in selected countries of the western paci˜c region...iv the health of older people in selected...

Ageing and Health

The health of older people in selected countries of the Western Paci�c Region

The health of older people in selected countries of the

Western Pacific Region

WHO Library Cataloguing in Publication Data The health of older people in selected countries of the Western Pacific Region.

1. Aged. 2. Ageing. 3. Health services for the aged. 4. Western Pacific. I. World Health Organization Regional Office for the Western Pacific.

ISBN 978 92 9061 657 3 (NLM Classification: WT 31)

© World Health Organization 2014

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Cover photograph credits: top-right, Stanislas Fradelizi/World Bank; middle, Khasar Sandag/World Bank; bottom-left, Rob Maccoll/AusAID

Contents iii

Contents

Acknowledgements iv

Acronyms iv

1. Introduction 1

2. Background 3

2.1 Population ageing in the Western Pacific Region 52.2 Increased life expectancy in the Western Pacific Region 72.3 Healthy life expectancy 9

3. The health of older people in the Western Pacific Region 10

3.1 Burden of disease 103.2 Comparison of disease, risk factors and disability across selected countries and

areas in the Western Pacific Region 153.2.1 Comparison of common health conditions 153.2.2 Comparison of health risk behaviours 153.2.3 Self-rated health, limitations in mobility and difficulty with self-care 173.2.4 Sociodemographic influences on health 19

4. Policy implications 24

4.1 Population ageing presents challenges, but also opportunities 244.2 Older people are valuable social, political and economic resources 254.3 Recognizing and reducing burden of disease among people 60 years and above

in the Western Pacific Region 274.4 Strengthening health systems and social protection 314.5 Supportive environments for older people 334.6 Regional and country-specific policy issues 34

5. Health data and need for further research 36

Appendix A. World Health Organization burden of disease classification groups 37Appendix B. Diagnoses and conditions for men and women aged 60 years and

above, selected countries, Western Pacific Region, 38

Appendix C. Health risk behaviours among men and women aged 60 years and above, selected countries, Western Pacific Region

, 39

Appendix D. Limitations in mobility and difficulties in self-care among persons aged 60 years and above, selected countries, Western Pacific Region

, 40

Appendix E. Sociodemographic characteristics of men and women aged 60 years and above, selected countries, Western Pacific Region

, 41

References 42

The health of older people in selected countries of the Western Pacific Regioniv

Acknowledgements

This report was prepared by Julie Byles, Cassie Curryer, Natalie Edwards, Natasha Weaver, Cate D’Este and John Hall, from the Faculty of Health and the Research Centre for Gender Health and Ageing (the World Health Organization Collaborating Centre for International Longitudinal Studies on Gender, Ageing and Health) at the University of Newcastle, Australia; and Paul Kowal from the World Health Organization.

Thanks to Hal Kendig, Somnath Chatterji and Nirmala Naidoo for assistance with obtaining data for this project; to Anjana Bhushan, Britta Baer, Joel Negin, John Beard, and Hal Kendig for critical comments; and to Kha Vo, University of Newcastle, for further assistance.

A draft version of the report was presented at the Informal Experts’ Consultation on Ageing and Health in the Western Pacific Region, held from 9 to 10 April 2013, in Manila, the Philippines. The final version incorporates the comments and input provided by the consultation participants.

Acronyms

BMI body mass indexDALY disability-adjusted life yearESCAP Economic and Social Commission for Asia PacificGNI gross national incomeNHS National Health SurveyOPA older people’s associationSAGE Study on global AGEing and adult healthSARS severe acute respiratory syndromeUNFPA United Nations Population FundWHO World Health OrganizationWHS World Health Survey

Introduction 1

1. Introduction

Population ageing has important social, economic, political and cultural implications. On the one hand, the risk of chronic illness and disability increases with older age.

On the other, older people represent a population of survivors who make significant contributions to their families and communities. Many opportunities exist to encourage optimal health and participation by older people and to maximize the potential for future generations to age well. However, improvements in older people’s health cannot be achieved in isolation. It requires a multisectoral approach that promotes health capacity across the life-course, provides supportive environments as well as social policies, and ensures adequate and effective health and long-term care for those in need.

This report provides an overview of population ageing and the health of people aged 60 years and above in the Western Pacific Region. The report highlights the extent and pace of population ageing across a diversity of settings in the Region, and emphasizes some key health challenges and opportunities that accompany these changes. Policy implications are also discussed.

The report draws on a variety of sources of information, such as the World Health Organization, World Bank, the Population Division of the United Nations Department of Economic and Social Affairs, HelpAge International, scholarly reports and peer-reviewed journal articles. Specific information on health indicators for people aged 60 years and above in seven countries in the Region was obtained from a range of health surveys including the World Health Survey and other country-specific surveys.

