Ageing in the Middle East and North Africa: A Contemporary Perspective

Abstract

One of the central themes in the study of population growth has been ageing. Ageing in the world's population has grown into a dominant demographic feature in twenty-first century society. An ageing population is the result of many contributing factors including the improvement of the health care system. The Middle East and North Africa (MENA) in recent years has attracted much interest from scholars, policy makers and social gerontology. By applying the geographical case studies of the Middle East and North Africa (MENA) this paper critically explores the issues and debates of ageing in a social policy context.

Full text

Population Horizons 2017; 14(2): AOP
Ageing in the Middle East and North Africa:
A Contemporary Perspective
Jamie P. Halsall1* and Ian G. Cook2
Abstract: One of the central themes in the study of population growth has been ageing. Ageing in the world's
population has grown into a dominant demographic feature in twenty-first century society. An ageing population
is the result of many contributing factors including the improvement of the health care system. The Middle East
and North Africa (MENA) in recent years has attracted much interest from scholars, policy makers and social
gerontology. By applying the geographical case studies of the Middle East and North Africa (MENA) this paper
critically explores the issues and debates of ageing in a social policy context.
Keywords: Ageing, Civic Society, Policy, MENA
DOI 10.1515/pophzn-2017-0001
Received 27 February 2017, Accepted: 12 July 2017
*Corresponding author: j.p.halsall@hud.ac.uk
1School of Human and Health Sciences, The University of Huddersfield
2School of Humanities and Social Science, Liverpool John Moores University
© 2017 Jamie P. Halsall, Ian G. Cook
This is an open access article licensed under the Creative Commons Attribution-NonCommercial-NoDerivs License
(http://creativecommons.org/licenses/by-nc-nd/3.0/)
1. Introduction
“Age structure changes in the countries of this
region are accompanied by other significant
transformations such as greater urbanization,
changes in patterns of fertility, and changes in
family structure including living arrangements
and migration within the region for economic,
political and other reasons. Other larger economic
and social changes also contribute to the
reshaping of the region at both the macro and
micro levels. These broad changes affect and are
affected by the various cultures of the peoples in
the region.”
(Glicksman and Aydin, 2009, p. 1).
The above citation is taken from a special journal
editorial that focused on an increasing academic
awareness of Ageing in the Middle East and North
Africa (MENA). In the editorial the authors argue that
‘The Middle East is a region of the world that is in a state
of flux in regard to the age distribution of its residents’
(Glicksman and Aydin, 2009, pp. 1-2). The authors go on
to explain the use of the term ‘flux’ as ‘referring to the
continuing societal change occurring across the region’
(Glicksman and Aydin, 2009, pp. 1-2). These changes
in age distribution have instigated contemporary
academic thinking on population ageing.
From a geographical context, the Middle East and
North Africa is frequently referred to by politicians,
institutions and scholars as the MENA region. The
region itself covers a vast geographical area extending
from Morocco to Iran and encompasses all Middle
Eastern countries. The region is distinct in terms of
social, economic, cultural and religious dimensions.
In a paper by Parkash, et al. (2015) the authors
have argued that in the MENA region the political,
economic, and social leadership are urged to re-define
and modernize the social policy programmes that
create a sustainable and healthy ageing population.
Their conclusion recommends:
“The success in global aging is a good barometer
of medical, social, and economic advances.
However, population aging also presents
special challenges to health care systems, social
insurance and pension schemes, and existing
models of social support. It affects economic
growth, disease patterns and prevalence, and
fundamental assumptions about growing older
[...] Addressing the health care and economic
needs of increasing numbers of elderly will also
require a delicate balancing act with the needs of
other populations as well as political courage to
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Jamie P. Halsall and Ian G. Cook: Ageing in the Middle East and North Africa: A Contemporary Perspective
support often very expensive programs. The time
to provide such measures is now because the cost
of missing this opportunity will be high.”
(Parkash, etal., 2015, pp. 10-11)
This paper is informed by these notions. The aim of
this paper is to analytically examine the contemporary
social policy debates in ageing in the geographical
MENA region. To meet this overall aim the paper
is divided into four sections. The first two sections
provide a critical insight into the academic debate on
the concept of ageing and the great importance that
civic society plays in the age of austerity. Then, the
paper briefly presents the methodology position of the
research. Finally, the paper provides an appraisal of
the past and current trends for the ageing population
in the Middle East and North Africa (MENA).
