Living arrangements of older women and men in Kuwait

In-Depth Ethical Analysis of the COVID-19 Vaccine Rollout for Migrant Workers in the Gulf Countries

During the initial COVID-19 vaccine rollout, supplies were scarce, necessitating rationing. Gulf countries, hosting millions of migrant workers, prioritized nationals over migrants for vaccination. As it turned out, many migrant workers found themselves waiting behind nationals to get vaccinated for COVID-19. Here, we discuss the public health ethical concerns surrounding this approach and call for fair and inclusive vaccine allocation policies. First, we examine global justice through the lens of statism, where distributive justice applies only to sovereign state members, and cosmopolitanism, advocating equal justice distribution for all humans. We propose a cooperativist perspective, suggesting that new justice obligations can arise between people beyond national ties. In cases of mutually beneficial cooperation, such as migrant workers contributing to a nation's economy, equal concern for all parties is required. Second, the principle of reciprocity further supports this stance, as migrants significantly contribute to host countries' societies and economies. Additional ethical principles-equity, utilitarianism, solidarity, and nondiscrimination-are essentially violated when excluding non-nationals in vaccine distribution. Finally, we argue that prioritizing nationals over migrants is not only ethically indefensible, but it also fails to ensure full protection for nationals and hampers efforts to curb COVID-19 community spread.

Ageing in Saudi Arabia: new dimensions and intervention strategies

Ageing process of population passing through demographic dividend in many of the Arab countries, including Saudi Arabia, where the demographic transition process entered a progressive stage. This process has been accelerated with rapid reductions in fertility caused by various changes in the socio-economic and life style dimensions. Researches on population ageing in the country are rare and thus this analytic research aims at exploring population ageing trends at the backdrop of demographic transition to help build up demanded strategies and policies. This analysis explains a rapid native population ageing especially on absolute size: an increase in line with theoretical demographic transition process. Consequently, structural changes in age distribution accompanied a change in age pyramid from an expansive shape of the late 1990s to a constrictive shape in 2010 and further shrinking by 2016. Obviously, various age related indices-age dependency, index of ageing, and median age-exemplify this trend. Still, the old aged population remain static in terms of percentages or indices, exemplifying that the movement of age cohorts continue in the early ages shall reach old age, soon, in this decade: hence, characterizes retirement boom and multiple pathologies compressed to last years of life. Thus, this is an ideal time to prepare for challenges of ageing, learning from the experiences of nations confronted with similar demographic trends. Old aged population deserves care, concern and compassion to 'add life to years' with dignity and independence. Informal care mechanisms, especially families, play a vital role on this behalf, and so, deserve to be strengthened and empowered through welfare measures, rather than turning to improving formal care system.

Extreme temperatures and mortality in Kuwait: Who is vulnerable?

BACKGROUND

Previous climate change temperature-related health studies have been performed mostly in western countries with relatively cooler temperatures than the Gulf region. Regions that are inherently hot, like Kuwait, are witnessing soaring temperatures unlike ever before. Meanwhile, Kuwait and other Gulf countries are unique in their demographic profiles due to the large number of non-national migrant workers.

OBJECTIVE

To examine the associations of hot and cold temperature extremes on the risk of mortality across gender, age groups and nationality in Kuwait.

METHODS

We investigated daily variations of all-cause non-accidental and cardiovascular mortality death counts and ambient temperatures from 2010 to 2016 in a time-series design using a negative binomial distribution. The temperature lag was modeled with distributed lag non-linear models.

RESULTS

A total of 33,472 all-cause non-accidental deaths happened during the study period. For the extreme hot temperatures and over the entire lag period, comparing the 99th percentile of temperature to the minimum mortality temperature, the risk of dying among males was 2.08 (95% CI: 1.23-3.52). Among non-Kuwaitis, males and working age group (15-64 year) had relative risks of death from extreme hot temperatures of 2.90 (1.42-5.93), and 2.59 (1.20-5.59), respectively. For extreme cold temperatures and over the entire lag period, comparing the 1st percentile of temperature to the minimum mortality temperature, the relative risk of death among Kuwaitis was 2.03 (1.05-3.93). Elderly Kuwaitis (65+ year) exposed to extreme cold temperatures had a relative risk of 2.75 (1.16-6.52).

