Pensions and the Health of Older People in South Africa: Is there an Effect?

Figures & data

Table 1. Older people’s reported access to essential medication, Brazil and South Africa, 2008/2009

	Brazil	South Africa
Always	78%	42%
Sometimes	19%	34%
Never	3%	24%

Source: Lloyd-Sherlock et al. (2012).

Table 2. Pension coverage of households containing at least one person aged 65 or over

Country	Pension coverage	Country	Pension coverage
China	54.3%	Mexico	35.1%
Ghana	9.6%	Russian Federation	98.4%
India	19.3%	South Africa	79.0%

Source: WHO SAGE database (details available on the SAGE website, http://www.who.int/healthinfo/systems/sage, and in Kowal et al. [2012]).

Table 3. Construction of health and wellbeing outcome measures

Variable	Original coding or components	Dichotomous recoding or recoding of quintiles
Sad [q2018]	None, mild, moderate, severe, extreme	0=none or mild
		1=at least some sad
Worry[q2019]	None, mild, moderate, severe, extreme	0=none or mild
		1=at least some worry
Unhappy[q7010]	Very happy, happy, neither, unhappy, very unhappy	0=happy
		1=at least some unhappy
Dissatisfied [q7008]	Very satisfied, satisfied, neither, dissatisfied, very dissatisfied	0=satisfied
		1=at least dissatisfied
Health status [q2002–2024]	Mobility, self-care, pain and discomfort, cognition, interpersonal activities, sleep, energy, affect, vision; scale 0 (poor health) to 100 (good health)	0=60% best health
		1=40% poorest health
Function [q2025–2046]	interpersonal activities, difficulties in daily living such as standing, walking, household duties, learning, concentrating, self-care; scale 0 (low ability) to 100 (high ability)	0=60% best1=40% poorest
Quality of life [q7001–7002]	Enough energy for daily life, enough money to meet needs, satisfaction withone’s health, with oneself, ability to perform daily activities, personal relationships, condition of your living space, rate your overall quality of life; scale 0 low quality of high to 100 high quality of life	0=60% best
		1=40% worst

Table 4. Sample distribution of black African households receiving no pension and receiving at least one pension, South Africa

Characteristics	Black African households
	Receive no pension^a N[%]	Chisq p value	Receive at least one pension^b N[%]	Chisq p value
Total number	1203 [56.4]		791 [40.8]
Gender of oldest member		<0.0001		0.007
Male	753 [62.6]		279 [35.3]
Female	450 [37.4]		512 [64.7]
Place of residence		0.020		0.005
Urban	667 [55.4]		406 [51.4]
Rural	536 [44.6]		384 [48.6]
Age groups of oldest member		<0.0001		<0.0001
50–54	408 [33.9]		–
55–59	310 [25.8]		–
60–62	133 [11.1]		80 [10.1]
63–66	60 [5.0]		122 [15.4]
67–70	110 [9.1]		191 [24.2]
71+	182 [15.1]		398 [50.3]
Household wealth quintile		0.452		0.059
Quintile 1 (poorest)	233 [28.7]		204 [26.0]
Q2	205 [25.2]		185 [23.6]
Q3	165 [20.3]		152 [19.4]
Q4	126 [15.5]		158 [20.1]
Q5 (richest)	84 [10.3]		86 [11.0]
Education of oldest member		0.001		<0.0001
No formal education	403 [33.5]		337 [42.6]
Incomplete primary	552 [45.9]		357 [45.1]
Complete primary	202 [16.8]		77 [9.7]
Complete secondary and above	46 [3.8]		20 [2.5]
Households with piped water	366 [44.9]	0.107	329 [41.7]	0.167
Households with piped sewerage	363 [44.5]	<0.0001	300 [38.0]	<0.0001
Health insurance status of oldest member		<0.0001		0.062
Covered by mandatory insurance	78 [6.5]		31 [3.9]
Covered by voluntary insurance	73 [6.1]		56 [7.1]
Covered by both mandatory and voluntary insurance	37 [3.1]		24 [3.0]
None	662 [83.7]		676 [85.5]
Hypertensive	418 [63.1]		419 [62.0]
Hypertensive and aware of status	123 [29.4]	0.262	226 [53.9]	0.785
Hypertensive and taking treatment	108 [25.8]	<0.0001	213 [50.8]	<0.0001
Hypertensive and condition controlled	24 [5.7]	0.262	56 [13.4]	0.785

Notes: ^acontain at least one women aged 50–59 and one men age 50–62.

