Successful Ageing Public Health aspects of Population Ageing

1
Successful Ageing Public Health aspects of
Population Ageing
CADENZA Symposium 2008

• Shah Ebrahim
• London School of Hygiene Tropical Medicine

2
Population ageing the challenges

• Size and rate of population ageing
• Increased burdens of chronic disease
• Appropriate and affordable health care and social
  support
• Inter-generational transfer of resources
• Pensions and income security for older people

3
The global picture 2000 and 2050
4
Life expectancy, 2007
5
The demographic time bomb?
6
An ageing population
Source Buckingham Palace, Anniversaries Office
7
The rise in numbers of older people is the major
challenge
8
Why has population ageing happened? The
rectangularisation of survival
9
Chinas rapid demographic transition a
political cause
10
(No Transcript)
11
The speed of population ageing in developing
countries
12
Population ageing is associated with increase in
chronic diseases

• Transition to chronic degenerative diseases
• Continuing burdens of infectious diseases
• Greater impact of human immunodeficiency virus

13
Other Violence Stroke Heart Cancer Infancy Diar
rhoea Infections TB
Omran, Milbank Mem. Quart 1971
14
(No Transcript)
15
Compression of morbidity and disability?
Percent
A
B
Years
16
Percentage of life expectancy spent able to
perform basic ADLs
Men
Women
11.2
6.1
8.6
4.8
Source Bone et al Health Expectancy, 1995
17
Percentage of life expectancy spent able to get
outdoors
Men
Women
11.2
6.1
8.6
4.8
Source Bone et al Health Expectancy, 1995
18
The first big challenge for middle income
countries

• Growing cost of health care
• Population expectations for health care
• Technological advances
• Increased complexity of care delivery
• Who pays?

19
Trends in different sectors of health care costs,
USA 1960 -1997
10,000
1000
100
Source National Center for Health Statistics,
1999
20
Health policy

• Health promotion
• Free primary health care
• Geriatric/psychogeriatric services
• Community rehabilitation
• Respite care
• Nursing homes
• Training for family carers

21
What might help meet the challenge?

• Focus on prevention
• Cost-effectiveness approach to prioritising
  health care
• Self and family care
• Development of primary care infrastructure
• Health care financing

22
The second big challenge for middle income
countries

• Will the family continue to support elderly
  people?
• Urbanisation
• Young migrate leaving old behind
• Employment patterns
• Working women
• Westernisation
• Devaluing of older people

23
The effect of social factorswild versus
protected
Survival
Protected
Wild
Age
24
Minimum income for healthy living older
people
Policy Unit Age Concern England
Jerry Morris (chair), Alan Dangour, Christopher
Deeming, Astrid Fletcher, Paul Wilkinson , LSHTM,
2005
25
Social policies

• Pensions
• Housing
• Caring/disability allowances
• Transport
• Organisations for elderly people

26
(No Transcript)
27
The World Bank view

• The need for multi-pillar support systems
• State pensions
• Private sector pensions
• Personal savings

BUT what is the evidence (CHILE) and who
benefits most? Is the idiom of crisis
appropriate?
28
Income security

• Inter-generational transfer of resources
• Young to old
• Old to young
• Pensions and income security
• confined to civil servants
• affordability
• Loans and community income generation
• old age should not be a barrier

29
HelpAge International role in promoting income
security e.g. universal pensions in Laos
30
Urbanisation and Modernisation

• Older people literally left behind in rural areas
• Under-valuation of verbal traditions, wisdom of
  old age
• Birthplaces and final resting places
• Housing in cities usually too small for extended
  families

31
Old style work but new industries
32
Employment prospects for older people?
33
Economic productivity
at each age classed as economically active
34
Maintaining extended family lifestyles

• The family will cope
• Housing
• Transportation
• Reciprocal contributions to household
• Child care and rearing
• Tax incentives

35
Malaysia Mahathirs 2020 vision
the needs of elderly people will be met by "a
social system in which the welfare of the people
will revolve not around the state or the
individual but around a strong and resilient
family system"
Mohammad Mahathir. Vision 2020 In Malaysia the
way forward. Prime Minister Department of
Malaysia, Kuala Lumpur 1991.
36
How do we ensure inter-generational support?
37
Housing fine for extended families is torn down
to make way for housing suitable only for nuclear
families
Wu Ping and Yang Wu have been fighting off
bulldozers in downtown Chongqing since 2004, when
they were one of 280 households asked to make way
for a redevelopment project in the booming
southwestern city of nearly 28 million
CNN News, 2 April 2007
38
The childless older people

• No family to cope
• 10-15 couples are infertile
• Adoptions may become more difficult
• Community support mechanisms required

39
The public health problems

• Ageing is a major challenge to integrity of
  populations
• Rate of ageing is rapid, policy making is slow
• Development programmes and aid agencies are not
  considering impacts on older people

40
How can we meet the social challenges?

• Ageing as central consideration in social policy
  (cf. gender, poverty, race)
• Incentives for families to care
• Move towards pensions for all
• Emphasise the economic productivity of older
  people
• Training and re-training for older people