Bussarawan Teerawichitchainan

The Long-term Impact of War on Health and Wellbeing in Northern Vietnam: Some Glimpses from a Recent Survey

War is deemed a major threat to public health; yet, the long-term effects of war on individual health have rarely been examined in the context of developing countries. Based on data collected as a pilot follow-up to the Vietnam Longitudinal Survey, this study examines current health profiles of northern Vietnamese war survivors who entered early adulthood during the Vietnam War and now represent Vietnams older adult population. To ascertain how war and military service in the early life course may have had long-term impacts on health status of Vietnams current older adults, we compare multi-dimensional measures of health among veterans and nonveterans, and within these groups, regardless of their military service, between combatants and noncombatants. Multivariate results suggest that despite prolonged exposure to war, veterans and those who served in combat roles are not significantly different from their civilian and noncombatant counterparts on most health outcomes later in life. This is in contrast to American veterans who fought on the opposing side of the war. The near absence of differences in older adult health among northern Vietnamese with varying degrees of war involvement might be explained by the encompassing extent of war; the notion that time heals; and the hardiness and resilience against ill health that are by-products of shared struggle in war and a victorious outcome.

Economic Status and Old-Age Health in Poverty-Stricken Myanmar

Objective: We examine the association between poverty, economic inequality, and health among elderly in Myanmar. Method: We analyze 2012 data from Myanmar’s first representative survey of older adults to investigate how health indicators vary across wealth quintiles as measured by household possessions and housing quality. Results: Poverty and poor health are pervasive. Self-assessed health, sensory impairment, and functional limitation consistently improve with higher wealth levels regardless of socio-demographic controls. Differentials in self-rated health and sensory impairment between the bottom and second quintiles are clearly evident, suggesting that relative economic inequality matters even among very poor elders and that a small difference in wealth can matter in an extreme poverty setting. Discussion: Findings support a global theory of economic gradients in health regardless of level of societal poverty. Modest efforts to improve the standard of living among elderly may improve not only their material well-being but also their health.

Military Service, Exposure to Trauma, and Health in Older Adulthood: An Analysis of Northern Vietnamese Survivors of the Vietnam War

OBJECTIVES We sought to better understand the association between early life exposure to war and trauma and older adult health status in a developing setting. METHODS We analyzed data of 405 Vietnamese men and women in 1 northern Vietnam commune who entered early adulthood during the Vietnam War and who are now entering late adulthood (i.e., ages 55 years and older in 2010). RESULTS The toll of wars trauma in the aging northern Vietnamese population was perceptible in the association between exposure to war trauma and various measures of physical health, including negative self-reported health and somatic symptoms. Killing another person and being exposed to toxic substances in warfare was especially detrimental to health in older adulthood. War traumas were likely implicated more strongly as determinants of late adulthood health in men than in women. The weak association between trauma exposure and reported depressive symptoms raised questions about measuring mental health. CONCLUSIONS Military service and war trauma were important determinants of older adult health beyond the US context, given the widespread waging of war and concentration of recent armed conflicts within developing societies.

Living Arrangements and Psychological Well-Being of the Older Adults After the Economic Transition in Vietnam

OBJECTIVES We examine the relationship between living arrangements and psychological well-being of the older adults in Vietnam, where there is an influence of Confucian values and a lack of close substitutes for family care of the older adults, by exploiting a great deal of regional variation in economic development. We also examine the role of living arrangements in well-being differentials across regions. METHOD We estimate a triangular simultaneous-equation discrete-response model, which accounts for the simultaneity between living arrangements and psychological well-being (happiness, depression, loneliness, poor appetite, and sleep disorder), using a nationally representative sample of 2,225 adults aged 60 and older drawn from the 2011 Vietnam Aging Survey. RESULTS Intergenerational coresidence significantly increases the psychological well-being of the older adults in Vietnam. The results are fairly robust, even after taking quasi-coresidence into account, decomposing the psychological well-being index into each affect and symptom, and splitting the sample by gender. DISCUSSION Changes in living arrangements induced by differences in labor market opportunities in neighboring regions have resulted in significant differences in psychological well-being among the older adults. The findings point to the need for attention to the mental health of elderly parents left behind in less economically developed regions.