CONCLUSIONS

Certain subpopulations in Kuwait are vulnerable to extreme temperatures with doubling to tripling risk of mortality. Nationality is an important effect modifier in temperature-related mortality studies in Kuwait and possibly the Gulf region. To the best of our knowledge, we are the first study to examine specific subpopulation vulnerabilities to temperature in this region. Our findings could carry a potential for broader insight into similar hyper-arid and hot regions.

Ageing and Elderly Care in the Arab Region: Policy Challenges and Opportunities

Populations are expected to age rapidly in the Arab countries during the coming few decades. However, the current evidence base indicates that many countries in the region are not paying attention to this demographic phenomenon. This is a particular concern as longevity is often accompanied by many years of ill health and disability and most of the countries in the region continue to rely on the family as the primary source of elder care. While the family, and particularly women, are expected to provide increasing support for longer, they are faced by a set of socio-demographic changes that may hinder their ability to provide such care. This paper focuses on the ageing demographics in the Arab region and reflects on the multiple-roles for women by utilising quantitative analysis of international population and socio-economic indicators as well as reviewing the background literature and current ageing policies in the region. The paper then discusses possible strategies to address increasing long-term care needs through a social capital lens, where support to informal carers particularly women is emphasised.

Gender and Material Transfers between Older Parents and Children in Ismailia, Egypt

In Egypt, kin relations have been governed by a patriarchal contract, which defines expectations for intergenerational support along gendered lines. Social changes may be disrupting these customs and bringing attention to the ways gender may influence intergenerational support in rapidly changing contexts. Using data from 4,465 parent-child dyads in Ismailia, Egypt, we examined whether intergenerational material transfers favored women over men and whether gaps in needs and endowments accounted for gender differences in transfers. Fathers gave children money and goods more often than did mothers; mothers received material transfers from children more often than did fathers. Compared to sons, daughters made transfers to parents less often and received transfers from parents more often. We found residual advantages to mothers and daughters, even adjusting for differential needs and endowments. Findings corroborate persistent norms of gender complementarity, patrilocal endogamy, and reciprocation for women's caregiving, despite changes that have threatened patriarchal rules of exchange.

Foreign live-in domestic workers as caretakers of older Kuwaiti men and women: socio-demographic and health correlates

Ageing of the population is posing new challenges for caretakers. This paper aims to examine: (a) age and gender differences in care provided by a domestic worker versus a family member in the performance of activities of daily living (ADL); (b) socio-demographic correlates of care during illness; and (c) self-reported physical, functional, and psychological health status in relation to care-giver. A cross-sectional household survey was conducted among 2,487 Kuwaiti nationals aged 50 years or older. This paper focuses on persons aged 70 or more. We found that domestic workers provided care to 28 per cent of men and 58 per cent of women who needed assistance with ADL; and to 14 per cent men and 51 per cent women during illness. These respondents ranked poorer on several health indicators and reported higher depressive symptoms score than those looked after by a family member. Logistic regression indicated that care by a domestic worker was approximately seven times more likely for women than men, about 10.8 times more likely for those without co-resident children compared with those who had three or more co-resident children, and 44 per cent less likely for the poorest compared with the richest persons. It appears that reliance on domestic workers is increasing and such reliance will remain necessary in the absence of culturally acceptable alternative institutional arrangements.

Decline in co-residence of parents and children among older Kuwaiti men and women: what are the significant correlates?

