countries, dependence on families and informal networks was further accentuated by the lack of resources at the disposal of governments. Furthermore, due to overpopulation, the sheer volume of the elderly people who needed support had been overwhelmingly disproportionate to the resources that were available (Morgan & Kunkel, 2007). Additionally, it has been well documented that pervasive corruption has long plagued government administrations across developing nations, which has further jeopardized the prospects of implementing effective initiatives for the welfare of the elderly. As a result, a majority of developing countries have historically failed to build comprehensive and sustainable social security and medical social insurance policies similar to that of the United States and the Western Europe (Dixon, 2002).

In the absence of nationally funded entitlement programs, the elderly population in developing countries primarily relied on the social capital in their families and communities (Ghai, 2003). Social capital includes high levels of social support, strong family ties, larger friend networks, trusting and nurturing environments, and higher social statuses for the elderly (Putnam, 2001). Traditionally, the aging population across developing countries enjoyed higher levels of social capital due to the influence of co-resident family structure and the prevalence of cultural norms and values that taught communities to revere seniors.

In the last two decades, the process of globalization has significantly impacted the social order in the developing countries described above (Subramanian, Lochner, & Kawachi, 2003). Globalization, for the purposes of this article, refers to unification of economic, socio-cultural, political, and technological forces across the world, primarily through the integration of global markets by the activities of the transnational organizations (Baars et al., 2006; ILO, 2004). Globalization has facilitated the exchange of goods, services, lifestyle norms, and entertainment commodities from the developed to the developing countries, fundamentally altering social cultural norms of life in the hitherto closed communities of developing regions.

As a result, developing countries have observed a steady growth of urban lifestyle and city-based employment that has transformed social norms and institutions, causing a disintegration of co-resident families, as well as necessitating rural to urban migration in many agrarian communities. Rapid industrialization and the growth of the service-based industries have further increased migration into cities (Dhar Chakraborti, 2004). The gradual but definite shift from agrarian values of interdependence to more global values of individualization has debilitated family and kinship support for seniors across developing societies, thereby eroding the local support based traditionally available to seniors.

Recent studies (Baars et al., 2006) have indicated that values such as individualism, personal responsibility, and the fragmentation of families, as opposed to collectivism, social responsibility, and co-residential family systems, have gradually been influencing the socio-cultural way of life across developing nations. As a result, social capital for older adults is declining. Older adults across developing nations are finding it more difficult to acculturate with the lifestyle of the younger generation dominated by technological finesse. Moreover, in many developing countries- like India, the Philippines, and Brazil- globalization has brought about employment opportunities that are mostly technologically driven. These jobs are ones with which older adults cannot easily identify. As a result, the social relevance that the elderly population has always enjoyed due to the knowledge and skills they acquire over a lifetime of service, a relevance that continued even after their retirement, appears to have lost its significance (Baars et al., 2006).

 Declining Potential Support Ratio

The decline in social capital among the elderly has been further marked by the increase in potential support ratio (PSR). PSR is the ratio of people between the ages of 15 and 64 to every person over 65 years. This ratio describes the burden placed on the working population by the non-working elderly population. The PSR is a key macro-economic marker of social and economic support available to non-working older adults. The social security income maintenance program in the United States has been conceived on the basis of PSR. When social security was created in 1935, the PSR in the United States was 16, which suggests that for every single individual aged 65 and older receiving benefits from the federal government, there were 16 working adults contributing to their retirement support fund. In 2008, the PSR for social security in the US has decreased to 3 working people per retired older adult, and in the next thirty years it is expected to assume a negative ratio.

Table 1.2 outlines the PSR ratio for developing nations. The table suggests that countries like India, the Philippines, Indonesia, Bangladesh, Iraq, Iran, Srilanka, Oman, and Kuwait will witness significant drops in PSR, which suggests a large increase in the elderly population and a lack of support resources with which they can be sustained. A majority of the countries listed in Table 1.2 have either a poorly implemented or non-existent national response mechanism to such a forecast. Along with decline in PSR, the population dependency ratio, which tells us how many young people (below 16) and older people (above 64) depend on people of working age (16-64), is increasing in almost every developing country.