2. Theorising Ageing
In one sense, population ageing is simple and
straightforward: more people are living longer. And
yet, this simplicity masks a whole series of difficult
and complex questions about ageing. As has been
suggested elsewhere, for example, an ageing society
is generally recognized as being one in which 7% or
more of the population is aged 60 or over (Cook and
Halsall, 2015). Within a society that has high birth
rates and high death rates this percentage is difficult
to achieve. Even if death rates decline, high birth
rates can continue to mask ageing, and so there is
a link to human fertility levels, and thus to gender
and cultural issues within a society. Patriarchal
attitudes, for example, may demand large families
as a means of enhancing family status, wealth and
prestige, and lead to pressures on women to be
child producers and devote themselves primarily
to the internal dynamics of family and household
life. When this is linked to patrilocal residence and
patrilineage, as has been found traditionally in
China for example, or the Arab world (Yount and
Sibai, 2009) then a ‘patriarchal bargain’ occurs
(Yount and Sibai, 2009, p. 291), in which the male is
the head of the household, the main breadwinner,
and the female is dependent not only on her husband
but also on other male kin within the extended
family. Modernization can change or disrupt such a
bargain as women seek greater independence and
opportunities, both within and outside of the home,
and childbearing is no longer seen as the be all and
end all of female life.
Poverty is another key element in this process of
change towards an ageing society. Societies with high
fertility levels tend also to have high rates of infant
mortality and poverty, being caught in a vice whereby
there is pressure to have male children particularly
in order to provide security for one’s old age; yet, the
resultant high population levels, notwithstanding
high rates of infant mortality, in turn limit wealth per
capita and potentially constrain life expectancy due
to associated diseases of poverty and lack of a welfare
system. Until recently, MENA has been caught in such
a vice; total fertility rates (TFRs) were high and life
expectancy was low:
“In 1950-55, 8 of the 23 countries […] had life
expectancies at birth below 40 years. In 12 of the
23 countries, life expectancies at birth ranged
from 40 to 49 years and in only 3 countries did life
expectancies at birth reach 50-59 years.”
(Yount and Sibai, 2009, p. 279)
It was not until the twenty-first century that the region
caught up with other parts of the world via social
change, introduction of pensions and health care
improvement for example, to reach the 7% level of
aged 60 or over noted above, and it is estimated that by
2050, the ‘Western Asia’ part of MENA will reach 18%
and the ‘Northern Africa’ part 19%, if current trends
continue (Dummer, Halsall and Cook, 2011, p. 311). As
for the 23 Arab countries specifically, three will reach
life expectancies of 60-69 years, thirteen will reach
70-79 years and seven will reach 80 years or more
(Yount and Sibai, 2009, p. 279). As has already occurred
in many other countries, more women than men will
reach these older ages and so the ‘feminization’ of age
will take place, as elsewhere. This in turn will affect
the discourse on ageing, which currently tends to be
dominated by the biomedical model in which ‘they’ are
in control of your body; ‘they’ being predominantly male
experts, consultants and physicians who command the
technologies of ageing that are unleashed in the ‘war’
with cancer, the ‘battle’ against heart disease and the
‘struggle’ with dementia, for example, via a neoliberal
agenda linked to modernization and urbanization
(Cook and Powell, 2007; Parker, Khatri, Cook and
Pant, 2014). The patriarchal bargain noted above is no
longer the patriarchal bargain of old traditions, but is
reborn and reshaped as the patriarchal bargain of the
new, gleaming modernities in high-tech hospitals and
medical centres.
Within MENA, there is a further resource
dimension to this projected increase in life
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Jamie P. Halsall and Ian G. Cook: Ageing in the Middle East and North Africa: A Contemporary Perspective
expectancy, resource in terms of economic cost, but
also of environmental resources such as oil and water.
