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Analysis of
Gender and
Emerging
Issues with
Focus on
Ageing
Population
The desk review report is developed by HelpAge Cambodia with the active and
invaluable contribution of Lyndsey McMahan, MSW Student at Boston College.
February 2014
Editing provided by Renée McHale-Garnaut, Policy Support Officer, Department of Older
People Welfare, Ministry of Social Affairs, Veterans and Youth Rehabilitation.
Table of Contents
DEMOGRAPHIC TRANSITION ...................................................................................................................................... 1
OBJECTIVE OF THE REPORT .................................................................................................................................................... 2
POPULATION AGEING IN CAMBODIA .......................................................................................................................... 3
Figure 1: Percentage of Population over aged 60 years from 1970 to 2070 ............................................................. 3
Figure 2: Age and Sex Pyramid for Cambodia 2010 to 2070 ..................................................................................... 4
PROFILE OF OLDER PEOPLE IN CAMBODIA ................................................................................................................................ 5
SOCIAL SECURITY ................................................................................................................................................................ 8
FEMINISATION OF AGEING ......................................................................................................................................... 9
POLICY AND FRAMEWORKS RESPONSE FOR POPULATION AGEING .......................................................................... 11
MADRID INTERNATIONAL PLAN OF ACTION ON AGEING, MIPAA ............................................................................................... 11
THE UNIVERSAL DECLARATION OF HUMAN RIGHTS AND THE ASEAN HUMAN RIGHTS DECLARATION ................................................ 12
UNITED NATIONS CONVENTION ON THE ELIMINATION OF ALL FORMS OF DISCRIMINATION AGAINST WOMEN ..................................... 13
ASEAN STRATEGIC FRAMEWORK FOR SOCIAL WELFARE AND DEVELOPMENT (SOMSWD) 2011-2015 .......................................... 14
POLICIES AND STRATEGIES IN CAMBODIA ................................................................................................................ 15
NATIONAL POLICY ON THE HEALTH CARE FOR ELDERLY AND DISABLED PEOPLE (1999) .................................................................. 15
NATIONAL POLICY FOR THE ELDERLY (2003) .......................................................................................................................... 15
CURRENT CAPACITY AND RESOURCES .................................................................................................................................... 16
RECOMMENDATIONS ............................................................................................................................................... 17
PARTICIPATION ................................................................................................................................................................. 17
HEALTH .......................................................................................................................................................................... 17
SECURITY......................................................................................................................................................................... 19
POLICY IMPLICATIONS ........................................................................................................................................................ 20
CONCLUSION ............................................................................................................................................................ 22
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Demographic transition
Population ageing is the phenomenon of which older individuals become a proportionately
larger share of a country’s total population.1 Throughout the world the fastest growing
segment of the population is adults aged 60 and over, with an expected 223 percent increase
between 1970 and 2025.2 In 2002, 400 million people aged 60 and older lived in the
developing world with this number more than doubling to 820 million by 2025.3 Today, one in
nine persons in the world is 60 years or over but, by 2050, this figure will increase to
one in five persons.4 Population ageing, although a triumph, is occurring because of
declining fertility rates, increased life expectancy rates and a decrease in infant mortality
rates.5
Age transition is taking place in the ASEAN region as well, with over half of the world’s older
population living in Southeast Asia. All ten ASEAN countries will, at different times, come to an
old age population structure. By 2020, five ASEAN countries; Singapore, Malaysia, Indonesia,
Myanmar and Thailand; will move to an ageing population and by 2050 all ten ASEAN
countries will come to an old age structure.6 A growing older population will be
associated with greater demands for care and health care.
As women tend to live longer than men they comprise the majority of older persons in all but a
few countries. The fact sheet on ageing from the World Health Organisation (2012) underlined
that married women or women living in partnership are more likely to spend their old age as
widows. In addition, the paper highlighted that traditional practices relating to widowhood may
result in violence and the abuse of older women, posing a threat to their health and well-
being. Older women living alone may not know where or how to negotiate access to health
care and welfare services on their own. The paper noted further that, while women have the
advantage of living longer, they are more likely than men to experience disadvantages in
access to education, food, meaningful work, health care, social security and political power
over their lives. These cumulative disadvantages mean that women are more likely than men
to be poor and to suffer disabilities in older age.
1 UNFPA, HelpAge International (2012). Ageing in the Twenty-First Century: A Celebration and a Challenge, p. 20 2 WHO (2002). Active Ageing: A Police Framework, p. 6 3 WHO (2002). Active Ageing: A Police Framework, p. 9 4 UNFPA and HelpAge (2012). Ageing in the Twenty-First Century A Celebration and A Challenge, p 3 5 UNFPA and HelpAge International (2012). Ageing in the Twenty-First Century: A Celebration and a Challenge, p. 21 6 ASEAN (2006). Demographic Changes and Challenges in ASEAN Countries: 18th ASSA Board Meeting Seminar: Implication of Ageing Population, Grand Plaza Park Royal, Penang, Malaysia, p. 7
2 | P a g e
Objective of the report
The purpose of this report is to look at the trend of ageing in Cambodia, to gain a better
understanding of the gender relations that influence the experiences of both older men and
women within specific social and economic contexts, to analyse their access to resources and
opportunities, and to review the policies and legal frameworks in relation to social protection,
especially health care, social care, and old age security.
The information will be drawn from a desk review of existing studies and research, policies
and frameworks materials, and other relevant materials.
