Ageing and Life Course
11TH WORLD CONGRESS OF PUBLIC HEALTH
GLOBAL AGEING:
IMPLICATIONS FOR PUBLIC HEALTH
Alexandre Kalache
WHO, Ageing and Life Course
Ageing and Life Course
Global Ageing
Ageing and development
Active Ageing Policy Framework
ALC activities
Ageing and Life Course
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
Ageing and Life Course
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
Ageing and Life Course
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
Ageing and Life Course
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
Ageing and Life Course
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
Ageing and Life Course
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
Ageing and Life Course
Inequalities – global extremes
Japan Sierra Leone
Total 81.9 34.0
Male 78.4 32.4
Female 85.3 35.7
LE
B
Ageing and Life Course
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
Ageing and Life Course
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
Ageing and Life Course
Social inequalities
São Paulo, Brazil
Ageing and Life Course
Ageing and Life Course
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
Ageing and Life Course
More and more countries have total fertility rates below replacement level
Source: UN , 1998
1970 2000 2020
22
68
121
Ageing and Life Course
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
Ageing and Life Course
Older people are theprinciple carers for AIDS patients and AIDS orphans in Africa
Photo:UNICEF
Ageing and Life Course
The role of non-contributory pensions in Brazil and South Africa
Ageing and Life Course
The Burden of DiseaseSpain, 2002
Health care professionals 588(12%)
Community 4300(88%)
Total number of hours (in millions)/year spent on providing care
Ageing and Life Course
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
Ageing and Life Course
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
Ageing and Life Course
The population dividend
Ageing and Life Course
1970
South Korea: Population PyramidsSource: United Nations World Population Prospects, 2000 Rev.
2000
20502025
Male
Female
Ageing and Life Course
1970
China: Population PyramidsSource: United Nations World Population Prospects, 2000 Rev.
2000
2025 2050
Male
Female
Ageing and Life Course
Brazil: Population PyramidsSource: United Nations World Population Prospects, 2000 Rev.
1970 2000
2025 2050
Male
Female
Ageing and Life Course
Ageing world-wide: contrasting realities
Ageing and Life Course
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
Ageing and Life Course
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
Ageing and Life Course
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
Ageing and Life Course
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.
Ageing and Life Course
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
Ageing and Life Course
WHO’s response
The WHO
Ageing and Life
Course
Programme
Ageing and Life Course
Ageing and Life Course - programme components
Information dissemination
Capacity building
(research and training)
Policy development Advocacy
Global Strategy for Active Ageing
Ageing and Life Course
WHO’s approaches and perspectives on Ageing
• life - course • development • gender• cultural • cohort• intergenerational• primary health care/ community based
Ageing and Life Course
Life Course
Ageing and Life Course
Life Course Perspective
“A life course approach offers an interdisciplinary framework for guiding research and policy on health, human
development and ageing ”
Ageing and Life Course
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
Ageing and Life Course
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
Ageing and Life Course
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+
Ageing and Life Course
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.
Ageing and Life Course
Active Ageing:
A Policy Framework
Ageing and Life Course
“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.
Ageing and Life Course
Determinants of Active Ageing
Ageing and Life Course
Three pillars of a policy framework for Active Ageing
Ageing and Life Course
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.
Ageing and Life Course
A culture of ageing is a culture of solidarity
Ageing and Life Course
Solidarity between•Rich and poor
•Public and private•North and South
But, above all,
Ageing and Life Course
Solidarity between...
Young and old
Ageing and Life Course
ALC MainActivities
Ageing and Life Course
1. The INTRA project:
Integrated Health Systems in rapidly ageing developing countries –
Ageing and Life Course
INTRA's ultimate aimStrengthening family and community care through the PHC sector
Ageing and Life Course
INTRA I: quantitativeINTRA II: qualitative (PHC users)INTRA III: qualitative
(non-users)
Ageing and Life Course
INTRA I INTRA II INTRA IIIChile Peru BoliviaJamaica T & T SurinameBotswana Ghana KenyaLebanon Syria PakistanThailand Sri Lanka IndiaKorea China Malaysia
Ageing and Life Course
INTRA IChile: national teams
country profilecoordinators
steering committee
methodologyfield work report
Ageing and Life Course
INTRA IIChile Peru
national teams;coordinators;country profile
steering committee
methodologyfield work report
Ageing and Life Course
INTRA IIIChile Peru Bolivia
national teams;coordinators;country profile
steering committee
methodologyfield work report
Ageing and Life Course
INTRA FeaturesCapacity buildingBottom upExchange of
knowledge/Experiences/modelsSouth to SouthRegional hubsSustainability
Ageing and Life Course
2. Age-friendly PHC Centres
Ageing and Life Course
WHO main staircase
Ageing and Life Course
Ageing and Life Course
Ageing and Life Course
Ageing and Life Course
3. A gender perspectiveto ageing:
Women, ageing andhealth
Ageing and Life Course
4. Prevention of elder abuse through the PHC sector
Ageing and Life Course
5. Older persons in emergency situations - their needs and strengths
Ageing and Life Course
6. Preventing falls in older age at community level
Ageing and Life Course
7. AIDS and Ageing in Africa - older persons as carers
Ageing and Life Course
8. Age-friendly urban settings
Ageing and Life Course
photo by: Stefan Anderssonphoto by: Stefan Andersson