Original data sources analysed for this report include the following: • National Health Survey (NHS), Australia (2007–2008). Available at: http://www.abs.

gov.au/ausstats/[email protected]/Latestproducts/4364.0Main%20Features120072008%20Reissue)?opendocument&tabname=Summary&prodno=4364.0&issue=2007–2008% 20(Reissue)&num=&view

• WHO Multi-Country Survey (2001). Available at: http://www.who.int/responsiveness/papers/MCSS_Analytical_Guidelines.pdf

• WHO Study on Global ageing and adult health (SAGE) (2008–2010). Available at: http://www.who.int/healthinfo/systems/sage/en/index1.html

• WHO World Health Survey (2002–2004). Available at: http://surveydata.who.int/data.html

• WHO SAGE–INDEPTH Viet Nam (FilaBavi) (2007–2008). Metadata available at: http://www.who.int/healthinfo/systems/sage/en/index2.html

• World Health Organization (2008). The Global Burden of Disease Report, 2004 Update. Available at: http://www.who.int/healthinfo/global_burden_disease/2004_report_update/en/index.html

1

The health of older people in selected countries of the Western Pacific Region2

Key points

Population ageing

• The populations of countries in the Western Pacific Region are ageing at different rates. Countries are at different stages of demographic transition.

• The fastest growth in the 60 years and above age group is taking place in low- and lower middle-income countries.• Women appear to outnumber men in older age groups.• Older people are a significant social and economic resource. They make valuable contributions to their

communities by providing paid and volunteer work and/or caring for family members. Longer life expectancy provides opportunities to participate and contribute to society in older age.

Health of older people

• The burden of disease from noncommunicable diseases such as ischaemic heart disease, stroke, cancer and diabetes has increased and presents a significant economic burden for countries across the Region.

• The burden of disease from communicable diseases, unintentional injuries and disability remains high in many settings.• Health inequalities among people 60 years or over exist both within and between countries.• Significant opportunities exist to reduce exposure to risk factors for chronic diseases and improve health and

participation in older age.

Policy implications

• The health of older people cannot be addressed or analysed in isolation, but must be approached through a broader population-wide, multisectoral response that recognizes the influence of social determinants on health across the life-course.

• Achieving optimal health for older people requires a cross-sectoral response including health-care provision, age-friendly environments, housing and transport, social protection, and other supportive policies and structures.

• Policies must ensure that adequate social and economic infrastructure, as well as health, social and financial resources are available to support diverse populations as they age.

• The provision of equitable, affordable health-care, together with enhanced provision of disability aids, services, access to essential medicines, and palliative care for older people should be prioritized.

• Public health efforts to support lifestyle changes and prevent exposure to risk factors can improve health and decrease the disease burden of both middle-aged and older-aged adults.

• Priority must be given to developing new policies that recognize the impact of inequality across the life-course on health outcomes and the experience of ageing.

• The inclusion of ageing and health issues in both pre-service and ongoing training for health professionals is vital to increase the awareness and quality of appropriate practice in providing health services for older persons.

• Surveillance for noncommunicable diseases should include older adults as well as other age groups and the total population.

• Improved data collection and standardization of global health indicators such as health surveys are needed to enable more accurate comparisons, identification of older populations at high risk of poor health, and monitoring of health inequalities across and within countries.

• Collection of data disaggregated by age, sex, socioeconomic groups or other relevant social stratifiers is crucial to identify gaps in health outcomes and inform the development of policies to address the needs of disadvantaged subgroups of older people.

• Further research on human behaviour, lifestyle modifications, risk-factor prevention and improving health outcomes for older people is needed to adequately inform policies and public health interventions.

• Analysis of why existing evidence on the health of older people has not been translated into policy and practice should be undertaken in order to identify and generate strategies that would enhance uptake of evidence in policy and practice development.

• Policies should recognize and facilitate the valuable contribution older people make to their communities.

Background 3

2. Background

The Western Pacific Region is bounded by China in the north and west, New Zealand in the south, and Pitcairn Islands in the east (see Figure 1). The Region is home to

approximately 1.8 billion people, more than a quarter of the world’s population. The 37 countries and areas that make up the Region1 are culturally, linguistically, politically, economically and demographically diverse. The Region includes some of the world’s least developed countries, as well as rapidly growing economies, such as China and Viet Nam. The Region also includes a number of high-income countries, such as Australia, Japan, the Republic of Korea and Singapore, and lower middle-income countries, such as Fiji, Papua New Guinea, and the Philippines.2

1 The countries and areas in the Western Pacific Region include American Samoa, Australia, Brunei Darussalam, Cambodia, China, Cook Islands, Fiji, French Polynesia, Guam, Hong Kong (China), Japan, Kiribati, the Republic of Korea, the Lao People’s Democratic Republic, Macao (China), Malaysia, the Marshall Islands, Micronesia (the Federated States of), Mongolia, Nauru, New Caledonia, New Zealand, Niue, Northern Mariana Islands (Commonwealth of), Palau, Papua New Guinea, the Philippines, the Pitcairn Islands, Samoa, Singapore, Solomon Islands, Tokelau, Tonga, Tuvalu, Vanuatu, Viet Nam and Wallis and Futuna (http://www.wpro.who.int/countries/en).

2 Using World Bank classifications, this report identifies a country as being in the “high income” category if it had a gross national income (GNI) per capita of US$ 12 476 or more; “upper middle income” if GNI per capita was between US$ 4036 and US$12 475; “lower middle income” if GNI per capital was between US$ 1026 and US$ 4035; and “low income” if GNI per capita was less than US$ 1025 (based on 2011 GNI per capita figures, using the World Bank Atlas Method, World Bank, 2011); http:data.worldbank.org/about/county-classifications; http://data.worldbank.org/about/country-classifications/world-bank-atlas-method; World Bank Country and Lending Group Classifications (July 2012); http://data.worldbank.org/about/country-classifications/country-and-lending-groups.

