Social determinants of health and aging in Africa: structural inequality, vulnerability, and the future of care

Abstract

Population aging is accelerating across Africa yet remains underrepresented in research, policy,and public health planning. This review critically examines how social determinants shape agingexperiences across the continent, focusing on health, care systems, and structural inequalities.While traditional African societies have historically valued older adults, modernization, migration, and economic hardship have eroded support systems, leaving many to face old age with limited resources. Older Africans, particularly women and rural residents, contend with lifelong disadvantages including low education, informal labor, poverty, and gendered caregiving roles that contribute to poor health and social vulnerability. Health systems remain poorly equipped to address chronic disease, mental health, and multimorbidity in later life, with minimal access to insurance, geriatric care, or social protection. The review draws on a life course perspective and cultural understandings of aging to highlight both challenges and resilience among older adults. It calls for rights-based, equity-focused reforms including expanded pensions, integrated geriatric care, caregiver support, and legal protections against age-based discrimination. Recognizing older adults not as dependents but as vital members of African societies, the review urges action aligned with global frameworks such as the UN Decade of Healthy Ageing and Africa’s Agenda 2063 to ensure dignity and wellbeing for aging populations.