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A GLOBAL SURVEY IN CONNECTION WITH THE INTERNATIONAL YEAR OF OLDER PERSONS
1999

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The United Nations Centre for Human Settlements (Habitat) was established in 1978, two years after the United Nations Conference on Human Settlements held in Vancouver, Canada. Based in Nairobi, Kenya, UNCHS (Habitat) is the lead agency within the United Nations System for coordinating activities in the field of human settlements and in the implementation of the Habitat Agenda adopted at the second United Nations Conference on Human Settlements (Habitat II) held in Istanbul, Turkey, in 1996. With an explicit focus on the urban poor and using universal principles of social justice and equity to guide its work, the Centre is a global advocacy agency dealing with human settlements issues in the context of an urbanizing world. Strategies of the Centre in implementing its work programmes include enablement and participation, capacity-building and institutional development on the two main themes “adequate shelter for all” and “sustainable urban development”. To address these themes effectively, the Centre is initiating two global campaigns on secure tenure and urban governance. Further information can be found on the website at www.habitat.unchs.org The Institute of Public Administration (IPA) is a private, non-profit organization concerned with building capacities for effective governance. It is headquartered in New York City where it was established in 1906, and operates worldwide with a programme of research, technical assistance and training organized around three themes: public sector governance and management, public finance and fiscal reform, and sustainable urban development. IPA is affiliated with the Wagner Graduate School of Public Service at New York University, and is governed by a distinguished Board of Trustees. Further information can be found on the website at www.theipa.org. In June 1998, UNCHS (Habitat) and IPA signed a Memorandum of understanding to establish and develop cooperation modalities to join their capacities in the implementation of the Habitat Agenda and relevant aspects of Agenda 21, with specific focus on initiation of a research project aimed at “improving living conditions of older persons in human settlements” as a contribution to the “International Year of Older Persons, 1999”.

Foreword

Demographers now predict that in fifty years time one third of the population living in the industrial world will be 60 years and older. The same age group will constitute 21 per cent of the total population in the developing countries. When the trend in increase of ageing populations is considered in parallel with the ongoing rapid urbanization process taking place, particularly in the developing countries, the challenge ahead becomes very significant. Cities all around the world will accommodate more and more senior citizens in the future.

A highly urbanized world, with increasing proportions of older age groups needs a new approach to facilitate societies for all where the young people, older persons, persons with disabilities, men and women, poor and rich - all segments of society - can integrate and live meaningful lives in harmony with their environments. This process needs adoption and implementation of comprehensive, inter-sectoral and inter-generational policies within a long-term strategy. Local authorities have a fundamental role in this process. This is particularly important when issues are related to housing, services, environment and generation of income earning opportunities for the less advantaged.

The Habitat Agenda, the blue print guidelines for human settlements management and development, gives utmost importance to the issues of ageing/older persons and social integration. Fourteen out of 241 paragraphs refer to this topic and elaborate on actions to be taken at both national and local levels. In relation to this, and as a contribution to the International Year of Older Persons, 1999, UNCHS (Habitat), jointly with the Institute of Public Administration, initiated a research project to document and analyze living conditions of low-income older persons in human settlements, and prepared this report.

This research initiative is unique in that its conclusions are based on the expressions of low-income older persons describing their homes and neighbourhoods and their living conditions in the surveys undertaken in twelve major cities. In addition, the research conclusions and recommendations were prepared by the Survey Managers who met at the workshop in Amersfoort, Netherlands, each of whom are professionals in gerontology and other disciplines related to human settlements development and ageing and actively engaged in voluntary or government organizations providing assistance to older persons in need. The findings of this research initiative show that most people in their 60s are able and willing to work and to maintain their homes and neighbourhoods, and should not be considered unproductive, useless or disabled. In fact, their continued participation in the active labour force is essential to national economic well being and social development - particularly in achieving integrated societies for all.

We wish to acknowledge the excellent contribution of Mr. Richard May, Senior Associate of the Institute of Public Administration who jointly with Mr. Selman Erguden, UNCHS (Habitat) Focal Point on Older Persons/Ageing, coordinated this research initiative and drafted this report. We also wish to acknowledge all those whose names are presented in Annex 1 for their invaluable efforts which made it possible to undertake this initiative in so many countries. In conclusion, we wish to express our gratitude to Ms. Mieke Andela-Baur and Mr. Ger J.M. Tielen of the “Netherlands Platform Older People and Europe” who hosted the workshop in Amersfoort, Netherlands in September 1999 where the findings and recommendations of this research initiative were discussed and finalized.

We hope that these findings and recommendations will be useful in initiating further research on this important field “ageing - urbanization” and in assisting the formulation of policies to appropriately address the needs of older persons globally.

Klaus Toepfer Acting Executive Director United Nations Centre for Human Settlements (Habitat)

David Mammen President Institute of Public Administration

Executive Summary

The Habitat Agenda and many other reports and publications by the UN Centre for Human Settlements (UNCHS) and other United Nations agencies suggest policies for governments regarding the shelter needs and rights of the growing proportion and numbers of ageing population. This report focuses attention on the rapid increase of elderly population taking place in the urban areas of developing countries and the difficulties they are experiencing in continuing to lead fruitful lives. It recognizes that due to their limited resources, few of these countries are able to mount substantial social welfare programmes assisting the ageing. However, it points out that there are other steps that national and local governments can take to improve the lives of the elderly.

OLDER PERSONS IN UN RESOLUTION “Older persons are entitled to lead fulfilling and productive lives and should have opportunities for full participation in their communities and society, and in all decision-making regarding their well-being, especially their shelter needs....” (The Habitat Agenda, Paragraph 17, Istanbul,1996) “Older persons should (inter-alia): · have access to adequate food, water, shelter, clothing and health care through the provision of income, family and community support and self-help; · have the opportunity to work....and have access to appropriate educational and training programmes; · be able to live in environments that are safe; · remain integrated in society; participate actively in the formulation and implementation of policies that directly affect their well-being; · be able to live in dignity and security and be free of exploitation....(United Nations Principles for Older Persons: General Assembly Resolution 46/91) The Habitat Agenda emphasizes that “...obligation by Governments to enable people to obtain shelter and to protect and improve dwellings and neighbourhoods.....so that everyone will have adequate shelter that is healthy, safe, secure, accessible and affordable, and that includes basic services, facilities and amenities....and legal security of tenure” (Paragraph 39). “In implementing these commitments, special attention should be given to the circumstances and needs of older people” (Paragraph 38).

To ascertain the specific problems and needs of older people case studies were undertaken including interviews with over 200 poor older persons in eleven major world cities under the direction of professional managers of ageing assistance programmes. The survey managers were then assembled at a Workshop in the Netherlands sponsored by UNCHS and the Netherlands Platform Elderly and Europe. The participants in the Workshop proposed specific measures and actions to national governments and local authorities designed to extend the useful lives of older people by guiding and training those who are healthy and not disabled to continue their useful employment and to share responsibility for maintaining and improving their shelter and community environments.

Thus, in recognition of the United Nations International Year of Older Persons-1999, the Survey and Workshop was undertaken in order to:

· Increase awareness of the growing proportion and numbers of older persons in urban areas;
· Identify and describe the various aspects of living conditions experienced by older persons;
· Suggest appropriate national policies and programmes for improving older people’s living conditions;
· Assist local officials by suggesting guidelines and successful practices that address and implement community activities to enable older persons to participate in improvements to their shelter and community environments.

The following sections elaborate on the conclusions of this research initiative, and recommendations to national and local governments as well as on the information regarding living conditions of low-income older persons in human settlements (summary of findings of the survey and general information on demographic trends in ageing and urbanization) and the country case studies. There are four annexes: acknowledgements, the survey questionnaire, best practices where three cases are presented, and the opening statement of Ms. Mieke Andela-Baur, President of Netherlands Platform Older People and Europe, of the workshop hosted in Amersfoort, Netherlands, from 9-11 September 1999 where the findings of this research initiative were discussed and finalized.

I. Conclusions

The rapid increase of aging population in urban areas presents a growing challenge for the national and local governments of developing countries.

United Nations population projections indicate that within the next 50 years the proportion of those over 60 years of age in developing countries will increase from the present 5 - 6 per cent to about 25 per cent, one-fourth of total population in urban areas.

Today, many governments are making the mistake of considering all aging people as disabled thus requiring special assistance and health care. Legislation and administrative responsibilities frequently lump these categories together. When both the aging and disabled formed a small minority of the population this seemed appropriate. The rapid growth of aging population requires new and greatly revised approaches and government policies for employment, retirement age, health care, shelter, and community facilities and services. The increase in aging population means that, if present policies are not revised, the earnings and taxes of the active labor force will have the burden of supporting an increasing number of retired persons as family members or recipients of public assistance.

The survey of older people reveals that over half of the aging population is in their 60s, and that three-fourths of those interviewed considered their health as good or fair. Furthermore, the majority of those citing disabilities were in their 70s or older; and only a very few people complained of major disabilities which would inhibit their ability to work. In fact, a goodly proportion of the elderly said they would like to work if they had the opportunity.

II. Recommendations (To National and Local Governments)

In view of these conditions and trends it was recommended by the participants in the Netherlands Workshop that governments take a fresh look at the policies, legislation and programmes affecting their aging population and consider revised approaches such as those set forth below. Each government will have to develop and enact programmes reflecting the most urgent needs and potentials of their aging population.

While most policy statements and reports have focused on the health and welfare needs of older people, this is recognized in this study as only one aspect of the problem. If the proportion of the aging population in developing countries increases from 8 percent to 25 percent in the next 50 years, as projected by the UN Population Division; the governments of these countries will have to adjust their policies and legal systems to cope with this change. The major impact of this trend will be in cities where the aging trends are combined with even more rapid increases in the total urban population.

While modest improvements can be expected in governments’ health and welfare services major changes will have to be made to increase the length of active employment. This will be necessary to maintain a sufficient number and proportion of men and women in the active labour force needed to maintain their national economies. Lengthening the period of active employment will have the twofold effect of reducing welfare expenditures and increasing tax revenues.

Shelter conditions and rights

1. Encourage and provide incentives to older people to continue sharing their family dwellings and maintain their traditional role as members and leaders of families. Urge younger family members to respect their elders and share their homes with them;

2. Provide legal land tenure, security of occupancy and prevent illegal evictions, particularly to squatters;

3. Assure people’s right of choice of where to live;

4. Provide sites at affordable costs and low interest loans to purchase building materials;

5. Establish minimum housing standards: accessible; affordable; of durable materials; adequate indoor and outdoor spaces; with minimum sanitary facilities: water, sewage and solid waste disposal;

6. Organize the older persons groups so they can join in building and maintaining their dwellings with the help of their families and neighbours;

7. For those unable to remain in family households: Alternative housing types: group homes with shared facilities; assisted living schemes, and congregate homes in areas with accessible social and community services;

8. Strategies to improve housing for older persons:

· Provide a voice in processes related to their living conditions;
· Empower community organizations in housing improvement and development;
· Promote the role of NGOs, CBOs and public-private sector cooperation in housing development.

Health maintenance

Health care is the most expensive social service, and in many cases its requirements are beyond the limited means of developing country governments. Aging persons have increasing problems as they grow older and require more frequent access to health care facilities. However, many health complaints are minor and do not require professional medical services.

1. Information, Education and Communication are essential keys to provision of health services to the elderly, to inform them of available services, educate them on health maintenance and enabling them to call for or gain access to clinics and hospitals.

2. Minor health services should be available at clinics or community centres.

3. Public transport at reduced fares for access to distant hospitals and clinics.

4. Subsidize health care and medicines for indigent ageing persons.

5. Home care to be provided by NGOs or trained older persons where governments cannot provide.

The residential environment

1. Provide protection from crime, discrimination, traffic and other hazards, with adequate police and fire fighting services.