American Samoa

Tonga

SamoaWallis and Futuna

Vanuatu

Solomon Islands TokelauTuvalu

NauruKiribati

Marshall Islands

Micronesia, Federated States of

New Caledonia

Niue

Northern Mariana Islands

Palau

Philippines

Pitcairn IslandsCook Islands French Polynesia

Fiji

Republicof Korea JapanChina

Mongolia

Lao People'sDemocraticRepublic

Viet NamCambodia

Malaysia

Singapore

BruneiDarussalam

Australia

New Zealand

Hong Kong(China)

Macao(China)

Papua New Guinea

Guam

2Figure 1. Countries and areas of the Western Pacific Region

The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. Data source/ map production: World Health Organization Regional Office for the Western Pacific; please see http://hiip.wpro.who.int/portal/Countryprofiles.aspx.© WHO 2014. All rights reserved.


Table 1. Key sociodemographic characteristics, selected countries and areas, Western Pacific Region, by year shown, and by country income classification group3

Sources: Central Intelligence Agency (2013); United Nations Department of Economic and Social Affairs (2011); United Nations Economic and Social Commission for Asia Pacific (2012); World Bank (2013).

3 World Bank Atlas method (World Bank, 2011); please see also http://data.worldbank.org/about/county-classifications and http://data.worldbank.org/about/country-classifications/world-bank-atlas-method; World Bank Country and Lending Group Classifications (July 2012); please see also http://data.worldbank.org/about/country-classifications/country-and-lending-groups.

Country/Area Total population Annual growth rate(%) (2012)

Fertility rate (%) (2012)

Rural (%) (2010)

GNI per capita1

(US$)Gini

coefficient

High-income

Australia 22 262 501 (2013) 1.4 2.0 11 49 130 (2011) 35.2 (1994)

Hong Kong (China)

7 182 724 (2013) 1.0 1.1 0 36 010 (2011) 43.4 (1996)

Japan 127 253 075 (2013) -0.1 1.4 33 44 900 (2011) 24.9 (1993)

Republic of Korea

48 955 203 (2013) 0.4 1.4 17 20 870 (2011) 31.59 (1998)

Macao (China) 583 003 (2013) 2.1 1.2 0 45 460 (2011) N/A

New Zealand 4 365 113 (2013) 1.0 2.1 14 29 140 (2010) 36.17 (1997)

Upper middle-income

China 1 343 239 923 (2013) 0.4 1.6 53 4 940 (2011) 42.5 (2005)

Malaysia 29 179 997 (2012) 1.6 2.6 28 8 770 (2011) 46.21 (2009)

Lower middle- income

Fiji 896 758 (2013) 0.5 2.6 48 3 720 (2011) 42.8 (2009)

Lao People’s Democratic Republic

6 695 166 (2013) 1.3 2.6 67 1 130 (2011) 36.74 (2008)


106 104 (2013) 0.4 3.3 77 2 860 (2011) 61.1 (2000)

Mongolia 3 179 997 (2010) 1.5 2.5 38 2 310 (2011) 36.52 (2008)

Papua New Guinea

6 431 902 (2013) 2.2 3.8 87 1 480 (2011) 50.88 (1996)

Philippines 105 720 644 (2013) 1.7 3.1 51 2 210 (2011) 42.98 (2009)

Samoa 195 476 (2013) 0.5 3.8 80 3 160 (2011) N/A

Solomon Islands 597 248 (2012) 2.5 4.1 81 1 110 (2011) N/A

Tonga 106 322 (2013) 0.4 3.8 77 3 820 (2011) N/A

Vanuatu 261 565 (2013) 2.4 3.8 74 2 750 (2011) N/A

Viet Nam 92 477 857 (2013) 1.0 1.8 70 1 270 (2011) 35.57 (2008)

Low-income

Cambodia 15 205 539 (2013) 1.2 2.5 80 820 (2011) 37.9 (2008)

Background 5

Table 1 provides an overview of key sociodemographic characteristics of selected countries and areas in the Region.

Within countries, there is considerable demographic diversity. There are variations in population, sex and age structure, ethnicity and culture, educational levels, occupation, extent of urbanization/rurality, and other factors affecting sociodemographic status. Overall, 50% of the population in the Region lives in urban areas, compared to 70% in Europe, 32% in South-East Asia and 38% in Africa (World Health Organization, 2012). Moreover, some countries, such as Australia, cover large geographical areas and have vast resources at their disposal, whereas others, such as Niue, Palau, Tuvalu and Vanuatu, are small island nations, with limited resources (http://www.wpro/who/int/countries/en/index.htm).