3 | P a g e
Population Ageing in Cambodia
Cambodia, unlike other ASEAN countries, will have a window of 20 years before it fully joins in
an old age structure.7 This relatively young age structure is due to conflicts and hardships for
nearly three decades that caused millions of deaths and the loss of much of the social
infrastructure. Although the country is demographically very young, the proportion of the
population aged 60 and over is projected to increase by 20% by 2050. By 2070, the
population in Cambodia aged 80 years and over will be the largest age group with significantly
more women than men.8
Figure 1: Percentage of Population over aged 60 years from 1970 to 2070 9
Figure 1 illustrates that Cambodia is presently behind the rest of the world and the Southeast
Asian region with respect to the percentage of the population that are elderly. However, the
percentage of elderly will become greater in Cambodia in comparison to the world by about
2050 and will equal the rest of Southeast Asia by about 2060.
7 International Council on Social Welfare (2010) Strengthening Family Institution: Caring for the Elderly, prepared for the 5th ASEAN GO-NGO
Forum, p. 6 8 MOH (2007), Community Services for the Elderly: the 5th ASEAN & Japan High Level Officials Meeting on Caring Societies. Prepared for the
Kingdom of Cambodia 9 UNFPA (2013), Fadane, K., Zimmer, Z. Cambodian Ministry of Planning “Ageing and Migration in Cambodia: A CRUMP Series Report”
0
5
10
15
20
25
30
19
70
19
80
19
90
20
00
20
10
20
20
20
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20
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20
60
20
70
% o
f p
op
ula
tio
n a
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60
yea
rs o
r o
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Year
Cambodia
All Southeast Asia
World
Population aged 35 years and over in 2015 will be over 60 years in 2040
4 | P a g e
According to the report “Ageing and Migration in Cambodia” released by the Ministry of
Planning in 2013 and based on the national census that was carried out in 2008, Cambodian
adults aged 60 years and older account for 848,000 people, which is 6.3 percent of the
population. Of this, 5.3 percent is male and 7.3 percent female.
Figure 2: Age and Sex Pyramid for Cambodia 2010 to 2070 10
The report detailed further that by 2015, the number of older adults is forecasted to reach 1.1
million people, 11 percent of the total population. By 2050, this number will quadruple
with one out of four Cambodians being aged 60 and above. By 2070, the older
population will be greater than the younger population. Moreover, the younger
10 UNFPA (2013), Fadane, K., Zimmer, Z. Cambodian Ministry of Planning “Ageing and Migration in Cambodia: A CRUMP Series Report”
0-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80+
2010
Females
Males
10% 5% 5% 10%
0-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80+
2030
Females
Males
10% 5% 5% 10%
0-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80+
2050
Females
Males
10% 5% 5% 10%
0-4
10-14
20-24
30-34
40-44
50-54
60-64
70-74
80+ 2070
Females
Males
5% 5% 10% 10%
5 | P a g e
population in Cambodia will drop from one-third of the total population in 2008 to one-fifth by
2050.
The report also underlined that the sex ratio of the older “old” indicated a growing number of
women in older ages compared to men. The sex ratio showed an increasing trend from 69.1
men per 100 women in 2008 to 67.0 in 2018 and 61.4 by 2030. The report observed that this
trend will pose challenges relating to very old women who are also likely to be widowed and
will have a high dependency for care and health care.
Profile of Older People in Cambodia
Today’s older people are survivors of three decades of hardship and conflicts from the
1970s until the end of the 20th century. Close to 80% live in the rural areas.11 A large number
of older people have low literacy levels, especially older women. Most are working in
subsistence farming and very few have regular incomes.12 According to Census 2008, the
economic activity rate of those aged 65 and above was 68.4 percent for men and 45.2 percent
for women. As formal social security is very limited, older persons have not had the
opportunity to save money throughout their working lives and as a result they move into old
age in a state of material and physical vulnerability. An increased number of older people are
now the primary caretakers of grandchildren due to the migration of adult children, divorce
and death of the parents.13
With regards to the health status of older people, according to GiZ paper “Linkages of Old-
age protection and Health: Access of the elderly to health care services in Cambodia: Analysis
of the CSES 2005-2009”, those 60 years and above experienced higher poor health incidence.
The paper on Fertility and Mortality in Cambodia, released by Japan International Cooperation
Agency (JICA) in 2013 reported that nearly 42 percent of deaths among males aged 60 years
and over, and nearly one half of deaths in older women are caused by illnesses. Heart disease
and tuberculosis are reported to have accounted for large proportions of deaths of males aged
60 years and over (18 and 14 percent respectively). 14
Furthermore, growing studies provided similar accounts that the next decades will see the rise
of those over 80 years of age, or the “older old”, as the population continues to age and life
11 MOH (2007). Community Services for the Elderly: the 5th ASEAN & Japan High Level Officials Meeting on Caring Societies. Prepared for the
Kingdom of Cambodia 12 UNFPA, Muhahid, G. (2005). Population Ageing in East and South-East Asia: Current Situation and Emerging Challenges, Papers in Population ,
Aging Southeast Asian Population May Create "Grey Collar" Economy, p. 11: http://www.searchlightcatalysts.org/node/645 13
UNFPA, Fadane, K., Zimmer, Z. Cambodian Ministry of Planning “Ageing and Migration in Cambodia: A CRUMP Series Report.” 14
http://www.stat.go.jp/info/meetings/cambodia/pdf/a01_chap.pdf. Page 36
6 | P a g e
expectancy keeps improving. The rise of the older old will be associated with declining health
and disability, increasing the risk of chronic disease such as joint pain, high blood pressure,
diabetes, and heart disease. There will be higher incidences of reduced function in the Daily
Living Activities (ADL), in the capacity for self-care such as bathing, dressing, transferring,
using the toilet, eating, and walking and in the Instrumental Activities of Daily Living (IADL)
which are activities that enable the older people to live independently in the community
including light housework, meal preparation, taking medications, shopping, using the
telephone and managing money. The older old will have a greater demand for special medical
care and social assistance.15
The study on disability and active life expectancy among older Cambodians released in
2006 by Zachary Zimmer, reported that older people in Cambodia are more disabled than their
counterparts living in the ASEAN region. The report added that Cambodian women live
longer than men, but a greater proportion are living in the states of disability and
severe disability. At age 60-64, only about 2 percent of men reported a severe disability
compared to about 6 percent of women. By age 80, about 20% of men reported severe
disability compared to about 24% of women. Those not married, living in rural areas and in
poverty, were generally more likely than others to report disabilities.
