Inequalities in Health and Wellbeing Among Elderly Populations: A Case Study of Central Uganda
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Sub-Saharan Africa (SSA) has the fastest aging population in the world. Yet its older population has the lowest life expectancy, lowest ratings of subjective wellbeing, and greatest burdens of disease in old age globally. While it is widely recognized that place processes have both positive and negative effects on health and wellbeing in old age, little attention has been given to the multiplicity of place processes that shape health and wellbeing in SSA. This is despite renewed calls from the World Health Organization (WHO) in its Global Strategy and Action Plan on Aging and Health (GSAP) for immediate actions on health and wellbeing in old age. This thesis explores the aging-health-place nexus in the Greater Mukono area of Central Uganda. The research focused on three broad objectives: first, to investigate the relationship between age and subjective wellbeing among older adults; second, to examine the socio-cultural, environmental and political-economic drivers of health and wellbeing in old age; and finally, to examine how gender inequalities over the life course shape health and wellbeing in old age. Drawing on (feminist) political ecology (of health), a social determinants of health framework, and a life course perspective, a mixed method case study approach― involving a secondary survey, in-depth interviews and focus groups with elderly residents, along with interviews with key informants knowledgeable about aging ― was used in the research. The findings from structural equation modelling suggest there are two main pathways through which determinants mediate the age-subjective wellbeing (SWB) relationship, varying by gender. First, social determinants more strongly and positively mediate the age-SWB relationship for women. Second, structural determinants more strongly and positively mediate the age-SWB relationship for men. Results from focus groups (n=15) and key informants (n=34) extend knowledge on the drivers of health, revealing how discriminatory and stereotypical beliefs about old age, at both institutional and interpersonal levels, have direct and indirect effects on aging bodies in multiple domains― political-economic, sociocultural, environmental― which together become embodied in deleterious physical and psychosocial health and wellbeing. Further, findings from in-depth interviews (n=53) and key informants (n=34) reveal the wellbeing of aging men and women is an amalgamation of embodied gendered experiences and social dynamics that are (re)produced and (re)articulated across the life course. The findings expose a counter narrative to the global representation of gendered aging inequalities, illuminating how gender and age are experienced and navigated in sometimes unexpected and contradictory ways. This research makes important contributions to knowledge, policy and practice. Theoretically, this research contributes knowledge on age-relationality, along with an enhanced understanding of the multiscale and multitemporal processes shaping the aging-health-place relation. Likewise, extending the WHO Social Determinants of Health framework to the study of subjective wellbeing provides the conceptual space to operationalize environmental barriers for wellbeing in old age, providing a framework for future operationalization of the GSAP domains. Methodologically, this research contributes to the conceptualization and identification of health and wellbeing determinants in old age in a SSA context; provides an example of how to employ an integrated knowledge translation approach to improve knowledge and understanding of health inequalities in old age; addresses methodological calls for integrated knowledge translation approaches on aging and health to enhance the likelihood that findings are both useful and translatable for programs, practices and policy; and contributes knowledge on the connections between people, health and place across time and over space through the application of qualitative history approaches, particularly event history calendars. Substantively, this research contributes to the geographies of aging literature, increasing understanding of aging experiences and the environmental factors (e.g. socio-cultural, economic, political, physical/built) that affect health and wellbeing outcomes in Uganda. This research brings forth new issues for consideration in the geographies of aging (e.g. implications of changing climates; gender-based violence; water and sanitation; double burdens of disease; demographic conflict) underscoring the importance of examining both social and physical environmental processes in health and wellbeing outcomes. Moreover, it fills important knowledge gaps identified by the WHO GSAP. In terms of policy, this research highlights that government actions are needed to implement: the National Policy for Older Persons through the provision of pensions schemes; the development of social groups and support systems; and strategies that address societal ageism, ill equipped health systems, gender norms, and environmental (natural, built) conditions. Equally, the government should provide opportunities for older people to be included in policy decisions and implementation, as well as put health in all policies to ensure health across the life course and positive outcomes in old age.
Cite this version of the work
Andrea Rishworth (2019). Inequalities in Health and Wellbeing Among Elderly Populations: A Case Study of Central Uganda. UWSpace. http://hdl.handle.net/10012/15122