^bcontain at least one women aged 60+ or one man age 63+.

Table 5. Association between old-age household pension status (households reporting pension income, and containing a man aged 63+ or a woman aged 60+) and outpatient visits and hypertension awareness, treatment and control

	Outpatient visit		Hypertension awareness		Hypertension treated		Hypertension controlled
	Unadjusted	Adjusted	Unadjusted	Adjusted	Unadjusted	Adjusted	Unadjusted	Adjusted
Predictors and confounders	OR[95%CI]	OR[95%CI]	OR[95%CI]	OR[95%CI]	OR[95%CI]	OR[95%CI]	OR[95%CI]	OR[95%CI]
Old age household pension status
No pension (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)
Receive pension	1.65[1.22–2.23]	1.77[1.00–3.15]	2.38[1.79–3.17]	2.80[1.68–4.67]	2.85[2.12–3.84]	3.26[1.89–5.61]	0.76[0.55–1.03]	0.80[0.47–1.40]
Gender
Male (ref)		1.00 (ref)		1.00 (ref)		1.00 (ref)		1.00 (ref)
Female		1.56[1.15–2.12]		1.95[1.44–2.64]		1.86[1.35–2.57]		0.83[0.62–1.12]
Place of residence
Urban (ref)		1.00 (ref)		1.00 (ref)		1.00 (ref)		1.00 (ref)
Rural		0.96[0.69–1.32]		0.61[0.45–0.82]		0.68[0.49–0.94]		0.98[0.72–1.33]
Age
50–54 (ref)		1.00 (ref)		1.00 (ref)		1.00 (ref)		1.00 (ref)
55–59		1.72[1.13–2.62]		1.75[1.14–2.68]		2.10[1.35–3.29]		0.77[0.52–1.15]
60–64		0.76[0.43–1.32]		0.76[0.43–1.34]		0.78[0.42–1.44]		0.71[0.39–1.22]
65–69		1.29[0.63–2.62]		1.32[0.70–2.48]		1.38[0.69–2.71]		1.12[0.56–2.18]
70+		1.04[0.53–2.06]		0.99[0.53–1.87]		1.13[0.59–2.18]		0.69[0.37–1.28]
Education
No formal education  (ref)		1.00 (ref)		1.00 (ref)		1.00 (ref)		1.00 (ref)
Incomplete primary		1.27[0.89–1.80]		1.00[0.71–1.41]		1.00[0.69–1.44]		1.03[0.70–1.40]
Complete primary		1.15[0.72–1.84]		1.11[0.68–1.83]		0.99[0.58–1.71]		1.29[0.79–1.88]
Complete secondary  and above		1.00[0.45–2.26]		0.55[0.24–1.26]		0.64[0.26–1.55]		1.32[0.63–2.52]
Household wealth
Poorest (Q1,2)		1.00 (ref)		1.00 (ref)		1.00 (ref)		1.00 (ref)
Middle and richest  (Q3,4,5)		1.53[1.11–2.10]		1.48[1.09–2.00]		1.30[0.95–1.79]		0.87[0.64–1.18]

Note: Dependent variables: outpatient visit – 1 (yes), 0 (no); awareness of hypertension – 1 (aware), 0 (not aware); hypertension treatment – 1 (on treatment since last 12 months), 0 (not on treatment); hypertension controlled – 1 (yes), 0 (no).

Table 6. Association between old-age household pension status (households reporting pension income, and containing a man aged 63+ or a woman aged 60+) and selected self-reported health outcomes