The Cambodia Inter-censal Population Survey, 2013 (CIPS, 2013) confirmed that as of 2013,
there were approximately 302,000 people in Cambodia living with some form of disability, of
which nearly 48 percent were female. Moreover, this report also showed that the proportion of
disabled among the oldest persons (age 75+), especially among women, is very high. Among
the total population living with disability, 21.4% are older people; this means that 1 out of 4
people with a disability is an old person. One third of the people with difficulty in seeing are
aged 60 and above. Nearly 50 percent of those having hearing problems are aged 60 or more.
Those aged 45 and more account for most of those having multiple disabilities. The most
prevalent of disabilities among both sexes was inadequate sight and difficulty in movement.
The report ‘Ageing: Cambodia Case Study’, released in 2011 (P. Bunnak), made reference to
the 2008 in-patient data from the Health Institute of Statistics (Ministry of Health) and
remarked that a high proportion of adults aged 50 years and above that were admitted to the
public health facilities was related to chronic illnesses (nearly 60 percent of all in-patients).
High blood pressure, cardiopathy, diabetes, and cancers (lung, liver, cervix, and uterus) were
the most observed illnesses.
15 Phillips, D.R., Chan, C.M. (2002). Ageing and long-term care: national policies in the Asia. Prepared for the Asian Development
Research Forum’s (ADRF) Ageing Research Network: -
7 | P a g e
Adults aged 60 years and over experience higher poor health incidence with nearly 42
percent of deaths among males and nearly one half of older women deaths caused by non-
communicable diseases. Heart disease and tuberculosis are reported to have accounted for
large proportions (18 and 14 percent respectively) of deaths of males aged 60 years and over.
While demographic transition and ageing population has increased attention from the
Government, public services for older people in Cambodia are not yet a priority for the
Government. The GiZ paper “Linkages of Old-age protection and Health: Access of the elderly
to health care services in Cambodia: Analysis of the CSES 2005-2009”, reiterated Dr. P.
Bunnak’s findings that the highest proportion of adults and the Elderly aged 50 years old and
above who were admitted to health facilities, according to the in-patient data from the national
Health Information System (HIS) in 2008, was related to chronic or non-communicable
illnesses (nearly 60 percent of all in-patients for this type of illness). However the health care
delivery system in Cambodia, especially public health services packages, does not sufficiently
cater for chronic non-communicable diseases (NCDs) or psychiatric conditions, and palliative
care and geriatric medicines are largely unavailable. The elderly are less likely to receive
treatment than the young, even though they carry a greater burden of disease. Most
older people do not use the existing health services because of the lack of geriatric services.
As a consequence the health conditions of older people may be worsened, affecting their
autonomy and participation in social and economic life.
Older people in Cambodia have had difficult lives including violence, hardship, deprivation, and
poverty resulting from the Khmer Rouge period. Many of those killed during that tragic period
were the children or spouses of today’s older generation. Therefore not only do they have to
cope with realities of growing old but also the trauma resulting from these years.
8 | P a g e
Social Security
Older adults in Cambodia have insufficient access to services and poor health outcomes. Very
few have social security. Emerging trends such as migration and urbanisation are
contributing to the increase in challenges experienced by older people. Migration and
urbanisation are worldwide trends, with younger generational cohorts moving to urban areas
in order to increase their ability to gain access to employment. In addition, the potential
support ratio is projected to decline rapidly 16 increasing the vulnerability of the
economy because there will be fewer working age adults in proportion to adults
aged 60 and over.
Family support is still the primary safety net for older people in Cambodia. Adult
children have the filial obligation to provide and care for their older parents. However, this
family support system of care for the aged is under pressure and is expected to weaken over
time due to the rapid urbanisation, migration of labour force, increased participation of
working aged women in productive work, and change of family structure.17 More importantly,
the global financial downturn has resulted in severe job losses in the region and has weakened
the opportunities for people to earn a living. Adult children are confronted with the difficulty of
sustaining their own living as well as responding to their filial duty. As a result, older people
are exposed to risk and poverty, particularly widowed women with meagre support, both
socially and financially. While population ageing is at an early stage, almost one in four
Cambodian households have at least one member who is aged 60 or older.18
In Southeast Asia, many countries have some sort of social security programme or provident
fund for the most vulnerable segment of the population, but often with limited coverage. The
more affluent and successful the country in the region, the better the social benefits; though
many countries are confronted with insufficient resources and competing priorities.19 In
Cambodia the Government, with the technical support and contribution from international
organisations, has put in place two social health protection schemes, Health Equity Fund (HEF)
and Community Based Health Insurance (CBHI), to facilitate access to health care for
vulnerable and poor households and to protect these marginalised households from severe
shocks.
16 UNFPA, Muhahid, G. (2005). Population Ageing in East and South-East Asia: Current Situation and Emerging Challenges, Papers in Population,
Aging Southeast Asian Population May Create "Grey Collar" Economy, p. 10 17 UNFPA, Muhahid, G. (2005). Population Ageing in East and South-East Asia: Current Situation and Emerging Challenges, Papers in Population, Aging Southeast Asian Population May Create "Grey Collar" Economy, p. 12. 18 Knodel, J., Zimmer, Z. (2009). Gender and well-being of older persons in Cambodia, page 3 19 Asher, M.G. (2009). Social Protection Systems in East Asia: An Overview and Reform Directions. National University of Singapore, ERIA Research Project Report, No. 9
http://www.eria.org/publications/research_project_reports/images/pdf/y2009/no9/SP_Compiling_corrected_2010-09-15_FINAL.pdf
9 | P a g e
The Identification of Poor Households (ID-Poor) is administered by the Ministry of Planning. If
an assessed household meets the criteria of ID-Poor, all the members in the household may
access social benefits and assistance such as free or partly subsidised healthcare services,
scholarships for primary and secondary school pupils in rural areas, social land concessions,
rural development and agriculture-related services and inputs. According to GiZ paper
“Linkages of Old-age protection and Health: Access of the elderly to health care services in
Cambodia: Analysis of the CSES 2005-2009”, HEF and CBHI have some positive effects on
the poor households, but have limited effectiveness for older persons.
