The Story Behind the Paper

The Spark From Observation to Question

During the pandemic, we witnessed older adults in nursing homes devastated by COVID-19, migrant labourers losing their jobs and social protections, and low-income communities suffering high infection rates and poor access to care. These patterns felt connected. For example, an ageing migrant worker living precariously, lacking protection, and exposed to the virus illustrates overlapping vulnerabilities that erode health resilience.
In Ghana and many low- and middle-income countries, age-related care gaps, internal and external migration, and informal work intersect. We asked what the evidence reveals when ageing, migration, and socioeconomic inequality are examined together. How did the pandemic deepen these links, and what policy gaps emerged?

Conceptual Framing: Bringing Theory to Life

We grounded the study in three theoretical lenses
Social Determinants of Health (SDH) explains how living and working conditions, social protection, and public policy shape health outcomes.
Human Capital Theory, which considers how investment or disinvestment in health and skills influences lifetime resilience.
Feminist Gerontology, which captures ageing as a gendered life course process and highlights the burdens borne by older women and ageing migrants.

Our premise is that ageing, migration, and socioeconomic disadvantage are not additive. They intersect to multiply risk. The pandemic was a global stress test of this reality.

Methodology Systematic Review of the Policy Terrain

Following PRISMA 2020 guidelines, we preregistered our protocol on the Open Science Framework (OSF) and reviewed studies, reports, and grey literature from 2020 to 2024 that linked ageing, migration, and socioeconomic factors to health equity. In total, 49 sources met inclusion standards.

Key Findings: Four Intersecting Themes

1. Demographic inequality and uneven exposure. Older adults, migrants, and low-income groups faced the greatest risk with limited protection.

2. Exclusionary health systems and digital divides. Health systems often lacked ageing and migrant-sensitive services, and unequal digital access worsened inequities.

3. Socioeconomic precarity, job losses, informal work, and weak social protection eroded human capital.

4. Fragmented policy responses. Post-pandemic strategies rarely integrated ageing, migration, and poverty, creating blind spots in design.

Comparative analysis showed these gaps were most severe in the Global South, where social protection and health infrastructure remain weak.

The Ghana Africa Lens and Why It Matters

Although global in scope, the review is deeply relevant to Ghana and similar contexts. Ageing, migration, and economic disparities intersect sharply across rural-urban divides and informal economies. Older migrants and rural elders often lack pensions, insurance, or digital access. Integrating these realities bridges global evidence with local policy relevance.

Policy Implications Beyond Health Care

Health equity cannot be achieved through clinical reforms alone. We recommend

• Age and migrant-inclusive health system design

• Comprehensive social protection coverage for informal and cross-border workers

• Bridging the digital divide in healthcare access

• Institutionalising intersectional policy design across ministries and agencies

Why the Timing Matters

Published in November 2025, this paper arrives as the world rebuilds from COVID-19. Without embedding ageing and migration into recovery strategies, cycles of cumulative disadvantage will persist. Our review aims to inform that global reckoning.

Personal Motivation and Ethical Imperative

For us as Ghanaian scholars, this study transcends academia and represents an ethical duty. Older adults, migrants, and low-income persons remain invisible in many policies. We sought to make their experiences visible and call for governance that upholds dignity and inclusion across Africa and the Global South.

Conclusion

This paper bridges divides between ageing and migration studies, health policy and social protection, and research and justice. We hope to advance a conversation where no older migrant is left behind and no low-income community is forgotten in future crises.