U n i v e r s a l h e a l t h c o v e r a g e a n d h e a l t h y a g e i n g morbidity and prioritising the restoration of functionality should lead to new professional approaches that provide patient-centred, multi-disciplinary, integrated care. Geriatricians who can provide multi-system evaluation and integrated care would have to play a greater role than disease- or organ-specific specialist care providers. From dental care and visual or hearing aids to nutrition counselling, the special needs of the elderly need attention from the health system. At the same time, allied health professionals like physiotherapists, mental health counsellors and elderly care providers would be needed in larger numbers. Non-physician case managers, who are trained to provide care for multiple chronic conditions, have been shown to be effective in providing integrated and continuous personalised care in the long term (Sutherland and Hayter, 2009). Physical rehabilitation has to be assisted by a variety of assistance devices and supportive services. Advances in technology should be appropriately utilised to reduce physical dependence, improve mobility and reduce social isolation. Innovations in systems of care delivery must improve both independent and assisted living. Universal health coverage (UHC) becomes especially important in adequately addressing the health needs of the elderly, who not only access health care more often but also become financially vulnerable if they are no longer generating an income. Quite often insurance schemes do not provide coverage to persons with pre-existing health conditions or do so at unaffordable premiums. The elderly, who often fall into this category, need health care that is tax funded or heavily subsidised through government-sponsored social insurance schemes. Access to essential drugs, diagnostics and technologies too needs to be an integral part of the UHC framework. At the same time, we need to change societal attitudes, from considering the elderly as non-productive dependents to regarding them as mature adults who can still contribute as mentors, through shared expertise and experience. That will make them feel relevant and valued, protecting their mental health and motivating them to preserve their physical health. Their productive participation and social security can be promoted by extended retirement ages and secure pension plans. The elderly should not experience active discrimination (social exclusion), apathetic neglect (social isolation) or disability-induced non-participation (social withdrawal). Elderly abuse, which is an extremely deplorable form of mistreatment, must be curbed both through strong legal safeguards and public education (Daichman et al., 2002). The need for strong social support systems is reinforced by the ‘feminisation of ageing’, which is now being witnessed even in large Asian countries like India and China. Women survive longer than men and are more numerous among the elderly and especially among the very elderly. Widowhood and abandonment by families, superimposed on lack of assured income, can render many women extremely vulnerable. Lack of kinship support is a growing problem for nuclear families resulting from urbanisation and migration of younger members of the family. Participation in social networks and group physical activities must be encouraged to protect physical and mental health, even as social security measures are provided. Health and well-being at all ages The proposed health goal among the Sustainable Development Goals (SDGs) to be adopted by the United Nations this year is ‘health and well-being at all ages’. This goal, as well as the targets that address health priorities across the life course along with the needed health system responses, are highly relevant to an ageing world population. Other SDGs related to poverty, gender, food security, education, conflict mitigation, environment and urbanisation also impact on the health and well-being of the elderly. The framework of sustainable development must, therefore, envision and enable the full and fulfilling lives that mature adults aspire to lead in the coming decades. The right to lead such a life with dignity must be encased in the safe shell of social solidarity and nurtured by the values of inter-generational equity and inclusive development. Ultimately, how well the most vulnerable segments of the human family fare, at both ends of the age spectrum, will be a test for our civilisation in this century. References Basten, S., 2013. ‘Redefining “Old Age” and “Dependency” in East Asia: Is “prospective aging” a more helpful concept?’. Asian Social Work and Policy Review, pp. 242–248. Daichman, L., Wolf, R. and Bennet, G., 2002. Abuse of the Elderly in the World. Geneva: WHO, pp. 125–145. Mathers, C. D., Stevens, G. A., Boerma, T., White, R. A. and Tobias, M. I., 2015. ‘Causes of international increases in older age life expectancy’. The Lancet, 385, pp. 540–548. Prince, M. J., Wu, F., Guo, Y. et al., 2015. ‘The burden of disease in older people and implications for health policy and practice’. The Lancet, 385, pp. 549–562. Sutherland, D. and Hayter, M., 2009. ‘Structured review: Evaluating the effectiveness of nurse case management in improving health outcomes in three major chronic diseases’. Journal of Clinical Nursing, 18, pp. 2978–2992. UNDESA (United Nations Department of Economic and Social Affairs), 2012. World Population Prospects. New York: UNDESA. 16 Commonwealth Health Partnerships 2015 PROFESSOR K. SRINATH REDDY is the president of the Public Health Foundation of India, which promotes interdisciplinary and health system-related professional education, research, knowledge translation and technology development. Trained in cardiology and epidemiology, he is currently also the president of the World Heart Federation. Reddy headed the Department of Cardiology at the All India Institute of Medical Sciences, New Delhi, and has visiting or adjunct professorships at Harvard, Emory and Sydney universities, He is the co-chair of the Thematic Group on Health for the Sustainable Solutions Development Network. He has authored more than 400 scientific publications and received several honours, which include the WHO Director-General’s Award for Outstanding Global Leadership in Tobacco Control, the Queen Elizabeth Medal for Health Promotion and the Padma Bhushan, conferred by the President of India. DR MANU RAJ MATHUR is a dental surgeon with a PhD in epidemiology and population health from University College London. He is currently working as research scientist and adjunct assistant professor at the Public Health Foundation of India (PHFI), and technical advisor to its president. He has worked on many projects funded by the government of India, WHO, BMGF, USAID and NIH in the past. His current research interests include the UN post- 2015 development agenda on health, as well as dietary and psychological factors in adolescent oral health (as principal investigator of a Wellcome Trust-funded study).
Commonwealth Health Partnerships 2015
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