Oil has become an essential component of economic
wealth in the region, with recent declines in oil prices
having an adverse effect on State revenues; although,
some countries such as Saudi Arabia have sufficient
reserve funds ($700 billion according to Bowler, 2015)
to withstand shortfalls, whereas Libya or Algeria for
example, require prices to be far higher than in recent
times in order to be able to balance their budgets. Due
to the rapidity of ageing in such developing societies,
compared to countries like Sweden or France where
ageing took over a century (Cook and Halsall, 2012):
‘their already stretched and under-resourced social
and healthcare systems are likely to struggle to deal
with the burgeoning ageing population’ (Dummer,
Halsall and Cook, 2011, p. 317), and older people are
likely to be affected more than most other parts of
the population by revenue shortfalls in the affected
countries. Similarly, as Vidal (2015) summarizes from
a World Resources Institute Report, water supplies
are due to deteriorate in this region over the next
25 years, as the combination of high temperatures,
overuse of water and “chronic mismanagement” lead
to a major impact on economic growth and national
security. Fourteen countries in MENA are on the list of
33 countries most at risk globally. Again, it will likely
be older people who are potentially most vulnerable,
as are the young, to the instability to which water
shortage will contribute. Already it is said that
drought and water shortage contributed to the conflict
in Syria, and to the consequent massive population
displacement. Theorisation of ageing in MENA must,
therefore, analyse a wide range of contributory factors
in order to more fully understand the context within
which ageing takes place in any specific location.
3. The Role of Civic Society
Many, perhaps most, external perceptions of MENA are
dominated by images of conflict, between Israelis and
Palestinians, Sunni and Shia Muslims, ISIL/Daesh/
Islamic State and others in Iraq and Syria, Libya and
elsewhere. And yet, away from the gunfire and the
oppression lie deep-rooted traditions of societies
that give support to each other via voluntary and
charitable acts that encourage community cohesion
and mutual aid. There are several studies of examples
of sociability, growth of social capital and community
development in a number of countries across the
globe (Cook, Halsall and Wankhade, 2015; Halsall,
Oberoi, Cook and Wankhade, 2013). These argue, for
example, that sociability is a key feature in human
society, notwithstanding the drive for competition
and conflict that is also found. Without sociability,
families and social groups would be left to fend for
themselves in a war of each against all. With it, social
capital can be nurtured and grown via a process of
what Battilani (2011, p. 158) called ‘sustained group-
level co-operative behaviour’, such that the social
resources of the society can enhance the wellbeing of
even the poorest members of society and enable the
society to be resilient in the face of both internal and
external threats. Social networks, institutions and
opportunities for public engagement and involvement
are key elements in this move towards a better future,
one in which community development, for example,
facilitates collective action and a response to local
grassroots situations and conditions.
Within the MENA region, these concepts have
tended to be expressed via religious faith groups, given
that the Middle East in particular is the crucible of three
of the world’s main religions: Judaism, Christianity
and Islam. Each of these religions offers a community
dimension via key ideas of voluntarism and charitable
giving (Arjomand, Feierman, Ilchman, Katz and
Queen,1998). Judaism, for instance, established the
idea and practice of the kibbutz, which is a collective
agricultural organization that was first established in
1909 at Degania (Baratz, 1956). Although there has
been criticism of the kibbutz model in recent years due
to the impact of neo-liberalization, which has led to
the introduction of differential salaries for differential
work, contrary to the original ideals of equal pay for
equal work. Dagan, for example, argues that there
has been a recent revival that is largely due to the
communal concept of shitafi that has been attractive
to many younger people (Dagan, 2010). Similarly,
the concept of tzedakahis a key feature of Judaism,
the charitable giving of 10% of income (www.jewfaq.
org), while in Christianity the parable of ‘The Good
Samaritan’ is indicative of how a Christian should
aid someone in need, regardless of their background,
and underpins charitable works in different parts of
MENA where Christians are found. And then for Islam
there are concepts that include community giving
ideas of ummah, or waqf or the month of Ramadan
itself in which, apart from fasting during the hours of
daylight, charitable giving via Zakat is a key feature,
particularly giving for the less fortunate (Harrison and
Alwan, 2016).
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Jamie P. Halsall and Ian G. Cook: Ageing in the Middle East and North Africa: A Contemporary Perspective
Across MENA, we suggest that it will be crucial
that such concepts as these, whichever religion they
emanate from, plus other ideas from secular traditions,
are developed and applied in order to aid the growth
of a civic society that transcends public or private
sector funding. This is not to say that social capital or
community engagement are easy to develop; they are
not, but in our research the authors are confident that
there are sufficient examples from across the globe,
in highly diverse circumstances, to ensure that a
combination of local initiative and external expertise
can nurture the seeds of a lasting and resilient civic
society across the region. Below, we shall provide
examples of how such ideas can be applied to ageing
per se, but firstly we present a brief summary of the
methodology that underpins this paper.
