Linking productive ageing to NCD prevention and control George Alleyne Robert Butler introduced the concept of productive ageing in 1983 and argued that mobilisation of the productive potential of the elders of society was of fundamental importance to human welfare (Butler and Gleason, 1985). It is by now axiomatic that good health is important for all forms of productivity and it is therefore important to note that all disease may contribute to disability and thereby reduce productivity, which does not only refer to employment as there are clearly other spheres in which the elderly may make a meaningful contribution to society. Noncommunicable diseases (NCDs) are increasing in prevalence and are therefore likely to affect productivity. However, mere ill health or frailty, Butler argued, need not preclude productivity in later life, as opportunity to remain productive continues within an individual’s remaining capacity to create meaning and to grow developmentally. The barriers to productive ageing so conceived include ageism or other forms of discrimination, economic conditions, institutional capabilities and social security frameworks (Holmerova et al., 2014). Butler’s is a very generous view of productivity and the position taken here is that disability due to impairment of physical and mental capacity as a result of NCDs must affect productivity in one form or another. Ageing figures in the global political agenda and the landmark Madrid International Plan of Action on Ageing of 2002 (UN, 2002) had governments expressing their commitment to act on three priority directions for action: older persons and development, advancing health and well-being into old age, and ensuring enabling and supportive environments (Robinson et al., 2006; see Box: ‘Three priorities for action’). All of these have relevance for the relationship between productive ageing and NCDs. There are several major links between productive ageing and NCDs, and many of these were elaborated in the recent Emerging Markets Symposium on ageing in emerging markets, held in Oxford in January 2015, where it was emphasised that humankind is getting older, but increasing years do not necessarily equate with senescence. The world is ageing It is estimated that by 2050 the persons over the age of 60 will outnumber those under 15 globally. Perhaps old age and ageing should be differentiated (see Box: ‘Human ageing’). However, it is almost inevitable that there is more disability as populations age and there is an increase in the length of time lived with disability with consequent reduced productivity. The loss of productivity may be more marked in developing countries, where the social conditions that might modulate the impact of disability are deficient or absent. The world’s disease pattern is changing The world’s epidemiological profile is changing and the diseases due to infections and pestilences are being replaced by chronic NCDs (WHO, 2014). Almost every chronic condition is more prevalent in the elderly, but the four that contribute 82 per cent to mortality from NCDs are cardiovascular disease, cancer, chronic respiratory disease and diabetes. As populations age, NCDs will represent an increased proportion of all deaths. Thus, in lower-income countries, because of a different population age structure, it is possible to underestimate the size of the NCD problem. It has been pointed out that ‘future population growth and population ageing will drive large increases in the burden of mortality due to NCDs even if no changes occur in the age-specific risks of dying from an NCD’ (UN, 2012). Of the 56 million deaths worldwide in 2012, 38 million were caused by NCDs, with 37 per cent of these due to cardiovascular disease, 27 per cent to malignant neoplasm, eight per cent to respiratory disease and four per cent to diabetes mellitus. NCDs are no longer the unique province of the so-called developed countries as three-quarters of deaths from them occur in low- and middleincome countries (LMICs; WHO, 2014). Three-quarters of deaths from cardiovascular disease and diabetes, and nearly 90 per cent of deaths from chronic respiratory distress occur in LMICs. While the poorer countries are indeed showing increases in death rates from NCDs, a division between rich and poor countries may be fictitious as a majority of the world’s poor live in LMICs. Mental health contributes significantly to disability throughout the life course and especially in later years. More than 20 per cent of 74 Commonwealth Health Partnerships 2015 Three priorities for action Priority direction one for action strives to integrate global ageing within the larger context of development. The overall goal is to ensure that older persons are full participants in the development process and also its beneficiaries. Priority direction two emphasises that the health of the population is vital to development and that, for the individual, good health is the most important asset and human right. To reach old age in good health requires the combined efforts of government, civil society and the individual. Priority direction three aims to ensure enabling and supportive environments. It promotes positive perceptions of ageing and positive, realistic images of older persons to influence public values relating to social, cultural and economic exchange between generations.
Commonwealth Health Partnerships 2015
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