Predictors and confounders	Self-rated health		Depression		Anxiety
	Unadjusted	Adjusted	Unadjusted	Adjusted	Unadjusted	Adjusted
	OR[95%CI]	OR[95%CI]	OR[95%CI]	OR[95%CI]	OR[95%CI]	OR[95%CI]
Old age household pension status
No pension (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)
Receive pension	0.73[0.51–1.04]	0.68[0.40–1.14]	0.75[0.58–0.97]	1.04[0.65–1.65]	0.74[0.57–0.96]	1.12[0.70–1.79]
Gender
Male (ref)		1.00 (ref)		1.00 (ref)		1.00 (ref)
Female		0.83[0.58–1.19]		1.19[0.93–1.57]		1.22[0.96–1.61]
Place of residence
Urban (ref)		1.00 (ref)		1.00 (ref)		1.00 (ref)
Rural		0.85[0.56–1.16]		0.82[0.62–1.05]		0.79[0.60–1.02]
Age
50–54 (ref)		1.00 (ref)		1.00 (ref)		1.00 (ref)
55–59		0.61[0.38–1.04]		1.09[0.78–1.57]		1.08[0.77–1.55]
60–64		1.29[0.64–2.63]		0.69[0.45–1.14]		0.69[0.45–1.13]
65–69		1.11[0.54–2.19]		0.78[0.45–1.41]		0.67[0.39–1.22]
70+		0.74[0.41–1.50]		0.61[0.36–1.12]		0.56[0.33–1.02]
Education
No formal education (ref)		1.00 (ref)		1.00 (ref)		1.00 (ref)
Incomplete primary		0.73[0.54–1.18]		1.30[0.98–1.72]		1.18[0.88–1.54]
Complete primary		1.45[0.86–2.84]		0.84[0.55–1.29]		0.87[0.56–1.29]
Complete secondary and above		5.31[1.60–17.65]		1.09[0.57–2.17]		0.89[0.46–1.69]
Household wealth
Poorest (Q1,2)		1.00 (ref)		1.00 (ref)		1.00 (ref)
Middle and richest (Q3,4,5)		1.68[1.17–2.43]		1.04[0.80–1.35]		0.96[0.74–1.25]

Note: Dependent variables: outpatient visit – 1 (yes), 0 (no); awareness of hypertension – 1 (aware), 0 (not aware); self-rated health – 1 (good), 0 (not good).

Table 7. Association between old-age household pension status (households reporting pension income, and containing a man aged 63+ or a woman aged 60+) and composite health and wellbeing outcomes

	Sad	Worry	Unhappy	Dissatisfied	Poor health status	Worse function	Worse quality of life
Predictors and confounders	Adjusted OR[95%CI]	Adjusted OR[95%CI]	Adjusted OR[95%CI]	Adjusted OR[95%CI]	Adjusted OR[95%CI]	Adjusted OR[95%CI]	Adjusted OR[95%CI]
Old age Household pension status
No pension (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)
Receive pension	0.97[0.57–1.58]	1.11[0.65–1.86]	1.40[0.87–2.25]	1.00[0.61–1.66]	0.98[0.53–1.76]	1.15[0.68–1.91]	0.85[0.50–1.39]
Gender
Male (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)
Female	1.15[0.85–1.58]	1.08[0.81–1.49]	0.90[0.68–1.18]	0.99[0.75–1.32]	1.34[0.94–1.92]	1.31[0.98–1.75]	1.16[0.86–1.49]
Place of residence
Urban (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)
Rural	1.41[1.04–1.96]	1.17[0.85–1.59]	1.12[0.92–1.59]	0.94[0.70–1.26]	1.36[0.96–1.96]	0.92[0.69–1.24]	1.18[0.98–1.68]
Age
50–54 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)
55–59	1.14[0.75–1.76]	0.89[0.58–1.35]	0.97[0.66–1.38]	0.69[0.47–0.99]	1.00[0.60–1.65]	1.39[0.95–2.11]	1.52[1.02–2.14]
60–64	0.97[0.56–1.71]	0.87[0.51–1.48]	0.69[0.39–1.06]	0.56[0.3 –0.85]	1.26[0.66–2.46]	1.23[0.75–2.24]	0.99[0.58–1.68]
65–69	1.20[0.65–2.34]	0.89[0.46–1.71]	0.78[0.45–1.42]	0.72[0.38–1.30]	1.13[0.54–2.35]	1.91[1.04–3.63]	1.66[0.89–3.11]
70+	1.27[0.68–2.37]	0.96[0.52–1.86]	0.50[0.26–0.81]	0.59[0.33–0.95]	2.00[0.97–4.10]	2.54[1.45–4.88]	1.55[0.86–2.86]
Education
No formal education (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)
Incomplete primary	1.47[1.04–2.06]	1.37[0.98–1.92]	0.93[0.70–1.25]	0.99[0.68–1.35]	1.25[0.82–1.81]	1.37[1.00–1.87]	1.07[0.80–1.44]
Complete primary	0.98[0.57–1.69]	0.92[0.54–1.54]	0.65[0.42–1.02]	0.71[0.45–1.11]	0.82[0.44–1.39]	0.64[0.41–1.02]	0.66[0.43–1.01]
Complete secondary and above	0.77[0.33–1.78]	0.69[0.31–1.50]	0.42[0.13–0.93]	0.11[0.04–0.27]	0.92[0.31–2.43]	0.69[0.34–1.53]	0.40[0.18–0.87]
Household wealth
Poorest (Q1,2)	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)
Middle and richest (Q3,4,5)	0.85[0.62–1.17]	0.98[0.72–1.34]	0.45[0.34–0.59]	0.54[0.40–0.72]	0.92[0.65–1.29]	1.09[0.81–1.45]	0.41[0.31–0.54]