2. Ensure that housing sites are non-hazardous. Avoid too-steep slopes and flood-prone locations; free of air, water and soil pollution; dumps, hazards, noise and odors.

3. Infrastructure: Safe access for pedestrians by road or path, water supply, electricity, and fuels for cooking and heating at affordable costs.

4. Transport services, accessible and at reduced, affordable fares for elderly persons to reach community facilities, churches, schools, shops and community centres.

Social services

Only very limited social services for the elderly can be provided in developing countries due to the scarcity of funds and traditions under which such facilities and services are not a part of the dominant rural cultures where families provide such support. Such services are more necessary in urban societies where citizens have become more dependent on government services. Local governments, in addition to providing schools, parks, health clinics and community centres, can therefore assure the provision of the following services:

1. Accessible retail shops and services provided by the private sector are a necessity for older people.

2. Religious facilities (churches, mosques) which are a traditional source of social contacts and in some cases provide services such as health services, recreation and home visits.

3. Encourage and support the activities of NGOs and CBOs in providing home health visits, meals on wheels, etc.

Maintaining livelihood

1. Older persons 60 to 70 be viewed as a valuable resource and not a burden or liability; legislation should no longer consider them along with the disabled.

2. Retirement and pension age levels be increased from 60 to at least 65, and possibly 70.

3. Employment policies encourage those with employable skills to continue working.

4. Those without skills be given vocational training for jobs or activities enabling them to be self-sufficient, or at least contributing to their livelihood.

5. Prohibit discriminatory practices in formal employment and discrimination against older people and women.

6. Recognize and support the vital role of the informal sector of the economy, and in providing work opportunities and income for the poor elderly and disabled. Since in many countries it is the largest source of employment, ways should be developed to legitimize and regulate its operations and provide some local or income tax contribution.

7. Promote opportunities for community and group income generating activities.

8. Offer small business loans on friendly terms to older people

9. Recognize non-paid, informal household work in national economic statistics; and desegregate by age and gender in national census statistics,

Participation

1. Promote civil rights and respect for the elderly among children and others.

2. Promote independence and responsibility among elderly to encourage their continued leadership in family life.

3. Government policies and the media to urge the ageing to actively participate in community activities; particularly in decision-making on matters affecting their interest and well being.

4. Break down barriers faced by older people that discriminate, deny their rights and exclude them economically, social and politically.

5. Encourage older people to express their opinions and needs, and for younger generations to listen to them.

Gender considerations

As in most countries women live longer than men, the majority of ageing population are usually women. In developing countries, older women present the most serious problems and greatest needs for a number of reasons:

- They are less likely to have received formal education
- They are less likely to have savings or material resources;
- They frequently are not allowed to own property;
- They are less likely to have received paid employment and have savings or a pension;
- They are more likely to have health problems due to hard physical work and child bearing.

For these reasons governments can reduce the problems and cost of providing assistance to aging women by:

- Enacting laws protecting women’s rights and forbidding sex discrimination;
- Protecting the rights of women to own land, have their own savings accounts and receive loans;
- Provide for equal pay for equal work and rights to pensions

III. Living conditions of low-income older persons in human settlements

A. SUMMARY OF SURVEY FINDINGS

Although each country surveyed differs from others in terms of its culture, climate, geography, economic and social problems, type of government, etc., one must also recognize that the surveys cover only a small percentage of the elderly poor in each city and cannot claim to represent the totality of conditions which may exist. Interestingly, despite differences among the countries surveyed, the survey provides evidence of many common conditions and problems, even between cities in less and more developed countries.

The following concerns, complaints and wishes for change were expressed by older people in the cities surveyed:

1. Shelter: Many of the ageing in squatter settlements complained about the inadequate size, poor construction and unhealthy surroundings of their homes. Those in good health said they would improve their homes if provided with legal tenure of their sites at affordable costs and with small low interest loans to purchase building materials.

2. Health maintenance: Convenient and affordable access to health clinics and hospitals, and home visits by people trained in geriatrics for those unable to get to these facilities.

3. A Safe, Secure and Healthy Environment: Protection from crime, discrimination, traffic and other hazards; adequate water supply, solid waste and sewage disposal, road or path access to homes, electricity, telephones and fuels at affordable costs; reduction or elimination of air and water pollution, hazardous wastes; and safer housing sites not located on steep slopes or wet areas.

4. Social Services, Jobs and Community Participation:

- Community or elderly centres for social contacts, recreation, counseling and minor health care
- Opportunities to participate in community affairs
- Employment, education and training services for those able to work
- Opportunities for inter-generational contacts.

Who are the people surveyed?

Gender - About two-thirds were women and less than a third were men, which is near the usual demographic split in aging populations globally.

Age- Just over half were in their 60s; one-third were in their 70s, and 15% were over 80.

Household Size - About one-fifth of the dwellings were occupied by elderly persons living alone, and almost half the households were composed of 1 to 3 persons of which one was a spouse. Large extended families of 4 to 6 or more persons were found in one-third of the homes, mainly concentrated in New Delhi, Cairo, Nairobi and Cape Town

Health - Three-fourths of the respondents considered their health as Good or Fair. Only one-fourth said Poor. However one-third complained of difficulty in walking; 42% had sight problems; 21% in hearing, and 13% said they used crutches or wheelchairs. Length of residence - Over half said they had lived in the community for 30 years or more.

Employment - While 16% said they were employed, there were wide variations: In Cape Town, New Delhi and Budapest about 30% had full or part time jobs or occupations.

Pensions - Over one-third reported that they received government pensions or social security payments; ten percent had private pensions.

Sources of housing funds - Two-thirds were dependent on their families; 28% drew from their savings to pay for housing; and 10% said that pensions covered their housing costs.

What are their living conditions?

Dwelling type - Over two-thirds of the dwellings were houses, and one-third were apartments. (Most of the apartments were in Cairo and Budapest. Houses were in outlying settlements such as Ankara, Cape Town and Sydney).

Building materials - Almost 60% of the dwellings were built of brick or concrete/cinder blocks. However, many were made of wood. Other materials such as earth, iron sheets, etc. were used in over one-third of the dwellings.

Own-Rent - 60% reported that they owned their homes, while 40% rented. Most of the owner occupied dwellings were in squatter settlements such as those near Nairobi, New Delhi, and Santiago where the house but not the land was owned. An exception was in Budapest where the elderly owned their apartments.

Dwelling size - Over half contained only 1 or 2 rooms; a third had 3 or 4 rooms, and a fifth had 5 or more rooms.

Gardens - Only one-third said they had a garden, indicating that many of the squatter houses did not have gardens.

Sanitary facilities - Two-thirds of the households reported having piped water in their dwelling, and 60% said they had private latrines. Less than half reported having a bath or shower in their dwelling and one-third said they bathed outdoors. (There is clearly some overlap in these responses; for example most people reported having piped water in their dwelling, but had no private bath or latrine).

Fuels -Two-thirds of the homes had electricity and 40% had gas for heat or cooking. One-fourth depended on wood or charcoal for fuel.

Public Services - (provided by local government) Waste disposal - 80% of respondents; Police/Fire protection - 60%; Street cleaning - 60%; Street lighting -70%

(* Note: Some respondents in Cape Town and Kingston stated that there was no police protection because they considered it inadequate).

Communication - Less than half of all respondents had telephones; 60%had radios, and 50% had TVs. Postal delivery was not uniform, particularly in squatter areas.

B. GENERAL INFORMATION ON DEMOGRAPHIC TRENDS IN AGING AND URBANIZATION

Special consideration of the problems of aging and urbanization is needed in view of the simultaneous acceleration of two demographic trends: the recent dramatic and continuing growth in urban population and in the growing percentage of world population over 60 years of age. Both of these trends are increasing most rapidly in

Developing countries. Projections by the UN Population Division indicate that the population aged 60 or over in the less developed world regions will be multiplied more than 9 times from 171 million in 1998 to 1,594 million in the year 2050- increasing its share from 8 percent to 21 percent.

Urban areas in less developed regions of the world housed one-third of the population in 1998 and were growing at a rate of 3.4% per annum. This trend is expected to continue and will comprise 57% of the population of these regions by 2030 when 4.1 billion people are projected to be living in urban communities as defined by each country.

The combination of these two UN demographic projections indicates that the urban population over 60 years of age in less developed regions of the world may multiply approximately 16 times, from about 56 million in 1998 to over 908 million people in 2050, or one-fourth of total urban population.

Such a dramatic increase in older persons in urban areas of the developing world will create new problems requiring adjustments in policies and administration for national and urban governments. Where current practices emphasize the provision of services to the elderly at government expense, they may have to be limited to the disabled and most indigent because of increased demand. Emphasis will have to be given to keeping the aging healthy and actively participating in the employed labour force by extending the retirement age, and also taking some responsibilities for their shelter and community improvements.

To grasp the magnitude of the impact of the projected increase of the aging population in developing countries, the following table shows the present (1990) percentage of population over 60 years of age in the cities or urban areas of the countries participating in the Survey of Older People: The percentage of elderly in developing countries is generally below 10%, whereas it is over 10% in industrial countries.

Cities	Percentage
Ankara	5.2
Budapest	21.6
Cairo	6.1
Cape Town	7.7
China*	8.2
Delhi	4.4
Kenya*	3.4
Philippines*	5.4
Kingston (Jamaica)	9.8
Santiago (Chile)	8.3
Sydney	15.3
USA*	16.8

* Note: City data of total urban population was not available

Source: UN Compendium of Human Settlement Statistics 1995

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In May 1998 invitations to participate in the Survey were sent to organizations providing services to the ageing in 30 countries representing each world region. Leaders of voluntary national organizations for the ageing in the following cities agreed to undertake case studies including surveys and interviews of poor older residents in their cities: Sydney, Australia; Santiago, Chile; Beijing, China; Cairo, Egypt; Budapest, Hungary; New Delhi, India; Kingston, Jamaica; Nairobi, Kenya; Manila, Philippines; Cape Town, South Africa; Ankara, Turkey; Newark City in New Jersey, USA.

Summaries of each of the country case studies are presented below:

Sydney, Australia

The surveys were conducted under the direction of Ms. Deborah Munns, Associate of “The People for Places and Spaces”, an NGO providing assistance to the ageing poor in Sydney. The Anglican Outreach Services assisted in locating the disadvantaged elderly for interviews, which were conducted in eight different communities in the Sydney metropolitan area. These were outlying communities ranging from 36 to 50 km from the city centre. As of 1996, 12 per cent of the Australian population was aged 65 and over. Almost one third of these were between 65 and 69, and a quarter were over 80, of whom two thirds were women. Many of the elderly live alone: 27% of those between 65-79, and 45% of those over 80. Older Australians have very high rates of home ownership-over three fourths of people over 60 are homeowners. However, property taxes and home maintenance costs exceed 25% of the family income of the poorest older persons dependent on government pensions.

As Sydney is within the State of New South Wales, it is governed by National, State and local government levels, and older people receive different services from each level. The National government issues aged and disability pensions; the State provides public transport subsidies; and the State and local governments provide older health services and other social services.

17 interviews in 7 different communities were completed. Each of these communities has a high rate of air and water pollution, particularly dust, as the climate is dry. Although most suburbs are serviced by trains, most poor older people can only reach hospitals and other public services by public transport.

The population interviewed was mostly female (9 women and 4 men), and mostly between the ages of 70-79, with 3 over 80. None worked and all receive government pensions. Only 5 owned their dwelling, whereas 8 rented. Only one lived in a congregate home. 6 lived alone and another 6 with their spouses. 5 had families in addition to spouses. 6 persons claimed that their housing costs exceeded 30% of their incomes; 4 of these said they paid over 50%. Most have no extra income, living only on their savings and government pensions.

All of those interviewed have indoor piped water and none complained about lack of sanitary facilities. 10 had indoor private toilets and baths; 4 had only outdoor bath/showers. All noted public waste disposal, street cleaning and lighting, and police/fire protection.