Other social protection schemes, such as social pensions, do not cover all older people. Formal
social pensions are available to war veterans, retirees from public services, and expanded
recently to regular employees in the formal sectors20 which totals nearly 17 percent of the
working population.21 However, more than 80 percent of Cambodia’s total workforce is
working in the informal sector. A significant portion of this number is older adults that are
hence ineligible for social pensions and government benefits. Although most older adults
are working in the informal sectors, 25 percent are identified as poor. 22 With regards
to pensions, when older adults begin to reach the age of frailty they rely heavily on family
support for continued livelihood and care.
Feminisation of Ageing
Population ageing is unique for Asia because of the speed at which it is occurring simultaneous
with economic and social changes.23 Much like population ageing, the feminisation of ageing is
also a double-edged sword. The segment of the population that is affected most by the shift in
age structure is women. Although ageing can be seen as a triumph for women because
decreased vulnerability and mortality has led to longer life expectancy, ageing for women can
signal increased social isolation, economic hardships and a higher risk of living with
impairment and disability.24
In most countries older women tend to outnumber older men because of longer life spans,
however because of Cambodia’s tumultuous past, that imbalance is quite substantial. Older
women account for 58 percent of the elderly population of which close to half are widowed,
20 Cambodia labour law provisions and National Social Security Fund (NSSF) 21 Sann, V, (2010), Social Protection in Cambodia: Toward Effective and Affordable Social Protection for the Poor and Vulnerable. Prepared for
Council for Agricultural and Rural Development, Council of Ministers, Cambodia, p. 332-335 22 Sann, V., (2012).Social Protection and Informal Economy: Formalize the Informal Sector. Council for Agricultural and Rural Development,
Council of Ministers, slide 5 23
Chan, A., (2005). Aging in Southeast and East Asia: Issues and Policy Directions, p. 269 24 Davidson, Di Giacomo, McGrath (2011). The Feminisation of Ageing: How will this Impact on Health Outcomes and Services, p. 1032.
10 | P a g e
compared to 11 percent for older men.25 A series of studies from leading academics in ageing
and development (Z. Zimmer and J. Knodel), highlighted that most of the surviving
Cambodian women, unlike their male counterparts, have less opportunity to remarry and
many live in widowhood as household heads with few surviving children. Marital status affects
many aspects of well-being in old age and in particular in informal family support during old
age. Moreover, the emotional toll of bereavement at the time of widowhood, compounded with
the social and economic struggles, can greatly affect both the physical and mental health of
the women due to increased isolation. 26
Among the age group 80 years and above, women are accounted as higher than men. The
sex ratio of the older “old” indicated a growing number of women in older ages
compared to men. The sex ratio shows an increasing trend from 69.1 men per 100 women in
2008 to 67.0 in 2018 and 61.4 by 2030. This trend poses more specific challenges relating to
very old women who are also likely to be widowed and will have high dependency for
care and health care.
Older women in Cambodia today are highly vulnerable as most are less educated,
dependent on family support and living in a state of poverty. Over the course of the
last 30 years, the people of Cambodia have experienced significant human rights violations
due to the Khmer Rouge and armed conflicts that did not end until 1993.27 Throughout these
periods of time, women experienced many different forms of gender based violence. Today, it
is likely that the older population of women were forced into marriages during the Khmer
Rouge time and often raped as a way to consummate the marriage. 28 Although there is very
little official data to support these claims, many women have broken the silence and reported
these abuses. Although they were forced into these marriages, the women chose to stay in
them at the end of the regime due to fear, traumatisation and cultural acceptance, often
experiencing continued abuse which increases their marginalization as they age 29. These
older women are a largely forgotten group in the development debates and discussions on
gender and disabilities as they are presumed to be under the care of their families.
Gender initiatives are usually limited to girls and women of reproductive age,
ignoring the specific needs of older women. Similarly, disability discussions tend to
focus on younger groups, although disability rates rise with age, with the prevalence
25 Knodel, J., Zimmer, Z. (2009) Gender and well-being of older persons in Cambodia 26 Davidson, Di Giacomo, McGrath (2011). The Feminisation of Ageing: How will this Impact on Health Outcomes and Services, p. 1036. 27
Cambodian Defenders Project (n.d.). List of Critial Issues Regarding Sexual and Gender-based Violence (SGBV) in conflict in Cambodia (1-9). 28
Cambodian Defenders Project (n.d.). List of Critial Issues Regarding Sexual and Gender-based Violence (SGBV) in conflict in Cambodia (1-9). 29
Cambodian Defenders Project (n.d.). List of Critial Issues Regarding Sexual and Gender-based Violence (SGBV) in conflict in Cambodia (1-9).