4. Methodology
In writing this paper the authors have used the
qualitative theorising research approach. This
stance in social research has become popular in the
social science discipline. For example, Alasuutari
(1996) notes that there has been ‘interplay’ between
theory and qualitative research. In the judgment by
Alasuutari (1996) the social science discipline theory
is driven around the collective social instrument that
enables the theory to explain. Coupled with this is the
notion that ‘qualitative inquiry deals with a singular
case, within the notion of theory - and the underlying
ontology - the case analysis is supposed to shed light
on such a general system or mechanism’ (Alasuutari,
1996, p. 372). The authors of this paper have used a
qualitative theorising research approach in other
previous studies (Cook, etal., 2015; Halsall, 2015; Cook
and Halsall, 2011) and found this technique beneficial
as it provides a holistic approach when dealing with
knowledge exchange. Knowledge exchange in the
authors’ work (Cook and Halsall) has allowed the
wider academic community and other interest groups
(e.g. public/private institutions, NGOs) to create
dialogue in the subject matter.
The authors have used a number of up-to-date
academic sources in the research field. Furthermore,
documentary data sources have been scrutinised, and
varied sources such as media information and policy
reports. Using a documentary data source as a method
has allowed the authors to provide a contemporary
insight into the economic, social, political and cultural
challenges in the MENA region. Moreover, Mogalakwe
(2006, p. 222) notes that applying the documentary
data source method ‘requires rigorous adherence
to research protocol’ in relation to qualitative data
analysis.
For this research the authors have applied
thematic analysis. Thematic analysis enables the
authors to identify, study and note patterns from the
documentary data sources. The research applied a
six-stage thematic analysis developed by Braun and
Clarke (2006):
1. “Familiarising with the data
2. Create codes
3. Investigate for themes
4. Review the themes
5. Define and name the themes
6. Write a report.”
(Braun and Clarke in Halsall, etal., 2015, p. 316)
After these stages were followed the authors
scrutinized the results, thus allowing them to compare
and contrast with the literature review.
5. Population Ageing in the
Middle East and North Africa
(MENA)
The MENA population rates have attracted much
critical attention in recent years (Yorulmaz, 2016;
Masoumi, 2014; Ncube, et al., 2014). A World
Population Ageing report written in 2015 by the United
Nations examined the global population projections
in the current social and economic climate. The report
highlights that in the Middle East 30% of older people
obtain a pension, whilst in North Africa the pension
coverage is almost 37% (Department of Economic and
Social Affairs, 2015, p. 84). The populations that live in
the MENA region have traditional cultural values. At
the heart of the population’s cultural values is a strong
emphasis on family, and more importantly, admiration
for elderly people. However, what has become evident
in recent times is the way in which family structures
are changing, in part due to the neoliberalization
noted above. Moreover, Parkash, et al. (2015, p. 9)
state that:
“Faced with a different kind of the realities of
present day living conditions, several families are
not able to properly look after their elderly resulting
in sending the elderly to nursing homes (Abyad,
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Jamie P. Halsall and Ian G. Cook: Ageing in the Middle East and North Africa: A Contemporary Perspective
1996, 2001). However, the political ruling classes
still assume that families will take care of their own
elderly. The changes in this setup of socio-economic
patterns demands for provision of long-term care as
an important part of health care structure (Abyad
1996, 2001; Kinsella and He, 2009).”
The demographic patterns in the MENA region with
regards to the elderly populations is one of increased
levels of longevity. As stated earlier in this paper, people
are living longer than ever before due to improvements
in the health care system. A paper written by Patrick
Clawson for the Washington Institute predicts that
within ‘a few decades, the Middle East is expected to
experience a rapid increase in the elderly population,
which by 2050 will exceed the number of children in
many of the region’s countries’ (Clawson, 2009, p. 1).
As we note below, even a country like Egypt that
currently has high numbers of those aged 15 years or
less is forecast to be in this situation. Research carried
out by the Rockefeller Foundation in 2011 notes that
life expectancy in the MENA region is on the increase.
