Population theory-A long view.

Any attempt to take a long view of population research, its findings, and applications is bound to raise questions about the state of population theory. Recent research on the history of population thought enables us to include a much more complete account of classical and early modern sources, and of parallel and complementary developments in population biology. This paper considers four major shifts in the conceptual and empirical ambitions of population inquiry over the long term. In general, major conceptual developments in ideas about population reflect major shifts in political and biological theory. The nature of population in European science and society was substantially established before demography emerged as a twentieth-century academic discipline focused chiefly on fertility and mortality. A long view suggests that demography is currently in the course of a shift that constructively re-integrates it with the wider field of scientific and historical population thinking.

Mortality among healthcare workers in Indonesia during 18 months of COVID-19.

The impact of SARS-CoV-2 infections upon Indonesian health care workers (HCWs) is unknown due to the lack of systematic collection and analysis of mortality data specific to HCWs in this setting. This report details the results of a systematic compilation, abstraction and analysis of HCW fatalities in Indonesia during the first 18 months of COVID-19. HCW who passed away between March 2020 and July 2021 were identified using Pusara Digital, a community-based digital cemetery database dedicated to HCW. We calculated the mortality rates and death risk ratio of HCWs versus the general population. The analysis indicates that at least 1,545 HCWs died during the study period. Death rates among males and females HCWs were nearly equivalent (51% vs. 49%). The majority were physicians and specialists (535, 35%), nurses (428, 28%), and midwives (359, 23%). Most deaths occurred between the ages of 40 to 59 years old, with the median age being 50 years (IQR: 39-59). At least 322 deaths (21%) occurred with pre-existing conditions, including 45 pregnant women. During the first 18 months of COVID-19 in Indonesia, we estimated a minimum HCW mortality rate of 1.707 deaths per 1,000 HCWs. The provincial rates of HCW mortality ranged from 0.136 (West Sulawesi) to 5.32 HCW deaths per 1,000 HCWs (East Java). The HCW mortality rate was significantly higher than that of the general population (RR = 4.92, 95% CI 4.67-5.17). The COVID-19 pandemic in Indonesia resulted in the loss of many hundreds of HCWs, the majority of whom were senior healthcare workers. The HCW mortality rate is five times that of the general population. A national systematic surveillance of occupational mortality is urgently needed in this setting.

Dementia and Dependency vs. Proxy Indicators of the Active Ageing Index in Indonesia.

Dementia prevalence is increasing worldwide and developing countries are expected to carry the highest burden of this. Dementia has high care needs and no current effective long-term treatment. However, factors associated with active ageing (e.g., longer employment; participation in society; independent, healthy and secure living; and enabling environments to allow people to remain psychosocially and physically active) could help maintain independence in older people for longer. We investigated proxy indicators of the Active Ageing Index (AAI), which were offset against dementia and dependency (assessed by Instrumental Activities of Daily Living or IADL) in multi-ethnic urban (Jakarta) and rural (Sumedang and Borobudur) health care districts on Java, Indonesia. Dementia was assessed using validated cognitive dementia screening tests, the IADL and carer reports. Dementia and dependency prevalence showed large interregional differences and were highest in rural Borobudur. Dementia and dependency were associated with an older age, lower education (for dementia), worse physical health (for dependency) and not engaging in psychosocial activities, such as attending community events, reading (for dementia) and sport activities (for dependency). By supporting active ageing activities in Puskesmas (primary health care centers) and improving access to medical care, rural areas could possibly reduce dementia and dependency risk. Our follow-up study planned in 2021 should illustrate whether recent relevant policies have rendered success in these areas. Using active ageing indicators could focus policies to support regions with targeted interventions to compress care needs in older people.

Indonesia against the trend? Ageing and inter-generational wealth flows in two Indonesian communities.

Indonesian family systems do not conform to the prevailing image of Asian families, the predominant arrangements being nuclear and bilateral, with an important matrilineal minority. This paper considers the strength of family ties in two communities, focussing particularly on inter-generational flows of support to and from older members. Data are drawn from a longitudinal anthropological demography that combines ethnographic and panel survey methods. Several sources of variation in family ties are detailed, particularly the heterogeneity of support flows - balanced, upward, and downward - that co-exist in both communities. Different norms in each locale give sharply contrasting valuations of these flows. The ability of families to observe norms is influenced by the effectiveness of networks and by socio-economic status.

AGE-STRUCTURAL TRANSITION IN INDONESIA: A comparison of macro- and micro-level evidence.

This paper responds to recent calls for empirical study of the impact of age-structural transition. It begins by reviewing evidence of cohort oscillations in twentieth-century Indonesia, which indicates that current older generations are likely to have smaller numbers of children on whom they may rely than generations before and after them. However, to assess whether the imbalances implied by this situation are actually influencing people's lives, attention to further factors shaping the availability and reliability of younger generations, notably differences in socio-economic status and in patterns of inter-generational support flows, is required. Community-level Indonesian data confirm that elders in the lower social strata are child-poor. Social structural and family network patterns, however, have a greater influence on the availability of inter-generational support than cohort differentials.

Gaps in the family networks of older people in three Indonesian communities.

Family networks are widely assumed to be a key source of support for older people in Indonesia and Southeast Asia more generally, although empirical study of their composition and functioning is in its infancy. This paper draws on ethnographic and survey data collected in longitudinal research of ageing in three rural Indonesian communities, in order to identify demographic and social factors limiting the size of elders' networks. Gaps in networks commonly emerge as a result of childlessness, migration and alienation, but their implications for older people's vulnerability are shaped by socio-economic status, reputation and cultural norms.

Migration, social structure and old-age support networks: a comparison of three Indonesian communities.

Contemporary trends in population ageing and urbanisation in the developing world imply that the extensive out-migration of young people from rural areas coincides with, and is likely to exacerbate, a rise in the older share of the rural population. This paper examines the impact of migration on vulnerability at older ages by drawing on the results of anthropological and demographic field studies in three Indonesian communities. The methodology for identifying vulnerable older people has a progressively sharper focus, beginning first with important differences between the communities, then examining variations by socio-economic strata, and finally the variability of older people's family networks. Comparative analysis indicates considerable heterogeneity in past and present migration patterns, both within and between villages. The migrants' contributions are a normal and important component of older people's support, often in combination with those of local family members. Higher status families are commonly able to reinforce their position by making better use of migration opportunities than the less advantaged. Although family networks in the poorer strata may effect some redistribution of the children's incomes, their social networks are smaller and insufficient to overcome their marked disadvantages. Vulnerability thus arises where several factors, including migration histories, result in unusually small networks, and when the migrations are within rural areas.