JAY SOKOLOVSKY

INTRODUCTION TO SPECIAL SECTION ON HEALTH, AGING AND DEVELOPMENT

While new research on elderly in Third and Fourth world societies is rapidly growing, one of the most neglected aspects of a qualitative examination of aging among such peoples is the way health of the elderly is related to their place in a rapidly changing world (Sokolovsky 1983; Counts and Counts 1985; Morgan 1985; Tout 1989; Sokolovsky 1990). Reports in the gerontological literature during the 1960s and 1970s described a small number of non-industrial mountain peoples who supposedly possessed extraordinary longevity and health. However, these claims have been discredited. Such assertions were made for the Abkhasian people of the Soviet Union, a peasant village in Vilcabamba, Ecuador (Davies 1975; Halsell 1976), the Hunzakut of the Karakoram mountains in Pakistan (Leaf 1975), and the inhabitants of Paros Island, Greece (Beaubier 1976). Not only were there said to be an exceptional number of centenarians (including people in the 120-150 year range) but their health was often likened to that of spry sixty-year-olds. While some would wish these reports to be true, the evidence for all four locales mentioned above are either very tenuous or have been completely discredited (Palmore 1984; Beall 1987). The broad international evidence seems clear that, from a health perspective, those over 60 in Third and Fourth world nations do not live in geriatric utopias. Rather, they are more likely living in endemic areas of debilitating diseases, where inadequate housing and water supplies increase their likelihood of frequent reinfection and inadequate diets lower resistance to illness causing microbes. For example, the seminal work of Dr. Thomas Lambo (1981) in rural Nigeria showed how the high levels of exposure to diseases such as typhoid, malaria, trypanosomiasis, and anemia can trigger or exacerbate late life psychiatric disorders and induce states mimicking organic senile dementias. To make matters worse, in the poorest Fourth world nations access to modern health services and personnel may be almost non-existent: in most such countries only one doctor exists for over 10,000 citizens (e.g., Papua New Guinea with one docter per 13,590 persons) and in some nations such as Ethiopia each doctor must serve close to 70,000 individuals (World Bank 1985). The papers in this issue were first presented in a symposium on "Health, Development and Aging" at the 12th International Congress of the Anthropological and Ethnological Sciences, July 25, 1988. While this small group of papers clearly does not represent an adequate sample of world regions or levels of socio-economic complexity, it does include important ethnographic and quantitative data about health of the aged in varied contexts of development. These articles show that one is hard pressed to use the word "development" in a positive sense for much of the so-called developing world. Over the last decade regressive international economic policies in industrialized countries have Journal of Cross-Cultural Gerontology 6: 273-276, 1991. © 1991 Kluwer Academic Publishers. Printed in the Netherlands.

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resulted in staggering debt and a growing disparity of resources between the poorer and wealthier nations. The nature of industrial policy and the encouragement of export oriented monocropping has begun to dislodge the social fabric of thousands of rural villages. Modern medical facilities are concentrated in the cities where the bulk of the population does not live. A great deal has been written about the impact of so called modernization on the elderly in the wake of urbanization, industrialization, mass education and literacy and modem health technologies (Cowgill 1986; Foner 1984). While the models linking modernization and the status of the elderly have generally predicted a negative relation between these variables, the ethnographic evidence shows that the impact of such massive change on the elderly is quite varied and depends on such factors as gender, class, social organization of the local community and the nation-state and the penetration of modernizing changes into the local region. The introduction of modern medical systems as a component of modernization most often is represented in programs to deal with the health needs of the young. In such countries as Papua New Guinea and in most of the sub-Sahara African nations, this strategy has a powerful logic because young children might represent over 40 percent of the population and those over age 65 number fewer than four percent. Yet as will be especially seen in the first three papers by Counts, Glascock, and Rosenmayr, the health and well-being of the elderly is crucial to maintaining cultural, social and even economic integrity of local communities in the face of direct and indirect modernization. The first paper, by Dorothy Counts, focuses on the impact of development in Papua New Guinea upon the health of aging women in a tribal horticultural society. In this country, as in Somalia and Mali, described in the succeeding two papers, modem medical technology and personnel rarely impinge directly on the life of the elderly. This is understandable, as travel to the nearest hospital involves a twelve hour boat trip. In this small-scale society with a life expectancy of under 50 years, a tiny percent make it to age 65. Over half are women, who have traditionally played important roles in community ritual life and systems of healing. While modem drugs and doctors have virtually no direct impact on elderly women, Counts predicts that modernization will negatively affect their lives and health states in the near future, especially those women who are the very physically dependent. Non-traditional work opportunities have begun to relocate more and more sons outside the village for long periods of time. Women themselves are beginning to limit their number of children in response to new opportunities for work a n d education. These factors are reducing the available family based support which will continue to be the bulwark of health care for the elderly into the foreseeable future. In the second article Glascock points out that it might seem inappropriate to focus on the health of the elderly in such demographically young nations as Somalia where the average age is about 20. Yet, the people over 60, especially in rural areas control a large share of the resources and can be instrumental to agricultural development in those regions. He reports on the health of the elderly in a large region of Somalia which

