The research team examined twenty-two states across the MENA region, from the wealthy Gulf Cooperation Council monarchies to middle-income countries such as Egypt, Morocco and Tunisia, and to fragile or conflict-affected settings including Yemen, Syria and the West Bank and Gaza. Drawing on demographic, economic and labour indicators from global datasets compiled by the United Nations Department of Economic and Social Affairs and the World Bank, the authors synthesised this quantitative picture with the international literature on long-term care models and regional care dynamics. Their conclusion is blunt: population ageing is outpacing the development of formal care systems across the region, and the costs of that gap are being paid invisibly, mostly by women.

The demographic mechanics behind the warning are well established but often misread. Fertility rates across MENA have fallen sharply over recent decades while life expectancy has climbed, producing the classic stages of a demographic transition. For years, the region enjoyed a favourable age structure, with large working-age cohorts supporting relatively few dependents, a dividend that fuelled growth in labour-abundant economies. That window is now closing. As cohorts born during earlier high-fertility eras move into older age, the share of adults over sixty-five is rising rapidly, and the total age dependency ratio, which measures the balance between people typically outside the labour force and those of working age, is shifting in ways that will strain pensions, health systems and household budgets alike.

What makes the MENA case distinctive is the speed and heterogeneity of the transition. The Gulf states face a compressed version of the challenge, where rapid modernisation, large migrant workforces and citizenship-based welfare systems create peculiar fiscal and social geometry. Middle-income countries such as Egypt and Jordan are ageing before they have become rich, leaving little fiscal room for new social programmes. Conflict-affected states face the starkest picture of all; research cited in the study documents how armed conflict in Syria has directly reduced life expectancy, while humanitarian assessments in Yemen describe older populations with minimal formal support. Any regional strategy, the authors argue, must account for this diversity rather than impose a single template.

At the heart of the analysis is the informal care economy, the vast, unrecorded system in which family members, overwhelmingly women, provide daily care for frail older relatives. Cultural norms across the Arab region place strong expectations on families, and particularly on daughters and daughters-in-law, to care for ageing parents at home. This system has historically absorbed demand at zero fiscal cost, but the study shows it is eroding under its own contradictions. Urbanisation is dispersing extended families, smaller family sizes mean fewer adult children per ageing parent, and rising female education and employment aspirations collide with the assumption that women will provide unpaid care indefinitely.

The consequences ripple through the entire economy. Women across MENA already have among the lowest labour force participation rates in the world, and the burden of informal caregiving is a documented barrier to paid work. The study highlights that women also spend more years in ill-health during old age than men, compounding the inequity across the life course. Every hour a woman spends providing unpaid care is an hour not spent in formal employment, not generating taxable income and not building her own pension entitlements. The authors frame this as a hidden economic cost that never appears in national accounts but systematically suppresses productivity, female economic inclusion and the long-term solvency of social insurance systems.

The quality-of-life dimension is equally serious. Without structured services, older people with dementia, disability or chronic multimorbidity depend entirely on relatives who may lack training, respite or support. The literature the authors synthesise points to elevated risks of elder abuse, caregiver burnout and depression among informal carers, and notes that conditions such as dementia are rising in prevalence across the region as populations age. Respite care, home-based health services and day centres remain scarce or absent in most MENA countries, with a few notable experiments such as Oman’s home health care programmes and Saudi Arabia’s expansion of home care under its Vision 2030 reform agenda cited as early signals of change.

The study’s most provocative argument is that this gap is not merely a liability but an opportunity. Formal long-term care is labour-intensive work that cannot be automated away, making it a potent source of employment, particularly for women. International Labour Organization analyses cited in the paper estimate that expanding care services globally generates employment multipliers well above those of comparable investments. The authors propose that MENA governments build regulated care infrastructure through workforce development, dedicated insurance financing models and public-private partnerships, creating decent jobs for care workers while simultaneously freeing other women to enter the labour market. In their framing, care investment functions like roads or power grids: infrastructure that unlocks broader economic activity.

Financing such systems in a region with tight budgets and large informal economies is the obvious objection, and the authors address it directly. They advocate incremental financing mechanisms that expand coverage gradually, learning from international experience including Japan’s long-term care insurance scheme and cash-for-care experiments in Europe, while adapting to regional realities such as the widespread reliance on migrant domestic workers in Gulf households. Formalising caregiving roles, extending social protection to care workers, and aligning long-term care investment with the Sustainable Development Goals are presented as mutually reinforcing priorities. The paper also points to recent pension reform in Saudi Arabia as evidence that structural social protection change is politically achievable in the region.

