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.
This article examines a sample of employer programmes in sub‐Saharan Africa that supplement government efforts to prevent and treat human immunodeficiency virus (HIV). Some of these programmes provide workers with in‐house education, voluntary HIV testing and antiretroviral treatment. Others rely on new forms of employment‐based group health insurance that include an HIV treatment package. In addition, some enterprises use the workplace as a platform for launching efforts into neighbouring communities to reach spouses, children, sex workers, secondary school students and others. Early evidence suggests that employer programmes maintain the health of large fractions of workers living with HIV who are served by them. They further enable enterprises to avoid productivity losses and turnover costs associated with HIV. At the same time, they take pressure off government agencies that face demands for treatment far exceeding their capacity. The article identifies features of successful employer programmes including “elite appeal”, which mobilizes community leaders and role models to deconstruct stigma, change perceptions and call for behavioural change; and “collateral linkage”, which extends the reach of HIV workplace programmes by linking them to related community concerns: e.g. alcohol abuse, malaria and domestic violence. Looking forward, the potential for expanding employer programmes as well as the restrictions associated with the limited scale of formal‐sector employment within sub‐Saharan African economies is assessed. Actions by which governments, employer associations, trade unions and international organizations can encourage further development of such programmes and extend their reach are suggested.