Furthermore, the improvement in life expectancy is due
to the better medical facilities that are available. The
RockefellerFoundation states that: ‘Life expectancy
across the Arab world averages nearly 68 years, up
from 52 in 1970-75. In 2000, approximately 10 million
people in the MENA region were aged above 65 years;
in 2030, this bracket will constitute roughly 50 million’
(2011). These observations are comparable with the
Population Reference Bureau, who in 2001 made
elderly population forecasts that caused the prediction
for Egypt and Saudi Arabia. As the MENA policy brief
notes, ‘the elderly population of Egypt (60 years and
older) is expected to grow from 4.3 million in 2000 to
23.7 million in 2050. Saudi Arabia’s elderly population
is expected to grow from 1 million in 2000 to 7.7 million
in 2050’ (Population Reference Bureau, 2001, p. 3).
The rise in the elderly population in the MENA
region has had significant ramifications for the
expenditure and structure of health and social care
systems. Parkash, et al. (2015) have warned that
governments across the MENA regions are facing a
number of social and economic challenges ranging
from adequate clean water, employment, education,
health care and housing in a geographical region
where population is rapidly increasing. In 2016, for
example, Egypt had to agree a three-year $12 billion
loan package from the IMF in order to shore up its
economy, which has high budget deficits (Britannica,
2017). Figure 1 offers a summary that has been created
by Parkash, et al. (2015) that provides an overall
picture of the challenges facing the ageing population
in the MENA region. To these we can add that it is
difficult to see how rapid population increase can
be sustained in the face of the resource constraints,
especially current and projected water shortages of
the type we note above.
Research carried out by Hajjar, etal. (2013) notes
that in the Middle East the geographical area is
enduring considerable adjustments in its population
and health connected issues. One commanding feature
is that chronic, non-communicable diseases are
replacing infectious diseases. It has been calculated
that non-communicable diseases make up 47% of the
Middle East’s illness and by 2020 it is estimated that
this could rise to 60%. As Hajjar, et al. (2013, p. 12)
observe:
“In a recent survey in nine Arab countries, the
percentage of older adults suffering from at least
one chronic disease ranged from 13.1% in Djibouti
to 63.8% in Lebanon, with a rate of 45% in the
majority of countries. Cancer rates vary in the
region, with elevated rates of lung and bladder
cancer noted among men in Tunisia, Algeria,
Jordan, Egypt, and Lebanon, and of breast cancer
among women in Israel and Lebanon: age-
standardized-rate (ASR) 91.9 and 71, respectively.”
More ominously, Hajjar, et al. (2013) state that
according to registry data in the Middle East the
information demonstrates a rise in cancer disease. The
• "Kuwait, most Persian Gulf states, and Saudi Arabia having substantial financial resources with a relatively smaller population
and rapid development.
• Algeria, Egypt, Israel, and other countries with less financial resources and significantly more population but having several
larger medical establishments and more trained medical personnel.
• Iran, Iraq, Lebanon, and other countries that have faced several devastating wars resulting in reduced number of medical
establishments."
Source: (Adapted from: Parkash, etal., 2015, p. 9)
Figure 1: The demographic and economic characteristics of the MENA region.
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Jamie P. Halsall and Ian G. Cook: Ageing in the Middle East and North Africa: A Contemporary Perspective
pattern of the rise in cancer patients is illustrated in
the following countries, namely Lebanon, Turkey and
Sultanate Oman. Figure 2 presents an overall ageing
picture in relation to cancerous diseases.
