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Social protection and preventing illness in developing countries: Establishing the health effects of pensions and health insurance


  • This paper uses data from the World Health Organization (WHO) Study on global AGEing and adult health (SAGE), supported through grants OGHA 04034785; YA1323-08-CN-0020; Y1-AG-1005-0 (R01-AG034479). We would like to acknowledge the principal investigators at the SAGE sites: P. Arokiasamy (India), R. Biritwum (Ghana), Wu Fan (People's Republic of China), R. Lopez Riadura (Mexico), T. Maximova (Russian Federation) and N. Phaswanamafuya (South Africa). The views expressed in this article are those of the authors and do not necessarily represent the views or policies of the WHO.

Addresses for correspondence: Peter Lloyd-Sherlock, School of International Development, University of East Anglia, Norwich, NR4 7TJ, United Kingdom; Email: Nadia Minicuci, National Council Research, Institute of Neuroscience, Padova, Italy; Email: John Beard, Director, Department of Ageing and Life Course, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland; Email: Somnath Chatterji, Measurement and Health Information Systems, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland; Email:


This article assesses the effectiveness of pension provision and health insurance in preventing ill health among older people in developing countries. It argues that, until recently, social protection agendas devoted insufficient attention to health risk prevention, instead focusing on the reduction of income poverty through cash transfers. The article shows that there is little reliable evidence to indicate that providing older people with pension benefits enhances their health status and that these effects should not be taken for granted by policy-makers. The article then focuses on the effect of inclusion in health insurance schemes on health outcomes for older people, with specific reference to outcomes related to hypertension. Drawing on newly-available data from the World Health Organization for Ghana, Mexico and South Africa, it shows that older people with health insurance are marginally more likely to be aware of health conditions such as hypertension and more likely to have them under control. Nevertheless, the great majority of hypertensive older people, insured or uninsured, are not effectively treated. The chief barriers to treatment are shown to be mainly related to awareness and service provision, rather than financial ones. Consequently, the capacity of pensions or health insurance to enhance health outcomes for older people in such countries, including in rural areas, is heavily contingent upon health education, health screening and adequate health service provision. These interventions should be viewed as an integral element of mainstream social protection strategies, rather than adjuncts to them. Yet, in practice, social protection and health promotion continue to be treated as almost entirely separate spheres, thus presenting substantial institutional barriers to developing combined interventions.