Women in developing countries have traditionally catered to the care-giving needs of the co-resident older adults but are now no longer able to serve in that capacity due, in large part, to the increasing participation of women in the workforce (Takamura, 2007). Furthermore, the funds that are usually appropriated for senior welfare are insufficient to comprehensively address the problem. As a result, senior citizens in many developing countries are facing a two-pronged challenge of financial uncertainty and the decline of social capital due to the disintegration of family support systems (Arun & Arun, 2001; Dhar Chakraborti, 2004).

Dhar Chakrabarti (2004) further discusses the relationship between aging and economic development issues such as production, consumption, and distribution, suggesting that a country's productivity is inversely related to the growth of the aging population. An aging population increases healthcare costs, raises demands for income supplements, and shifts resources from the young to the old (Atkinson & Hills, 1991; Jutting, 2000; Kaseke, 1999; Midgley, 1993). In the absence of institutionalized social security in many developing countries, the onerous task of maintaining a basic minimum income for the aging population usually rests on the social capital from families, extended relations, and the civil society (Ghai, 2003).

The projected retirement of baby boomers in the US and Western Europe is expected to create an exodus of labor to fill the global vacuum in the job market (Goure, 2000; Paterson, 1999). This would cause the migration of young workers from developing to developed countries, as well as the reverse migration of older adults from developed countries to the developing ones. On one hand, the developed economies would create new high-skilled jobs for which they would have to hire workers from foreign countries, while at the same time, social entitlement programs such as social security and Medicare would witness a decline in benefits. In some cases, the program itself may be suspended. While developing countries are expected to see more federal involvement in creating social protection for the elderly, developed countries will experience a reverse trend, i.e., de-federalization of social security for the aged (Ghai, 2003; Kannan, 2007; Kaseke, 1999; Mukherjee, 2008; Overbye, 2005).

 Implications for Global Social Work Policy Practice

The importance of global aging to social work is clear. However, even with that recognition, how do social workers and policy practitioners respond to these trends through policy and practice intervention designs? Could a global standard be set on intervention techniques that could be adopted across nations? There has been significant writing on the worries caused by the impending global aging. However, unless these discussions move towards integrated practices in a standardized fashion, nothing substantial can be realized on an international level. In this regard, the role of international social work organizations and entities, such as the International Federation of Social Workers (IFSW), the International Association of Schools of Social Work (IASSW), and the International Council of Social Welfare (ICSW), is imperative. Beyond these social work associations, there is also a need for action on behalf of the aging population by NGOs, FBOs, International Aid Organizations, International Government Organizations, and local groups.

Before social workers even begin thinking about designing transnational policy interventions, they need to have a thorough understanding of the ethical codes that bind them at the national and international levels. The IFSW code states that social workers should "contribute professional expertise to the development of policies and programs which improve the quality of life in society" (IFSW, 2004, Section 3.2.6). Section 4.2.4 of the IFSW code further states that social workers "have a duty to bring to the attention of their employers, policy makers, politicians, and the general public situations where resources are inadequate or where distribution of resources, policies and practices are oppressive, unfair and harmful" (IFSW, 2004). The need for global social workers to attend to the issues of the global aging and its impact on the affected populations in developing countries is an apt case for the above-referred ethical code from IFSW. The lack of policies focusing on the elderly in developing countries have undermined their human rights and hindered social justice - two of the guiding ethical principles of IFSW (IFSW, 2004).

Recent research has indicated that the surge in global aging could generate tasks for international social workers at both macro and micro levels (Moody, 2006). According to Takamura (2007), the 2002 Madrid International Plan on Aging had identified three crucial issues around which global social work policy practice could be developed: 1) economic security for the elderly, 2) long-term care needs for older adults, and 3) developing strategies for promoting healthy and active aging. These broad areas of practice are relevant to older adults across developing nations and should be addressed through concerted global policy practice. The next step for global social work practitioners is to prepare and address these crucial issues by developing culturally competent interventions in the global aging field in developing countries. Intervention may be developed in the following five stages:

Intervention stage one - global consortium: International consensus regarding agreed upon issues play a major role in influencing national policies. Global social workers should try to use the already existing international diplomatic forums of developing countries to endorse global aging in their policy agenda. Brazil, Russia, India, and China (BRIC) have already formed a forum to work together on relevant issues. Global social work consortiums need to work with the United Nations and international non-governmental organizations (INGOs) - such as Help Age International, which works on aging issues in all 43 developing countries- to form an UN-sponsored global commission on developing countries. The consortium can then develop task forces to influence national policies across developing countries.