Table 8. Relationship (adjusted odds ratios with 95%CI) of gender, five-year age group, residence and other socioeconomic characteristics and the recent pension-eligible age group to health and wellbeing among black/Africans in South Africa

Characteristics	Sad	Worry	Unhappy	Dissatisfied	Poor health status	Worse function	Worse quality of life	Hypertension awareness	Hypertension treatment	Hypertension controlled
Gender
Male	1.00	1.00	1.00	1.00	1.00	1.00	1.00	1.00	1.00	1.00
Female	1.19[0.87–1.62]	1.13[0.83–1.52]	0.86[0.65–1.14]	0.95[0.71–1.27]	1.32[0.92–1.88]	1.35[1.01–1.81]	1.08[0.82–1.44]	1.97[1.45–2.68]	1.90[1.38–2.62]	0.82[0.61–1.11]
Age groups
50–54	1.00	1.00	1.00	1.00	1.00	1.00	1.00	1.00	1.00	1.00
55–59	1.14[0.74–1.75]	0.88[0.58–1.33]	0.98[0.67–1.42]	0.70[0.47–1.04]	1.00[0.60–1.66]	1.40[0.94–2.10]	1.54[1.05–2.24]	1.75[1.14–2.69]	2.12[1.36–3.30]	0.77[0.52–1.15]
60–64	0.94[0.57–1.54]	0.86[0.53–1.39]	0.80[0.50–1.29]	0.57[0.35–0.91]	1.25[0.70–2.25]	1.32[0.81–2.14]	0.95[0.59–1.54]	1.27[0.79–2.05]	1.46[0.88–2.42]	0.65[0.39–1.08]
65–69	1.11[0.69–1.80]	0.91[0.56–1.47]	1.15[0.75–1.77]	0.76[0.49–1.20]	1.12[0.67–1.90]	2.15[1.39–3.32]	1.57[1.03–2.41]	3.30[2.09–5.20]	4.09[2.53–6.62]	0.91[0.56–1.49]
70+	1.18[0.75–1.87]	1.02[0.66–1.60]	0.70[0.46–1.05]	0.60[0.35–0.91]	1.98[1.23–3.19]	2.84[1.90–4.24]	1.41[0.95–2.10]	2.46[1.59–3.80]	3.23[2.06–5.09]	0.57[039–0.85]
Place of residence
Urban	1.00	1.00	1.00	1.00	1.00	1.00	1.00	1.00	1.00	1.00
Rural	1.48[1.07–2.03]	1.23[0.90–1.69]	1.04[0.78–1.40]	0.86[0.64–1.15]	0.32[0.91–1.89]	0.94[0.70–1.26]	1.09[0.81–1.46]	0.63[0.47–0.85]	0.70[0.50–0.97]	0.98[0.71–1.33]
Education
No formal  education	1.00	1.00	1.00	1.00	1.00	1.00	1.00	1.00	1.00	1.00
Incomplete  primary	1.50[1.06–2.13]	1.36[0.96–1.91]	1.08[0.80–1.46]	1.10[0.74–1.39]	1.26[0.85–1.88]	1.37[0.99–1.89]	1.10[0.81–1.48]	0.97[0.69–1.37]	0.97[0.67–1.39]	1.04[0.73–1.46]
Complete  primary	1.00[0.58–1.73]	0.88[0.51–1.52]	0.92[0.58–1.45]	0.75[0.48–1.18]	0.85[0.47–1.53]	0.62[0.39–0.98]	0.71[0.46–1.10]	1.11[0.67–1.84]	0.99[0.57–1.72]	1.30[0.83–2.02]
Complete  secondary  and above	0.73[0.31–1.74]	0.60[0.26–1.36]	0.53[0.23–1.21]	0.14[0.05–0.35]	1.02[0.35–2.94]	0.62[0.29–1.33]	0.50[0.23–1.11]	0.54[0.23–1.25]	0.62[0.25–1.53]	1.35[0.64–2.86]