Complaints received generally related to the community environment, lack of safety, poor public transport and living costs. Half had difficulty in walking, and over a third in their sight or hearing ability. Seven used crutches or wheelchairs.

Most complaints were that their dwellings had inadequate living space, even though one-third of their homes had over 5 rooms. Other complaints related to lack of health services, poor access to dwellings, inadequate transport and poor security.

Santiago, Chile

The Survey was performed under the direction of Sra. Sonia Zapata Donoso, Master of Social Science at Santo Tomas University and consultant to the Inter American Institute of Agricultural Cooperation. Her specialization is in social studies of poor older people in rural areas. A total of 60 interviews were conducted, 20 in each of three poor communities within the Santiago metropolitan area. Of these, 20 cases were in La Pintana Municipality in the City; and 40 cases in very poor outlying settlements, including 20 in “El Pincoy” in the Recoleta municipality, and 20 in Mun. de Penalolen.

The ageing process in Chile is not uniform throughout the country; the Santiago metropolitan area has the highest concentration in the country: 39% over 60 years old. Practically all lived in houses which, they owned. Two thirds of the houses were built of brick and the remaining third of wood. The majority of houses have four small rooms and a garden. Most of the houses are old and have structural deficiencies needing repair. The people interviewed have been living in their homes for 30 or 40 years.

Practically all households were multi-generational with about half-composed of from 1 to 3 persons and over half of 5 or more persons. 90% of those interviewed were women, although this may have been due to the time of the interviews. Almost half of those interviewed were in their 60’s; about the same percentage were in their 70s, and ten percent were above 80. Almost 40% of the women over 60 were widowed, and this condition is three times that for men.

Sanitary conditions are satisfactory. All have potable water supply. An indoor toilet and shower. All have electricity and use liquid gas as fuel.

However, two-thirds consider the cost of these services as excessive even though some ageing receive a State subsidy for these costs. Trash is publicly removed and the areas have streetlights. Over half reported having telephones and three fourths have colour TVs.

Only half reported that there was a police command post in their neighbourhood, and a third said there was a fire station nearby. All reported that there were schools and churches in the neighbourhood, including access to an adult learning centre. Half reported that a medical clinic providing emergency services was available. Three fourths said shops were nearby and half-reported parks in the vicinity. Bus service is available, but not at reduced fare for the elderly.

Many of the ageing suffer sight and hearing disabilities, and a few complained about walking difficulties. 40% said they wanted to work although only 3% had jobs. About 60% receive government pensions which, they say were insufficient to cover their living expenses. Almost two thirds live with relatives and depend on their families’ assistance to meet housing costs.

Only 12% of their income is received from the State, and 17% consist of savings.

The most common living problems expressed were:

Inadequate living space	37%
Lack of health services	53%
Lack of transportation	48%
Lack of safety and security	73%

Sra. Zapata described a number of government programmes providing services and subsidies to older citizens, but indicated that actual delivery of benefits and services is below expectations:

· Pensions for the poor elderly include the right of free medical attention in clinics and hospitals for those with identity cards.

· Housing Programme for the Elderly. However, very few have actually been built: only 1200 units in 6 years for the entire country

· Education Improvement Programme for the Elderly. Literacy classes at adult education centres for those over 55

· Medical Programme for the Elderly includes provision of eye glasses, hearing aids, prosthetics, etc., and the option of medical loans to cover expensive treatments such as chemotherapy

· Pilot Programme for Improving the Quality of Life addressed to ten poor communities.

· Recreation and Tourism, offering 40% discounts at hotels during low seasons

· Physical activity and recreation to develop self-value, capability and greater autonomy

· Houses for Everyone: for persons over 60 in certain poor settlements.

There are also a number of government and NGO programmes for the handicapped, which serve elderly citizens with incapacities.

Beijing, China

Mr. Xiao Caiwei, Deputy Director, International Department of the China National Committee on Ageing, very kindly volunteered to undertake the sample survey of older people himself. Mr. Xiao provided the statistical results of his survey, which provides the basis for the following report on his findings. Unfortunately, he was unable to attend the workshop as he was at another meeting on ageing in Canada.

All of the older people interviewed lived in apartments in the City of Beijing. Most (70%) of the elderly were over 65, and 30% were over 70. The vast majority (80%) were women. Two thirds of those interviewed said they were in good health; over half reported no disabilities, but 40% reported hearing loss and a few reported difficulties in sight and walking. Only 2 used wheelchairs or crutches. They were mostly long-term residents as most had moved to Beijing before 1960, and three-fourths had moved into their dwelling before 1980 or during the 1980’s. Household sizes were small, with 55% living alone or with a spouse, and 45% reporting they lived with children.

Only one person had a job, and half those interviewed said they were not willing to work. This may be because all respondents said they received a pension. However, one-third said the pension was sufficient. The housing was predominantly government- only 20% said they owned their apartment. The rents seem to be low, as 40% said it was less than 30% of their income. (However, half the people did not answer this question)

All dwellings have indoor piped water and private toilets. Three-fourths have indoor showers, and most said the cost of water and utilities is affordable. Most said that public waste disposal is provided at affordable cost. However, only half reported adequate police and fire protection. Street cleaning was satisfactory. Most people reported that health and other community services were provided, but only a third recognized the existence of inter-generational activities. Most reported using public transport, but said there was no reduced fare for older people. In communications, half the people have TV, radio and telephones, and some of the others had only 1 or 2 types of communication.

When asked to cite their problems, 7 reported they had none; 2 needed more space; 2 needed more health services and only one cited lack of security and safety. As 5 did not respond to this question, we may assume they also had no problems to report. In reviewing the findings, one may wonder if the sample included poor people.

Cairo, Egypt

The interviews in Cairo were performed by college students under the direction of Dr. Magda N. Iskander, Health Consultant with the Coptic Evangelical Organization for Social Services (CEOSS), located at the Centre for Geriatric Services. CEOSS is a well established Egyptian Non-Government Organization registered with the Ministry of Social Affairs which addresses problems of health, education, economics, community organization and community interrelationships serving members of all denominations. Older people in four different communities were visited: El-Kolali and Shoubra which are very old crowded areas adjacent to the centre of the city near the railroad station; and Ein Shams and Ezbet El Nakhl which are located 13 km from the centre.

El-Kolali and Shoubra are in a part of old Cairo that is fully and densely developed. It is built on land which has poor soil and subsoil qualities, causing problems in water supply and wastewater drainage. The wastewater network is saturated and overflows regularly in numerous places, responsible for the poor stability of buildings. Air pollution is common to all of Cairo, and water pollution is common in poor crowded areas.

Ein Shams and Ezbet El Nakhl are in a relatively new area. The buildings are small and often built without permit and without proper so connections to water and sewers. However, all dwellings have electric service. All four communities surveyed are characterized by:

1. Overcrowding in cramped buildings that lack proper ventilation, access to sunlight and are subject to dampness.

2. Poor sanitary conditions with inadequate water and waste disposal networks due to old deteriorating pipes and clogged overflowing sewers that may lead to contamination of water supplies, especially in Shoubra and El-Kolali.

3. Deficiencies in the system of garbage collection and disposal which may attract roaches and rodents.

4. Inadequate, crowded transportation facilities with no reduced rates or special provisions for the needs of older persons

5. Difficult access to public health services due to the poor transportation system and inadequate roads (unpaved, no side walks, no crossing lines, etc.).

The home interviews brought out the following: About half the respondents live in one or 2 rooms, and the other half have 3 or 4 rooms. Most lived with spouses and one to 3 other persons. Monthly housing costs are surprisingly low, requiring only 10 to 20 percent of income. (This may be because many of the elderly occupy only one room in extended family households; and also due to government rent control.) Most dwellings have indoor piped water and private baths. However, one third reported having to use group latrines, and a few have only outdoor showers. Public waste disposal services are generally available at reasonable costs.

Slightly more than a majority (58%) of those interviewed were women, as there was a strong representation (42%) of male led households. One-fifth owned their dwellings, including some of the women, but the majority were tenants. Most were in their 60s, with only one-third over 70. They reported only minor health problems. Only a few said they were employed, but less than half reported receiving pensions. The greatest living problem cited was the lack of health services, which is somewhat strange considering that few reported health problems or disabilities, and almost half reported using public transport to visit hospitals or clinics. However, it was mainly those living outside the central area who complained about the transport services. Actually, the described distances to health clinics or hospitals is less than half a kilometre in the central areas and 1 km in the outlying community. Home visits and health care were reported as available in the central areas, but not in the outlying areas. Health services are mainly supplied by local religious (charitable) organizations (mosques and churches) at reduced costs. However, the price of medicines is high. Most old people complained of joint problems due to dampness and lack of exercise. (Some minor complaints were to draw the attention of their families)

Dr. Iskander reported that most poor people work in services or as hired hands around the city, and continue to work for as long as they are able, knowing that once they stop they would have to depend on their extended family for their livelihood. Few receive government social security, which is not adequate in the face of inflation.

The government has plans to meet the increased need for housing and other services. However, the increase in population outstrips these efforts, including the needs of older persons. More assistance from the private sector and particularly NGOs will also be required.

Budapest, Hungary

The survey was conducted under the direction of Mrs. Edina Reviczky of the Florence Nightingale Association, which provides home care services to older people in Budapest. The area selected is one of the poorest and oldest districts in the City, comprising 1,253 Ha. with a resident population of 72,000. The density is high at 5638 persons per square km.

From 1960 to 1990 the population has aged considerably with marked declines in the age groups below 60. The population over 70 includes twice as many women as men. 15% of those interviewed were 60-69, 40% were 70-79, and 45% were 80 or older. 80% had walking disabilities, 40% use crutches, and another 40% have sight and hearing difficulties. 80% have always lived in Budapest, and 20% for more than 35 years.

Intensive industrial development took place in this area during the 19^th century and dwelling conditions deteriorated. The old houses had toilets in the corridors for group use. The City government has improved conditions and the apartments though small are comfortable. Many of the older residents were former factory workers in the district. An urban redevelopment project from 1958-1966 replaced a large portion of one of Budapest’s worst slum areas with a large housing estate with extensive parks and central heating. Nevertheless, a large portion of poor older housing remains.

The Social Welfare Act of 1993 requires the City to provide health and family services, day care centres and clubs for the elderly. Rent subsidies are given to the poorest residents and district heating and hot water supplies are provide to ensure that these people can stay in their homes. The local government also provides medicines to those over 70. Some of the twenty older people in the district interviewed were clients of the Florence Nightingale Foundation whose volunteers bring them meals, assist them in getting medical care and medicines, take them shopping, etc.

All people taking part in the Survey live in apartments made of brick with no gardens. 30% live in 1-room apartments, 50% have 2 rooms and the remainder 3 rooms. 45% live alone; 35% with their spouse; 15% live with 1-3 persons, and 5% with 4 to 6 persons. All are home owners and their housing costs as a percent of pension income was as follows: 20 to 30% of income for 55% of the households; over 30%-50% of income for 35% of those interviewed; and over 50% for one-fourth of the respondents.

Piped water is available in all dwellings, and all now have private toilets and baths. They heat with gas and 75% consider the price excessive. Streets are kept clean by the City. The area has a health clinic, park, elderly centre, churches, shops, schools and home meal delivery. The schools have intergenerational programmes. Most of the elderly use public transport, which is free for those over 65. Communications services are good.

Twenty five percent of those interviewed had part time jobs, working on average 10 hours a week. Their sources of funds for housing included savings, family, and pensions. Their greatest living problems were safety and security, except for disabled people who need vehicles or assistance in order to leave their apartments.

