Pensions, consumption and health: evidence from rural South Africa
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RESEARCH ARTICLE
Open Access
Pensions, consumption and health: evidence from rural South Africa Peter Lloyd-Sherlock1*, Sutapa Agrawal2 and Francesc Xavier Gómez-Olivé3
Abstract Background: Increasing numbers of older people in sub-Saharan Africa are gaining access to pension benefits and it is often claimed that these benefits promote healthy forms of consumption, which contribute to significant improvements in their health status. However, evidence to support these claims is limited. Methods: The paper uses data for 2701 people aged 60 or over who participated in a population-based study in rural north-eastern South Africa. It analyses effects of receiving a pension on reported food scarcity, body mass index and patterns of consumption. Results: The paper finds that living in a pension household is associated with a reduced risk of reported food scarcity and with higher levels of consumption of food and drink. The paper does not find that living in a pension household is associated with a higher prevalence of current smoking nor current alcohol consumption. However, the paper still finds that tobacco and alcohol make up over 40% of reported food and drink consumption, and that the correlation between reported food scarcity and body mass index status is imperfect. Conclusions: The paper does not show significant associations between pension receipt and the selected risk factors. However, the context of prevalent obesity and high shares of household spending allocated to tobacco and alcohol call into question widely-made claims that pensions enhance healthy consumption among older people in low and middle-income countries. Keywords: Cash transfers; older adults, Consumption, South Africa
Background With reference to sub-Saharan Africa, there is a broad agreement across academic studies and the grey literature that receiving a pension is associated with higher rates of consumption by older people, and it is inferred that this, in turn, is associated with enhanced health and subjective wellbeing [1–6]. Similar claims are made by studies set in other low and middle-income countries, including Peru, Mexico and China [7–9]. Although the evidence supporting this received wisdom is not always robust, there is considerable plausibility to these assertions, especially in settings or for specific groups where * Correspondence: [email protected] 1 School of International Development, University of East Anglia, Norwich NR4 7QE, UK Full list of author information is available at the end of the article
income is scarce and food insecurity prevalent. As well as food, additional forms of “healthy” consumption may include medication and personal hygiene products. These arguments have played an important role in persuading governments across the region to extend or to implement new pension schemes for older people. For example, in 2018 the Kenyan government upgraded a limited set of pilot interventions into a universal old age pension scheme, while Uganda set up a new Senior Citizens Grant in 2011. An underlying assump
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