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depends on mixed cropping of sorghum and herding of camels, cattle and sheep. It is an area of importance for development because it has the potential for producing grain surpluses. Health developments have been directed at establishing local primary health care units to provide health care, train local medical assistants and improve the sanitation of the area. As is the case in many such programs much of the work was focused on reducing the very high rate of infant mortality but it was also starting to have a beneficial effect on improving the physical health of the elderly. However, expanding economic opportunities were giving the younger men more options than being under the control of their elderly fathers and the cultural fabric supporting prestige of the aged was beginning to erode. In the third article, Rosenmayr notes the crucial need to understand the integration of the elderly into the indigenous health system. Having worked among the Bambara of Mali with an Austrian physician and local health providers he gives a detailed case study of health status of the elderly. He shows that while on some parameters of health the elderly appear fit in terms of their low blood cholesterol and serum triglyceride levels, they are plagued by severe eye problems, malaria and rheumatism. Importantly, he notes that use of modern drugs to deal with these problems was not rejected out of hand but was most successfully used when administered within the context of the local social structure and belief systems. The final paper, by Sokolovsky, Sogi6 and Pavlekovi6, represents a shift in political-economy, culture and demography from the previous three. Here in the case of Yugoslavia, over the last two decades the population as a whole has aged to the point where some urban areas have a percentage of the elderly similar to that found generally in more industrialized nations. While during this period of time Yugoslavia has also become rapidly urbanized and industrialized this country has not seen the types of disjunctures in traditional culture typically accompanying the later stages of modernization. One reason for this is a unique, decentralized social system which gives the local community an exceptional amount of autonomy in dealing with its basic needs such as health care. Unlike the other three case studies presented in this issue, but like nations such as China, Nigeria, and Malaysia, health service providers in Yugoslavia have come to realize that with regards to the aged a major shift is needed involving less intervention for acute care and more continuous care for chronic states (Manton, Dowd, and Woodbury 1986). The authors show that the rising number of older citizens with hypertension in Yugoslavia has caused considerable strain on medical services just to perform basic tasks of blood pressure regulation, let alone to cope with the various forms of disability related to high blood pressure. They examine one recent response: to promote locally based self-help groups trained collectively by medical personnel to take their own pressures and maintain required diet and drug regimens. The authors explore the effectiveness of such groups in urban and rural contexts and suggest the conditions which make these types of health interventions most effective. A serious cross-cultural examination of the health of the elderly in developing

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nations is just beginning. The information contained in this set of papers indicates the vital importance of such data in helping to facilitate an understanding of the social and medical planning required by these nations to cope with the enormous changes these countries are encountering. REFERENCES CITED Beall, C. 1987 Studies of Longevity. In The Elderly as Modem Pioneers. P. Silverman, ed. Pp. 73-93. Bloomington and Indianapolis, IN: Indiana University Press. Beaubier, J. 1976 High Life Expectancy on the Island of Paros, Greece. New York: Philosophical Library. Counts, D.A. and D.R. Counts, eds. 1985 Aging and Its Transformations: Moving Toward Death in Pacific Societies. Boston: University Press of America. Cowgill, D. 1986 Aging Around the World. Belmont, CA: Wadsworth. Davies, D. 1975 The Centenarians of the Andes. Garden City, NY: Anchor Press. Foner, N. 1984 Ages in Conflict: A Cross-Cultural Perspective on Inequality Between Old and Young. New York: Columbia University Press. Halsell, G. 1976 Los Viejos - Secrets of Long Life from the Sacred Valley. Emmaus: Rodale Press. Lambo, T. 1981 Psychiatric Disorders of the Aged: Epidemiology and Preventative Measures. In Aging, a Challenge to Science and Society, Vol. 2, Part I: Medicine. A.JJ. Gilmore, A. Svanborg, and M. Marois eds. Pp. 74-81. Oxford: Oxford University Press. Leaf, A. 1975 Youth in Old Age. New York: McGraw-Hill. Manton, K.G., J.E. Dowd and M.A. Woodbury 1986 Conceptual and Measurement Issues in Assessing Disability Cross-Nationally: Analysis of a WHO-Sponsored Survey of the Disablement Process in Indonesia. Journal of Cross-Cultural Gerontology 1(4):339-362. Morgan, J., ed. 1985 Aging in Developing Societies. Scholastic Monograph Series. Bristol: Wyndham Hall Press. Palmore, E.B. 1984 Longevity in Abkhazia: A Reevaluation. The Gerontologist 24:95-96. Sokolovsky, J. 1983 Aging and the Aged in the Third World: Part II: Regional and Ethnographc Perspectives. Studies in Third World Society, No 23. Williamsburg: William and Mary. Sokolovsky, J. 1990 The Cultural Context of Aging: World-Wide Perspectives. New York: Bergin and Garvey. Tout, Ken 1989 Aging in Developing Countries. Oxford, England: Oxford University Press. World Bank 1985 World Development Report. Washington, D.C.: World Bank.

Department of Sociology and Anthropology University of Maryland Baltimore County Catonsville, MD 21045 U.SA.