A research study undertaken by Sibai, etal. (2014)
discovered that there are other health concerns in
the MENA region. In their report they identify two
areas: (1) disability and impairments in the elderly
population, and (2) mental health. The report states
that for disability and impairments:
“Wide variations in physical dependence among
older Arab persons are noted across countries and
by gender. High prevalence rates of limitations
in activities of daily living (ADL) were reported
in Egypt, Jordan, Lebanon and Tunisia (varying
between 25 and 38 percent) followed by the UAE
and Saudi Arabia (17–19 percent).” (Sibai, etal.,
2014, p. 36)
Sibai, etal. (2014) have noted that mental health data
in the MENA region is lacking and according to work
by Okasha (2003, p. 41) the cultural beliefs of using
a ‘traditional healers’ to deal with mental health is
somewhat complex. However, the study suggests
that depression is the most prevailing psychiatric
complication amongst the elderly population. It
has been indicated that, in terms of the population
‘over 50 percent in Tunisia, 35 percent in Saudi
Arabia and 23 percent in Jordan and Lebanon’ are
affected (Sibai, etal., 2014, p. 36). Depression as a
mental health issue is higher in women, the elderly,
divorced, separated and those who are widowed. The
report goes on to warn that dementia is progressively
becoming a prevalent cause of cognitive impairment
amongst the elderly. A high portion of suffers are
diagnosed as having Alzheimer’s disease. As Sibai,
etal.(2014, p. 36) note:
“In the Middle East and North Africa (MENA)
region, the estimated number of people with
dementia is expected to grow exponentially
from 1.2 million in 2010 to over 2.5 million in
2030 (Alzheimer’s Disease International, 2009).
Epidemiological studies on dementia in Arab
populations have rarely been reported. A single
prevalence study among people 60 years and
older in the Assiut province of Egypt revealed
an overall prevalence of clinically diagnosed
dementia of about 5 percent, increasing to 19 and
25 percent, respectively, among men and women
aged 85 years and older.”
Across the MENA region there are a number of support
groups and associations that support the elderly with
particular health concerns. However, a recent article
by Hussein and Ismail (2016) noted that in the Arab
states there is more work required on policy initiatives
to set up a sustainable and official long-term care
provision to support people who provide for elderly
and disabled family members. Moreover, Hussein and
Ismail (2016, p. 11) called for more emphasis on joined
up thinking with governments in the with region and
policy makers:
“One strand of policies relates to increasing
access to care facilities, such as the availability
of services including community based care. Very
little information is available on the levels or use
of care homes or long-term nursing or social care
• Lebanon:
“The number of new cases of cancer in Lebanon has increased steadily over the past decade, according to the National Cancer
Registry of the Ministry of Public Health and WHO. In 2004, the most recent year for which data was provided, 7197 new cases of
cancer were reported, representing a modest increase over the previous year.”
• Turkey:
“Aging is one of the fundamental factors in the development of cancer. Given the fact that almost 60% of cancers are connected
to aging, health policies in Turkey should be reconsidered in this context.”
• Sultanate of Oman:
“A significant increase in cancer incidence is projected in Oman due to aging. Globocan predicts an increase there from 949
cases in 2010 to 2451 cases by 2020 and 3792 cases by 2030. Factors such as changes in smoking habits, diet and lifestyle, are not
included in this analysis.”
Source: (Adapted from: Hajjar, etal., 2013, p. 14-17)
Figure 2: Current ageing health challenges facing: Lebanon, Turkey and Oman.
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Jamie P. Halsall and Ian G. Cook: Ageing in the Middle East and North Africa: A Contemporary Perspective
in the region, with studies limited mainly to Egypt,
Kuwait, Lebanon and more recently Jordan. In a
number of the Arab countries, including Egypt and
Tunisia, some universities and voluntary sector
initiatives play an important role in providing
basic health and care services, usually staffed by
students and volunteers, to poorer older people.
These might be expanded and encouraged by
policies or offered financial incentives in the form
of tax relief or other benefits.”
To tackle this problem head on Hussein and Ismail
(2016) believe that there should be greater investment
in the programmes that would support and facilitate
health care provision. This can be achieved by
a stronger relationship between civil society
organisations and the state, thus allowing institutions
to develop new health programmes in the geographical
region. Hussein and Ismail stress ‘a particular need
to foster a regulated and well-organised home-based
care service, this would facilitate caring for older
people while remaining within their own families and
communities’ (2016, p. 12). For this to work, greater
involvement from the private sector healthcare is
required, as in Lebanon. There are other academic
studies that call for similar changes in the elderly
health care system in the region (Abdelmoneium
and Alharahsheh, 2016). It will of course be essential
that within state systems the needs of minorities are
fully taken into account. The Kurds, for example, are
reckoned to be one of the largest stateless minorities
in the world, numbering between 30-45 million
in contrasting estimates, and are a transnational
community that straddles Turkey, Iraq, Syria and Iran.