A trend towards decline in co-residence with children is apparent in several countries while it is absent in others. The objectives of this paper are to address the patterns of co-residence with children among older Kuwaiti men and women aged 60+ and to assess the determinants of such patterns within the context of rapid socioeconomic changes occurring in the country (n = 1588). The data for this paper were collected as part of a household survey on the psychosocial health and disability among 2487 older Kuwaitis aged 50+. Forward step-wise logistic regression was run to assess the significant socio-demographic and health related correlates of living without any co-resident children. We found that the percentage living without any co-resident children increased from 5% in 1999 to 24% in 2005/6. About 13% women and 1% men were living alone in 2005/6. In the multivariate analysis, older age, female gender, non-Bedouin cultural background, a smaller number of children, higher educational level, and the presence of one or more domestic helpers were positively associated with the absence of co-resident children. On the other hand, those who were not married were less likely to reside without co-resident children, as were those with higher family incomes. Except for self-rated health none of the health related variables, such as chronic illnesses or depressive symptom experience, emerged as significant. Modernization forces seem to be at the core of the observed decline in co-residence with children.

Socioeconomic resources and living arrangements of older adults in Lebanon: who chooses to live alone?

During recent decades, Lebanon has experienced demographic and social changes which, coupled with political instability, have led to waves of youth migration and a higher proportion of older adults living alone. This paper uses the 2004 data of the ‘Pan Arab Project for Family Health’ to assess the levels of various living arrangements and to examine the correlates of living alone, with a focus on economic resources. The findings reveal that 12 per cent of older adults in Lebanon lived alone (17.3 per cent of women and 6.2 per cent of men). Financially better-off older adults and those who reported being satisfied with their income were, respectively, 4.4 and 1.7 times significantly more likely to live alone than their counterparts. The incomes of Lebanese older adults were mainly provided by their children (74.8%) and a relatively small share derived from pension schemes. Contrary to findings from other Arab countries, variations in living arrangements among Lebanese older adults seem to follow the western model whereby wealthier older individuals are more likely to live alone and to be residentially independent. Further studies are warranted to examine to what extent this trend is the result of past migration of adult children who are now established elsewhere and sending remittances home.

The Role of Sociodemographic Factors and Chronic Illness in Functional Disability of Older Kuwaitis

A cross-sectional interview survey of 2,487 Kuwaiti individuals aged 50 and above was conducted to identify the background factors and chronic diseases that exacerbate functional disability among older Kuwaitis. Functional disability was measured as physical ability, ability for self-care, and ability to perform daily routine activities. Association of sociodemographic factors, lifestyle, depressive symptoms, and five chronic illnesses with disability was analyzed. A quarter of respondents ( n = 607) reported to suffer from functional disability and 33% of them from severe disability. Logistic regression indicated that stroke, arthritis, and heart disease were positively associated with functional disability. Older age, unmarried status, non-Bedouin background, lower education, and lower income were significant positive correlates. Stroke was significantly associated with severe disability, as were older age, unmarried status, lower socioeconomic status (SES), higher depression level, and lack of coresident children. Thus, several sociodemographic factors, chronic illnesses, and depressive symptom experience are significant correlates of disability.

Living arrangements of ever-married older Lebanese women: is living with married children advantageous?

In many Middle Eastern countries including Lebanon, the family as a social institution is greatly valued and local norms regarding family ties and living arrangements are especially important for older adults, in particular older women. While the presence of an adult child is often seen as responsive to the financial, health and social needs of older parents, it is not clear whether co-residence with married children offers a similar advantage as in the case of co-residence with unmarried children. Using data from a national Population and Housing Survey, this study examines associations of co-residence with adult children among ever-married women aged 65 years and older in Lebanon. Results showed a considerable proportion of elderly women who were living alone (18%) at the time of the survey. Co-residence was more frequent with unmarried than married children, but the gender ratio of the co-residing child varied with the marital status of both the older woman and the child. Moreover, among those co-residing with married children, results indicate a greater likelihood of co-residence with married sons over married daughters. Co-residence with an adult child associated positively with the availability of surviving children and negatively with the socioeconomic status of the woman and her spouse. Compared to other living arrangements, co-residence with a married child entailed the least advantageous Household Socioeconomic Status (HSES) score in terms of housing characteristics, infrastructure, and material possessions, for both married and unmarried women.