By Camilla Williamson, Global Healthy Ageing Adviser at HelpAge International
Our health and our access to services that support our health are central to our wellbeing and our ability to do the things that matter to us. This is true at any age but can become increasingly important as we get older and face more health-related challenges. I’m reminded of this often seeing my own parents age, as well as friends and family. But it’s the people I’ve met through my work who have given me the greatest sense of this – older people in Thailand, in Ethiopia, in Mozambique and Myanmar, or most recently in Ukraine. Many of these older people have faced inequalities across their life-course and in the conditions in which they have been born, live and are growing old which have had a significant impact on their health and well-being in older age. They are among those with the greatest need for health and care services, but the furthest behind in accessing them.
© Credit Benj Binks/HelpAge International
Barriers to ensuring older peoples’ right to health
The right to health – that is, the right to the highest attainable standard of physical and mental health, includes the right to health and care services that meet our needs. Yet the majority of the older people we work with in low- and middle-income countries, tell us they face multiple barriers to realising this right.
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In many settings, particularly more rural and hard-to-reach locations, there are few health services if at all. Those that do exist are often unable to meet older people’s diverse health and care needs – including those related to long-term conditions and disabilities.
“For older adults like me, disabled and with a high-risk of disease, it’s impossible to access health services”
60-year-old man, Colombia
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Poverty and the costs involved in accessing services present some of the greatest barriers older people face. With limited access to health insurance and high out-of-pocket costs, many say they have no choice but to forgo seeking healthcare or face impossible choices between health and other basic needs.
“My husband needs five medications for blood pressure and heart disease. He is now taking his medications once every two days in order to save money.”
67-year-old woman, Lebanon
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Ageism and age discrimination within health systems also routinely lead to violations of older people’s right to health. Older women and men say their health issues are often dismissed as ‘old age’, that they are treated like a burden. They also report incidents of violence, abuse and neglect in accessing care.
“When you go to the hospital, they say, ‘This one is too old, we are wasting medicine, it’s better she dies.’ And if a younger woman goes, they know that she still has more years to live.”
70-year-old woman, Kenya
Our right to health and Universal health coverage
World Health Day 2023 coincides with the Open-Ended Working Group (OEWG) on Ageing in New York which this year is focusing on older people’s right to health and health services. Together with partners from grassroots to global levels, we are using the opportunity to remind governments of their duty to uphold older people’s rights – both through delivering a stronger global framework for the rights of older people and by strengthening a rights-based approach in progress towards universal health coverage (UHC).
“The mere thought of sickness terrifies me because we do not have any social safety net, healthcare coverage, or protection. Who would care for our fate?”
60-year-old woman, Lebanon
The commitment of governments to achieve UHC as part of Sustainable Development Goal 3 (ensuring healthy lives and promoting well-being for all at all ages) is critical to fulfilling the right of all people to health and to health services. This will not happen overnight – we know the journey to UHC is long and requires tough choices to be made on how to progress. But the right to health provides us with a guide for how to proceed. If there is one take away from the right to health that I would urge governments to focus on for guiding progress towards UHC now, it is the principle of equity.
Refocusing on equity
In recent months, I have been disappointed and disheartened by a seeming failure of the global health community to fully grasp what an equity-based approach means in practice.
Simply put, health equity refers to the concept of ensuring that all individuals, regardless of social, economic, environmental or other factors, have a fair and equal opportunity to achieve optimal health and wellbeing. While equality is about people being treated equally, equity is about people being treated fairly and according to need. In practice, this means putting those with the greatest need first.
The words ‘leave no one behind’ are spoken often, but less so ‘reaching the furthest behind first’ and how this should be translated into action. But this is the very heart of a rights-based approach and the principle of equity upon which health and care services must be delivered: that is, based on need. It is also key to ensuring that older people in low- and middle-income countries – particularly those who face multiple and intersecting inequalities, including those related to poverty, age, gender, disability, race or other characteristics, can enjoy their right to health.
On World Health Day, we urgently need to refocus the debate. The right to health and the principle of equity must guide decision making on UHC. This means using inclusive data and engaging people and communities to understand who has the greatest need for health and care services in different contexts and is furthest behind in accessing them, then prioritising them in progress towards UHC at all levels.
As we look ahead to the high-level meeting on UHC in September 2023 whilst supporting progress at national and local levels, HelpAge will be working with our partners to ensure this message reaches decision makers.
About the author
This blog is written by Camilla Williamson, Global Healthy Ageing Adviser at HelpAge International.
Camilla has been in the role of global healthy ageing adviser since 2021 but has worked with HelpAge on a range of projects at global, regional and country level since 2011. Her background is in public policy and ageing. Camilla’s current role is focused on promoting healthy ageing and universal health coverage, in which she works with partners from local to global levels on policy, advocacy, programmes and resource development.