POPULATION AGING IN LOW-AND MIDDLE INCOME COUNTRIES: HEALTH SYSTEM CHALLENGES, RESPONSES, AND PATHWAYS TO HEALTHY AGING

Abstract

Population aging is accelerating rapidly in low and middle income countries (LMICs), where nearly 80% of the global population aged 60 years and above will reside by 2050. Unlike high-income countries that aged alongside sustained economic growth, many LMICs are experiencing "aging before getting rich" with limited fiscal and institutional preparedness. This narrative review synthesizes literature published between 2015 and 2025, drawing on peer-reviewed articles and institutional reports from PubMed, Web of Science, Google Scholar, WHO, World Bank, and UN Population Division. Evidence shows that rapid fertility decline and rising life expectancy are reshaping population age structures across East Asia, Latin America, and increasingly sub-rising burden of non-Saharan Africa. These shifts coincide with Population Aging in Low and Middle lacome Countries: Health Syston Challenges, 147 Responses, and Pathways Healthy Aging communicable diseases, multi-morbidity, disability, and mental health conditions among older adults. However, health systems in many LMICS remain oriented toward acute and infectious diseases, creating gaps in chronic care, geriatric services, and long-term care provision. Structural challenges including weak primary health care, poverty, gender inequality, rural-urban disparities, migration, and dependence on informal caregiving further exacerbate later-life health inequities. Although initiatives such as the WHO's Integrated Care for Older People (ICOPE) framework offer promising reform pathways, implementation remains constrained by limited financing and institutional capacity. Population aging in LMICs represents both a major policy challenge and a strategic opportunity requiring strengthened primary care, expanded long-term care systems, and equity focused interventions.