Pension exposure and health: Evidence from a longitudinal study in South Africa

Expanded child support grant eligibility and later-life mortality among mothers in rural South Africa

The South African Child Support Grant (CSG) may be associated with mother's mortality via pathways linked to CSG spending, however, this relationship remains uncertain. To identify the association between CSG eligibility and mortality among mothers, we exploited exogenous variation in CSG-eligibility due to iterative age-eligibility expansions. Data were obtained from the Agincourt Health and Socio-Demographic Surveillance System. Mothers contributed person-time from age 50 till they died or were censored in March 2022. The cumulative duration of CSG-eligibility was calculated using children's birthdates and CSG expansion years and dichotomised at the median to give high (>18) and low (≤18) duration. We matched mothers with high vs low duration of CSG-eligibility based on their birth years and number of children. To estimate the association between cumulative duration of CSG eligibility by age 50 and subsequent all-cause mortality, we specified Cox proportional hazards models, adjusting for sociodemographic variables. Duration of CSG-eligibility was not associated with mortality among mothers in the full sample (adjusted HR: 1.05, 95% CI: 0.75, 1.44) nor within sociodemographic sub-groups. Future studies should explore the association of CSG eligibility with premature and cause-specific mortality in mothers and at different life course timings to promote their health and longevity.

Investing in equitable healthy aging: Why Africa must reform social pension schemes to improve Alzheimer's disease and dementia outcomes

The eligibility criteria for social pension schemes in Africa hinder equitable and healthy aging. In 2019, women in 14 sub-Saharan African countries had an average life expectancy of 67 years but a healthy life expectancy of only 57 years, leaving them 5 years in poor health before receiving a pension at age 62. Men had a similar situation-a life expectancy of 62 years and a healthy life expectancy of 53 years, spending 10 years in poor health before becoming eligible for pensions at age 63. Many men do not receive pensions due to early death. Delays and low pension payouts contribute to a 2.5% increase in the death rate from Alzheimer's disease and dementia. HIGHLIGHTS: Eligibility criteria for social pension schemes in Africa hinder equitable and healthy aging. Delays and low pension payouts are associated with worsening death rates from dementia. Average health life expectancy for both genders should serve as a basis for initiating pension payouts.

Effect of a cash transfer intervention on memory decline and dementia probability in older adults in rural South Africa

Evidence on cash transfers as a population-level intervention to support healthy cognitive aging in low-income settings is sparse. We assessed the effect of a cash transfer intervention on cognitive aging outcomes in older South African adults. We leveraged the overlap in the sampling frames of a Phase 3 randomized cash transfer trial [HIV Prevention Trial Network (HPTN) 068, 2011-2015] and an aging cohort [Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community (HAALSI), 2014-2022] in rural Mpumalanga Province, South Africa. In 2011/12, young women and their primary caregivers were randomly assigned 1:1 to receive a monthly cash transfer or control. In 2014/2015, 862 adults aged 40+ y living in trial households were enrolled in the HAALSI cohort, with cognitive data collected in three waves over 7 y. We estimated the impact of the intervention on rate of memory decline and dementia probability scores. Memory decline in the cash transfer arm was 0.03 SD units (95% CI: 0.002, 0.05) slower per year than in the control arm. Dementia probability scores were three percentage points lower in the cash transfer arm than the control arm (β = -0.03; 95% CI: -0.05, -0.001). Effects were consistent across subgroups. A modestly sized household cash transfer delivered over a short period in mid- to later-life led to a meaningful slowing of memory decline and reduction in dementia probability 7 y later. Cash transfer programs could help stem the tide of new dementia cases in economically vulnerable populations in the coming decades.

The impacts of COVID-19 on older adults in Uganda and Ethiopia: Perspectives from non-governmental organization staff and volunteers

The COVID-19 pandemic had a substantial impact on older adults, especially in Sub-Saharan Africa (SSA). To support older adults during this time, non-governmental organizations (NGOs) coordinated programs to help provide for basic needs related to food and water security and healthcare. This research explores the attitudes, perceptions and experiences of NGO staff and volunteers who provided support to older adults in SSA in rural East Africa during the COVID-19 pandemic. In-depth interviews (n = 28) were conducted with NGO staff and volunteers in Uganda and Ethiopia between September and December of 2022. Overall, NGO staff and volunteers reported high levels of knowledge surrounding the COVID-19 pandemic and stated that one positive of the COVID-19 pandemic was the improved hygiene practices. However, the NGO staff and volunteers also reported that the pandemic and the associated public health measures exacerbated pre-existing social inequalities, such as increasing pre-existing levels of food insecurity. The exacerbation of pre-existing social inequalities may be one reason for the increased reliance on NGO services. The learnings from the COVID-19 pandemic and associated public health measures can be utilized to create targeted strategies to mitigate the negative impacts of future public health crises on vulnerable populations.

Child support grant expansion and cognitive function among women in rural South Africa: Findings from a natural experiment in the HAALSI cohort

BACKGROUND

Cash transfers are a promising but understudied intervention that may protect cognitive function in adults. Although South Africa has a rapidly ageing population, little is known about the nature of association between cash transfers and cognitive function in this setting.