11 | P a g e
of disability highest among the older populations.30 Women are more vulnerable than
men because they have a different social construct over their life course which influences
access to resources, opportunities, living arrangements, support networks, health and
morbidity.31 In addition to the physiological factors of chronic illness and social roles within
families, higher rates of poverty and greater exposure to violence throughout the life course
has detrimental effects on the health and wellbeing of Cambodian women as they continue to
age.32
In order to understand the affects that ageing has on women, it is important to look at the
costs of ageing through the life course perspective.33 One fundamental concept of life course
epidemiology is time in regards to both age and history.34 Although the process of ageing is
generally synonymous with the onset of poor health and disability, it is important to recognize
that these processes are more than biological, but psychological and social as well.35
Policy and Frameworks Response for Population Ageing
Madrid International Plan of Action on Ageing,
MIPAA MIPAA is the first international agreement that recognizes the need for government and non-
governmental bodies to address the needs of the world’s ageing population. Although MIPAA
is not a legally binding document, it has been agreed upon by 159 countries, including
Cambodia.36 MIPAA makes recommendations for governments to include policies that will
improve the lives of those in the shifting old age structure. These recommendations include;
discrimination and decision making which promotes the adoption of human rights policies;
work and pensions that would encourage older adults to participate in the work force for as
long as they are capable of doing so; access to palliative, preventative, and hospice care to
help decrease health disparities between older adults and other demographic groups; and
establishing supportive environments that would allow older people to be free from abuse,
neglect, discrimination and violence.37
30 Ministry of Planning (2009), The Cambodia socio economic survey 31 UNFPA, HelpAge International (2012) Ageing in the Twenty-First Century: A Celebration and a Challenge, p. 27 32 Davidson, Di Giacomo, and McGrath (2011),.The Feminisation of Ageing: How will this Impact on Health Outcomes and Services, p. 1035 33 UN ESCAP (2009). Are Older Women in Southeast Asia More Vulnerable than Men? Bangkok. 34 Kuh, D., Shlomo, Y.B., (2002). A Life Course Approach to Chronic Disease Epidemiology 35 Moen, P., Dempster-McClain, D., Williams Jr., R.M. (1992) Successful ageing: a life course perspective on women’s multiple roles and health 36 HelpAge International The Madrid Plan, http://www.helpage.org/what-we-do/rights/the-madrid-plan-mipaa/ 37 HelpAge International The Madrid Plan,, http://www.helpage.org/what-we-do/rights/the-madrid-plan-mipaa/
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A study recently completed by HelpAge Cambodia shows that out of 71 women surveyed, 49
of them had never attended school and the other 22 had lower than primary school level
completed. Lack of education inhibits the ability that women have for exercising rights such as
property ownership, inheritance, and money management, which puts them at greater risk for
both social and physical abuse as they continue to age.38 Moreover, women who are working
in either the formal or informal sectors experience greater stress because of the increased
burden to provide childcare which, although it has its own economic contributions, keeps them
at a cumulative disadvantage because they are not eligible for social pensions in the informal
work sectors.
The Universal Declaration of Human Rights and
the ASEAN Human Rights Declaration The Universal Declaration of Human Rights was adopted by the United Nations General
Assembly in 1948 and serves as a guide to guarantee the rights of individuals everywhere.
This document is complete with 30 articles that outline different rights, including health,
education, social security, and freedom of participation in society and culture. Articles
specifically pertaining to older adults are 22 and 25.
Article 22 states:
“Everyone, as a member of society, has the right to social security and is entitled to
realisation, through national effort and international co-operation and in accordance
with the organisation and resources of each State, of the economic, social and cultural
rights indispensable for his dignity and the free development of his personality.”39
Article 25(1) states:
“Everyone has the right to a standard of living adequate for the health and well-being
of [oneself] and of [one’s] family, including food, clothing, housing and medical care
and necessary social services, and the right to security in the event of unemployment,
sickness, disability, widowhood, old age or other lack of livelihood in circumstances
beyond his control.”40
In 2012, all ASEAN member states signed the ASEAN Declaration of Human Rights which has
40 articles that outline the individual rights of persons who reside in these countries. There are
many articles within this document that are concerned with the rights of older adults, including
those with disabilities or widowed. Articles 4, 28, 30 and 36 are of particular importance to
older women. Article 4 states that “the rights of women, children, the elderly, persons with
disabilities, migrant workers, and vulnerable and marginalized groups are an inalienable,
38 Kuh, D., Shlomo, Y.B., (2002). A Life Course Approach to Chronic Disease Epidemiology 39 The Universal Declaration of Human Rights, United Nations General Assembly (1948) http://www.un.org/en/documents/udhr/index.shtml 40 The Universal Declaration of Human Rights, United Nations General Assembly (1948) http://www.un.org/en/documents/udhr/index.shtml
13 | P a g e
integral and indivisible part of human rights and fundamental freedoms.”41 To further define
the specific rights of marginalized populations,
Article 28 states:
“Every person has the right to an adequate standard of living for himself or herself and
his or her family including:
a. The right to adequate and affordable food, freedom from hunger and access to safe
and nutritious food;
b. The right to clothing;
c. The right to adequate and affordable housing;
d. The right to medical care and necessary social services;
e. The right to safe drinking water and sanitation;
f. The right to a safe, clean and sustainable environment.”42
Articles 30 and 36 are important for policy decisions regarding older adults and helping them
to meet their full needs of healthy and fulfilled livelihoods. Article 30 (1) states “Every person
shall have the right to social security, including social insurance where available, which assists
him or her to secure the means for a dignified and decent existence.”43
Lastly, Article 36 states:
“ASEAN Member States should adopt meaningful people-oriented and gender
responsive development programmes aimed at poverty alleviation, the creation of
conditions including the protection and sustainability of the environment for the peoples
of ASEAN to enjoy all human rights recognised in this Declaration on an equitable basis,
and the progressive narrowing of the development gap within ASEAN.”44
Much like the articles in the Universal Declaration of Human Rights, those in the ASEAN
Human Rights Declaration should be used as a road map to guide policies and programmes
that will address the growing needs of older adults, including disabled and widowed women.
