World Health Day: The challenges and opportunities of ageing
Population ageing is a global phenomenon that is occurring fastest in low and middle-income countries. While ageing presents challenges to society, it also creates many opportunities. Older people make important contributions as family members, volunteers and as active participants in the workforce. Where the balance lies between the challenges and opportunities of ageing will be determined by how society responds.
To a large degree it will also be determined by whether the added years people are enjoying are healthy ones. The burden of poor health in older age is often shared by families and ultimately by society. Fostering good health in older age is therefore good for everyone, not just older people, and the World Health Organization (WHO) believes that this needs to be central to the response to population ageing.
Chronic conditions are biggest killers
Unfortunately, this is not yet the case. New research shows just how big the challenge of poor health in older age is; particularly in low and middle-income countries. The main health challenges for older people, regardless of where they live, are non-communicable diseases. Heart disease, strokes and chronic lung disease are the biggest killers, while the biggest causes of disability are visual impairment, dementia and hearing loss. The impact of these conditions is two to three times greater for older people in low and middle-income countries than for people in high-income countries.
WHO is working with health economists to estimate just how big this gap between rich and poor is. This analysis is only in its early stages, but it seems likely that the extra cost runs into trillions of dollars. This could be saved each year just by reducing the burden of these conditions in older people living in low and middle-income countries to the same level as high-income countries. And for most of these conditions there is very strong evidence on cost effective strategies for prevention. These need to start early in life and continue into older age.
Yet even if we prevent much of this burden, many older people will still suffer from chronic disease. Current health systems however are often poorly designed to meet chronic care needs. For example, a recent study of older people in low and middle-income countries found only between 4 and 14% of older people with high blood pressure were effectively treated. Older people also tend to have more than one problem, which healthcare is not designed to deal with.
Supportive environment is necessary
And we must not forget the needs of people who can no longer look after themselves. At present, most of the long term care provided to older people comes from family members. This is a heavy load and will increase as the proportion of older people grows.
Regardless of their level of health or disability, older people need to live in a physical and social environment that supports their health and participation. In many places this is not the case. A WHO flagship initiative in the field of ageing is the WHO Global Network of Age-friendly Cities and Communities. This was only launched two years ago, but already involves hundreds of municipalities; large and small. All have committed to becoming more age-friendly.
Finally, a key idea we are promoting on World Health Day is the need to "reinvent" ageing. Strategies to foster healthy and active ageing can be undermined by stereotypes that are often applied to older people. While we tend to view older people within our own family or personal networks in a positive light, older people in a more general sense are often viewed in negative ways.
There are many "ageist" stereotypes that limit our capacity to really understand the challenges and opportunities of population ageing. For example, portraying older people as a burden rather than a resource leads us to think of ways to minimise the cost of ageing rather than to maximise the opportunity for older people to contribute. Viewing older people as out of touch stops us thinking of strategies that might better draw on their experience and knowledge.
Some of these stereotypes will change as more older people start to live lives that vary from previous norms. But taking active steps to break down these negative beliefs will not only benefit older people, it will reduce the costs of population ageing. It will also help us to build sustainable, cohesive, equitable and secure societies - the sort of society of which we may all want to be part.
Find out about what HelpAge is doing for World Health Day through our Age Demands Action on Health campaign.