Age International second submission to the IDC inquiry into COVID-19 on longer term impacts

1. Governments around the world are facing the double challenge of having to contain a health pandemic at the same time as responding to its economic and social impacts.
    
2. In our first submission to the IDC inquiry into COVID-19 we highlighted the discrimination that older people are dealing with when accessing healthcare, the risk that older people face in humanitarian settings, and the increased levels of gender-based violence that older women are forced to endure.

3. This submission will outline the need for the UK Government to include older women and men in longer-term efforts to respond to COVID-19 through building inclusive health systems, increasing support for social protection, and by aligning itself with the growing international consensus that older women and men are integral to achieving international development objectives.
    
4. Speaking in the recent IDC evidence session on Effectiveness of UK Aid, Secretary of State for International Development, Anne-Marie Trevelyan said “We have before us a health crisis, a humanitarian crisis and an economic crisis, which threatens to undo 30 years of international development work."[1]

5. The COVID-19 crisis should also be seen as an opportunity for the UK Government to improve its international development assistance so that it is fully inclusive of every member of society, no matter their age. This extends to supporting countries to build inclusive healthcare systems, improve social protection systems and strengthening the protection of human rights of women and men of all ages.

Introduction
 

6. Age International is a UK charity focused on improving the lives of older people in developing countries. Age International is the international arm of Age UK and works together with HelpAge International as the UK member of the HelpAge global network. Our mission is to help older people around the world to overcome poverty, claim their rights and challenge discrimination, so they can lead dignified, secure, active and healthy lives.

Building better health systems

7. COVID-19 has exposed the importance of universal health coverage that is inclusive of people of all ages. Current healthcare systems in most lower and middle-income countries lack the resources and specialist expertise necessary to take into account the health rights and needs of older women and men. Basic gerontological training and primary healthcare provision would greatly strengthen the resilience of countries to prepare for future possible pandemics.

8. COVID-19 has also demonstrated the significance of the prevention, treatment and management of non-communicable diseases (NCDs)[2]. NCDs such as cardiovascular diseases, cancer, diabetes and chronic respiratory diseases have been recognised as a leading cause of death and disability. They are the number one cause of death worldwide, accounting for 70% of all deaths and more than three out of four years lived with a disability. Additionally, four out of five people with an NCD live in low- and middle-income countries.[3] Older people are at increased risk of NCDs. It is estimated that 71 per cent of those who die of non-communicable diseases are people aged 60 and over.[4]
    
9. Discussions on how to deliver better healthcare in low and middle-income countries often exclude the rights and needs of older people. COVID-19 has exposed ageist stereotyping of older people and discriminatory attitudes in the provision of healthcare.
    
10. International agreements, such as the Sustainable Development Goals, the UN Political Declaration of the High-Level Meeting on Universal Health Coverage in 2019, and the WHO Global Strategy and Action Plan on Ageing and Health, make clear achieving better health must be for people of all ages and that this benefits society as a whole.
     

Building better social protection systems

11. Strong social protection systems are a key part of the short and long-term response to COVID-19 to ensure that people can access healthcare while supporting job and income security for those who are most affected. The International Labour Organisation (ILO) says that "countries that have effective health and social protection systems in place that provide universal coverage are better prepared to respond to the crisis."[5]
     
12. Efforts to tackle the long-term social and economic impacts of COVID-19 need to include older people and their families. Pensions are a crucial form of social protection, which older people often invest in their family’s future by educating children or setting up a business. Globally just over half of older people receive a pension, however in low income countries, only 20 per cent of older people have access to a pension.[6]
     
13. As of 1st May, a total of 159 countries have planned, introduced or adapted 752 social protection measures in response to COVID-19.[7] Social assistance or non-contributory transfers are the most widely used class of intervention, followed by actions in social insurance and supply-side labour market programmes. Examples of social protection efforts for older people include:
1. In Sri Lanka the government has increased the amount of social pension paid to an older person, from LKR 2,000 to 5,000, benefiting 559,109 people.[8]
2. In the Philippines, households with at least one older person will receive an emergency cash aid of P5000-P8000 (£79-£127).[9]
3. The Malaysian government has granted a one-cash transfer to all public pensioners of RM500 (£94) which will benefit 850,000 pensioners.[10]
4. In Kenya the government has released Sh8.8 billion (about £66m) to over a million older people and people with disabilities under the Inua Jamii Social Protection Programme.[11]
    
14. Investing in social protection programmes, and in particular social pensions, makes sense for the long-term recovery and growth of economies. The money given to an older person through a social pension is invested in their families and spent in their communities. Families depend on an older person’s income to supplement the family budget and to support younger generations to attend school. The introduction of lockdowns and physical distancing measures to reduce the spread of COVID-19 is limiting an older person’s ability to earn an income and the introduction of social protection systems in many low and middle income countries are enabling families to feed themselves and keep themselves afloat. Simply put, when an older person’s income is restricted, all generations suffer.
     
