Ageing and Life Course 11 TH WORLD CONGRESS OF PUBLIC HEALTH GLOBAL AGEING: IMPLICATIONS FOR PUBLIC...

Ageing and Life Course

11TH WORLD CONGRESS OF PUBLIC HEALTH

GLOBAL AGEING:

IMPLICATIONS FOR PUBLIC HEALTH

Alexandre Kalache

WHO, Ageing and Life Course


Global Ageing

Ageing and development

Active Ageing Policy Framework

ALC activities


The world population is ageingPopulation Pyramid in

1995 and 2025

00-04

10-14

20-24

30-34

40-44

50-54

60-64

70-74

80+

Millions

Age

MALEMALE FEMALEFEMALE

300 300200 100 100 200

UN Population Division, 1998 Revision


The population in developing countries is fast increasing - particularly the

agedPopulation 2000 2025 2050(in billion)Total 6.0 7.8 8.9

More developed countries 1.2 1.2 1.2

Lessdeveloped countries 4.7 6.6 7.860+ 0.6 1.2 2.0

More developed countries 0.2 0.3 0.3

Lessdeveloped countries 0.4 0.9 1.7


Population 60 years and over as Percentage of total Population in selected Developing

Countries

% of total population

0

5

10

15

20

1975 2000 2025 Source: UN, 2000

Nigeria

Thailand

SouthAfricaIndonesia

Mexico

Brazil

India

China


Life expectancy at birth isincreasing in all regions

Source: UN Population Division, 1998 Revision

30

40

50

60

70

80

90

1950-55 1970-75 1990-95 2010-15 2030-35

Ye

ars

Africa Asia Europe Latin America and Caribbean Northern America

Japan

Sierra Leone


Women live longer than men - life expectancy at birth 2000-05

0 20 40 60 80 100

Nigeria

Russian Fed.

Bangladesh

Pakistan

India

Indonesia

Brazil

China

Mexico

USA

Japan

Men Women


Life Expectancy at the Age of 60 in Selected Countries

Source: UN, Population Data-Base, up-date 2001

COUNTRY

2000-05 Women

2025-30 Women

2000-05 Men

2025-30 Men

France 30.0 31.9 20.0 22.1 Japan 27.0 31.1 21.4 23.9 USA 23.9 26.1 19.5 21.7 UK 23.3 25.9 19.4 21.6 Cuba 22.5 24.1 20.3 21.3 Mexico 22.0 23.9 19.6 20.8 China 20.1 22.7 16.3 18.6 Russ. Fed. 18.7 21.4 13.5 16.2


Inequalities – global extremes

Japan Sierra Leone

Total 81.9 34.0

Male 78.4 32.4

Female 85.3 35.7

LE

B


Inequalities – global extremes

Japan Sierra Leone

Total 81.9 34.0

Male 78.4 32.4

Female 85.3 35.7

Japan Sierra Leone

Total 75.0 28.6

Male 72.3 27.2

Female 77.7 29.9

LE

BH

AL

E


Years of LEB lost to ill-health

Total 6.9 8.4% 5.4 16.0%

Male 6.1 7.8% 5.2 15.9%

Female 7.6 8.9% 5.8 16.3%

Japan Sierra Leone

Lo

st t

o

ill h

ealt

h


Social inequalities

São Paulo, Brazil



Total fertility rates are decreasing

0

1

2

3

4

5

6

7

1950-55 1970-75 1990-95 2010-15 2030-35

Africa AsiaEurope Latin America and CaribbeanNorthern America Source: UN, 1998


More and more countries have total fertility rates below replacement level

Source: UN , 1998

1970 2000 2020

22

68

121


Ageing in the development agenda

“Ageing is a development issue.

Healthy older persons are a

resource for their families, their communities and the economy.”

WHO Brasilia Declaration on Ageing, July, 1996


Older people are theprinciple carers for AIDS patients and AIDS orphans in Africa

Photo:UNICEF


The role of non-contributory pensions in Brazil and South Africa


The Burden of DiseaseSpain, 2002

Health care professionals 588(12%)

Community 4300(88%)

Total number of hours (in millions)/year spent on providing care


Total number of hours (in millions)/year spent on providing non-paid health care,

Spain 2002

Men Women

Caring for others 52199

Self-care 140 108

Total 192 307


Average number of minutes/day spent by the head of the household in providing health-related care,

Spain 2002

Age Group Household with a sick person

18 - 29

30 - 49

50 - 64

64 - 74

75- 84

85 +

Total

23

50

154

201

318

61

122


The population dividend


1970

South Korea: Population PyramidsSource: United Nations World Population Prospects, 2000 Rev.

2000

20502025

Male

Female


1970

China: Population PyramidsSource: United Nations World Population Prospects, 2000 Rev.

2000

2025 2050

Male

Female


Brazil: Population PyramidsSource: United Nations World Population Prospects, 2000 Rev.

