These are the best and worst countries to be elderly

October 3, 2013

The best and worst countries to be elderly, according to a study by HelpAge International (Max Fisher / Washington Post)

The United States ranks eighth in the world for the wellbeing of the elderly, according to a new study that looks at the welfare of people aged over 65 in 91 different countries. Sweden ranks first, followed by Norway and Germany. At the bottom of the list are Pakistan, Tanzania and Afghanistan. The United States, which typically ranked near the bottom of developed nations on these sorts of human welfare indices, performs unusually well here.

The report was conducted by the United Nations Population Fund and a group called HelpAge International that advocates for policies in support of the elderly. It uses a number of metrics: health, income security, employment and education opportunities as well as something it describes as "enabling environment." This last metric measures how friendly a society is to the elderly, such as physical safety, access to public transportation and the ease of maintaining social connections late in life, a key component of mental health and happiness.

There are some interesting trends in what makes a country better or worse for the elderly. More on this below, as well as a few revealing surprise cases. First, let's look at how the United States does in the report.

Why the United States is a great place to be elderly

The United States, though typically an under-performer among developed nations on things like public health and income equality, actually outperforms much of the developed world here. It ranks above Iceland, Japan, Britain and much of Europe.

Here's why: education and employment opportunities for elderly Americans are some of the best in the world. Actually, second-best, behind only Norway. As the report explains, "Older people value their capacity to work" because they "wish to maintain social contacts and self-worth" as well as remain self-sufficient. In most countries, people start getting locked out of the labor market once they get older. The United States is unusual in that the elderly face less age discrimination and have an easier time getting the education and skills to remain competent members of the workforce. That's not just good because it means they can work if they want to, but because it allows them to be active and self-sufficient, which go a long way toward promoting health and happiness.

Paradoxically, this may also partly be a product of the United States's relatively weak social safety net; the report finds that elderly in the United States have "the lowest levels of dependency on public transfers" of wealth in the world. A World Bank report found that many other developed countries, particularly in Europe, can create dependency among the elderly with higher social benefits.

This gets to the United States's big weakness when it comes to the elderly: the ever-present danger of poverty. Because of high income inequality and weaker social safety nets, the United States ranks only 36th in the world for "income security" among older citizens. By this measure, the United States ranks behind virtually all of the developed world and most of Eastern Europe. The United States ranks 24th globally on health of the elderly, which the report concludes is likely a product of economic inequality. It warns, "lifetime inequalities in areas such as wealth, healthcare and educational attainment play a key role in differing outcomes at older ages" and in the United States's relatively low score on these metrics.

Surprise: Rich countries are better for the elderly (but not always)

Accessibility programs, social welfare programs and public-health programs all cost money. So it's not shocking that wealthier countries tend to be better for the elderly. This chart, below, compares the AgeWatch Index score (the well-being for older people) against GDP per capita. You'll notice a clear general trend – with some telling exceptions.

Click to enlarge. (Global AgeWatch)

This is another big clue as to how the United States can be so good for the elderly: it's a very rich country with a lot of money to spend on them. In fact, just based on GDP per capita, you can see that the United States actually slightly underperforms the trend, which is indicated by the line between light and dark brown.

Some countries significantly over-perform by GDP per capita; in other words, do better than you would expect of countries with their amount of wealth. New Zealand is one, owing to a strong social safety net and low income inequality. So is Chile, for similar reasons. A huge success story here is Sri Lanka, a very poor country that nonetheless scores only a bit below much-richer Portugal, Malta and even Italy. The report singles out Sri Lanka for "long-term investments in education and health have had a lifetime benefit for many of today’s older population."

Bolivia also does unusually well, due to providing universal health care for the elderly and a universal pension plan. A number of Latin countries score well for similar reasons.

Russia scores extremely poorly on elderly welfare for its wealth levels. The country is plagued by age discrimination;

Where the elderly are better- and worse-off compared to the general population

The report compares its elderly welfare index to each country's human development index, a rough measurement of the well-being of the general population. The chart gives you a hint as to how the elderly in each country are doing compared to the rest of the country.

Click to enlarge. (Global AgeWatch)

To be clear, this doesn't tell us where the elderly are better- or worse-off than everyone else. It's a relative metric; countries that score above that diagonal line are the places where the elderly are doing best compared to the national norm; countries that score below the diagonal line are places where the elderly are doing worst compared to the national norm.

Scandinavian countries, owing to strong social safety nets for the elderly, do pretty well even when compared with the region's already well-off populations. So does the United States, for the reasons explained above.

You might notice South Korea scoring very poorly here. Though most South Koreans are very well-off, with a nationwide human development score comparable to Israel's and Denmark's, elderly South Koreans are only about as well-off as those from Ukraine or Ghana. The main reason is that elderly poverty rates are disastrously high, in large part because public pensions were not introduced until 1988, meaning that many older Koreans have no source of income.

Countries with lots of elderly tend to be better at caring for them

This chart compares elderly well-being with the share of a country's population that is over 65. It's a loose correlation, but in general, countries where larger shares of the population are older tend to be better at caring for them.

Click to enlarge (Global AgeWatch)

This makes sense for two reasons. First, developed countries tend to have more old people, both for demographic reasons (richer families have fewer children) and because they can afford the health care to live longer. And, second, countries with more elderly are naturally going to put more energy into developing policies and programs for them.

The countries marked by red dots are going to have the elderly make up more than 30 percent of their population, a huge share, by 2050. Red dots that appear toward the bottom of the chart – that have lower scores for elderly welfare – are disasters in the making. As the elderly make up a larger share of the populations in countries such as Russia and South Korea, already-weak resources are going to be further strained. That puts the next generation of elderly in those countries at risk, but it also endangers the national economies, which are ill-prepared to care for the elderly who are making up more of their populations.

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