2.1 Population ageing in the Western Pacific Region

Population ageing is a global demographic phenomenon, but the process varies among regions, individual countries and areas. A population may be classified as ageing when the proportion of people aged 60 years and above increases (UNFPA and HelpAge International, 2012). In the Western Pacific Region, there are more than 235 million people aged 60 years and above, accounting for 13.1% of the total population, and more than 30 million people aged 80 years and above, accounting for 2% (WHO Regional Office for the Western Pacific, 2012). In comparison, children aged 15 years and younger represent 20% of the total population of the Region (World Health Organization, 2012). The proportion of people aged 60 years and above is projected to increase (UNFPA and HelpAge International, 2012). Figure 2 shows the proportions of people aged 60 years and above in selected countries and areas of the Western Pacific Region for the years 2010 and 2030 (projected).

Although high-income countries have the greatest proportions of people aged 60 years and above, the fastest growth in this age group is taking place in low- and middle-income countries as well as less developed countries (World Health Organization, 2001). For instance, in Cambodia and Papua New Guinea, the proportions of older people are expected to double in less than 30 years (WHO Regional Office for the Western Pacific, 2012).

In China, the population aged 60 years and above is projected to exceed the younger population (aged 0–14 years) in 2020; and in Viet Nam by 2030. In Solomon Islands and Papua New Guinea, these population trends will not be seen until 2079 and 2084, respectively. However, in Australia (2011), Hong Kong (China) (2004), and the Republic of Korea (2011), the shares of the population aged 60 and above have already surpassed those of people in the 0–14 year age group (see Table 2).

The ratio of older women to older men is also increasing in many countries in the Region, especially among the very old (WHO Regional Office for the Western Pacific, 2012, World Health Organization, 2001). Across the Region, among those 80 years and above, there are 62 men for every 100 women.

Population ageing is occurring due to a number of factors, including declining fertility rates. Fertility rates are a measure of children born into a population. Fertility rates are said to be below replacement level when not enough children are born to ensure that on average each adult woman has a daughter who survives to the age of procreation (estimated to be around 2.1 children per woman). Decreases in women’s fertility rates have been attributed to a host of cultural and social factors such as increases in the


Figure 2. Proportion of people aged 60 years and above, selected countries and areas, Western Pacific Region, 2010 and 2030 (projected)

Proportion (%) of population aged 60 years and over

China

Tonga

Fiji

Australia

New Zealand

Republic of Korea

Hong Kong (China)

Macao (China)

Malaysia

Viet Nam

Samoa

Micronesia,Federated States of

Mongolia

Lao People'sDemocratic Republic

Philippines

Vanuatu

Solomon Islands

Papua New Guinea

Cambodia

Japan

0 5 10 15 20 25 30 35 40

2010

2030

4.6%

7.0%

5.0%

7.1%

5.4%

8.5%

5.7%

10.0%

5.9%

9.7%

5.9%

12.0%

5.9%

9.5%

6.2%

10.9%

7.3%

12.0%

7.7%

14.7%

7.9%

14.6%

8.0%

10.4%

8.4%

18.3%

11.5%

26.3%

12.3%

24.4%

15.7%

30.9%

18.2%

32.7%

18.3%

25.8%

19.0%

24.9%

30.5%

37.1%

Background 7

Table 2. Decade (and year) when the population aged 60 years or over exceeds the population aged between 0–14 years, selected countries and areas, Western Pacific Region, by country income classification group

2.2 Increased life expectancy in the Western Pacific Region

In the Western Pacific Region, life expectancy at birth has risen from 69 years in 1990 to 75 in 2009 (World Health Organization, 2012). Life expectancy at age 60 years has similarly risen, from 18 years in 1990 to 20 in 2009 (World Health Organization, 2012). This increase compares to Europe, where life expectancy at birth has risen from 71 years in 1990 to 75 in 2009, while that at age 60 years has risen from 19 years in 1990 to 21 in 2009 (World Health Organization, 2012).

DecadeLow-income

countriesLower middle-income

countriesUpper middle-

income countriesHigh-income

countries

1990–1999 Japan (1991)

2000–2009 Hong Kong (China) (2004)

2010–2009 Australia (2011)Macao (China) (2013)New Zealand (2016)Republic of Korea (2011)

2020–2029 China (2020)

2030–2039 Viet Nam (2030)

2040–2049 Cambodia (2048) Lao People’s Democratic Republic (2049)

Malaysia (2049)

2050–2059 Fiji (2051)Mongolia (2056)

2060–2069 Micronesia, Federated States of (2064)Philippines (2065)

2070–2079 Solomon Islands (2079)Vanuatu (2079)

2080–2089 Papua New Guinea (2084)Samoa (2085)Tonga (2087)

average age of marriage and childbirth, easy access to reliable contraceptive methods, longer educational and career paths and economic factors such as the ability to give up work to care for a child, or affordability and accessibility of childcare (McDonald, 2008). In 2010, the fertility rate in the Western Pacific Region was 1.7, compared to 4.8 in Africa, 2.5 in South-East Asia, and 1.7 in Europe (World Health Organization, 2012).

Population ageing is also occurring due to increased survival to older ages (life expectancy), across all regions and countries at various levels of development. Increased life expectancy at birth has resulted from better survival in infancy and childhood. Increased life expectancy at older ages has resulted from advances in public health, such as improved drinking-water and sanitation, improvements in health and nutrition across the life-course, preventive medicine including childhood immunization, and improvements in the health-care of older people (Rau et al., 2008).