Evaluation by Edina Reviczky: “Age is, in fact, used simply as a proxy variable for a variety of biological and psychological factors that are the proximate causes of age trends in physical health and disease. The chances of living to old age have increased as life expectancy has improved. The study shows that older people’s social, psychological, or even physical functioning does not inevitably decline with age. The data gave a real picture of the needs of old people, many of whom had lived in this district before retiring, and consider this their home. Their problem is that they have very low income and can hardly live on their pensions. Those on minimum pensions can ask the local government to help with supplements for their electricity, gas and heating bills. Whilst this case study proved to be interesting and worthwhile for all those involved, it nevertheless did not produce any surprising results. An overwhelming conclusion was that the central and local governments should offer more financial assistance to the elderly to ease their living conditions”.

New Delhi, India

The 20 survey questionnaires completed under the supervision of Dr. Shubha Soneja, Head, Research and Development Division of HelpAge India, assisted by Ms. Maneeta Sawhney, Research Associate reveal deplorable living conditions in the slums of New Delhi. The surveys undertaken in three areas showed that the national, state and local governments provide very little direct assistance to the ageing, but are making efforts to provide some shelter assistance and improve basic services. However, the City government provides health, transport, water supply and waste disposal, and has a programme to improve the living environments of poor communities.

A sample of 20 elderly over 60 years was taken from three different slums in Delhi. These were the Ekta Vihar, RK Puram, Sector VI, New Delhi; the Jungpura- B, Madras Colony near Nizamuddin Railway station; and the J.P. Colony near L.N.J.P. Hospital, New Delhi. The sample was taken randomly irrespective of caste, religion, socio-economic status, sex or place of origin, and included 10 males and 10 females.

SLUM AREA DESCRIPTIONS

1. Ekta Vihar, Sector VI, RK Puram, New Delhi

Located 15 km to the south of the centre of Delhi this slum occupies 1980 square metres. There are 612 households with a population of about 6,000 people. It is situated beside a sewage wastewater canal, which produces foul odors, and an open dump. In rainy season the canal floods adjacent houses. It is surrounded by well-off colonies on three sides and served in the north by a pitch road.

Nearly 15 years old this slum was previously a temporary unauthorized hutment, but about 10 years ago the local government made it a permanent resettlement in which each hut owner was given title to a piece of land and Rs.15,000 to construct a house of one room and a kitchen. According to local government definition this slum is now an authorized resettlement. It can be reached by road and path, and is provided with electricity, waste collection, fire and police protection and a public telephone. The nearest hospital or clinic is 8 km away reached by public transport. An NGO: ASHA provides health services for a nominal fee.

2. Jungpura-B, Jhopari Madras Colony

Containing 750 people on 1500 square metres this area is 15 km southeast of the city centre and consists of a relatively new colony of huts located beside a railroad with a big open wastewater canal to the north. It also is foul smelling due an open dump and human excreta. Garbage is scattered all over and the area is covered with black dust and smoke as well as loud noise from the passing trains. The same public services are provided as in Ekta Vihar, but the clinic is 10 km distant.

This slum consists of temporary, removable unauthorized hutment’s. It evolved on unauthorized railway land and can be removed at any time by the local government. Smaller than the other two, this is a new settlement, less than 10 years old, consisting of scattered and less dense hutment’s. Air pollution is prevalent in this area, mainly due to train smoke, the open garbage dump, cooking on wood fires and auto traffic. There are no public toilets so the dwellers have to use open land by the railroad tracks and the canal. Train noise is also a problem.

3. J.P. Colony, Ranjit Singh

This slum is situated in the middle of Delhi. I t is surrounded by a hospital in the east, New Delhi Railway station in the west, pitch road and turkman gate of the Walled City of Old Delhi in the north and Minto bridge in the south. Its area is about 2000 square metres and contains nearly 1400 households with 7000 people. Nearly 25 years old this is a very crowded, dense permanent settlement. It is served by good roads, sewer lines, drains and public toilets. Pollution is prevalent due to the rush of vehicles on the surrounding roads. This colony was created under the Slum Resettlement Programme, which provides financial housing assistance.

People living in all three areas seem to share the same difficult living conditions. Practically all dwellings consist of one room in which extended families of 4 to 6 or more live. 18 of the 20 people interviewed claimed to own their homes (but this may not include the land). All sorts of building material were listed, including bricks for at least part of 15 of the houses. Earth was also cited by 11, which was probably for the floors rather than the walls. Others mentioned block and wood. None said they had a yard or garden. Sanitary facilities consisted of outdoor taps and public toilets (which many said they did not use because of the charges. All said there were outdoor bath/showers, but this may also have been the tap. Electricity was available (in some cases illegally tapped), and the other fuel mentioned was oil. Public waste disposal and street cleaning was cited, but other comments indicated that these were not very efficient. Police and fire protection, were provided and no residents complained about security and safety which is very different from most other countries.

SOCIAL AND ECONOMIC ISSUES

Society and Culture

The social composition of these slums is unique with all sorts of people of different social and cultural backgrounds. The majority belongs to the lower castes, but higher castes are also represented. The uniqueness of slum society is that economic criteria are more important than caste levels. Those who belong to the poorest economic levels in rural areas, irrespective of their castes, migrated to urban areas for their livelihood and settled in the slums, as these were the only places they could find shelter. So caste and religion do not matter; they all constitute a society, the society of lower people, which is a slum society.

In Ekta Vihar there are nearly all castes and two religions: Hindu and Muslim. There is a Temple, but no church or mosque. The dwellers go to the temple. People are grouped in terms of their local politics. Drinking, card playing, beating drums, etc. are prevalent. They practice the religious rituals of their native rural villages. The Hindus practice their festival Holi, Diwali, Deshehra, etc. and the Muslims practice their Ed, Eidul-Azaha, Muharram, etc. The elderly visit the temples or mosques to have meetings, recreation and for festivals. Social and cultural activities of slum dwellers are very similar, differing only in their native background. For example in Jungpura nearly all come from the south Indian states like Tamil Nadu and Kerala. They are all Hindus and their culture is South India. They generally speak Tamil language, but those who have lived in Delhi for a long time speak Hindi also. In this slum the majority are Dalits (lower castes). In the JP Colony the majority of the dwellers are Muslims. There is a mosque and the elderly go there to pray (Namaz).

Migration

Migration is common for the slum dwellers. In almost all households some members migrate to their native places from time to time. Therefore, their native place, rather than the slum, is a permanent inheritance for them. There they have purchased some land; their parents and other family members live there, so their kinship bond exists even after migrating to urban areas and settling in slums. They visit their villages at times of relatives’ marriages, festivals and the harvest season. The slum dwellers belong to different states of West Bangal, Assam, Orissa, Tamil, Nadu, Madhya, Pradesh, Rajasthan, etc. Hence there is a constant urban to rural movement of people, and vice versa. Due to migration exact demographic data are not available. Population estimates are based on the number of households. However, there are statistics on health, mortality and birth rates, age and sex ratios.

Economy

The slum society has a unique economy. Slum dwellers are the lowest economic level of urban society. They have to fend for their bread by doing whatever work is available irrespective of their caste or religion. The majority are casual labourers while some are skilled and semi-skilled masons, white-washer, construction laborers, etc. Women are maid servants in well-off colonies. Some are safe karmacharies (sewagers) with local government. Economic conditions of the elderly are very poor. Those who are able to work cannot find jobs due to their age. In the Madras Colony some were railway workers as coolies, cleaners, etc. on a casual basis. The teenagers work as servants at tea stalls and roadside restaurants. Some are engaged in cottage industries like sewing clothes, making wood furniture, etc. Few slum dwellers have salaried jobs in private firms or in the public sector.

SURVEY RESULTS

Age: Three fourths of the elderly surveyed were in the age group 60-69. 10% were in their 70’s and 15% were in their 80’s. Housing conditions: Housing conditions of the slum dwellers is very poor. The majority live in small temporary huts of one room and a kitchen made of jute, poly papers and earth. Permanent dwellings are called houses or homes; temporary structures are called huts. Out of 20 dwellings only 8 were permanent, built of brick and cement. Living space inside the dwellings is very limited for the elderly. It is obvious that the majority of elderly (17 out of 20) have inadequate living space as they sleep in a single room with at least several others. Two elderly were bound to sleep outside the house in temporary shacks, which hardly contained a small cot. Living space for the elderly and home ownership is correlated.

Those who own the house sleep in it and receive better care.

Household composition: The type and composition of family is unique due to two aspects: unlike rural areas there is no joint family system, but no elderly lives alone. Families are either nuclear or extended. Out of 20 elderly, 9 were nuclear (with spouse) and 11 were extended with 7 or more members. Hence, in urban slums the elderly get support and care in the extended families.

Community services: Water is provided at several public taps and there are also several hand pumps, some of which are defective. At times during the summer season there are shortages and water is not supplied through the taps. Slum dwellers then have to buy water from private tankers. Out of 20 elderly, 4 take baths inside the house and 11 outside. No elderly use public baths. Public toilets are available at Re.1 per use. Although the toilets are not properly cleaned 11 elderly said they nevertheless used them, while 8 prefer to use open land on the side of the canal, and only one has a private toilet in his house. Waste disposal is provided by the local government personnel, but not regularly, and due to irregular removal there are open dumps near the slums, which cause pollution.

Utilities: The main sources of fuel are electricity and kerosene, but some use wood for cooking. No one uses coal because it is too costly and not available. Most of the houses had illegal electric connections and thus stole the electricity. The cost of fuel was affordable to some, but 8 said it was too expensive. Kerosene is available from government ration shops at an affordable price, but black market cost is excessive. Wood is collected from the nearby jungles and bushes, and some take it from their masters’ houses where they work.

Police and fire protection: Police and fire protection is provided. However the attitude of slum dwellers towards the police was not good, as the police do not come in times of need. In recent incidents of fire the services were unable to save the dwellings. Street lighting is very poor. Only the front side of the light was working and people have to provide their own outdoor lighting.

Health services: The Municipal Corporation of Delhi provides primary health centres, which provide limited services to all age groups. Complete medical treatment facilities are provided by the general city hospitals. In Ekta Vihar there is an NGO called “ASHA” providing health services, but not exclusively for the elderly. They charge Rs4/- for a registration card and provide free check-ups, but medicines have to be purchased outside. However, in the other two slums even this facility is not available. The J.P. Colony is next to the two big city hospitals, but the problem of medicines remains. Some government health workers and NGOs distribute medicines in the slums occasionally. Other services: There are no community centres, libraries, parks and recreation areas for the elderly or others in these slums. No facilities for meal delivery or inter-generational programmes.

Personal Characteristics: (Physical Health) No elderly reported that their health was excellent or good. 7 reported their health as fair while 13 cited poor conditions. Of the 7 reporting fair bonehead walking difficulty, 4 had weak eyesight, 3 were hard of hearing and 3 cited no specific problems. Of those who reported their health as poor, 10 had severe walking difficulties of which 3 were using sticks or crutches; 2 were completely disabled, unable to stand.

Transport: For elderly there is a concession in the fare of buses on all city routes if they have a monthly pass. However, hardly any elderly in the slums take monthly bus passes. No special seats are reserved for the elderly although there are posted instructions to give seats to senior citizens. Yet, there are seats reserved for women. A majority of the elderly use the bus to go to the hospitals; some use it to go shopping or to churches.

Communication: Slum dwellers generally use the postal system, though there are local and long distance telephones everywhere in the city, in or near the slums. However, since phones do no exist in the rural areas where most peoples’ families live, they prefer to use the postal services. Mail is delivered to some of the houses; others receive mail at their work places. For media communications, 3 had TV sets, 3 had radios and only one had a telephone in the house. The remaining 7 elderly had no such facilities.

Finances: A person of any age group, who is physically able to work, works. Some elderly were willing to set up petty shopping, selling vegetables, tea stall or Dhabi, etc., but were unable to do so because of the lack of financing. Seven elderly were doing casual jobs, shopping or working as servants. A few were in railways as coolies. Five were not working due to physical disability or illness. Others were active in social and political activities, doing some non-economic activities or housekeeping: cooking, caring for children, etc.