The study’s bottom line is a reframing. Ageing in MENA has been treated as a distant problem, perpetually deferred by the region’s youth bulge legacy. Hussein and her colleagues argue that the window for proactive policy is closing now, and that governments which integrate long-term care into national development planning, rather than quarantining it in health or welfare ministries, can convert a looming fiscal burden into a driver of equitable growth. The alternative, they warn, is a future in which ageing households are impoverished by care costs, women remain locked out of the labour market by unpaid caring obligations, and governments confront the same demographic pressures a decade later with fewer options and higher price tags. The choice, on their reading of the data, is between building the care economy deliberately or paying for its absence involuntarily.

Subject of Research: Demographic ageing and long-term care policy in the Middle East and North Africa

Article Title: Ageing and Long-Term Care in the Middle East: Towards Inclusive Development Strategies

Article References: Hussein, S., Ismail, M., & Pallares-Miralles, M. (2026). Ageing and Long-Term Care in the Middle East: Towards Inclusive Development Strategies. Ageing International, 51(4), Article 38. https://doi.org/10.1007/s12126-026-09678-4

Image Credits: AI Generated

DOI: 10.1007/s12126-026-09678-4

Keywords: population ageing, long-term care, MENA, informal caregiving, gender inequality, care economy, demographic transition, labour force participation, social protection, economic development, Gulf Cooperation Council, sustainable development goals

The research team, led by Alexandra Minuk of McMaster University’s School of Rehabilitation Science together with Kenneth Fyie, Christiane Roth and Jennifer D. Zwicker of the University of Calgary’s School of Public Policy, used nationally representative cross-sectional data linked to the Canadian Census, which added more than 350 socio-demographic variables to the analysis. The Canadian Survey on Disability identifies disability using the Disability Screening Questions, a tool first deployed in the 2012 cycle that assesses both the severity and frequency of functional limitations across ten disability types. The 2022 cycle achieved a response rate of 61.1 percent with a final unweighted sample of 54,081 individuals aged 15 and older, sampled from respondents to the 2021 Long-Form Census who reported limitations on at least one activity of daily living question.

Developmental disabilities are lifelong conditions, emerging before age 18, that significantly limit intellectual functioning and adaptive behaviour. According to the World Health Organization’s ICD-10 framework, they encompass conditions affecting the developing nervous system that impair motor, cognitive, language, behavioural or sensory functioning, and they explicitly include autism spectrum disorder. As of 2022, approximately 1.5 percent of Canadians were identified as having a developmental disability. The researchers isolated a subsample of autistic individuals, identified through self-reported medical conditions linked to ICD-10 code F84, to examine heterogeneity within the broader developmental disability population while preserving comparability with earlier estimates. Comparison groups included people with any other lifelong disability and people without disabilities, and all statistics were weighted to the national population with bootstrapped variance estimation using 1,000 replicate weights supplied by Statistics Canada.

The demographic portrait that emerged is striking. In 2022, individuals with developmental disabilities had a mean age of just 36 years, compared with 53 years for those with other disabilities and 45 years for those without disabilities; within the developmental disability group, autistic individuals were younger still, averaging 27.1 years. Disability prevalence rose across all age groups between 2017 and 2022, with the sharpest increases among 19-to-24-year-olds, the very age range in which young people typically encounter the so-called support cliff after leaving high school. Prevalence of developmental disability was highest in New Brunswick at 2.2 percent, and autism prevalence peaked at 0.6 percent each in New Brunswick, Prince Edward Island and British Columbia. Notably, the proportion of women and girls identified with developmental disabilities rose from 39.1 percent in 2017 to 43.5 percent in 2022, and the share of autistic females climbed from 31.7 percent to 33.9 percent, trends the authors suggest may reflect improving diagnostic recognition among populations, such as autistic women, that have historically been underdiagnosed.

Educational outcomes improved substantially over the five-year window, though profound disparities endure. Among people with developmental disabilities, the proportion without a high school diploma fell from 49 percent in 2017 to 33 percent in 2022, a statistically significant 16-point decline, while high school attainment rose from 26 percent to 37 percent. For autistic individuals, the share lacking high school completion dropped from 53 percent to 39 percent, and university completion rose from 13 percent to 18 percent. Yet post-secondary attainment remains startlingly low: only 22 percent of people with developmental disabilities held a college diploma and just 8 percent had completed university by 2022, far below rates for people with other disabilities and for the non-disabled population. Respondents with developmental disabilities and autism also reported qualitatively different school experiences. More than half in each group reported starting school later than their peers, attending special education programs, and taking fewer courses, and a majority reported experiencing bullying during their education, with rates of 55 percent for developmental disabilities and 60 percent for autism.