Table 3. Life expectancy at birth and at age 60 years, for women and men, by country income classification group4, Western Pacific Region, 1990 and 2030

Source: World Health Organization (2012).

4 World Bank Atlas Method (World Bank, 2011); please see also http://data.worldbank.org/about/county-classifications and http://data.worldbank.org/about/country-classifications/world-bank-atlas-method; World Bank Country and Lending Group Classifications (July 2012); please see also http://data.worldbank.org/about/country-classifications/country-and-lending-groups.

Country/Area2010 2030

Life expectancy at birth

Life expectancy at 60 years

Life expectancy at birth

Life expectancy at 60 years

High-income Women Men Women Men Women Men Women Men

Australia 84.3 79.9 26.5 23.3 86.5 82.4 28.3 25.2

Hong Kong (China) 86.4 80.2 27.8 22.9 88.5 82.4 29.6 24.6

Japan 87.1 80.1 29.0 23.2 89.4 82.4 30.8 25.0

Republic of Korea 84.0 77.3 26.0 21.0 86.2 79.7 27.8 22.7

Macao (China) 83.8 79.1 25.4 22.0 86.1 81.3 27.2 23.7

New Zealand 82.8 78.9 25.4 22.5 85.2 81.5 27.3 24.5

Upper middle-income

China 75.6 72.1 20.8 18.0 79.2 75.3 22.9 19.9

Malaysia 76.9 72.5 19.7 17.9 80.1 75.7 22.1 19.9

Lower middle-income

Fiji 72.3 66.9 18.7 15.5 76.0 70.6 21.0 17.6


69.4 66.4 17.9 16.2 75.5 71.6 20.2 17.5


70.2 68.3 18.0 16.6 74.6 71.7 19.7 17.5

Mongolia 72.8 65.0 19.6 16.2 77.5 70.0 21.9 17.4

Papua New Guinea 65.5 61.2 16.8 13.5 71.6 67.0 19.0 15.2

Philippines 72.6 66.0 18.9 15.8 76.6 70.7 21.3 18.4

Samoa 76.0 69.9 21.2 16.3 79.5 73.8 23.4 18.2

Solomon Islands 70.0 67.0 18.0 16.3 75.9 71.9 20.4 17.6

Tonga 75.4 69.7 20.9 16.3 77.9 72.5 22.3 17.5

Vanuatu 73.6 69.5 19.2 16.9 77.9 73.5 21.7 18.3

Viet Nam 77.4 73.4 22.5 20.0 80.8 76.5 24.8 21.8

Low-income

Cambodia 65.1 62.2 17.2 15.5 73.0 68.9 19.1 16.8

However, not all countries have experienced similar rates of increase in life expectancy (see Table 3). Cambodia has the lowest life expectancy (62.2 years for men born in 2010), while Japan has the highest (80.1 years for men and 87.1 for women). While life expectancy at birth varies greatly from country to country, life expectancy at age 60 shows less variation. In most populations, people who survive to age 60 years can, on average, expect to live around another 15 to 25 years.

Life expectancy at birth and at age 60 is higher for women compared to men, for all countries in the Region. It is also projected to increase for both sexes. On average, across the Region, a boy born in 2010 could be expected to live to the age of 72 years, and a girl to 77 years.

Background 9

2.3 Healthy life expectancy

Healthy life expectancy is an estimate of the number of years that a person can expect to live in good health, taking into account age-specific mortality, morbidity and functional health status (http://www.who.int/topics/life_expectancy/en/). Estimates of healthy life expectancy for countries in the Western Pacific Region are shown in Table 4.

In 2010, Japan had the highest healthy life expectancy from birth for men (70.6 years) and women (75.5 years). The lowest healthy life expectancy was in Papua New Guinea, where men and women can expect to live 49.6 years and 51.5 years in good health respectively.

Table 4. Healthy life expectancy5 at birth for men and women in selected countries of the Western Pacific Region, by country income classification group6, 2010

Source: Salomon et al. (2012).7

5 Salomon et al., (2012) “Healthy life expectancy for 187 countries, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010”. Estimates of healthy life expectancy are based on estimates of average overall health for each age group, adjusted for co-morbidity using a Monte Carlo simulation to capture how multiple co-morbidities can combine in an individual. These estimates are then incorporated into life tables using the Sullivan method to produce healthy life expectancy estimates for each population defined by sex, country and year. The authors then estimated the contributions of changes in child mortality, adult mortality and disability to overall change in population health between 1990 and 2010.


7 Data have been drawn from the 2004 burden of disease as more recent (2010) country-specific data have not been released in time for inclusion in this report.

