|REGIONAL HEALTH OBSERVATORY|
|The challenges of population ageing worldwide|
The fast ageing of populations around the world is presenting challenges for developed and developing countries. These include:
These challenges can be counteracted by implementing the following measures.
Tax-funded pensions that provide basic support to vulnerable older people are an effective way of helping them avoid poverty. These are not unaffordable. It has been estimated that abolishing extreme poverty in old age by providing a universal, tax-funded, basic pension equivalent to$1 a day to all over age 60 would cost less than % of the gross domestic product of the majority of developing countries.
For any given level of physical limitation, a key determinant of an older person’s capacity to function is the environment in which they live. The World Health Organization recently commenced a programme designed to foster ‘‘age-friendly’’ environments that encourage ‘‘active ageing by optimizing opportunities for health, participation and security in order to enhance quality of life as people age’’. The core of the programme is the WHO Global Network of Age-friendly Cities.
In less developed countries, access to basic primary care including the early detection and management of common conditions like hypertension and diabetes can allow older people to maintain their health and capacity to live independently. In developed countries, the feared increase in demand for health care from population ageing is likely to be largely met by economic growth. An integrated continuum of long-term care can support older people to age in place and provide institutional care for those with severe limitation. Several developed countries have established such systems, but a major challenge will be developing integrated long term care in less developed countries
Many changing social patterns are likely to influence both the behaviours and well being of older people. One common trend during economic development has been for a shift from extended households to more nuclear households comprising one or two generations. For example, in Japan, the proportion of people living in 3-generation households has fallen from 46% in 1985 to 20.5% in 2006. These patterns present some challenges for older people. Since older people living alone are less able to benefit from the sharing of goods that might be available in a larger household, the risk of falling into poverty in older age may increase with falling family size.
Another recent social change has occurred in countries with a high prevalence of HIV/AIDS. Here, high mortality among adults has seen increasing numbers of ‘‘skipped generation households’’. In these households, surviving older adults have taken on responsibility for the children of younger generations who have died in the AIDS epidemic. Across sub-Saharan Africa, families headed by older adults are often the poorest, not only placing these vulnerable older people at greater risk, but also making it harder for the children in these households to escape poverty. Another impact of the HIV epidemic is the nearly 1,000,000 older people in sub-Saharan Africa who are estimated to have been ‘‘orphaned’’. In the past, they could have expected support from younger generations if they become frail and lost their independence. Now, that support will not be available.
The ageing of population represent as well an opportunity for societies. If older people can retain their health, and if they live in an environment that promotes their active participation, their experience, skills and wisdom will be without any doubts a resource for societies. However, most people of very advanced will be needing accessible and effective acute and long-term care. Developing integrated systems that provide seamless access to the care they require is a priority for both developed and developing countries.
Regional Office for the Americas of the World Health Organization