CONCLUSIONS

The most prevalent difficulties faced by the older people are lack of adequate space, health care and sanitary facilities in addition to the filthy environment. Due to lack of living space, some are forced to sleep outdoors. Surprisingly, the males interviewed outnumbered the females 11 to 8, which is not true in other countries. Most have only lived in New Delhi for less than 20 years.

Practically all the people surveyed are totally dependent upon their families for their existence. Thus, there is a high level of insecurity and fear of abandonment. Some are also forced to endure physical and emotional abuse by their family members. Most feel they are a burden to the family, especially those who are disabled. It is noteworthy that in comparison with the reports from some of the other countries, the elderly in India find or seek some means of livelihood to alleviate their desperate conditions. Only 3 said they had pensions from previous employers, and no government pensions were mentioned.

Kingston, Jamaica

Dr. Denise Eldemire, Director of the WHO Collaborating Centre on Ageing and Health in the Department of Community Health and Psychiatry of the University of the West Indies supervised the survey, which was conducted in the Mona section of Kingston. This area consists largely of small 1 and 2 room wooden houses with gardens. The 23 older persons interviewed were mainly women in their 60s who lived with their small families of 2 to 3 persons. Only 4 were in their 70s and one was in her 80s. Of the 4 men interviewed, 2 lived alone. All those interviewed were tenants. Most people have lived in their homes at least 30 years. Living conditions are primitive with only 11 homes having electricity, and most having to use outdoor group toilets and showers.

There are severe social problems in the poor sections of Kingston due in part to high unemployment on the island and the cultural mix of the population which includes blacks, Indians, Lebanese and Portuguese. Youth gangs cause serious crime problems and there is apparently little police protection to provide security for older persons. Half those surveyed said they receive home health services, and most said their health was good or fair except for difficulties in walking, sight and hearing in some cases. Travel to the hospital is available by public bus. Although there are reduced fares for the elderly, the drivers often will not take them unless they pay full fare. The Sanitary Facilities in these houses were very deficient, consisting largely of outdoor toilets and showers used by groups of families even though most houses have indoor piped water. Most respondents said that the cost of water was excessive, but in fact they were tapping it illegally and not paying.

Community services: Half of the older people said they received home visits from social workers. None reported the existence of a community centre. Three-fourths said they went to church regularly. Public Services: Although most people found public waste disposal and street lighting satisfactory; they all reported that there was no police or fire protection. Also, only 3 reported that streets were cleaned, and 6 said night soil removal was public. Communications: None had telephones. Only half had TVs or Radios. Postal services were available.

Utilities/Fuels: Although only 4 said they had Electricity, 10 had televisions, which indicates they have electricity. 19 used Gas or Oil, and 12 used Charcoal for cooking.

Sources of Funds: Only three reported having full or part-time jobs as housekeeper or janitors. Several said they sold cigarettes, peanuts or ice. Only 4 had pensions. Otherwise, their source of funds was their family. Daily Activities and Bus Services:

Most spent their time on household tasks and visiting family and friends. Eight reported Community activities. Bus services were used to Shops, Church and Hospitals/Clinics. 5 reported reduced fares for seniors, but 11 said there were not.

Living Problems: Almost all reported that their living space was inadequate, the health services were deficient, and that security and safety was a serious problem. Others complained about poor access to their dwellings and the inadequacy of the public transport services.

Most Important Needs of those interviewed:

Housing improvements	78%
Security/Safety	74%
Adequate food supply	61%
Financial support	43%
Work opportunities	17%
Better sanitary facilities	13%

The data gathered from the Survey indicates that the cost of water and fuel is too high. It also appears that a majority of older persons have neither pensions nor social security. 61% are dependent on their families for financial support, or have resorted to selling peanuts, ice or cigarettes to make ends meet.

Nairobi, Kenya

The Survey of elderly persons living in four squatter settlements around Nairobi was conducted by a research team from HelpAge Kenya directed by Mrs. Kathleen Okatcha, Chief Executive. Except for the care and attention given to them by HelpAge, other NGOs and CBOs, and religious organizations, the elderly in these settlements receive very meagre services or assistance to maintain their livelihoods. Due to migration to Nairobi, many of them have lost family ties left behind in their rural areas of origin. Many have no close relatives; they have been abandoned by their children, or have lost their families. At a mean age of 73 years the 21 respondents taking part in this study, the fact that they have chosen to remain in these poor urban environments suggests no alternative choices. They are consequently denied the right to opt for better living conditions due to historical factors influencing their early lives: lack of education, lack of income due to low or no bargaining power and resultant extreme poverty.

The environment in the four areas surveyed: Huruma, Maili Saba, Kuwinda and Dandora can only be described as slum. Located on steep hillsides or wet areas, adjacent to open dumps and accessible only by paths, conditions are generally crowded. Most of the dwellings are one-room shacks constructed of earth and sticks with metal or plastic roofs. Sanitary facilities are primitive with outdoor taps as the only source of water for drinking or bathing- and the charges for water are excessive. The few pit latrines are seldom used, as people prefer to go into the nearby forests. These areas have a lot of environmental pollution. In elderly people’s weakened state this makes them susceptible to respiratory, water borne and a myriad of other diseases. Health facilities are few and inaccessible to older persons who cannot walk long distances, certainly when unaccompanied. The public bus transport is too expensive and the stops are not nearby. There are no reduced fares for older persons.

For example, Huruma Settlement is described as follows:

Size	7 acres
Population	5,300
Distance from city centre	12km
Physical Conditions	Steep hillside
Pollution	Next to open dump and stagnant water
Means of access	Path
Public services	Piped water, Police/Fire protection
Health facilities	Clinic 10 km by bus

However, Maili Saba, located furthest from the city centre, some 15km has comparatively less extreme circumstances.

Five elderly persons in each area were selected at random for interviews; 13 women and 8 men. The youngest was 57 and the oldest 96. 8 were in their 60s, 7 in their 70s and 6 were over 80. The problems expressed to some extent reflect those in rural areas due to the decaying extended family care system:

· Extreme loneliness and neglect in the face of lost family ties, abandonment by children and kin, and lost families. Of the 21 respondents, 11 were living alone.

· Displacement from the traditional family care system due to displacement and dispossession of their rights to ancestral land. About half those interviewed had lived here 30 or more years.

· Unemployment due to lack of competitive skills or the retirement age. 2 said they had jobs and 10 said they wanted to work.

· Six considered their health as good, and 15 rated it as fair. However, 6 complained of difficulty in walking, 12 had poor eyesight, and 5 had hearing loss.

· None have pensions. Indeed, the formal sector in Kenya provides pensions beyond age 55 to only about 10% of retirees formerly engaged in salaried employment. Majority have worked in the informal sector and many of these are women.

· Overcrowding. 3 respondents lived in one room with 1 to 3 other persons; 2 with 4 to 6 others, and 4 households had 7 or more persons.

· When asked about their daily activities, 4 cited work, 2 did volunteering, 13 attended community meetings, 8 were minding children and 12 spent time with friends.

· Lack of land tenure is an issue as most are squatters on government land and are threatened with eviction if their land is sold to private developers. 14 said they owned their homes, and 4 were tenants.

· Of the houses visited, 13 were made of earth, 4 of wood, 2 of iron sheets and 1 of brick. 16 consisted of 1 or 2 rooms, 2 of 4, and 1 had 5 rooms. Only 3 said they had yards, but some seemed nevertheless to have small gardens.

· Decent Sanitary facilities are a dream that almost all cannot afford. However, some water taps were installed by the city council and by NGOs for most of the residents. 18 persons said they had only access to outdoor taps, and 19 used outdoor baths or showers. 1 house had indoor piped water. It is not uncommon to find residents using contaminated water from nearby rivers.

Fuels: Most of the residents said they could not afford to pay for electricity and therefore used other sources. Only 2 said they had electricity; 4 used oil and 16 used only wood or charcoal.

Public Services: 13 reported public waste collection and disposal, and 14 cited police and fire protection services. Only 1 said that streets were publicly cleaned.

Community Services: Hospitals, clinics, churches, schools and shops are reported as available by bus with no reduced fare for seniors. Only 3 reported they had home health visits and where elderly community centres existed they were provided by NGOs (Note: Health provision through home care is definitely an area that NGOs can focus on in poor neighbourhoods in the short term).

Difficult Living Conditions - Summary of responses:

Inadequate living space	3
Lack of health services	9
Difficult access to dwelling	5
Lack of transport	4
Security and Safety	5
Lack of shops	3

(Note: Wayside “Dukas/Kiosks” (shops) are plentiful in these areas. However, these are owned by outsiders who can afford or borrow capital to set them up. These would be good income generating ventures for the residents of these areas and would provide work opportunities for the elderly.)

Final Comment by Kathleen Okatcha:

“HelpAge Kenya has indeed enjoyed being part of this world-wide study whose information has been shared with our Government through the Ministry of Home Affairs, Heritage and Sports. Incidentally, after the launch of the International Year for Older Persons (IYOP) on October 1, 1998, the National Committee for IYOP was formed to focus on activities for older persons during 1999 and beyond. We do hope that during the tenure of this working committee, policies and legislation will be put in place to address most of the thorny issues that plague the senior citizens in our country”.

“In this survey we had an opportunity to meet and talk with older persons who were not only energetic, but whose mental acumen were still strong and useful. These people should not be treated as outcasts in community. Rather they should be given the respect they deserve, in accordance with our African heritage. They should be given an opportunity to participate in development decision-making and education of the younger generations: their traditional role. They need not be involved in strenuous work, but their contribution is vital and should be tapped into. Our hope is that analyses from this study will form the basis of clear and concise policies; and their rapid adoption so as to secure a present and future hope for older persons in Kenya”.

Manila, Philippines

Information on the ageing in Manila is provided by Mr. Edward M. Gerlock, who for 10 years was the Executive Director of the Coalition of Services of the Elderly, Inc. (COSE). In place of interviews, Mr. Gerlock chose to describe conditions in the “Pasadena, San Juan neighbourhood” as he is very familiar with its living conditions. The following sections are selected quotations from COSE’s submission to Habitat’s Best Practices Programme:

Due to a confluence of factors, the Philippines is on the verge of a crisis in the care of the elderly due to:

1. An estimated 10 million mainly young and majority women workers (the traditional care-givers of the elderly) are employed outside the country

2. As in many Asian countries, a massive rural to urban migration has put a strain on the traditional extended family system.

3. Due to better health care people are living longer and a moderately successful family planning programme is resulting in people over 60 being the fastest growing sector of Philippine society.

There are presently 40 organized urban poor communities of older people in Manila with affiliates throughout the country. Older people are respected, but not a priority on anyone’s agenda. For example, there are more than 200 groups in Greater Manila alone dealing with street children; but for the “street elderly” and urban poor elderly, virtually nothing. Resources are scarce and the potential of residential care for older persons is not only economically but also culturally unattractive. The potential for community based programmes for the elderly is vast.

COSE was founded in 1989 as an attempt to keep the elderly poor in their communities. The programme empowers them to make the decisions, which determine their lives. The programme includes a social component, an income generating capability, an insurance system to assure a decent burial; and in 1998 was about to embark on a peer-counseling programme. In a “Community-Based Health Programme” an organized urban poor community (“squatter area”) chooses two of their members to become “community gerontologists. For 3 days they are trained by a doctor, dentist and a nurse with an emphasis on ailments of older people and their prevention. At their graduation they receive a kit with a thermometre, blood pressure and sugar measuring instruments, etc., and become health workers for their own organized elderly in their community. They meet regularly to deepen their knowledge, and keep health records of every older person in the community.

Mr. Gerlock described Pasadena, San Juan “as having an area of 3-1/2Ha. with a population of about 3,000, located on top of the City water reservoir. The San Juan River which flows around the area is very polluted. A road leads to the area, but only narrow dark paths provide access within it. Electricity is available, but expensive, so a number of connections are illegal.