Country2010

Healthy life expectancy, men Healthy life expectancy, women

High-income

Australia 68.4 71.8

Brunei Darussalam 66.2 68.6

Japan 70.6 75.5

Republic of Korea 67.9 72.6

New Zealand 67.7 70.7

Singapore 69.6 72.6

Upper middle-income

China 65.5 70.4

Malaysia 62.6 66.4

Lower middle-income

Fiji 57.1 59.0

Kiribati 49.6 54.7

Lao People’s Democratic Republic 54.1 57.8

Marshall Islands 53.1 66.0

Micronesia, Federated States of 55.2 58.6

Papua New Guinea 49.6 51.5

Philippines 57.4 63.2

Samoa 59.8 63.2

Solomon Islands 53.0 55.3

Tonga 58.9 63.2

Vanuatu 54.3 57.4

Viet Nam 62.6 69.1

Low-income

Cambodia 55.9 60.0


3. The health of older people in the Western Pacific Region

Older people experience a diversity of health states. While some are in relatively good physical and mental health, others experience considerable disability and burden of

disease. The health of older people differs between and within countries by sex, rural/urban residence, ethnicity and socioeconomic status. Also, while health across the life-course has a substantial impact on the experience of ageing, many older people are able to adapt to changes in their health and remain independent and productive into very old age (UNFPA and HelpAge International, 2012).

3.1 Burden of disease

Table 5. Percentage burden of disease due to noncommunicable (Group II)8 diseases for people aged 60 years and above, selected countries and areas, Western Pacific Region, by country income classification group9, 2004

Source: World Health Organization (February 2009).

8 Burden of Disease Classification Groups is shown in Appendix A.


Country/Area Noncommunicable conditions (Group II) (%)

High-income

Australia 96

Hong Kong (China) 91

Japan 89

Republic of Korea 90

Macao (China) 91

New Zealand 97

Upper middle-income

China 91

Malaysia 87

Lower middle-income

Fiji 87

Lao People’s Democratic Republic 83

Micronesia, Federated States of 90

Mongolia 93

Papua New Guinea 79

Philippines 79

Samoa 86

Solomon Islands 86

Tonga 86

Vanuatu 86

Viet Nam 87

Low-income

Cambodia 79

3

The health of older people in the Western Pacific Region 11

By far the largest share of burden of disease in older persons in the Region comes from noncommunicable diseases that increase in prevalence with age (Group II),10 including ischaemic heart disease, stroke, chronic lung disease, osteoarthritis, dementia and diabetes (UNFPA and HelpAge International, 2012). Table 5 shows the share of disease burden, measured as disability-adjusted life years (DALYs)11 for people aged 60 years and above in selected countries and areas in 2004 (World Health Organization, February 2009). In Australia and New Zealand, over 95% of DALYs in this age group were from noncommunicable conditions. In other high-income countries, and in China, the Federated States of Micronesia and Mongolia, these conditions account for around 90% of disease burden.

In some countries, communicable diseases such as malaria, tuberculosis, pneumonia, meningitis, severe acute respiratory syndrome (SARS) and HIV/AIDS continue to be major causes of mortality and morbidity. These countries experience a double burden: increases in noncommunicable diseases as well as high incidence of communicable diseases (World Health Organization Western Pacific Regional Office, 2011).

In many countries population ageing has produced a shift in disease patterns from a preponderance of childhood and communicable diseases to lifestyle diseases of later life, such as cancer, cerebrovascular disease and diabetes. In Japan, for instance, the share of deaths from malignant neoplasms (compared to all causes, both sexes) has risen from 7.1% in 1950 to 30.7% in 2000 (National Institute of Population and Social Security Research, 2010).

Figure 3 shows the increase in burden of disease in each major disease group for the Region, measured as DALYs for men and women aged 60 years and above for the years 2005, 2015 and 2030. While the disability burden for Group I and Group III diseases remains fairly constant, there are massive increases in the burden of Group II diseases.

It is projected that noncommunicable diseases will cause 12.3 million deaths in the Region by 2020, exceeding mortality from communicable, maternal, perinatal and nutritional conditions combined (World Health Organization, 2011), and that, by 2030, noncommunicable diseases will account for three times as many DALYs and nearly five

10 Burden of Disease Classification Groups are shown in Appendix A.

11 Disability-adjusted life years are a composite summary measure that combines years lost to premature death and years lost through disability for incident causes of a given health condition.

Figure 3. Burden of disease estimates and projections in DALYs for persons aged 60 and above, by major disease group and sex, Western Pacific Region, 2005, 2015, 2030


DALY

s in

000

's

Year

50

40

30

20

10

060+2005

60+2015

60+2030

Group I Group II Group III


times as many deaths as communicable, maternal, perinatal and nutritional conditions in low- and middle-income countries (World Health Organization, 2011). Moreover, the increase in burden of disease between countries is not uniform; inequalities exist based on social determinants such as poverty, lack of education, alcohol and tobacco use, adverse effects of globalization such as exposure to air pollutants, and rural residence (World Health Organization, 2001).

Cardiovascular disease, malignant neoplasms (cancer) and respiratory disease account for the largest share of DALYs among both men and women aged 60 years and above. In most countries, cardiovascular disease (including ischaemic heart disease and cerebrovascular disease) is the leading cause of death and overall disease burden (see Table 6). However, in high-income countries such as Australia, Japan and the Republic of Korea, malignant neoplasms overtake cardiovascular disease as the leading cause of disease burden, particularly for men. Malignant neoplasms are the second major cause of disease burden in China and Mongolia, and feature among the top five causes of disease burden in most other countries.

