Mental health articles

economic changes and health care. A shift in the nature of the economy can alter the well-being of the elderly. Many developing countries have primarily rural economies, based on agricultural production. Throughout the world, as countries have industrialized, the values of agricultural products and related assets, like agricultural land, have fallen relative to those of manufactured goods. In rural communities, social status and financial security frequently depend on land or cattle often owned by the elderly. If they become devalued, the elderly person is vulnerable to both financial hardships and social marginalization. For example, according to a review and empirical evidence presented by Guillette, economic change from an agricultural subsistence economy to a money market economy in Botswanadiminished the importance of the traditional system of'status construction' for the elderly that was based onagriculture and pastoralism. Remittances fromchildren and other relatives in the main city assumedincreasing importance. Moreover, retailing andbrewing of beer, food production and cattle raisingwere particularly hard hit by a drought in the 1980s,and the elderly as a group seemed to suffer disproportionately, since a greater percentage of them were involved in these activities in relation to other age groups.

economic changes and health care. Several studies in Asian societies have produced similar conclusions. In examining the effects of thetransition from a kin-based to a cash-based economy on the family system of care for the elderly in ruralNortheast Thailand, Caffrey found that householdsin which the youngest daughter cared for theelder at home according to tradition were significantlylarger, had more cultivated land and a higher yearlyincome than did households in which the elder caredfor him/herself. Although very high levels of familyin the developing world 989support for the elderly in Thailand are shown insurveys, a portion of elderly in Caffrey'sstudy, those without enough land to establishattractive lives for their children, complained of littlesupport. They cited their children's departure fromhome in search of education and jobs in explainingtheir own loneliness, a felt lack of respect on the partof their children, and why they perceived the care fromtheir children as worse than that which their ownparents received. In rural Zhejiang province, China,after forced collectivization of the agriculturaleconomy in the 1950s, the commune oversaw thefamily support system for the elderly and ensured theirfinancial security. According to a study by Goldstein and Ku the shift toward a marketsystem and household production in the early 1980s has not necessarily resulted in a resurgence of filialpiety and traditional patterns of extended family careas hoped, and in fact, they found that the nature offamily support varied from situations in which theelderly had little power and independence to ones inwhich they controlled resources and were fairlyautonomous. The elderly in the study notedmaterialism (i.e. consumption for pleasure and toshow social status) of the younger generation in thecontext of the market economy as an important newfactor diminishing the respect and support they, aselderly, commanded. In a rural Taiwanese villagewhere Gallin  conducted research intermittentlysince 1957, the almost entirely agricultural economychanged to one based mainly on off-farm employmentin a span of 30 years. The old pattern of dominationof mothers-in-law over their daughters-in-law beganto vary as more of the young gained access to resourcesthrough wage employment and involvement in familycottage industry. Daughters-in-law who controlledmore resources than their mothers-in-law were able toreverse the power structure and defy norms of filialpiety. This created a situation in which older womentried to make themselves useful to daughters-in-law inorder to secure adequate care and provision for theirbasic needs.

economic changes and health care. Economic forces can transform systems ofinheritance of land and other assets that helped securecare for the elderly. For example, in thetraditional agro-pastoralist system in the Bay region ofSomalia, sons' families cared for their fathers untiltheir deaths in order to ensure inheritance of land andanimals, but if the sons can make money byworking in the city, for another agriculturalist or asmerchants, they may purchase land and animalsbefore their father dies, making them less dependenton family inheritance. This challenges the customarypattern of inheritance and caregiving and the statusand prestige of elderly males in the society. The elderlymay attempt to adapt to such changes, but they oftensuffer in the process. In the Somali case, instead ofdistributing resources to their sons at times prescribedby the Koran and by custom, fathers manipulate therules regarding transfer in order to retain economic power and the greater likelihood of care from sons.

Similarly, when the young family members of theSherpa in Nepal move from the villages to urbancenters, and so become unavailable to share thehousehold and take care of the elderly, the old resistestablished methods of dividing up property and keeptheir sons' share of the family land for themselves. Bydoing this, they maintain their economic security, butthey also expressed loneliness and dissatisfaction withdisruption of old family residence patterns.

As documented in many studies throughout the world, perceived employment opportunities in thecities can draw the younger generations away from therural environment and leave the elderly there with noone to care for them (for example, regardingsub-Saharan Africa). In fact, rural areas are disproportionately olderin most of Africa, Asia and Latin America. Forexample, although 57% of all South Korean men livein cities, only 39% of men aged 55 and older and 29%of men aged 75 and over reside in them. InZimbabwe in 1982, 26% of the population was urban,while only 3.3% of the urban population was aged 60or more, vs nearly 6% of the rural population. InEast, West and Central Africa, 90, 83 and 82%,respectively, of the elderly lived in rural areas in 1980. Among the Temne of Sierra Leone, the elderlywho migrated to an urban area during their productiveyears often retire to their rural area of origin, and the"rural elderly almost never migrate to live with urbankin if there is anything approaching a viablealternative". The author generalizes thisphenomenon to many West African societies. Thus,villages in many African countries have essentiallybecome homes for the very young and very old, who must bear responsibility forfarming as well as household maintenance. Accentuatingthis trend, especially in parts of Africa, is the AIDSepidemic which predominately infects and kills peopleduring their reproductive years. Migrantsoften send money back to their relatives, but the careof the elderly in the villages may become moreproblematic with increased migration.The situation in Latin America, and especially inBrazil, is somewhat different from otherdeveloping countries because the migrants tend to staypermanently in urban areas and because largerproportions of the populations live in urban areas.Thus, to a greater extent, Latin America has witnessedthe phenomenon of migrants "aging in place" afterthey settled in the cities in their younger years.Not only will economic development spur migrationof both men and women, but it will also increase the number of women in the work force in many countries, and as women tend to provide the bulk ofcare for the elderly, this will reduce possibilities forinformal care.

economic changes and health care. In some circumstances the caregivers may still be meeting the needs of their own children while also juggling the demands of their elders andthose of work. Many researchers havedocumented the stresses of caregiving, includingisolation, financial troubles, depression, lack ofsatisfaction with life, decline in health and adverseeffects on family activities. Those caring for relatives with cognitiveimpairments are at particular risk. Since lifee xpectancy continues to increase in most developing countries, women caring for older husbands orrelatives may be in the later years of middle age or evenolder. 

Tags: Health, health care