1970 2000

2025 2050

Male

Female


Ageing world-wide: contrasting realities


The reality in the developed world

• Cohorts of future older persons quite different – the ‘baby boomers’ effect

• Contributions of biotechnology and new pharmaceuticals affordable by most

• Awareness• Disability rates declining• Dependency ratios inappropriately

calculated


4

5

6

7

8

9

10

1982 1989 1994 1996 1999

in M

illi

on

s

Projected numbers Actual numbers

4

5

6

7

8

9

10

1982 1989 1994 1996 1999

in M

illi

on

s

Projected numbers Actual numbers

Source: US National LTC Survey, NY Times, May 2001

Chronically disabled Americans 65 years and older

Evidence from the US: disability rates are declining

27 million 33 million 35 million


The reality in the developing world

• “poor raw material”

• prevailing poverty

• fast ageing in parallel with rapid social changes

– urban vs. rural ageing

– changes in family structure

– AIDS epidemic in Africa


In a nutshell:

The developed world became The developed world became rich before it became old.rich before it became old.

Developing countries are Developing countries are becoming old becoming old

before they become rich.before they become rich.


High Specificity of ageing from a public health perspective

•Increased NCD risk

•Multiple pathology

•Iatrogenic factors

•Drug interactions & dosage

•Socio-economic factors

•Emphasis on quality of life

•Community based health approaches


WHO’s response

The WHO

Ageing and Life

Course

Programme


Ageing and Life Course - programme components

Information dissemination

Capacity building

(research and training)

Policy development Advocacy

Global Strategy for Active Ageing


WHO’s approaches and perspectives on Ageing

• life - course • development • gender• cultural • cohort• intergenerational• primary health care/ community based


Life Course


Life Course Perspective

“A life course approach offers an interdisciplinary framework for guiding research and policy on health, human

development and ageing ”


A Life Course Approach to Active Ageing

Range of functionin individuals

Age

Fu

ncti

on

al

cap

acit

y

Early Life

Growth and developmen

t

Adult Life

Maintaining highest possible level of function

Older Age

Maintaining independence and

preventing disability

Rehabilitation and ensuring the quality

of life

Disability threshold

Source:Kalache and Kickbusch, 1997


Scope for NCD Prevention

Age

Develo

pm

en

t of

NC

D FetalLife

Adult Life Adolescence Infancy andChildhood

SEPdiseasesgrowth rate

obesitylack of PAsmoking

SEP; birth weight,maternal nutrition status

Source: Aboderin and Kalache. WHO,2002

PA: physical activity SEP: socio-economic position

Accumulated

Risk(Range)

high

low

SEP, established adult behavioural/biologicalrisk factors


2 billion older people in 2050

For those already aged 20+ an exclusive focus on children and the youth is already too late: by 2050

they will be 65+


It is time for a new paradigm, one that views older people as active participants in an age-integrated society and as active contributors aswell as beneficiaries of

development.


Active Ageing:

A Policy Framework


“Active Ageing” – WHO definition:

Active ageing is the process ofoptimizing opportunities for health, participation and security in order to enhance quality of life as people age.


Determinants of Active Ageing


Three pillars of a policy framework for Active Ageing


The time to plan and to act is now

In all countries, and in developing

countries in particular, measures to help older people remain healthy and active are a necessity, not a luxury.


A culture of ageing is a culture of solidarity


Solidarity between•Rich and poor

•Public and private•North and South

But, above all,


Solidarity between...

Young and old


ALC MainActivities


1. The INTRA project:

Integrated Health Systems in rapidly ageing developing countries –


INTRA's ultimate aimStrengthening family and community care through the PHC sector


INTRA I: quantitativeINTRA II: qualitative (PHC users)INTRA III: qualitative

(non-users)


INTRA I INTRA II INTRA IIIChile Peru BoliviaJamaica T & T SurinameBotswana Ghana KenyaLebanon Syria PakistanThailand Sri Lanka IndiaKorea China Malaysia


INTRA IChile: national teams

country profilecoordinators

steering committee

methodologyfield work report


INTRA IIChile Peru

national teams;coordinators;country profile

steering committee



INTRA IIIChile Peru Bolivia

national teams;coordinators;country profile

steering committee



INTRA FeaturesCapacity buildingBottom upExchange of

knowledge/Experiences/modelsSouth to SouthRegional hubsSustainability


2. Age-friendly PHC Centres


WHO main staircase





3. A gender perspectiveto ageing:

Women, ageing andhealth


4. Prevention of elder abuse through the PHC sector


5. Older persons in emergency situations - their needs and strengths


6. Preventing falls in older age at community level


7. AIDS and Ageing in Africa - older persons as carers


8. Age-friendly urban settings


photo by: Stefan Anderssonphoto by: Stefan Andersson

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Ageing and Life Course 11 TH WORLD CONGRESS OF PUBLIC HEALTH GLOBAL AGEING: IMPLICATIONS FOR PUBLIC...

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