Sensory organ diseases and neuropsychiatric conditions (particularly dementia) also feature prominently among the major causes of disease burden, especially in higher-income countries and those with greater proportions of older people. Moreover, the demographic shift towards older age groups and projected increased longevity will result in increased burden of sense organ diseases. Sense organ diseases account for the second greatest burden of disease in the Federated States of Micronesia, Fiji, the Lao People’s Democratic Republic, the Philippines, Samoa, Solomon Islands, Tonga and Vanuatu; and the third highest in Cambodia, the Republic of Korea, Malaysia and Mongolia. In Japan and China, sense organ diseases such as cataracts are ranked the fourth highest burden of disease. In China, 5.7% of the population aged 65 and above has been formally diagnosed with cataracts (Yong et al., 2011). Cataracts cause 73.1% of low vision and blindness in Chinese people aged 60 years and above, resulting in lower quality of life (Yong et al., 2011). In Australia, cataracts is the second most frequent cause of unilateral blindness, and the most frequent cause of mild to moderate visual impairment among older people (Kanthan et al., 2008). Cataracts increase with age (Yong et al., 2011; Kanthan et al., 2008). They also affect a larger share of women than men, and have a higher prevalence in urban than rural areas, although this effect could be due in part to the relative infrequency of eye examinations in rural areas (Yong et al., 2011). Although cataracts can be surgically removed by a simple and low-cost procedure, cataract blindness accounts for almost 47.9% of global blindness (about 20 million people worldwide) (Yong et al., 2011).

Globally, dementia is the second greatest cause of disability among older people (UNFPA and HelpAge International, 2012). Dementia is projected to increase due to population ageing, particularly among the oldest (80 years and above) and in countries experiencing demographic transition. Currently, the burden of disability from dementia is slightly more in developing countries (7 million) than in developed countries (6.2 million) (UNFPA and HelpAge International, 2012).

Respiratory diseases, including chronic obstructive pulmonary disease, rate among the top five conditions affecting older people in most countries.

The burden of noncommunicable diseases across the Region reflects the prevalence of lifestyle and disease risk factors including high rates of smoking in many countries, and the development of predisposing conditions such as hypertension, obesity and diabetes.


Table 6. Top five causes of disease burdens (DALYs) by sex and disease subgroups, selected countries, Western Pacific Region, by country income classification group12, 2004


Country/AreaLeading cause

of disease burden

Second greatest cause of disease

burden

Third greatest cause of disease

burden

Fourth greatest cause of disease

burden

Fifth greatest cause of disease

burden

High-income

Australia Neoplasms Cardiovascular diseases

Neuropsychiatric conditions

Respiratory diseases Sense organ diseases

Hong Kong (China) N/A N/A N/A N/A N/A

Japan Neoplasms Cardiovascular diseases

Neuropsychiatric conditions

Sense organ diseases Respiratory diseases

Republic of Korea Neoplasms Cardiovascular diseases

Sense organ diseases Neuropsychiatric conditions

Diabetes mellitus

Macao (China) N/A N/A N/A N/A N/A

New Zealand Cardiovascular diseases

Neoplasms Neuropsychiatric conditions

Respiratory diseases Sense organ diseases

Upper middle-income

China Cardiovascular diseases

Neoplasms Respiratory diseases Sense organ diseases Neuropsychiatric conditions

Malaysia Cardiovascular diseases

Sense organ diseases Neoplasms Respiratory diseases Infectious and parasitic diseases

Lower middle-income

Fiji Cardiovascular diseases

Sense organ diseases Respiratory diseases Infectious and parasitic diseases

Diabetes mellitus


Cardiovascular diseases





Neoplasms

Mongolia Cardiovascular diseases

Neoplasms Sense organ diseases Digestive diseases Infectious and parasitic diseases

Papua New Guinea Cardiovascular diseases

Infectious and parasitic diseases

Neoplasms Respiratory diseases Sense organ diseases

Philippines Cardiovascular diseases

Sense organ diseases Infectious and parasitic diseases

Respiratory diseases Respiratory infections

Samoa Cardiovascular diseases


Respiratory diseases Neoplasms

Solomon Islands Cardiovascular diseases



Tonga Cardiovascular diseases


Neoplasms

Vanuatu Cardiovascular diseases



Viet Nam Cardiovascular diseases


Low-income

Cambodia Cardiovascular diseases

Infectious and parasitic

Sense organ diseases Neoplasms Respiratory diseases


Figures 4 (a,b,c,d) show the top ten causes of DALYs for men and women aged 60 years and above in four countries in the Western Pacific Region. While the magnitude and lead order of disease burden varies, there are many similarities in terms of the leading cause of disability.

The changing pattern and burden of disease associated with population ageing has important implications for provision and planning of health services for older populations. As populations age, the number of older people living with disability will increase. Moreover, older people tend to have more than one health condition (co-morbidity) which complicates the management and treatment of health conditions such as diabetes. Both communicable and noncommunicable diseases create a significant health burden on the individual (as a result of disability, inability to work and/or maintain valued social roles, and reduced quality of life), and a growing economic burden for countries (World Health Organization, 2011). The challenge is to reduce this disease burden through modification of risk factors and health promotion and to enhance effective management of chronic conditions.