United Nations Convention on the Elimination of All Forms of Discrimination against Women The Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) was
signed by Cambodia in 1980, acceded in 1992, and ratified the optional protocol in 2010. The
National Council of Women and the Ministry of Women’s Affairs are coordinating agencies for
reporting to CEDAW. CEDAW was adopted by the United Nations General Assembly in 1979
and acts as a Bill of Rights for Women.
41 ASEAN Human Rights Declaration (2012) http://www.asean.org/news/asean-statement-communiques/item/asean-human-rights-declaration 42 ASEAN Human Rights Declaration (2012) http://www.asean.org/news/asean-statement-communiques/item/asean-human-rights-declaration 43 ASEAN Human Rights Declaration (2012) http://www.asean.org/news/asean-statement-communiques/item/asean-human-rights-declaration 44 ASEAN Human Rights Declaration (2012) http://www.asean.org/news/asean-statement-communiques/item/asean-human-rights-declaration
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The convention defines discrimination against women as:
“any distinction, exclusion or restriction made on the basis of sex which has the effect
or purpose of impairing or nullifying the recognition, enjoyment or exercise by women,
irrespective of their marital status, on a basis of equality of men and women, of human
rights and fundamental freedoms in the political, economic, social, cultural, civil or any
other field."45
By ratifying this convention, Cambodia has committed to uphold the rights of women and
make sure that they are free from discrimination of all forms as well as targeting culture and
traditions that tend to shape social, economic, and political experiences of women.46
ASEAN Strategic Framework for Social Welfare
and Development (SOMSWD) 2011-201547 The ASEAN Strategic Framework for Social Welfare and Development (2011-2015) also has a
section on ageing and set the tone by prioritising the enhancement of the well-being,
livelihoods and equitable opportunities for vulnerable people groups, including older people.
The framework emphasised the pending social and economic challenges of an ageing
population for the member states, especially the growing demand for adequate care and
support for the elderly who are in need of social assistance. It stated that the three challenges
facing older people in the region are income security, access to health services and community
recognition and participation.
In terms of policy responses and programme design, governments are handling the ageing
issue differently. The Strategic Framework emphasises the importance of cost-effective,
targeted policy and programmes based upon evidence-based research. Some countries are
applying the welfare based approach, others attempt to increase the opportunities of ageing as
a productive and participatory force and an asset to the society while a few are trying to take
a balanced approach of welfare based and productive ageing.
45 Convention on the Elimination of All Forms of Discrimination against Women (1979) http://www.un.org/womenwatch/daw/cedaw/cedaw.htm 46 Convention on the Elimination of All Forms of Discrimination against Women (1979) http://www.un.org/womenwatch/daw/cedaw/cedaw.htm 47 ASEAN Strategic Framework for Social Welfare and Development (2011-2015)
http://www.dpiap.org/resources/pdf/somswd_strategic_framework_2011-2015_final_12_01_04.pdf
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Policies and Strategies in Cambodia
Cambodia currently has three main policies related to the elderly: the National Policy for the
Elderly, the National Policy on the Health Care for Elderly and Disabled People, and the Law of
Pension Fund.
In 1987, Cambodia endorsed policies related to the Elderly as the policy on Pension Fund for veterans and civil servant
In 1999, establishment of the National Policy on the Health care for Elderly and Disable people
In 2003, adoption of the National Policy for the Elderly and celebration of the International Day for the older people
In 2009, adoption of the National Guidelines for the Establishment of Older People
Associations (OPAs)
In 2013, adoption of the National Guidelines for the Establishment of Home Based Care for
Older People
National Policy on the Health Care for Elderly and Disabled People (1999) The NPHCED was created as a provision of health care for the elderly and disabled people
through the cooperation of concerned ministries such as MoH, MoSVY, IOs, NGOs and other
CBOs. NPHCED has four primary objectives: improve the welfare of the elderly and disabled;
provide human resources training; promote healthy ageing through health education; and
provide special care for older people in the communities.48 Each of these four goals has
different strategies that are used to address them, for example: reduce the prevalence of non-
communicable disease and their consequences in later life and expand the knowledge of health
care of older people to all health staff- be them doctors or community leaders.49
National Policy for the Elderly (2003)
The NPE was created to address the growing vulnerability of older persons with the goal of full
integration and participation of older people in society. The primary goal of NPE is to promote
the well being of older adults and to ensure their access to opportunities and benefits that are
a result of the development of the nation.50 The NPE addresses the social welfare, health care,
economic needs, and inclusion of older adults by creating goals within the government to
address each of these areas.
48 Bunnak, P. (2011), Ageing: Cambodia Case Study 49 Bunnak, P. (2011), Ageing: Cambodia Case Study 50 Bunnak, P. (2011), Ageing: Cambodia Case Study
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Current Capacity and Resources
Currently in Cambodia there are a number of government organisations that are interested in
the impact of population ageing throughout the country as it will cause great shifts in not only
the age structure but social, economic and political structures as well. The Committee on
Agriculture and Rural Development (CARD) has commissioned a series of studies on the
situation of vulnerable groups including older people and has released key policy papers,
notably the National Social Protection Strategy (NSPS) for the poor and vulnerable (2011).
The Royal Government of Cambodia has issued a sub-decree dated 15 July 2011 on the
establishment of an inter-ministerial Committee for the elderly which is charged to review
policies and framework on ageing. The Cambodian National Committee for Elderly (NCE) is
mainly tasked to; maintain the spirit and celebration of the International Day for the older
people; to promote, review, develop and steer ageing sensitive policies and framework; to put
in place a structure and programme that are adapted to the social and economic context of the
country to address old age needs; and to coordinate the implementation of specific measure
ensuring an equitable protection to older people and to promote best practices. The National
Committee for the Elderly is composed of senior officials from line ministries and is led by the
Minister of the Ministry of Social Affairs, Veterans and Youth Rehabilitation, and the Prime
Minister.