People have tapped into the reservoir for water. There are a number of small shops in the area. A hospital and a day centre are 2-1/2km. distant. Transport is by “Jeepney” or tricycle.

Of the 9.6 million people in Metro Manila, about 2-1/2 to 3 million are squatters who say they “own their home” even though they don’t own the property it sits on. Piped water is available and baths where it is drawn from the reservoir. Bottled gas and charcoal are used for cooking. Waste disposal is into the San Juan River. Police and fire protection is theoretically, but not practically available. However, security from those within the settlement does not seem to be a problem. The residents are tight-knit groups from different homogenous areas of the country who supply most of their own services. Intergenerational activities consist of fiestas, and everyone participates in older persons sponsored activities such as fund raising, socials, etc. TV and radios are common, and mail is delivered somehow.

Of the organized group, which has 113 members, about 25% of the elderly are men and 75% are women. The most common health complaints are rheumatism, high blood pressure, TB/lung diseases, and Diabetes. Most people do income generating projects at home in the informal sector. A major source of income is remittances from children working abroad which is estimated at $5 to $7 billion per year for the nation. A small but significant number of NGOs have achieved grass roots impact. For example, St. Lukes Geriatric Centre invites Pasadena elderly to come for day care activities 3 times a week free. With a little support the elderly virtually run their own Programmes.

Cape Town, South Africa

Dr. Monica M. Ferreira, Director of the HSRC/UCT Centre for Gerontology in the Faculty of Health Sciences at the University of Cape Town Medical School supervised the survey of 20 households in six townships on the Cape Flats, which form part of the Cape Town metropolitan area in the Western Cape province. A total of 30 persons aged 60 years and over living in the households were interviewed by two specially trained fieldworkers who spoke the same language as persons in the households.

LOCATION

The Western Cape is the most urbanized of South Africa’s nine provinces: It is 89% urbanized, compared to 55% for the total country (1996 Census). Total population of the province is over 4 million and constitutes 11% of South Africa’s population. Under the apartheid design, people belonging to different racial groups (White, Black, African, Coloured, Indian) lived in separate areas. The residential areas of the province were thus historically divided according to racial classification. In Cape Town, whites lived in the “leafy” suburbs or on the Atlantic seaboard, while the majority of the coloured population and all black persons have lived in townships on the expansive and environmentally harsh Cape Flats. Since the repeal of the Group Areas Act in 1988, people may live in any area, and the majority of suburbs and townships are to some extent becoming racially integrated, with an economic factor being the only divider.

DESCRIPTION OF TOWNSHIPS

The townships are located 10 to 30kms from the city centre and in 1991 their populations ranged from as little as 16,000 to over 300,000, such as the sprawling township of Khayelitsha which with its many transients may have a population of up to a million. Many settlers migrated in the massive urbanization from the Transkei and Ciskei in the Eastern Cape to the Western Cape 10 to 15 years ago. The majority have settled in informal settlements or squatter areas on the periphery of Cape Town. They share a harsh climate, experiencing the brunt of the sandiness and wind of the expansive Flats which blow refuse from garbage bid sites and open dumps all over the Flats. Some parts may be described as orderly settlements of homes, while others are densely populated with shacks. Local authorities did not anticipate the rapid rate of urbanization and consequently the areas are characterized by poor infrastructure and are underserviced.

Travel time to the city from the townships is between 20 and 40 minutes. Although public transport by train and bus is available, most people prefer to travel in mini-bus taxis, which drop them close to their destination accessible by public transport. The larger townships have day-service centres and libraries. Most respondents said they had no knowledge of plans or programmes to improve environmental or housing conditions. There are NGOs and church groups, which assist older and disabled persons with services. Older residents are mainly late-life in-migrants. Some are transients who have come to the city for health care.

The Western Cape has particularly heavy winter rains and shack dwellers suffer to the extreme, rainwater that does not drain away and drenches their shelters. The shack areas are terribly overcrowded and socially disorganized, exacerbated by the high unemployment rate. Crime and abuse of women and children are rife. There are high levels of violence, especially by gang-related activities. The living conditions of older persons vary from those for shack dwellers to those where the older person co-resides with family in a multigenerational, conventional, brick home with a garden/yard. The majority of dwellings are cozy, comfortable and orderly. However, many wish for more security (burglar bars, walls, etc.).

In the older settlement dwellings are typically constructed of brick walls with asbestos or sheet-iron roofs. The dwellings, referred to as sub-economic or matchbox houses, were originally provided by the local authority and rented to families; the houses may now be purchased for a nominal sum. Each house typically has a small yard and is surrounded by a fence or vibracrete wall. Virtually all townships have electricity, water supply, streetlights, waste collection, health-care facilities, a post office, public telephones, shops, churches, etc.

Survey based on national data, the estimated population of the Western Cape aged 60 years and over is 301,942, constituting 7.6% of the total regional population. Approximately a fifth of the region’s population, in each case, are blacks and whites, while coloureds constitute 54% (Indians 1%) of the older population. The sample for the Case Study was drawn from 6 low-income poor townships on the Cape Flats: 3 historically inhabited by coloureds, and 3 by blacks. Very few Indians reside in this area. The sampled townships were:

Coloured Townships	Black Townships
Bonteheuwel	Delft
Heideveld	Guguletu
Manenberg	Hayelitsha

Ten households were randomly selected in the coloured townships and ten in the black townships. Most of the older black and coloured households were multigenerational with more than four persons. More of the black households than the coloured were homeowners. Most of the black and only half of the coloured elderly lived in houses; others in flats or cardboard shacks. However, all dwellings in the coloured townships were built of brick, compared to only half of those in black townships. Most houses had 3 to 4 rooms. Half of the coloured families and only a quarter of the blacks had gardens. Few elderly complained about inadequate living space or difficult access to their dwelling.

Practically all dwellings had piped water and flush toilets inside the dwelling; others had toilets in the yard. Half the coloured, but only a few blacks had an indoor bath or shower. Few of families paid for their water or electricity charges even though they said these charges were affordable. Municipal garbage disposal services, street cleaning and lighting were provided. However, few people perceived that they had police and fire protection.

All households had access to a health clinic or a day hospital and some could access home nursing services. While all coloured households reported access to a park, community centre, churches, shops and schools, most of the blacks had only a church and shops nearby.

All of the coloured subjects had lived in their townships for 20 years or more, compared to only half the blacks. Some blacks said their home was elsewhere- they were circular migrants (similar to many of the squatters in Delhi, India) A third of the elderly coloured were still gainfully employed. Although none of the elderly blacks had jobs, most said they would like to work. Most of the coloured subjects and all of the blacks interviewed received social pensions under South Africa’s means-tested social pension system whereby males over 65 and females over 60 receive a monthly pension of approximately US$85.

COMMUNITY PERCEPTIONS

The subjects’ greatest concerns were not about their houses or living arrangements, but about their personal safety, with the context of the crime and violence in the townships. In particular, they wanted burglar bars on the windows, safety gates with padlocks, and secure walls around the yard to protect them from criminals and gangsters.

“Police only come when everything is over and gangs have dispersed. Only come when drive-by shootings and murders in homes. “When there is a crime committed and you phone the police, they ask: ‘is he/she dead?’ We don’t have protection because the police are so scared of the gangsters”. “We have to lock the doors during the day when we go to the toilet”.

“It’s not too safe either during the day when one is alone and you have to walk to the shop. I always wait at a distance when a car rides by because you don’t know when you will be shot at”.

PARTICIPATION OF OLDER PEOPLE IN COMMUNITY AFFAIRS

Older women in particular are amenable to participating in self-help group development produce. However, because of frailty and a cultural construction of old age as being frail these persons are generally less involved physically in projects. Yet, numerous individuals do indeed join in community improvement efforts in creative and valuable ways. There is a need for additional information on community programmes for the purpose of this study and its outcome.

The subjects described community programmes in their townships in which older persons participate, including some aimed at connecting the generations: “We have a day out to the beach and the youth accompany us. Any function that we have, the youth is at our service. Not every week or month, but on occasions”.

“Our youth do shopping, household chores for the elderly - church choir outings, advice to youth”.

“Once I tried to start an after school (care facility) - to keep the youth from the streets. I have done a course in after-school care. Funding is necessary”.

EFFORTS TO IMPROVE LIVING CONDITIONS

By Government and Local Authorities

Since the new government took power in 1994 it has made concerted efforts with measurable success to address the infrastructure deficiencies in the townships. It is unable to meet the demand for new houses, although it continues to build houses, but is upgrading streets and developing sports and recreational facilities. However, it is up against an institutionalized “culture of non-payment” in the townships whereby it is unable to recover billions of Rands of arrears payment for services. People also harbor a strong expectation that the new government will provide everyone with a house- as they were told when they voted.

There are scant government funds available to meet the needs of older people in the “new” South Africa. Indeed, the old are not a priority- the young are. The young represent a brighter, long-awaited future for the country in political and democratic terms. All dedicated geriatric services have been withdrawn under the new national primary health care plan. Virtually all social services for older persons have also been withdrawn. On the other hand more than 90% of all age-eligible black and coloured receive the social pension. As virtually all black and coloured South Africans live in multigenerational households all household income including pensions is pooled.

NGO Efforts to Improve Living Conditions

Efforts of NGOs to improve living conditions vary among communities. Prior to 1994 NGOs were receiving extensive international donor funding, and were active in engaging people in development programmes where the apartheid government was failing to develop areas. Since then donor agencies have been encouraged to contribute funds directly to the new government’s central coffers. Yet, there are still innumerable organizations engaged in development projects many of which draw on volunteers. The national “Masikane” project to develop local national pride in “building our nation together” is encouraging people to assume responsibilities within communities and to pay for their utilities. Virtually all community -based services to older persons are operated by NGOs. Most notable among these services are the senior centres, partially subsidized by government, which offer members opportunities for social interaction and recreation; and a hot midday meal at nominal cost known as luncheon clubs.

Final comment

Finally, the situation in South Africa is extremely complex-more so now as the country continues to free itself of the shackles of apartheid and to come up with a better deal for all its citizens. Given cultural patterns of multigenerational co-residence, the future of older South Africans may well be best served by strengthening their integration in society - and supporting families with whom they reside- and possibly by dispensing with notions of aged-specific service models.

Ankara, Turkey

Professor Dr. Rusen Keles, Director of the Centre for Urban Studies at Ankara University organized the Survey which was carried out by three members of the Department of City and Regional Planning in Gazi University including Ms. Nilgun Gorer who later attended the Workshop.

The older people interviewed lived in 8 squatter colonies from 5 to 15km from the centre of Ankara. The colonies ranged in size from only 3Ha to 150Ha. and were characterized as “old, crowded, high density squatter settlements”. All of the people interviewed lived in houses of which seven were located on steep hillsides and 3 in wetlands. Both water and air pollution conditions were noted and 4 were adjacent to open dumps. Some had road access, but most were reached by paths or stairways.

Other than the adverse environments, the living conditions did not seem as bad as those found in other country surveys. All houses were built of brick, and 8 had two or three rooms and two had 4 or more rooms. The areas surveyed were all served by public water and sewer lines and electricity. Public waste collection and police and fire protection services were provided. Hospitals and health clinics were within 1 or 2km. of some homes, but others were 5 or 10km distant. However, only one or two people reported the existence of services specifically for senior citizens. Also, no government programmes for housing or community improvement were noted.

A majority of those interviewed were women. Six persons were in their 60s and 5 were in their 70s. One was over 80. All were living with their spouses and had families of 4 to 6 people. Although most of the respondents said their health was fair or good, 4 complained of disability in walking, 3 in their sight, 2 in hearing, and 4 used crutches. Most said they had lived in their houses for over ten years.