Employment trends moved in the right direction but remained sobering. Employment among people with developmental disabilities rose from 27 percent in 2017 to 30 percent in 2022, while the proportion outside the labour force declined from 66 percent to 62 percent. Autistic respondents saw an even larger jump, from 22 percent employed in 2017 to 29 percent in 2022, with labour force exclusion falling from 68 percent to 60 percent. These gains are notable because employment among people without disabilities actually declined by a statistically significant 3 percent over the same period, from 66.4 percent to 63.3 percent, suggesting the improvement is not simply a product of a favourable labour market. Nevertheless, unemployment remained higher among people with developmental disabilities at 8 percent, and 11 percent among autistic individuals, and roughly two-thirds of those outside the labour force cited their health condition as the primary barrier to working.

The barriers documented extend well beyond health status. Among people with developmental disabilities not in the labour force, 17 percent cited inadequate training or experience, 14 percent reported discrimination, and 14 percent pointed to prior unsuccessful job attempts. Access to training itself was constrained: 57 percent said reasons related to their condition prevented participation, 37 percent said available courses were not adapted to their needs, and 28 percent cited cost. When workplace accommodations were needed, the most common involved modified hours, modified duties and human support. Yet a striking 40 percent of employed people with developmental disabilities and 34 percent of autistic employees reported needing no accommodations at all, a figure the authors suggest may indicate under-recognition of needs or obstacles to requesting and receiving supports. Employment was also heavily concentrated in a narrow band of industries, dominated by retail trade, healthcare and social assistance, accommodation and food services, and educational services, sectors often associated with low wages, limited security and few advancement opportunities.

To probe which factors actually predict employment, the team ran a population-weighted logistic regression model across the disability population. Higher odds of employment were associated with older age, higher educational attainment, being married or in a common-law relationship, and living outside Ontario or the Maritimes. Significantly reduced odds were linked to being female, having greater disability severity, residing in large urban centres, speaking neither English nor French, and, critically, having a developmental disability. The findings underscore the intersectional character of labour market exclusion: gender, geography, language and disability type combine to shape who gets hired, with marginalized subgroups within the disability community facing compounding disadvantages that single-axis policies are poorly equipped to address.

The authors frame these results within Canada’s ambitious policy architecture, including the United Nations Convention on the Rights of Persons with Disabilities, ratified in 2010; the Accessible Canada Act of 2019, which targets a barrier-free Canada by 2040; the Disability Inclusion Action Plan; the Canada Disability Benefit Act; and the National Autism Strategy. Because the analysis relies on repeated cross-sections rather than longitudinal follow-up, the observed improvements cannot be attributed to any specific policy or program. But the descriptive trends provide an essential baseline for evaluating whether these legislative commitments are translating into changed lives. The study also carries important caveats: the survey excludes people under 15, those living on First Nations reserves, institutionalized populations, and people experiencing homelessness, meaning the true extent of disadvantage is likely underestimated, and self-reported diagnosis introduces potential misclassification.

The overall message is one of cautious progress shadowed by structural inequity. High school completion is rising, more people are working, and diagnostic recognition, particularly for women and girls, appears to be improving. Yet people with developmental disabilities and autism still finish school at lower rates, hold university degrees at a fraction of the population average, cluster in low-wage industries, and remain outside the labour force at rates that would be unacceptable in almost any other policy domain. The researchers call for strengthened provincial leadership in inclusive education, tailored vocational training and supported employment models, individualized workplace accommodation strategies, employer engagement and accountability, and better data systems to track trajectories over time. Until those pieces come together, they argue, incremental gains will keep falling short of the full societal participation that Canadian law, and the evidence, now demand.

Subject of Research: National trends in educational attainment and employment outcomes among Canadians with developmental disabilities and autism, using linked 2017 and 2022 Canadian Survey on Disability data

Article Title: National Trends in Education and Employment Outcomes for Canadians With Developmental Disabilities and Autism: Findings From the 2017 and 2022 Canadian Survey on Disability

Article References: Minuk, A., Fyie, K., Roth, C., & D Zwicker, J. (2026). National Trends in Education and Employment Outcomes for Canadians With Developmental Disabilities and Autism: Findings From the 2017 and 2022 Canadian Survey on Disability. Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s10803-026-07489-9

Image Credits: AI Generated

DOI: 10.1007/s10803-026-07489-9

Keywords: developmental disabilities, autism spectrum disorder, employment, education, Canadian Survey on Disability, disability policy, labour force participation, inclusive education, workplace accommodations, Accessible Canada Act, National Autism Strategy, intersectionality