Long-term care needs in the context of poverty and population aging: The case of older persons in Myanmar

Myanmar is one of the poorest and least healthy countries in Southeast Asia. As elsewhere in the region, population aging is occurring. Yet the government welfare and health systems have done little to address the long-term care (LTC) needs of the increasing number of older persons thus leaving families to cope on their own. Our study, based on the 2012 Myanmar Aging Survey, documents the LTC needs of persons aged 60 and older and how they are met within the context of the family. Nearly 40% of persons in their early 60s and 90% of those 80 and older reported at least one physical difficulty. Spouses and children constitute the mainstay of the financial and instrumental support of elderly including those with LTC needs. Nearly two-thirds of older persons reported receiving assistance with daily living activities. More than three quarters coreside with children, a living arrangement that in turn is strongly associated with receiving regular assistance in daily living. Daughters represent almost half and spouses, primarily wives, one-fourth of primary caregivers. Unmet need for care as well as inadequate care decline almost linearly with increased household wealth. Thus elderly in the poorest households are most likely to experience gaps in LTC. Given mounting concerns regarding health disparities among Myanmar’s population, this pattern of inequality clearly needs to be recognized and addressed. This needs attention now rather than later given that reduced family size and increased migration pose additional challenges for family caregiving of frail elderly in the coming decades.

Aging in Myanmar

This spotlight provides an overview of the situation of older persons in Myanmar, an understudied country of over-50-million population. Myanmar is of particular interest to researchers and policy makers, given its overall level of poverty and modestly rapid population aging. Research on older persons, while increasing in recent years, remains sparse. Empirical evidence indicates that Myanmar older persons are in relatively poorer health compared to those in neighboring countries. Many live in abject poverty and depend on their families for material support. Coresidence is very common and facilitates reciprocal exchanges across generations. Looking ahead, Myanmar confronts important challenges including demographic shifts that reduce availability of family support for older persons and increasing burden from chronic illnesses. Currently, government measures are essentially absent, although a law on aging was drafted and is in the process to become legislation.

Productive aging in developing Southeast Asia: Comparative analyses between Myanmar, Vietnam and Thailand

Alarmist views regarding the burden that older persons pose for family and society are prevalent; yet, such views are not necessarily warranted. To fill the research gap, this study examines prevalence and differentials in later-life productive engagement in developing Southeast Asia with a focus on the roles of educational attainment and gender. Based on analyses of recent aging surveys in Myanmar, Vietnam and Thailand, we assess three major dimensions of productive engagement among persons aged 60 and above, i.e. their economic activity, assistance to family members, and caregiving. Results suggest that elders in all three countries make important contributions to their families-consistent with Southeast Asias prevailing norm of reciprocity in intergenerational support. Across the three countries, assistance in household chores is the most common contribution that older persons make, followed by caregiving and economic activity. We find that education is an important factor influencing productive aging. For example, elderly Thais with some educational attainment are more likely than those without any education to participate in the labor force and in turn are able to provide financial assistance to their children. Across the three countries, we find gender differences in later-life productive engagement. While older women tend to provide non-economic contributions to family, older men provide economic contributions more than their female counterparts. Our cross-country comparison additionally indicates that societal contexts such as economic development are likely to have important implications for the extent of productive engagement among older persons with different levels of educational attainment. We discuss policy implications of our empirical findings.

Caring for Thai older persons with long-term care needs

Objective: To provide a situation analysis of recent long-term care (LTC) needs among older persons in Thailand. Method: The 2014 Survey of Older Persons in Thailand (SOPT) provides data to assess patterns of caregiving, whether care needs are met, and who are main caregivers for older Thais. We examine how types of familial and nonfamilial caregivers are associated with the well-being of older persons. Results: The need for LTC increases sharply with age and is more common among women than men. Spouses and children constitute approximately 90% of main caregivers. The association of a family member as the main caregiver and education or value of assets is quite weak underscoring the general normative prescription for family members to serve as care providers. Discussion: Thailand is experiencing acute population aging but empirical evidence to support LTC needs remains lacking. This analysis helps close the gap.

Tradition and Change in Marriage Payments in Vietnam, 1963–2000

This study analyses data from the Vietnam Study of Family Change to document trends and determinants of marriage payments in Vietnam from 1963 to 2000. We investigate the extent to which structural and policy transformations influenced the practice of payments, and estimate how societal changes indirectly impacted payments via their effects on population characteristics. Results indicate that marriage payments surged following market reform, but also reveal nuanced trends during earlier years. While the socialist attempts to eradicate brideprice appear to have been successful in the North before economic renovation, they were unsuccessful in the South. Structural and policy change explained most of the observed variations in payments. The changing characteristics of the married individuals mattered relatively less. We interpret the re-emergence of marriage payments as attesting to the resilience of traditional values and the unravelling of the socialist agenda, but also as a reflection of Vietnams economic prosperity in the 1990s.