One of the residents said he had a job doing car repair. All others said they had pensions or social security payments, which 4 said were insufficient to live on. Many also complained that the cost of water and fuel (coal) was excessive and beyond their means.

Difficult living problems cited included poor access to their dwelling and lack of transport. (However, a majority reported they used public transport to get to shops, mosques, and health clinics, and that bus fares were reduced for elderly persons) 4 reported there was a lack of health services and shops. Only one person mentioned lack of safety and security. There were only a few responses to how they would improve their living conditions: 5 requested more financial support or social security, 4 for improving their house, and 3 for a more healthy environment.

NOTE: By Ms. Nilgun Gorer in response to some questions regarding the above summary:

“The concept of squatter housing in Turkey is different from that in Asian and Latin American countries. In Turkey, until the 1980’s squatter housing was an individual process in which most was built by users on government land, usually on steep sites with access problems. These areas, called ‘gecekondu’ were occupied by individuals who built with second hand bricks, windows and doors, etc. The ‘gecekondu’ areas were legitimate and were provided with municipal services. After that squatters became a speculative investment process organized by the ‘land mafia’. In the mid-80s another process called ‘redevelopment’ turned the old squatter sites into middle-high income residential neighbourhoods of high rise buildings.”

Finally some comments on aids provided by the City of Ankara. The public bus services are free from 10AM to 4PM for persons over 60. The municipality also provides health care, cleaning and some home repairs to the elderly poor. Discounts of 40% in water bills and natural gas are provided. (However, there is no natural gas service in the poor settlements surveyed)

United States of America, the city of Newark/New Jersey

The survey and report were prepared by Ms. Khadijah Odeh-Piper, graduate of the New Jersey Institute of Technology School of Management. She is a business consultant and researcher.

Community Overview

Newark is located in the state of New Jersey ten miles west of New York City. It is the largest city in New Jersey with a total population of 275,000 in 1990 and has an extremely high population density (11,254 per square mile) U.S. census data indicates that the population is composed of three predominant ethnic groups: Black (58%), White (28.6%) and Hispanic (26%). Newark has unusually high poverty, public assistance and crime rates, and low educational attainment among U.S. cities.

The City’s Older Persons

There are approximately 32,000 older persons living in Newark. The largest number over 60 is the group of 65 to 69 year-olds which includes approximately 9000 individuals comprised of 5,000 females and 3800 males. There are more than 4,000 persons over the age of 80, and in all cases the majority are women. Over 2,000 seniors do not speak English very well.

The overwhelming majority of elderly interviewed were African American males. The persons interviewed were between the ages of 65 and 80 years old. Over 90% had fairly good health meaning that they were mobile and coping with their multiple medical diagnosis. Less than 5% were disabled or unable to walk.

The majority live on fixed incomes, including social security, pensions and their own savings. Two were still working: one aged 75 year old male, traveling daily to New York and one 67 year old woman. She still worked part-time because she stated she needed the money for her household, comprised of two other older persons and an adult child. Most respondents felt they were fortunate with very few problems.

Living Arrangements

Half of the older persons are living in households with family members. The other half are living with non-family members, or alone. 500 are institutionalized. Most of Newark’s elderly live in apartment dwellings, Senior Housing and private homes. Senior Housing are apartment buildings for the elderly and disabled. Some units are subsidized. Housing alternatives include boarding homes, shared living residences, and continued care retirement communities.

Construction and utilities

The majority of buildings are constructed of brick and ranged from three to seven story apartment complexes. The private homes that were visited were wood frame dwellings with ten or more rooms. Space was more than adequate, but many community residents feel there is not enough senior housing for everyone. All of the survey respondents have piped water supply included in their rent. All have individual bathroom and modern sewage disposal systems.

Transport services

Transportation services are quite extensive in the city of Newark and all of the survey respondents have easy access to public buses routes. Inexpensive van and taxi services are available and utilized if necessary when going shopping. Most of the active seniors don’t utilize the senior discount because there is no discount if one uses the monthly bus pass. This was a cause for complaint.

Health care services

All of the respondents reported satisfactory assess to health services. All stated they were under a doctors care and did not necessarily distinguish the quality of care received, whether hospital, clinic or private physician. However, many seniors reported unmet needs. Many stated they needed glasses and help with the cost of their prescribed medication. Many respondents had arthritis and other conditions requiring pain relief medication and apparently needed help to pay for pain relief. And a few were not satisfied with the quality of care giving provided by home caretakers. All respondents when asked said that they needed help with dental services.

Need for individualized assistance

Male respondents articulated strongly their need for meal planning and household help. While unable to articulate the need for the friend and advocate assistance, many seniors were in need of such personalized and individualized assistance. In some instances, seniors were not utilizing available services because the information is not readily available. One of the older and frailer respondents has been totally house bound for the majority of the year. She stated she had not been outdoors or able to visit her place of worship. She said she would to do so if she was able.

Strong need for companionship

Male respondents articulated strongly their personalized sense of loss of companionship and need for meal planning and household help. Neither money nor improved health status were perceived as more of a problem than that of the loss of female companionship. Most of the single males stated this was a primary problem in their lives. Elderly urban males need for companionship is contributing to a complex, growing relationship with prostitution and illicit drug usage. Repeated visits by young women prostitutes to elderly men are observed daily. Security officers, managers and community police officers corroborate an increase of prostitution and illicit drug usage in certain housing residences.

Increase in illicit drug usage

There are current research findings corroborating substance abuse by adults age 60 of more. It is easy to see how an urban environment may exacerbate major life changes accompanying the loss of spouses, family members and friends. There is a pressing need to recognize and address the unique problems of the elderly urban male. Creative solutions are needed. In one residence complex there was ‘talk’ about persons becoming sick with HIV related illness. Both the housing security and in-house residents attribute the rise in recent years’ deaths to the increase of drug usage, prostitution and the AIDS virus. It is commonly known there as AIDS related deaths.

Urban elderly feel safe for the most part

Urban elderly do not express a general fear of criminality in their neighbourhoods. If given a choice, they prefer to remain in their familiar neighbourhoods even though specific crime data for the City indicates that 20 elderly persons were murdered in 1997. Many elders are not afraid to travel freely in their neighbourhoods; however many were quick to add that there is ‘not enough respect’ for the elderly in today’s communities. Those respondents having locomotion impairment expressed general concern about going out alone due to imbalance and other physical impairments.

Homeowners and middle-class elders may be suffering more than low-income residents

Respondents with higher pensions felt they were often penalized because of their incomes. In one instance, a retired wheelchair bound individual was not able to partake in receiving in-house meals because his monthly income was too high. While he lived in senior housing, ironically daily eating was still a tremendous hardship. Another senior felt that persons not living in special housing were not privy to free amenities like meal assistance or tax relief.

Homeowners appeared to be in more dire straights than persons living in senior housing. Two respondents expressed an inability to purchase additional family food items or needed family prescriptions. This was particular true in families where there may be two or more seniors.

Homeowners expressed a need for home repairs and help to pay higher taxes. One respondent stated she couldn’t afford the taxes now and she was unable to fix her roof. She has rain pouring into her three-floor home from a terrible leak in the roof. Homeowners asked what they needed to improve their quality of life said they need ‘help in housing maintenance and repair of roofing, heating, and plumbing problems.’

Available services

Publicized services available include Adult Day Care, Adult Protective Services, Alzheimer’s Disease-Caregiver Support, Case Management, Consumer Complaints, Dental Health Services, Friend/Advocate, Home Health Aide assistance, Home Friend (in-home chore service) Nursing Home Ombudsman, Residential Repair, Telephone Reassurance, Reduced Fare Transportation Programmes and Visiting Nurse Service. Vision and Hearing services are also available for some persons having visual and hearing impairment. There is a gap in delivery of benefits and not all older persons are able to receive or access publicized services.

There are many agencies whose services affect the quality of older person’s lives. The following short list are just a few selected agencies in Newark, the county and the state: Department of Health and Senior Services, the Essex County Centre for Substance Abuse Treatment Centre, Department of Citizen Services, the Essex County Division on ageing, the New Jersey Advisory Council on Elder Care, the NJ Division of Medical Assistance and the New ark Division of Housing Assistance, the State Department of Health, the Essex County Division of Welfare and the NJ Department of Community Affairs.

1. Acknowledgements

This survey and workshop could not have been undertaken without the financial support of UNCHS (Habitat), and the Netherlands Platform Older People and Europe. Thanks is also due to the Institute of Public Administration for its continued voluntary support services to the project. Advice and support was also given by the NGO Committee on Human Settlements, and the NGO Committee on Ageing, both at United Nations Headquarters in New York.

Great appreciation is expressed to the following Country Managers and their organizations who directed the Case Studies and Surveys of Older Persons for the Study; prepared the reports on their studies; and to those who participated in the Workshop:

Deborah Munns and Jim Longley of The People for Places and Spaces, and the Anglican Outreach Services, Sydney, Australia

Sonia Zapata Donoso, Escuela Trabajo Social, Universidad Santo Tomas, Santiago, Chile

Xiao Caiwei, China National Committee on Aging, Beijing, China

Dr. Magda Iskander, Coptic Evangelical Organization for Social Services, and the Centre for Geriatric Services, Cairo, Egypt

Edina Reviczky, Florence Nightingale Association, Budapest, Hungary

Dr. Shubha Soneja, HelpAge India, New Delhi, India

Dr. Denise Eldemire and Ken-Garfield Douglas, Dept. of Community Health and Psychiatry, University of West Indies, Kingston, Jamaica

Kathleen Okatcha, HelpAge Kenya, Nairobi, Kenya

Edward M. Gerlock, Coalition of Services for the Elderly (COSE), Manila, Philippines

Dr. Monica Ferreira, Centre for Gerontology, University of Cape Town, South Africa

Dr. Rusen Keles and Ms. Nilgun Gorer, Research Assistant, Department of City and Regional Planning, Gazi University, Ankara, Turkey

Ms. Khadijah Odeh-Piper, New Jersey Institute of Technology

Appreciation is also expressed to the following individuals who contributed greatly to the success of the Study and Workshop:

Richard May, Senior Associate, Institute of Public Administration

Selman Erguden, UNCHS (Habitat)

David Mammen, President of the Institute of Public Administration

Virginia Hazzard, of the NGO Committee on Ageing

Mieke Andela-Bauer, President, Ger J.M. Tielen, Director and Mira Weber of Netherlands Platform Older People and Europe

Prof. Dr. Gertrud Krueskemper, EURAG

Amanda Heslop and Mark Gorman of HelpAge International

2. Survey questionnaire

To guide the Country Managers and field interviewers a detailed questionnaire was prepared by IPA as a framework for conducting the community case studies and interviews. Translations of the questionnaire in Spanish and Chinese were provided by volunteers. The questionnaire form follows:

CASE - STUDY QUESTIONNAIRE

1. Identification

Country _______________________________ Date _____________________

Manager ___________________________ Interviewer ____________________

Organization______________________________________________________

Address_________________________________________________________

Phone ________________ Fax _________________ Email ________________

2. Local Government

2.1 Total population 1990 ________________ 1980 _____________________

2.2 Percent of population over 60 __________; Over 70 __________________

2.3 Percent of population over 60 who are disabled ______________________

2.4 Local government departments that exist in your City:

Health _____; Social Services _______; Housing _________;Transport ______

Water Supply ________, Waste Disposal _______

2.5 In your opinion, is the current annual funding for the needs of Older Persons adequate? (yes/no):

Health ____ Housing _____

Social Services ____ Transport______

3. The Low-income Community Environment

3.1 Name of community, neighbourhood or settlement ________________

____________________________________________________________

3.2 Size: _______ Hectares/Acres? Population (approx.) _______________

3.3 Distance from city centre: _____miles, or Kilometres _______?

Travel time by public transport: ___________minutes.

