Growing old together: Policy and public health responses to ageing John Beard and co-collaborators, Lancet Series on Ageing (2014) Health in an ageing world: What do we know? Richard Suzman, John Beard, Ties Boerma and Somnath Chatterji Health systems need to find effective strategies to extend health care and to respond to the needs of older adults (aged 60 years and older). As the international momentum towards universal health coverage (UHC) increases, the specific needs of older adults, who often have many chronic health conditions, will have to be addressed by health systems. Health care for older adults that is effective, safe, efficient and responsive, without imposing an unbearable financial burden on individuals, will be central to achieving the goal of UHC. Furthermore, in the post-2015 development agenda, the goal of ensuring healthy lives and promoting well-being for everyone at all ages cannot be achieved without paying attention to the health of older adults. With an increasingly large proportion of this population living in low- and middle-income countries (LMICs), this will have implications worldwide. Although most data comes from high-income countries and a few middle-income countries, the major progress in reducing deaths from avoidable causes in older adults in countries with scarce resources is a reason to be optimistic. With increased international commitment, sound policies and strengthening of health systems, marked gains in life expectancy in older adults could be feasible in all countries. Because a substantial proportion of older adults will have poor health and be in need of long-term care, this will not only strain health systems but will also have economic implications. However, several responses are possible. These range from prevention of chronic disease through population-level public health responses to individual-level lifestyle changes. Effective treatment of chronic diseases to reduce disability; an extension of basic packages of cost-effective interventions to match the needs of older adults with appropriate technologies; a reduction of reliance on institutional care; training of appropriate human resources; and modification of policies so as to encourage older adults to remain part of the workforce for longer are all necessary. Ageing populations are typified by marked heterogeneity in functioning. This heterogeneity might have resulted from the cumulative effect of health inequities during an older person’s life course. This situation presents challenges to decision-makers, who must avoid reinforcing these inequities while developing policy that responds to an enormous diversity of needs. These challenges are compounded by evidence gaps in many fields, and persistent approaches to care and research that view older people as generic vessels of single-organ diseases that are best managed independently. Unless health systems change the selective underuse of interventions that are known to be effective in older adults, the burden on health systems is set to reach unmanageable proportions. Primary care systems need to be age-friendly. In LMICs, partly because the epidemiological and demographic transitions have been recent and more rapid, the knowledge base is thin. However, a burgeoning body of multidisciplinary international research from a range of LMICs supported by the US National Institute on Aging, such as the WHO Study on global AGEing and adult health (SAGE), has begun gradually to increase our understanding. Towards a comprehensive public health response John Beard and David E. Bloom Several factors make development of a policy on ageing difficult. First, the changes that constitute and affect ageing are complex. These alterations only loosely correspond to chronological age, which changes at a steady rate, whereas the variations in functioning linked with ageing are neither smooth nor well defined. As a consequence, great inter-individual functional variability is a hallmark of older populations; thus, policies to meet the needs of older people should consider many different subpopulations. For example, although some older people might wish to continue to participate in social and occupational activities to a similar extent to younger people, less healthy individuals in the same age group might need substantial health and social care, and have little capacity for social engagement. Encompassing such diversity in a simple policy framework is difficult. Second, this diversity is not random. Roughly 25 per cent of the heterogeneity in health and function in older age is genetically determined (Brooks-Wilson, 2013), with the remainder strongly affected by the cumulative effect of health behaviours and inequities across the life course (González-González et al., 2014). Thus, someone born into a poor family with limited access to education, or in a marginalised cultural group, is likely to have poor health in older age and earlier mortality. Recent findings suggest that there might even be an association between the ability to The Lancet Series on Ageing (November 2014) highlighted a neglected area in the health sector and in social and economic-policy development. The six papers address issues related to mortality, morbidity and disability, well-being and potential health-system responses. Adapted by kind permission. For full references and further information see: www.thelancet.com/series/ageing Accessed 1 April 2015. 38 Commonwealth Health Partnerships 2015
Commonwealth Health Partnerships 2015
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