Household wealth
Q1(Lowest)	1.00	1.00	1.00	1.00	1.00	1.00	1.00	1.00	1.00	1.00
Q2	1.05[0.68–1.63]	1.18[0.76–1.83]	0.57[0.38–0.84]	0.48[0.32–0.74]	0.84[0.51–1.38]	0.98[0.65–1.48]	0.60[0.40–0.90]	1.21[0.77–1.88]	0.93[0.57–1.50]	1.10[0.70–1.73]
Q3	0.71[0.45–1.11]	0.86[0.55–1.35]	0.46[0.31–0.69]	0.53[0.35–0.82]	0.89[0.54–1.47]	1.13[0.75–1.71]	0.41[0.27–0.62]	1.65[1.06–2.56]	1.38[0.87–2.18]	0.85[0.54–1.31]
Q4	0.97[0.61–1.54]	1.21[0.76–1.92]	0.26[0.17–0.40]	0.27[0.17–0.43]	0.85[0.51–1.43]	0.82[0.53–1.29]	0.28[0.18–0.43]	1.48[0.92–2.38]	0.95[0.59–1.52]	1.09[0.69–1.72]
Q5(highest)	1.17[0.64–2.13]	1.41[0.79–2.54]	0.23[0.13–0.42]	0.26[0.14–0.47]	0.70[0.36–1.34]	1.57[0.91–2.69]	0.20[0.11–0.35]	1.87[1.09–3.20]	1.61[0.92–2.84]	0.79[0.45–1.41]
Improvement at pension-eligibility
Women 60–64  vs 55–59	0.70[0.37–1.34]	1.04[0.55–2.06]	0.67[0.36–1.26]	0.78[0.42–1.47]	1.20[0.58–2.47]	0.81[0.44–1.48]	0.34[0.18–0.64]	0.80[0.43–1.47]	0.81[0.44–1.50]	0.83[0.42–1.65]
Men 65–69  vs 60–64	0.84[0.36–1.95]	0.89[0.39–2.05]	1.19[0.51–2.77]	1.44[0.61–3.38]	0.66[0.21–2.07]	1.36[0.60–3.12]	0.91[0.38–2.17]	4.85[1.77–13.29]	5.45[1.79–16.59]	0.84[0.34–2.08]
Decline in next age group
Women 65–69  vs 60–64	1.62[0.83–3.16]	1.10[0.57–2.13]	2.15[1.15–4.02]	1.63[0.84–3.16]	1.08[0.53–2.20]	2.10[1.16–3.82]	3.15[1.69–5.87]	2.09[1.12–3.89]	2.28[1.22–4.24]	1.87[0.94–3.73]
Men 70–74  vs 65–69	0.89[0.29–2.68]	0.91[0.32–2.61]	0.65[0.27–1.60]	0.71[0.28–1.82]	1.50[0.48–4.71]	1.62[0.67–3.90]	1.06[0.41–2.73]	0.75[0.29–1.93]	1.01[0.39–2.64]	1.30[0.43–3.94]
Number	1912	1910	1844	1746	1155	1748	1797	1925	1808	1808

Lloyd-Sherlock, P., Barrientos, A., Moller, V., & Saboia, J. (2012). Pensions, poverty and wellbeing in later life: Comparative research from South Africa and Brazil. Journal of Aging Studies, 26(3), 243–252.

 Web of Science ®Google Scholar

Kowal, P., Chatterji, S., Naidoo, N., Biritwum, R., Fan, W., Lopez Riadura, R., … SAGE Collaborators. (2012). Data resource profile: The World Health Organisation Study of global AGEing and adult health. International Journal of Epidemiology, 41, 1639–1649.

 PubMed Web of Science ®Google Scholar