Association between the Older Person's Grant and Cardiovascular Health among Older Adults in Agincourt, South Africa

Abstract

Cardiovascular health has been a significant concern in aging populations. Studies have well established that the public pension policy, the Older Person’s Grant (OPG), alleviates poverty among older adults in rural South Africa. Despite this, the pathways through which pensions affect health are not well understood. Emerging evidence suggests that public pensions and cash transfers play a role in cardiovascular disease risks, which may also be gender specific. This dissertation aimed to provide new evidence on how public pensions affect hypertension, food security, and overall well-being among older adults in rural South Africa, an under-represented population facing significant health and economic disparities. In three separate papers, I examined public pension impact on cardiovascular risk and outcomes among older adults in rural South Africa. For Chapter 2, I used a quasi-experimental design to assess the OPG expansion policy eligibility impact on probabilities of hypertension among older men using the baseline Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI, 2014/15). For Chapter 3, I used a regression discontinuity design to examine the effect of pension eligibility at age 60 on self-reported food expenditures and food insecurity using the baseline HAALSI. For Chapter 4, I used a qualitative study design to explore how the OPG influences health and spending patterns through semi-structured, in-depth interviews using the Agincourt health and socio-demographic surveillance system 2022. In Chapter 2, exposure to five additional years of the OPG expansion eligibility was associated with a moderate increase of 3.0 to 5.2 percentage points in probabilities of hypertension among men, translating to approximately 120 to 208 additional cases of hypertension out of 4,000 older men. In Chapter 3, the OPG eligibility was associated with 83.11 Rand increase in total monthly household food expenditure, with a significant 28.09 Rand and 6.17 Rand increase in meat, fruits and vegetables expenditures, respectively. The OPG eligibility also significantly reduced the odds of severe food insecurity, with a mean odds ratio difference of 0.52 among pension-eligible older adults compared to those not eligible. Gender-stratified analysis showed women had a more pronounced increase in meat, fruits, and vegetables expenditures, highlighting women’s pivotal role in household nutritional diversity. In Chapter 4, key determinants of spending patterns included morality, religious beliefs, age-related health needs, rural residency, and gender. Pension beneficiaries perceived the OPG as beneficial for improving food security, economic stability, psychosocial health, and chronic disease management. However, significant challenges included out-of-pocket healthcare expenses and the financial burden of hiring caregivers. Across our studies, I found that the OPG plays a critical role in the lives of rural-dwelling older adults in South Africa. The additional income from the OPG expansion influenced health outcomes, particularly hypertension, and spending behaviors, particularly on food. The findings indicate that while the OPG provides essential financial support, it may not be substantial enough to elicit significant improvements in probabilities of hypertension among men due to insufficient funds. Additionally, the research highlights the need for gender-sensitive policies, as women play a crucial role in enhancing household food security and nutritional diversity. However, gaps in the current pension system, such as insufficient funds to cover all healthcare needs and the need for supplementary support, must be addressed to maximize the positive impact of the OPG on aging health among older adults in rural South Africa.