OBJECTIVES

We leveraged age-eligibility expansions to South Africa's Child Support Grant (CSG) to investigate the association between duration of CSG eligibility and cognitive function of biological mothers of child beneficiaries in South Africa.

METHODS

We analysed 2014/2015 baseline data from 944 women, aged 40-59 years with at least one CSG-eligible child, enrolled in the population-representative HAALSI cohort in Agincourt, South Africa. Duration of CSG eligibility for each mother was calculated based on the birth dates of all their children and the CSG age-eligibility expansion years (2003-2012). Cognitive function was measured using a cognitive battery administered at the HAALSI baseline interview. Linear regression was used to estimate the association between duration of CSG eligibility, dichotomized as low (≤10 years) and high (>10 years) eligibility, and cognitive function z-scores of the mothers.

RESULTS

High vs. low duration of CSG eligibility, was associated with higher cognitive function z-scores in the full sample [β: 0.15 SD units; 95% CI: 0.04, 0.26; p-value = 0.01]. In mothers with one to four lifetime children, but not five or more, high vs. low duration of CSG eligibility, was associated with higher cognitive function z-scores [β: 0.19 SD units; 95% CI: 0.05, 0.34, p-value = 0.02].

CONCLUSION

Government cash transfers given to support raising children may confer substantial protective effects on the subsequent cognitive function of mothers. Further studies are needed to understand how parity may influence this relationship. Our findings bring evidence to policymakers for designing income supplementation programmes to promote healthy cognitive ageing in low-income settings.

Mid-life employment trajectories and subsequent memory function and rate of decline in rural South Africa, 2000-22

AIM

To investigate mid-life employment trajectories in relation to later-life memory function and rate of decline in rural South Africa.

METHODS

Data from the Agincourt Health and Socio-Demographic Surveillance System were linked to the 'Health and Ageing in Africa: A Longitudinal Study of an INDEPTH Community in South Africa' (HAALSI) in rural Agincourt, South Africa (N = 3133). Employment was assessed every 4 years over 2000-12 as being employed (0, 1, 2 and ≥3 time points), being employed in a higher-skill occupation (0, 1, 2 and ≥3 time points) and dynamic employment trajectories identified using sequence analysis. Latent memory z-scores were assessed over 2014-22. Mixed-effects linear regression models were fitted to examine the associations of interest.

RESULTS

Sustained mid-life employment from 2000-12 (β = 0.052, 95% CI: -0.028 to 0.132, 1 vs 0 time points; β = 0.163, 95% CI: 0.077 to 0.250, 2 vs 0 time points; β = 0.212, 95% CI: 0.128 to 0.296, ≥3 vs 0 time points) and greater time spent in a higher-skill occupation (β = 0.077, 95% CI: -0.020 to 0.175, 1 vs 0 time points; β = 0.241, 95% CI: 0.070 to 0.412, 2 vs 0 time points; β = 0.361, 95% CI: 0.201 to 0.520, ≥3 vs 0 time points) were associated with higher memory scores in 2014/15, but not subsequent rate of memory decline. Moving from a lower-skill to higher-skill occupation was associated with higher memory function, but a faster rate of decline over 2014-22.

CONCLUSIONS

Sustained mid-life employment, particularly in higher-skill occupations, may contribute to later-life memory function in this post-Apartheid South African setting.

New rural pension scheme, intergenerational interaction and rural family human capital investments

Introduction

The new rural pension scheme (NRPS) can improve the quality of life for rural older adult individuals; however, can it have a spillover effect on rural household human capital investments through intergenerational interactions?

Methods

Based on data from the China Family Panel Studies (CFPS) in 2010, 2012, 2014, 2016, and 2018 and from the perspective of intergenerational interactions, the spillover effect and influencing mechanism of the new rural insurance policy on rural household human capital investments are empirically tested.

Results

The results show that the participation of families in the new rural insurance policy can significantly promote the human capital investments of rural families, and they are robust. Moreover, the spillover effect of this new policy is significantly different due to the gender, insurance phase, and family income of the insured. Through intergenerational interactions, the new rural insurance policy has an impact on the human capital investments of rural families from the material level of intergenerational economic support, housework and childcare for children and the nonmaterial level of old-age care cognition.

Discussion

Therefore, continuing to promote the coverage of the new rural insurance policy and scientifically improving rural social security through publicity and education to promote benign intergenerational family interactions can improve the accumulation of human capital in rural areas.

Has new rural pension system reduced the intake of junk food among rural older adults? Evidence from China

At present, China has become one of the fastest growing countries in terms of junk food consumption. However, there has been less previous evidence for the effect of endowment insurance on dietary health. Using the data China Family Panel Studies (CFPS) from 2014, this paper exploits a policy, the New Rural Pension System (NRPS), that only the older adults who have reached 60 years old can receive pensions and conduct a fuzzy regression discontinuity (FRD) to address endogeneity and examine the causal effect of the NRPS on the intake of junk food among rural older adults in China. We find that the NRPS can significantly reduce junk food intake among them, which remains robust after a series of robustness tests. In addition, heterogeneity analysis shows that the female, low-educated, unemployed, and low-income groups are more sensitive to the pension shock from the NRPS. The result of our study provides insights to effectively improve people's dietary quality and related policy formulation.