15. Speaking before Kenya introduced the Inua Jamii Social Protection Programme, Mama Agnes Kariuki who is the coordinator of Kibera Daycare Centre for the Elderly, an organisation that caters for vulnerable older persons in the Kibera informal settlement in Nairobi, Kenya said, "The greatest cry I get from the older people here right now is their wish that the near lockdown would have been implemented after they have been paid their monthly social pension. The last time the older people were paid their stipend was in January when they got the November and December payment. Right now they have no money to pay rent let alone to afford stock up necessities should the ban on gathering and walking about prolong. The situation is dire and some are getting desperate."[12] The situation was compounded by the fact that payments due in March 2020 from another government scheme, Inua Jamii Plus 70 for older people had also not been paid, however now the Kenyan government has released funds and allowed older people to access them while respecting physical distancing.
     
16. As mentioned in our previous submission, DFID has worked with the Government of Uganda to deliver a Senior Citizens Grant, which currently supports over 168,000 older people with a cash transfer. As populations around the world continue to age, the topic of providing a basic income and support package to older people continues to increase in relevance. The UK government will play a key role in efforts to build back communities to deal with the social and economic impact of COVID-19 and will want to invest their efforts in supporting countries to help themselves.
     
17. In the longer term, there is an opportunity to make economic and financial systems, more inclusive and to redress inequalities. The lack of investment in and erosion of public services including social protection and health systems has left them ill-equipped to cope with crises such as COVID-19. It is crucial that the rights, specific realities and needs of older women and men are included in UK government efforts to support economic recovery from COVID-19.[13]
     

Tackling ageism and supporting human rights

18. COVID-19 has shone a light on the persistent age discrimination that many older people face in their everyday lives. Before COVID-19, there were cases of older people being turned away from healthcare services or told that they “were not ill, just old”. Reported cases of ageism, discrimination and denial of healthcare are now increasing at a time when older people face the highest risk. Partners on the ground in The Philippines are reporting the discrimination that older people are facing when attempting to access healthcare, they said: “Two older people died because they were denied treatment (one older person went to 6 hospitals but was refused admission and the other one denied by 10 hospitals and 1 clinic and died at the ambulance).”[14]
     
19. The impact of COVID-19 on older persons has been recognised by the UN with two reports produced by the Secretary-General providing clear guidance and leadership[15][16]. In the launch of his Policy Brief “The Impact of COVID-19 on older persons”[17], the Secretary General highlighted four main messages:
1. No person, young or old, is expendable. Older people have the same rights to life and health as everyone else. Difficult decisions around life-saving medical care must respect the human rights and dignity of all.
2. While physical distancing is crucial, let’s not forget we are one community and we all belong to each other. We need improved social support and smarter efforts to reach older people through digital technology, that is vital to older people who may face great suffering and isolation under lockdowns and other restrictions.
3. All social, economic and humanitarian responses must take the needs of older people fully into account, from universal health coverage to social protection, decent work and pensions. The majority of older people are women, who are more likely to enter this period of their lives in poverty and without access to healthcare. Policies must be targeted at meeting their needs. 
4. Do not treat older people as invisible or powerless. Many older people depend on an income and are fully engaged in work, in family life, in teaching and learning, and in looking after others. Their voices and leadership count.
    
20. The UN has taken significant steps forward in how it views older people, recognising that they are a group that is being disproportionately affected by COVID-19, not just in relation to fatality from the virus, but also in the longer term social and economic impacts of the virus. The UK Government should be taking the same approach to align themselves with global thinking and to ensure that its interventions around the world do not reinforce structural inequalities.
     
21. The UK Government’s international response to COVID-19 needs to focus on responding to the rights and needs of those who face the highest-risk from COVID-19. The UK Government needs to avoid ‘leap-frogging’ over the primary health impacts of the pandemic and ensure its approach to the secondary economic and social impacts, are inclusive of all groups and do not leave older women and men behind.
     

Leave No One Behind

22. The Secretary of State for International Development, Anne-Marie Trevelyan recently said that her “profoundest concern is that the secondary impacts will be felt for years to come and the poorest will be most disproportionately affected.”[18] DFID has recognised that older people “are disproportionately impacted and at more serious risk of severe complications and fatality due to COVID-19”.[19] However older people are not just affected by the health part of the crisis, they also face social and economic impacts alongside all other sectors of the population.

23. The UK Government’s commitment to Leave No One Behind, as part of its support for delivering the SDGs, makes clear that the rights and needs of older women and men who are marginalised must be addressed. Failure to do so in the context of COVID-19 could leave older people facing even greater levels of discrimination and inequalities.

24. The Government’s response to COVID-19 offers the opportunity to articulate more clearly how it will meet its commitments to Leave No One Behind, and to support partner governments to build back better.

Recommendations

25. DFID has recognised the disproportionate impact that COVID-19 is having on the health of older people but now needs to recognise the social and economic impact that the crisis will have on them in their longer-term plans as well.
     
26. The UK Government needs to articulate more clearly how its response to COVID-19 is taking into account the rights and needs of older women and men. Older people must be protected globally on an equal basis with others in response to COVID-19.
     
27. The UK Government needs to ensure that its work to “strengthen health systems through our work in-country, as well as through our support to the WHO and other global health initiatives”[20] is inclusive of people of all ages, and includes a greater focus on non-communicable diseases.
     
28. DFID must ensure that older people are included in longer-term efforts to respond to the secondary economic and social impacts of COVID-19 by extending the Government’s support for improving social protection systems such as universal social pensions.

For further information, please contact:

Zoe Russell

Parliamentary Officer, Age International
zoe.russell@ageinternational.org.uk