Outside of government entities, HelpAge Cambodia, a local NGO, is working in Battambang
and Banteay Meanchey provinces to increase the capacity of older adults by connecting them
with Older People’s Associations (OPAs). HelpAge views Older People as resources. OPAs
provide a mechanism for a primary safety net and informal social protection for older people in
their communities. OPAs are intergenerational community-based associations that are led and
managed by local volunteers to address the needs and concerns of older people and their
households. They are inclusive of all groups and multifunctional. There any many activities in
which an OPA can choose to engage. Commonly, the OPAs manage; cow bank, sustainable
farming, rice bank, health camps, livelihoods training and local planning for development
projects. Currently in Cambodia HelpAge has helped to establish 170 OPAs with over 60
percent of its members being female. Over 10,000 members, households, and communities
have benefited from the work of OPAs. The Ministry of Social Affairs, Veterans and Youth
Rehabilitation (MoSVY) has a vision for each commune in Cambodia to have functioning OPA.
It has currently established over 460 OPAs across 18 provinces with goal to replicate 900 OPAs
across all 24 provinces within 5 years.
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Together with government ministry departments and local NGOs, it is possible to help build
capacity of older adults through continued efforts instilling in people the responsibility to care
for older people, helping decrease discrimination, increasing inclusion, and encouraging the
participation of women in both the informal workforce and social support systems.
Recommendations
While Cambodia is not yet facing an ageing population, it is important to begin to plan for the
demographic change and anticipate its consequences. In order to address the emerging issues
that older women are facing, such as widowhood, disabilities, migration of adult children and
limited care, it is important to invest in policies and programmes that ensure basic social
security including access to health care and pension for old age and to promote the importance
of active ageing alongside these policies and programmes.
There are three basic pillars of active ageing policies: participation, health, and security.51
Participation
It is necessary to understand that people will be more likely to contribute to and participate in
society if policies that address education, health, and employment are meant to address the
needs of the people. For instance, according to both the Universal Declaration of Human
Rights and the ASEAN Human Rights Declaration, education is only compulsory for children.
However, if there were educational opportunities throughout the life course, including teaching
people how to care for themselves then they will be able to more actively contribute to, and
participate in, both the labor force and social engagements.52
Health
In order to promote healthy ageing, it is important that risk factors for chronic, non-
communicable diseases are kept low while building up protective factors, such as social
engagement. This balance will increase not only the quality but the quantity of life making
older women more self-sufficient during the ageing process. For those who are in need of
health care, there should be a network of assistance either through a government entity or
other subsidized care that will meet the full range of rights of people as they age.53
51
WHO (2002). Active Ageing: A Police Framework, p. 45. 52
WHO (2002), Active Ageing: A Police Framework, p. 51 53
WHO (2002), Active Ageing: A Police Framework, p. 46-48
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In order to meet the health needs of older women it is important to set very specific health
outcome goals including improvements in chronic disease. In order to do this it is necessary
to look at how economic and social issues affect ageing, and create policies that directly
address reducing the disparities in order to promote healthy ageing.
In 2003, as part of the response for an alternative and complementing mechanism for viable,
affordable and effective care, HelpAge Korea (through the project ‘Home Based Care’ funded
by ROK-ASEAN) supported NGOs and Governments in 10 ASEAN countries, including
Cambodia, to develop a model of Home Care suitable to the local contexts. The project was
implemented from April 2003 up to May 2012, in three different phases, each phase lasting for
a period of four years.
In Cambodia the Home Care project was implemented by HelpAge through the OPAs. The
OPAs managed the activity, facilitated the identification of the recipients and the volunteers,
and contributed to the case management. The project promoted village based volunteers to
provide companionship and household care to poor, frail and homebound older people. Most of
the home care recipients were older women. The implementation of the project was done
through consultation with different stakeholders and on different levels. From government, the
Ministry of Social Affairs, Veterans and Youth Rehabilitation (MoSVY) and the Ministry of Health
(MoH) took the lead in representing the project to national and international forums. The
model was successfully implemented through the OPAs in 43 communities of the provinces of
Battambang and Banteay Meanchey.
HelpAge commissioned an evaluation of the project in October 2011. The evaluation findings
highlighted that the system of volunteer care-givers goes a long way towards rebuilding the
trust among villagers, as evidenced by the good relationships between older people and the
caregivers. This builds the image of the community as an interactive organism that cares for
its members. Furthermore, the report pointed out that the way the model home care is
developed can be a complementary service to the primary health care system. The health
camp, village based health consultation promoted by HelpAge Cambodia country office, is the
primary level of primary health care, delivering the most basic of health educations, as well as
simple screening and consultation. Home care, as currently organised, forms a part of the
tertiary level of primary health care delivery. The OPAs perform the role of case manager for
their village members. The Government of Cambodia has acknowledged the model as viable
and effective and has endorsed in December 2013 a National Guidelines on Home Based Care
adapted from the Korean model. As a member of the National Committee for the Elderly, the
Ministry of Women’s Affairs could consider promoting the replication of home care for older
people of which older women are among the largest recipients.
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Security
Formal social protection for old age is still very limited in Cambodia. Systems for public
provision are limited. A pension for old age is currently available for retirees from public
service, war veterans and to employees in the formal sector (recent legislation 2012). Health
care and other essential services are not universal for all older people but subsidised for poor
households through HEF and CBHI. All ASEAN countries have Social Pension in place or are
moving ahead (e.g Lao, Myanmar) but Cambodia has yet to make this shift.
The report ”Financial assessment of the National Social Protection Strategy for the Poor and
Vulnerable-Cambodia, 2012”, RGC and ILO/EU, gave a projected costing for various social
protection programmes including the costing of social age pension programme for the ages 70,
65 and 60. The report noted that since the share of elderly among Cambodia’s population is
very low due to the country’s tragic history, the cost of a universal pension scheme would be
comparatively modest but may exceed the fiscal space. It recommended as an alternative a
targeted social pension programme for the poor which may already be within reach for the
RGC.
