Three social determinants have significant effects on the health of aging women. The first, education and literacy, is part of earlier life experience. The second and third are major and widely-experienced events that occur in the later life course: the likelihood of caring for a disabled spouse or relative; and widowhood.
These experiences can be regarded as normal insofar as there are social and cultural norms that govern roles and expectations. These events can have both positive and negative impacts on health, and the individual experiences of older women vary widely even within the same society.
Other events that may occur in later life, such as violence and abuse, can be seen as abnormal and can only have negative effects on the health of aging women. Fear of these events as well as actual experience can add to their vulnerability.
The current cohort of older women includes women born in the 1930s and those born in the 1950s. This very wide range presents considerable contrasts not only in education and occupational opportunities but also social experiences and major life experiences. Women who will become senior citizens in a decade or so will have different expectations about their future life from the current cohorts of older women. The health status of current cohorts of older women reflects social conditions of many years ago, whereas the health of future aging cohorts will reflect current and future economic and social conditions. It is not easy to predict the future health effects of these factors.
Education is one of the more readily modifiable social determinants of health. The relationship between education and health is well-established, with higher educational levels being associated with good health. People with greater education consistently show less disability and better chances of recovery after illness.
Levels of literacy and education among current cohorts of aging women are low in many developing countries. Improvements in education of girls will result in better-educated future cohorts.
Achieving basic literacy for aging women is a prerequisite to promoting their participation in increasingly literate societies. Just as education of younger women has been a central factor in improving maternal and child health, so increased literacy for older women can be expected to bring health improvements for them.
If attention is not given to literacy, older women will be even further marginalised. In developed countries, the high level of involvement of older women in continuing education indicates their desire to ‘catch up’ on missed opportunities. The current shifts in workforce participation of young and middle-aged women, together with their improved education and work experience, will create a potentially large group of aging women who will wish to be involved not only in the workforce but in other aspects of public life, in both the formal and informal sectors.
The importance of informal care-giving in both developed and developing countries can never be overestimated. Since in industrialised countries the age range above 60 spans more than a generation, it contains a wide variety of lifestyles and living arrangements.
A striking feature is the proportion of older women who are carers. Support within the family largely rests on the spouse; aging women are more likely to care for their older husbands than the reverse.
When a spouse is unavailable, it is largely women (usually adult daughters and daughters-in-law) who fill this role; many of these women are themselves aged 50 years and over, caring for parents (usually mothers) who are in their late 70s or 80s. Aging women also act as caregivers for disabled adult children and for younger children.
"Family care" generally means care provided by women. Conversely, in developed countries, it is the relative absence of family support for older women that underlie their greater use of residential care. Providing assistance for caregivers is appropriate, and regular relief from care-giving responsibilities is essential.
Care-giving women need options. While there are many positive aspects to the caring role, a growing literature has documented the adverse emotional and physical effects of caring for a disabled older adult over extended periods. Severely disabled people now live for many years, even decades.
The value placed on the role of wife or daughter as the primary care-giver is such that providing them with support may be more appropriate than relieving them of care-giving.
The social value placed on care-giving is a potent force shaping the nature of assistance provided, and public recognition of this value is fundamental to the provision of public funds to support carers.
The entry of more women into the paid workforce in India has often been seen to be eroding the availability of family caregivers. The scale of this trend is limited by the low degree of participation of women over 50 in the paid workforce, although younger working women caring for elderly relatives are a small but special minority of carers.
The rapidly industrialising countries of Asia are currently undergoing major transformations in women’s workforce participation. The impact on intergenerational relationships, and the extent to which benefits of development are shared across generations, are not yet apparent.
Rather than overstating the impact of increased workforce participation on the availability of carers, it is more important that a range of options be developed to enable women to choose the balance of work and the caring responsibilities that best meet their particular circumstances.
Aging women everywhere are far more likely to be widowed than older men, but some countries have greater numbers of widowed women than others. The marked differences in the proportion of men and women over age 60 who are widowed in developing countries is due as much to high remarriage rates as to women’s better life expectancy, which is the main factor in developed countries.
Though social norms that sanction men remarrying or marrying younger women make widowhood far less likely for men, most women can expect widowhood to be part of their normal adult life. However, few older women are prepared for this role.
Social norms of widowhood generally mean restrictions of independence, as widowhood triggers a series of adjustments including changes in living arrangements and financial security as well as in personal relationships affecting companionship and intimacy.
The vast majority of aging women in developed countries live in extended family households, as much by necessity as by choice.
In addition to urbanisation which can leave widows isolated in rural areas, growing mega-cities are giving rise to ever-expanding urban slums, where often there is a lack of support from the extended family.
Even when the widow has access to family support and the opportunity to contribute to the household in practical ways, this situation can result in dependency on the younger family members.
The situation of widows in developed countries presents a different picture of economic resources and dependency. While it is a degree of independence that enables widows to live alone, living alone also makes them more vulnerable to isolation, a vulnerability that is compounded if health declines.
Independent relationships with adult children and younger generations provide greater support, but dependence on children can cause a conflict of cultural and intergenerational values. As values change, aging women are in an increasingly vulnerable social position.
“To be old used to be the best part of life.” This statement from a Kenyan woman refers to a time when older women were respected for their great age and wisdom and played important roles in society as judges, teachers, and community leaders.
Aging women in many such cultures no longer automatically have a central role in the community and the spread of Western education and values has diminished the respect previously accorded to the traditional knowledge possessed by older people.
The original essay was published in The Statesman in 2002