Alawites in Syria, Druze in Lebanon, Sunni Muslims
in Iraq, Coptic Christians in Egypt and the Tuareg in
the Saharan reaches of Southern Libya and Southern
Algeria are other significant minorities that will have
their own specific histories and cultures within the
broad analysis that we present here. Further research
will be required to tease out the specificities of their
needs within the broad trends to which we refer here.
6. Conclusion
This article provides an analytical overview of the
key social and economic challenges in ageing in the
MENA region. At the start of the paper the authors
present an overall geographical illustration of the
MENA area. As shown, when it comes to ageing the
MENA region has a well-defined society in terms of
social, economic, cultural and religious aspects. The
authors offer a theoretical viewpoint on ageing from a
global perspective. Globalization is now seen as a key
economic force in society and thus has had an impact
on the way people live, and, as the authors note in this
paper, there is a great emphasis on the civil society.
The common factor in a successful civil society is
citizens that have common interests that create a
positive, unified environment.
The paper also highlights that family structures
have become vital as they act as key support
mechanisms to support the elderly by providing
quality health and social care. People living longer
in the MENA region brings new health concerns,
such as cancer and dementia. Hence, this brings new
focus on health and social care systems. Providing
quality health and social care comes at a cost. As
found in this paper and other research by Hussein
and Ismail (2016), there is a clear demand by states
in the MENA area to create new policy initiatives to
support the elderly. This can be tackled by redefining
health and social care services by moving towards a
community-based care approach. A community-based
care approach is perceived by scholars and social
policy makers (Abdelmoneium and Alharahsheh,
2016; Hussein and Ismail, 2016) as the best type of
approach, as this concept enables health and social
care programmes to be applied at a local level. More
crucially, this local approach allows different social
groups and institutions to work closely together.
Acknowledgements
The authors of this paper would like to thank the
reviewers for their constructive comments. Special
thanks go to Ms Stefanie El Madawi, who was our
proofreader.
References
Abyad, A. (1996). Family Medicine in the Middle-East: reflection
on the experiences of Several Countries. Journal of the
American Board of Family Physicians, 9(4): 289-97.
Abyad, A. (2001). Health care services for the elderly a country
profile - Lebanon. Journal of the American Geriatrics
Society, 49: 1366-1370.
Abdelmoneium, A. O. and Alharahsheh, S. T. (2016). Family
home caregivers for old persons in the Arab Region:
perceived challenges and policy implications. Open Journal
of Social Sciences, 4(1): 151-64.
Alasuutari, P. (1996). Theorising in qualitative research: a
cultural perspective.Qualitative Inquiry, 2(4): 371-84.
Unauthenticated
Download Date | 8/9/17 2:36 PM

8
Jamie P. Halsall and Ian G. Cook: Ageing in the Middle East and North Africa: A Contemporary Perspective
Arjomand, S. A., Feierman, S., Ilchman, W. F., Katz, S. N. &
Queen, E. L. (1998). Philanthropy in the World’s Traditions,
Bloomington, Indiana: Indiana University Press. 398p.
Baratz, J. (1956). A Village by the Jordan: The Story of Degania,
Tel Aviv: IchudHabonim. 174p.
Battilani, P. (2011). The creation of new entities: stakeholders
and shareholders in nineteenth century Italian
co-operatives. In: A. Webster., L. Shaw, J.K. Walton, A.
Brown., & D. Stewart. (Eds.), The Hidden Alternative:
Co-operative Values, Past, Present and Future, pp. 157-176.
Manchester: Manchester University Press.
Bowler, T. (2015). Falling oil prices: who are the winners and
losers? www.bbc.co.uk/businessAccessed 19January 2017.
Braun, V. & Clarke, V. (2006).Using thematic analysis in
psychology.Qualitative Research in Psychology, 3(2): 77-101.
Britannica. (2017). World Data: Egypt. Chicago, 443-444.
Clawson, P. (2009). Demography in the Middle East: Population
Growth Slowing, Women’s Situation Unresolved,
Washington: The Washington Institute.
Cook, I. G. & Powell, J. L. (2007). Ageing urban society:
discourse and policy. In: F. Wu, (Ed.), China’s Emerging
Cities: The Making of New Urbanism, pp. 126-42. London:
Routledge.