3.4 Character: Old? ______ Crowded, high density? _______

Built recently? ________ Squatter settlement? _________

Describe: _________________________________________________

3.5 Site conditions: Steep hillside? ______ Wetland ______ Other, describe:

________________________________________________________

3.6 Pollution conditions? Air ______Water______ Open dump______

Describe: _________________________________________________

3.7 Means of access: Road_____ Path_______ Stairs________

Describe__________________________________________________

3.8 Utilities and Public Services available: Piped - water _____Sewer____

Electricity ____Gas line ____Waste collection ____Police/Fire _______

3.9 In your opinion: are the monthly costs for these services too expensive for older people?

Water ____ Sewer ____ Electricity ____ Gas ____?

3.10 Are the following Public Facilities available?

Hospital or health clinic? _____ Distance? ______ km. Is it accessible by

Public transport? ________ Library _____ Distance ______ km.

By public transport? ______ Day Centre? _______ Distance _____ km.

By public transport? _____

3.11 Describe Day Centre facilities provided for older persons_______

________________________________________________________

3.12 Are there any private, non-governmental organizations (NGOs) or religious groups providing assistance or services to older or disabled persons in the community, such as: Home visits _______ Meals ______

Health visits ______ Describe ___________________________________________________

3.13 Are there any city or local government programmes for improving housing conditions or the environment underway or planned for in the community? ______ If yes, describe: ___________________________________

4. Home Interviews

Please interview at least 20 older persons living in this community to learn about their living conditions and problems. First, please note the condition of each dwelling, and then ask the following questions:

4.1 Building type: House? _____, or Apartment?______

4.2 Building material: Wood _____Block _____ Brick _____Earth_____

4.2 Size of dwelling: Number of rooms ________Yard/Garden?_______

4.3 Household description: Living alone? _____ With spouse?_______

Number of others: 1 - 3 persons _____; 4 - 6 persons_____

(Is this a Homeless person? ______)

4.4 Do you own: _____ or rent_______ your home?

Cost per month as a percent of income: 10-20%______; 20-30%_____

30 -50%_____; Over 50%______?

4.5 Sanitary facilities: Piped water in dwelling? _____. Public outdoor tap? _____;

Buy from tanker? ______.

Private _____ or Group _____Latrine?

Indoor _____ or Outdoor ______ Bath/Shower?

Is cost of water ______, or use of facilities ______affordable?

4.6 Utilities/Fuels available: Electricity? _____. Gas?_____

Oil? _____Coal? _____Charcoal?_____

Are fuel costs affordable? ________

Waste Disposal: Public? ______Private?_____

Night soil removal: Public? ____ Private? _____

At affordable cost? _____

4.8 Is Police/Fire protection adequate? Yes _____No____

Is street cleaning and lighting adequate? Yes ____No___

4.9 Community Services available? Hospital/Health clinic?_____

Park or Recreation facilities? _______Church? ______ Shops _____?

Elderly community centre? ________ School? Meal delivery _____?

Home visits?______ Which of these do you visit or use?___________

_______________________________________________________

Any Inter-generational programmes with youths?_________________

4.10 Public Transport Service to: shops?_____church?______Hospital or health clinic?_____Community centre?_____ Is the bus fare reduced for elderly persons?_______

4.11 Communication services: Do you have a Telephone? _____TV _______ Radio?

______; Postal service? ______

5. Personal/Family Description

5.1 Male _____ Female ______;Age? ______. Spouses age? ______

5.2 Health? Excellent ____Good _____Fair_____ Poor_____

5.3 Do you have any disabilities?

Respondent: Walking ____Sight _____Hearing _____ Other ______

Spouse: Walking ____Sight _____Hearing _____ Other ______

5.4 Moved to this City from? ______________ Year?______

How long have you lived in: This dwelling? _______ months/years

This community?_____

What place do you call your home? _______________________

5.5 Financial Situation

5.5.1 Do you have a job? _______Type of work _____________________

Hours per week? ___________

5.5.2 Do you receive a pension? ________Social Security?______

Is it enough for your living expenses? _______

5.5.3 Sources of funds for housing and other living expenses:

Job _____ %. Pension ______% Family _______% Savings ______%

Other ______%

5.6 Activities: Work _____ Social _____ Political ______ Voluntary ______ Housekeeping: Cleaning _____Cooking _____Watching children______

5.7 What are your most difficult Living Problems? For example:

Housing conditions: Size ______Needs repairs______

Access problems _____Too crowded? ______Too costly_______

Sanitary facilities: Lacking: ______Inadequate______

Transportation to: shops _____Health centres _____Church______

Environment: Hazardous location _____Unhealthy ____Polluted_____

Safety and Security: Inadequate police and fire protection.

How would you improve your living conditions?

_______________________________________________________

6. Evaluation by Interviewer and Manager

Please write your impressions of the living conditions of older people in this community, responding to the following questions:

- Most important living problems of older persons?
- Adequacy of local government services for older persons
- Are people in the local community trying to help the older people or improve living conditions?
- Involvement of older people in community improvement?
- Any other comments on the Case Study?

3. Best Practices

A session at the Workshop in Amersfoort was devoted to a presentation and discussion of programmes developed in countries to improve the living conditions of Older Persons. Among those discussed were examples from the Best Practices Programme which was conceived by UNCHS to identify success stories in human settlements development for the Habitat II Conference in Istanbul, 1996. Over 600 examples from 80 countries were submitted according to the criteria of impact, partnerships and sustainability. The work of identifying and disseminating best practices is now a continuing UNCHS programme. In 1998, over 300 submissions were made to the Dubai International Award for Best Practices from which 10 were selected.

A brief description of several examples of Best Practices focused on Older Persons are presented below to present an opportunity for their replication in other countries. More detailed descriptions of these examples can be procured from UNCHS through E-mail: [email protected], or at their Web page: http://www.bestpractices.org.

“Care with love”, a training programme for home health care providers, Cairo, Egypt

In the last few years Egypt experienced socio-economic changes that have affected the structure of urban families. This has created new situations of need for health care for the elderly. There are an increasing number of ageing persons who need short or long term non-hospital health care. Family members are rarely available, have the time or the necessary skills to provide these services at home. This brings the need for training health care providers.

“Care with Love” is a training programme developed at the Centre for Geriatric Services in partnership with the Coptic Evangelical Organization for social Services with the following objectives:

1. To provide a comprehensive curriculum for training home health care providers
2. To provide for training of trainers in home health care
3. To create new job opportunities
4. To establish referral units providing accessible and reliable services

Students are recruited from communities where the Coptic Evangelical Organization have development projects and from other NGOs and Church groups. The training process is a well-balanced mixture of theory and lab training in: Public Health and Nutrition; Body mechanics; Communication; Daycare skills; First aid and common diseases. Upon completion of the course the trainees spend a month of internship as Home Health Care Providers under close supervision and evaluation before graduation. The first training course started in 1996 with the objective of training 80 to 100 trainees with two years. For more information contact Magda N. Iskander, MD, email: [email protected].

Urban poor elderly health workers; the Philippines

Older people are respected, but not a priority on anyone’s agenda in the Philippines. For example: there are more than 200 groups in the Greater Manila area dealing with street children, but for “street elderly” and urban poor elderly, virtually nothing. Resources are scarce and the potential of residential care for older persons is economically, culturally unattractive.

The Coalition of Services of the Elderly (COSE) was founded in 1989 as an attempt to keep the elderly poor in the community. The programme empowers them to make decisions, which determine their lives. An organized urban poor community chooses two of its members to become “Community Gerontologists (CGs). A number of the chosen ones have been involved in traditional health care through herbal medicine, as massager, midwives, etc. For three days they are trained by a doctor, dentist and a nurse with an emphasis on ailments and their prevention, especially those of older people. Upon graduation, they receive a kit with a thermometer, blood pressure and sugar measuring instruments; basic tools for examining teeth and common medicines. The two then become the health workers for their own organized elderly in their area. Thereafter, all the CGs from different areas meet once a month with the medical staff/team of COSE to discuss their experiences of the past month and upgrade their skills. Four times a month, the medical team along with the CGs visit a community to render medical outreach services. On days when there is no outreach, the COSE medical team and a rotation of CGs maintain a clinic on health care for older people.

The COSE medical team has produced in Filipino a 120 page “Health Care Manual for the Community Gerontologists and Gerodontists”. The greatest indicator of the success of the programme has come from the Government Department of Health, which recently has proposed a nation-wide health programme for the elderly and invited the COSE medical team as health trainers to participate in the formulation of this programme. Legislation is pending in Congress to establish a national commission for older persons. Original funding for the health programme came from Caritas Netherlands with supplementary aid from HelpAge International. Total cost of the first year of operation was approximately US$15,000.

A city for all: Barrier-free environment in Finland

The neighbourhood of Marjala in the city of Joensuu in eastern Finland is designed to meet the needs of wheelchair-bound inhabitants. All the homes, connections between the home and all streets, parks, etc. are being planned and built to meet this requirement.

Over the past l5 years the City has built special housing for the elderly and disabled. A set of design guidelines require that all dwellings, all shared facilities and all connecting routes allow barrier-free access and mobility. This requirement is applied to even the smallest detail in the neighbourhood so that all streets, pavements, squares, bridges, parks and green areas with their paths and promenades are built to be accessible by all. In order to guarantee the high quality of design the City Council organized a nationwide architectural competition for the master plan for Marjala.

International estimates indicate that 18 to 20 percent of the population face difficulties in mobility in the ordinary urban environment. Many neighbourhoods in Finland have been built for the kind of life that people no longer lead. The majority of inhabitants today spend 24 hours a day in the areas where they live. The elderly, unemployed or people working at home and young people are often left without adequate facilities or opportunities for shared or individual activities. The unemployed rate of Joensuu is extremely high (27% in 1995) and has increased within the last few years.

Marjala has been built so that people can work, live and enjoy their leisure time within their residential area. Cooperation between the inhabitants and the city employees creates networks, which provide support, increase the inhabitants participation and create jobs within the area.

4. Speech of welcome to the workshop by Ms. Mieke Andela-Baur, President of Netherlands Platform Older People And Europe, 9 September 1999

Let me first welcome you on behalf of the Netherlands Platform Older People and Europe (NPOE) to this excellent conference Centre Onze Lieve Vrouwe Maria ter Eem in Amersfoort. The theme of this workshop: Living Conditions of Poor Older Persons in Human Settlements, is a serious and important issue, which has been a policy issue on our political agenda for many years. As people grow older they develop other priorities, demands and needs; a different space or adaptations of their homes that bring them comfort when mobility or visibility is declining. They may also need a different environment in which shops or public transport is available in the neighbourhood, or communication equipment, etc.

On Friday afternoon we hope to tell you about the “Senior Label” which is a sign or insignia indicating that a house is designed for a whole life course. Senior Organization has developed this Label with a research institute and it is being applied in many communities. Good criteria for building and renovation and for the environment are extremely important for the future of a graying society. The Dutch social system is intended to provide care and attention to frail older people in such a way that they still feel and are independent.

One matter of concern is the expectation of loneliness among older People. European research in 1993 found that the percentage of older people who feel lonely in the Netherlands and Denmark is the lowest in Europe: 4 - 5 percent against 36 percent in Portugal and Greece.

NPOE is a project organization aiming at stronger participation of older people in international co-operation and exchange of experience, knowledge and technology. We have developed a number of projects of interest to you. I will mention two briefly.

One of these projects called “Senior Web” is an internet web site and a training and education initiative involving more than 400 volunteer senior “ambassadors” all over the country who train older people in the use of computers and the internet. A new communication channel is opening for older people and is becoming a tool in international communication.

Two, we use the same internet technology to spread news and views on ageing through a website www.MediaAge.net. We would like your Workshop to decide that the wonderful network of experts gathered here will continue through a list, or for a website that Senior Web might build for you to make use of new technology to keep each other informed.

Thank you for your attention. I wish you a fine and fruitful discussion.