Intervention stage two - influencing national policy: Social workers should be equipped with training, skills, and motivation to influence their respective national legislators to adopt policy positions that would provide social security, long-term care needs, and affordable health care services to their native older adults. This may be done through adopting lobbying techniques and media interventions from developed countries. Social workers should understand differences in the policy making process at the global level and identify the differences across nations.

Intervention stage three- transnational electronic lobbying: Electronic lobbying is a supplement to the traditional lobbying tools, such as letter writing, telephoning, radio programming, and television advertising. The development of information communication technologies, like multimedia supported emails, online podcasts and Web 2.0 supported social networking technologies (Facebook, Myspace, and Twitter) could be used to influence public opinion internationally. There are no legal boundaries on communication protocols across these forums, which make it possible for internationally located social workers to participate electronically in national lobbying activities.

Intervention stage four - resource mobilization: Currently, inadequate resources and trained professionals remain the biggest impediment to policy practice implementation in developing countries. Very few national or international organizations are working in the field of aging, especially in developing regions. Thus, global social workers should get involved in fund raising activities to support such efforts.

Intervention stage five - developing knowledge base: Global social workers should compile culture specific exploratory and descriptive data on best social work practices with older adults, and support practice research to implement them across cultures. For example, the Older Americans Act (OAA, 1964) in the United States has been designed to produce greater involvement of civil society and community groups in addressing the needs of older adults. Similar models can be implemented in developing societies where families, community-based organizations, and non-governmental organizations can forge partnerships with the state in conceiving, testing, and developing interventions and policies that target the elderly population.

The above mentioned stages to global social work practice with older adults interact with each other and transcend national issues, and thus would need an international perspective to implement.

 Conclusion and Future Directions

Aging policies across developing regions should devise strategies to stem the projected decline in social capital (Bhagwati, 2004). Forging partnerships with international organizations, such as Help Age International, could be a beginning of international social work practice with the elderly in the developing world. Without any institutional support from the state, a vast elderly population in the developing world - approximately 800 million by 2020 - will need immediate attention from international social workers (Dhar Chakraborti, 2004; Ghai, 2003; Kannan, 2007; Kumar, 2003; Mukherjee, 2008; Yusuf, 2001).

There are several common issues around which global social work strategies between the developed and the developing countries could be forged. These issues include growth of the aging population, shifts in family structure, redefinition of inter-generational relations, loss of social capital and social support, vulnerabilities to poverty and elder abuse, debate over the role of government, interest groups, and multi-national organizations in program planning and delivery, and, finally, issues of cultural competency and political economy. Successful policy practice would include implementing interventions among developed and developing nations, thereby promoting international collaborative partnerships. In order to address and fruitfully achieve results across these goals, more comparative research on social policy and population aging across international borders must be supported (Bengtson, Kim, Myers, & Eun, 2000). Future research on the pervasive influence of culture must be carried out to refine global social work approaches. Moreover, encouraging interdisciplinary partnerships among demographers, gerontologists, social workers, economists, and policy makers can further generate cohesion among international stakeholders and would facilitate knowledge sharing.

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 About the Author

Dhrubodhi Mukherjee, MSW, Ph.D., is Assistant Professor in the School of Social Work at Southern Illinois University. His research agenda includes elder abuse, social gerontology, technology aided civic engagement by older adults, cross-cultural gerontology, and social network analysis. Dr. Mukherjee's research and practice in international social work and education include a World Bank project in India on urban slum rehabilitation program, administration of a study abroad program to India, and presentations in several international conferences in Europe, Hong Kong, China, and Toronto, Canada. He is actively involved in the International Consortium for Social Development (ICSD) and Human Service Information Technology Applications (HUSITA).