Cook, I. G. and Halsall, J. P. (2012). Aging in Comparative
Perspective: Processes and Policies. New York: Springer.
94p.
Cook, I. G., Halsall, J. P. and Wankhade, P. (2015). Sociability,
Social Capital, and Community Development: An
International Health Perspective. New York: Springer. 140p.
Dagan, D. (2010). Kibbutz-diary: socialism for the 21st century,
www.huffingtonpost.com/david-dagan Accessed June 14th
2 0 1 7.
Department of Economic and Social Affairs (2015).World
Population Aging 2015. United Nations: New York.
Dummer, T. J. B., Halsall, J. P. & Cook, I. G. (2011). Longevity
in the 21stCentury: A Global Environmental Perspective.
International Journal of Society Systems Science, 3(4): pp.
307-24.
Glicksman A. &Aydin, M. J. (2009).Introduction to Special Issue
of Journal of Cross Cultural Gerontology on Aging and the
Middle East.Journal of Cross-Cultural Gerontology, 24(1):
1-4 .
Hajjar, R. R., Atli, T., Al-Mandhari, Z., Oudrhiri, M., Balducci,
L.&Silbermann, M. (2013).Prevalence of aging population
in the Middle East and its implications on cancer incidence
and care.Annals of Oncology, 23(7): 11-24.
Halsall, J. P., Cook, I. G. and Wankhade, P. (2015). The British
big society effect: the challenges of the third sector.
International Journal of Sustainable Society, 7(4): 309-21.
Halsall, J. P., Oberoi, R., Cook, I.G. and Wankhade, P. (2013).
Understanding community governance: a global
perspective. International Journal of Asian Social Science,
3(5): 1112-1127.
Harrison, P. &Alwal, L. (2016). Charity in Ramadan explained:
giving up food, giving back to society https://english.
alarabiya.net. Accessed 20 June 2016.
http://www.jewfaq.org/tzedakah.htm Accessed June 12th 2017.
Hussein, S. & Ismail, M. (2016).Ageing and elderly care in the
Arab Region: policy challenges and opportunities, Ageing
International.Doi:10.1007/s12126-016-9244-8
Kinsella, K. & He, W. (2009). International Population Reports,
P95/09-1, An Aging World: 2008 U.S. Census Bureau, U.S.
Government Printing Office, Washington, DC: National
Institute of Aging.
Masoumi, H. E. (2014). Urban sprawl in mid-sized cities of
MENA, evidence from Yazd and Kashan in Central Iran.
Management Research and Practice, 6(2): 25-41.
Mogalakwe, M. (2006).The use of documentary research
methods in social research.African Sociological Review,
10(1): 221-30.
Ncube, M., Anyanwu, J. C &Hausken, K. (2014).Inequality,
economic growth and poverty in the Middle East and
North Africa (MENA).African Development Review, 26(4):
435-53.
Okasha, A. (2003) Mental Health Services in the Arab world,
Arab Studies Quarterly,25(4): 39-52.
Parkash, J., Younis, M. Z. & Ward, W. (2015).Healthcare for the
ageing populations of countries of the Middle East and
North Africa.Ageing International, 40(1): 3-12.
Parker, S. L., Khatri, R., Cook, I. G. &Pant, B. (2014). Theorising
aging in Nepal: beyond the biomedical model. Canadian
Journal of Sociology, 39(2): 231-54.
Population Reference Bureau (2001). Population Trends and
Challenges in the Middle East and North Africa,MENA
Policy Brief.
Rockefeller Foundation. (2011). MENA’s aging population could
lead to difficult choices. http://www.searchlightcatalysts.
org/node/176Accessed 6thFebruary 2017.
Sibai, A. M., Rizk, A. and Kronfol, N. M. (2014).Ageing in the
Arab Region: Trends, Implications and Policy Options,
Lebanon: The Center for Studies on Aging.
Vidal, J. (2015). Middle East faces water shortages for the next
25 years, Study Says The Guardian. www.theguardian.com
Accessed 6thFebruary 2017.
Yount, K. M. and Sibai, A. M. (2009).Demography of aging in
Arab countries. In: P. Uhlenberg, P (Ed.), International
Handbook of Population Aging, pp. 277-315. New York:
Springer
Unauthenticated
Download Date | 8/9/17 2:36 PM