First published in 1948, the International Social Security Review is the principal international quarterly publication in the field of social security.
This article assesses the effectiveness of pension provision and health insurance in preventing ill health among older people in developing countries. It argues that, until recently, social protection agendas devoted insufficient attention to health risk prevention, instead focusing on the reduction of income poverty through cash transfers. The article shows that there is little reliable evidence to indicate that providing older people with pension benefits enhances their health status and that these effects should not be taken for granted by policy‐makers. The article then focuses on the effect of inclusion in health insurance schemes on health outcomes for older people, with specific reference to outcomes related to hypertension. Drawing on newly‐available data from the World Health Organization for Ghana, Mexico and South Africa, it shows that older people with health insurance are marginally more likely to be aware of health conditions such as hypertension and more likely to have them under control. Nevertheless, the great majority of hypertensive older people, insured or uninsured, are not effectively treated. The chief barriers to treatment are shown to be mainly related to awareness and service provision, rather than financial ones. Consequently, the capacity of pensions or health insurance to enhance health outcomes for older people in such countries, including in rural areas, is heavily contingent upon health education, health screening and adequate health service provision. These interventions should be viewed as an integral element of mainstream social protection strategies, rather than adjuncts to them. Yet, in practice, social protection and health promotion continue to be treated as almost entirely separate spheres, thus presenting substantial institutional barriers to developing combined interventions.
Upward intergenerational flows — from the working ages to old age — are increasing substantially in the advanced industrialized countries and are much larger than in developing countries. Population ageing is the most important factor leading to this change. Thus, in the absence of a major demographic shift (e.g. a return to high fertility), an increase in upward flows is inevitable. Even so, three other important factors will influence the magnitudes of upward flows. First, labour income varies at older ages due to differences in average age at retirement, productivity, unemployment, and hours worked. Second, the age patterns of consumption at older ages vary primarily due to differences in spending on health. Third, spending on human capital (i.e. spending on child health and education) varies. Human capital spending competes with spending on the elderly, but it also increases the productivity of subsequent generations of workers and the resources available to support consumption in old age. All contemporary societies rely on a variety of institutions and economic mechanisms to shift economic resources from the working ages to the dependent ages — the young and the old. Three institutions dominate intergenerational flows: governments which implement social security, education, and other public transfer programmes; markets which are key to the accumulation of assets (e.g. funded pensions and housing); and families which provide economic support to children in all societies and to the elderly in many. The objectives of this article are, first, to describe how population ageing and other changes influence the direction and magnitude of intergenerational flows; and, second, to contrast the institutional approaches to intergenerational flows as they are practiced around the world. The article relies extensively on National Transfer Accounts (NTA), a system for measuring economic flows across age in a manner consistent with the United Nations' System of National Accounts. These accounts are currently being constructed by research teams located in 33 countries on six continents representing wide variations in the level of development, demographics, and policies regarding intergenerational transfers.