The CARD/ UNICEF study “Estimating Rates of Return on Social protection Instruments in
Cambodia” showed that providing a basic Social Protection package of addressing early
childhood and old age vulnerability, working-age seasonal unemployment, as well as
promoting school attendance (i.e. human capital constraints) will cost the government around
USD 166 million, equivalent to 1.6 percent of GDP, per year. Investment in social protection
will yield return above 15 percent after a decade, poverty will reduced by 5.9 percentage
points, while the poverty gap will be decreased by 14.4 percent and inequality is expected to
decline by 4.9 percent.
Security in this sense does not mean solely physical needs but social and financial ones as
well. When policies and programmes address these needs, either through social pension funds
or investment in human capital, people will be more likely to find care within their
communities when they can no longer rely on themselves.54 In order to increase the likelihood
that as people age they will feel secure it is important to create a system that teaches current
younger generations to invest in their future health and finances. It is also necessary to
engage in policies that remove the inequities of services for both gender and socioeconomic
status. All people, despite their income levels or previous work experience, should be allowed
54
WHO (2002) Active Ageing: A Police Framework, p. 46
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to receive some sort of social pension that will help prevent them from falling further into
poverty as they age because they are less likely to be capable of both formal and informal
employment.55
Policy implications
The Royal Government of Cambodia (RGC) has mandated the Council for Agriculture and Rural
Development (CARD) to coordinate and develop a national strategy prioritizing the
development of effective and social safety nets for the poor and vulnerable and to establish a
framework for sustainable and comprehensive social protection for all Cambodians
contributory and non contributory. As a result, the National Social Protection Strategy for the
Poor and Vulnerable 2011-2015 (NSPS) was released in 2011. The NSPS includes ranges of
recommended instruments of social protection of vulnerabilities including for old age. While
the current fiscal space cannot support the financing of the social protection programme, it is a
hope that the RGC, through the line ministries, will continue to closely work with all
development partners to mobilize, engage, devolve and scale up when possible the necessary
funds for achieving basic health care and income security for children, the working-age
population and the elderly.
It is hoped females will not be neglected in health and care programme and services among
the elderly, since they outlive men and are more likely to experience multiple health
problems, chronic illnesses and impairments and disabilities associated with old age.
The Cambodian Rural Urban Migration Project (CRUMP) released by the Ministry of Planning in
December 2013 summarized with the following policy considerations:
A programme should be established to support older adults in rural areas, particularly ones
that are taking care of grandchildren. Social security systems, welfare services for elderly,
and health care for elderly should be strengthened and expanded. Centers for older adults
that might provide information, health care and other services could be established. Old
Person Associations, which do exist, should be supported and strengthened.
Any policy agenda needs to give adequate consideration to the implications of a growing
older population. There should be recognition of the fact that older household members are
important providers and contribute to households. Involvement of older persons in all
spheres of life is important for development. Older people increasingly want to remain
economically active and make a contribution to development. Societies need to recognise
the strengths of older persons and empower them. While Cambodia needs to recognise that
55
WHO (2002) Active Ageing: A Police Framework, p. 53
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older persons are essential for the development of the nation, there also needs to be
recognition that non-elderly household members are major supporters for the care of
elders.
Because the population of Cambodia is ageing, there is a growing need for information on
elderly persons, their households, communities in which they live, and various aspects
related to their well-being. A national survey of older persons is in order. These data could
be used to better understand the elderly situation and to determine informed policy moving
forward.
Older persons are impacted upon by the migration of family members. A follow-up CRUMP
project should provide some specific focus on elderly left behind.
Health care of older persons needs to be examined, particularly in rural areas. Cambodia
has for many years been a young country, but increased population ageing will give rise to
new health concerns. Some training of medical practitioners should focus on elderly health
problems. Formal and informal mechanisms for the support of older people need to be
examined. Health insurance for older persons should be introduced.
Elderly persons from poor migrant households should be a focus for social welfare services
and economic support. Poor older persons with one child or two children who are migrants
could be in the most disadvantage situation. Social welfare at the community level could
provide both direct and indirect services to these elderly persons. There should be
formulation or expansion of an elderly health insurance card programme for rural poor
households through government funds.
Social affairs should continue to implement an elderly policy. A national committee of
elderly persons existing in Cambodia suggests there is a political will for such
implementation to continue.
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Conclusion
One way of addressing and encouraging advances in health, participation, and security in
today’s older adults and the future ageing population, is to have government bodies invest in
both for-profit and not-for-profit entities that have a mission of addressing the emerging
issues that older Cambodian women currently face, and will face as the age structure of the
country changes. The partnerships should work to engage the population in order to better
understand their needs and create a model that can scale nationally. Not addressing the needs
of the ageing population, especially in regards to women, will be detrimental for Cambodian
households over the course of the next twenty years. Moreover, the government should seek
age-sex disaggregated research, especially in regards to women, health, and increased social
isolation. These results can then be used to develop programmes and policies that will help to
decrease cumulative disadvantage as well as better understand how to prevent non-
communicable diseases in the elderly population.
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For further information please contact
For more information, visit
Website: http://www.helpage.org/
Facebook: HelpAgeinCambodia
Twitter: HelpAgeCambodia
Laen LONG (Mr.)
Advocacy and Information Officer
HelpAge Cambodia
House No. 305, Group 5
Rumchek 4, Rattanak, Battambang, Battambang, Cambodia
H/P: +855 (0) 77 812 813 | Office Phone: +855 53 952 707
Email: [email protected]
Skype: longlaen
HelpAge envisions a world in which all older people fulfil their
potential to lead dignified, active, healthy and secure lives.
2014