Figure 4a. Japan, 2004

Figure 4c. Cambodia, 2004

Figures 4 (a,b,c,d). Leading causes of disease burden (DALYs) for persons aged 60 years and above, by sex and disease subgroups, in Japan, the Philippines, Cambodia and China, 2004


Figure 4b. Philippines, 2004

Figure 4d. China, 2004

1 000

800

600

400

200

0

Musculoskeletal diseases

Sense organ diseases

Neuropsychiatric co

nditions


Malignant neoplasms

Unintentional injuries

Digestive diseases

Respiratory infections

Respiratory diseases

Genitourinary diseases

Diabetes mellitu

s

Digestive diseases

Neuropsychiatric co

nditions

Malignant neoplasms

Respiratory infections


Infectious and parasiti

c diseases




350300250200150100

500

DALYs in 000's DALYs in 000's

9 000

7 000

5 000

3 000

1 0000

Unintentional injuries

Digestive diseases

Neuropsychiatric co

nditions



Malignant neoplasms


Diabetes mellitu

s

Men Women

DALYs in 000's DALYs in 000's



c diseases

60

50

40

30

20

10

0

Diabetes mellitu

s

Genitourinary diseases

Neuropsychiatric co

nditions

Digestive diseases


Malignant neoplasms



c diseases




3.2 Comparison of disease, risk factors and disability across selected countries and areas in the Western Pacific Region

Survey data allow comparison of health among people aged 60 years and above in different countries and areas of the Western Pacific Region.13,14,15 These range from high-income (Australia and the Republic of Korea) to upper middle-income (China and Malaysia) and lower middle-income countries (the Lao People’s Democratic Republic, the Philippines and Viet Nam).

3.2.1 Comparison of common health conditions

Survey data include comparable information on asthma, arthritis, angina pectoris and cataract. Of these, the most common condition was arthritis (see Figure 5).

The highest prevalence of arthritis was reported in Australia, and arthritis was generally higher in women than men. Corresponding to this high prevalence of arthritis, reports of back pain and stiff and painful joints were also common. For example, 56% of men and 51% of women in the Philippines reported back pain, and 47% and 49% reported pain, aching, stiffness or swelling in the joints. In Viet Nam, 40% of men and 58% of women reported back pain, and 13% and 16% reported joint symptoms.

Cataracts were common across all countries where data were collected and more common among women than men in China and Viet Nam (see Figure 6).

The prevalence of angina pectoris varied between countries, being highest among men in Australia (18%) (see Figure 7).

A comparative table of common health conditions and diagnoses for persons aged 60 years and above in selected countries of the Western Pacific Region is shown in Appendix B.

3.2.2 Comparison of health risk behaviours

The age-standardized prevalence of smoking and alcohol consumption varied considerably across countries and was substantially lower in women than in men.

The lowest prevalence of smoking in men was in Australia (12%), followed by Viet Nam (37%, see Figure 8); while Malaysia had the lowest prevalence of alcohol consumption (18%) in men (see Figure 9).

Mean body mass index (BMI) was similar for men and women in all countries where data were available, with the lowest BMI found in Viet Nam (age-standardized mean of 20 for both men and women) and the highest in Australia (age-standardized mean of 27 for both men and women, see Figure 10).

A comparative table of health risk behaviours among persons aged 60 years and above in selected countries of the Western Pacific Region is shown in Appendix C.

13 Data for this report were taken from the WHO World Health Survey (WHS), WHO Multi-country Survey Study and country-specific surveys such as SAGE (China), SAGE-INDEPTH (Viet Nam) and NHS (Australia).

14 A more detailed description of the comparative study, survey analyses and the results is available in the Data Book published separately on the WHO website.

15 Differences in measures by sociodemographic characteristics are reported where 95% confidence intervals (CIs) do not overlap. It is important to note that the sample size for the study will impact the width of the CIs, to such an extent that studies with large numbers of participants will have narrow CIs and thus demonstrate smaller differences.


Figure 5. Age-standardized percentage of men and women aged 60 years and above with arthritis, by country

Figure 6. Age-standardized percentage of men and women aged 60 years and above with cataracts, by country

Figure 7. Age-standardized percentage of men and women aged 60 years and above with angina pectoris, by country

Figure 8. Age-standardized percentage of smokers for men and women aged 60 years and above, by country

Figure 9. Age-standardized percentage of men and women aged 60 years and above who consume alcohol, by country

Figure 10. Age-standardized BMI for men and women aged 60 years and above, by country

Men Women 95% Cl

China

China (SAGE)

Malaysia

Lao People's

Democratic

RepublicPhilip

pines

Viet Nam

100

80

60

40

20

0

UPPER MIDDLE-INCOME LOWER MIDDLE-INCOME

Perc

enta

ge d

iagn

osed

w

ith c

atar

acts

Australia

Australia (N

HS)China

Malaysia

Lao People's

Democratic

RepublicPhilip

pines

Viet Nam

100

80

60

40

20

0

HIGH-INCOME UPPER MIDDLE-INCOME

LOWER MIDDLE-INCOME

Perc

enta

ge d

iagn

osed

w

ith a

rthr

itis

Australia

China

China (SAGE)

Malaysia

Lao People's

Democratic

RepublicPhilip

pines

Viet Nam

100

80

60

40

20

0

HIGH-INCOME UPPER MIDDLE-INCOME LOWER MIDDLE-INCOME

Perc

enta

ge o

f sm

oker

s

Australia

China

China (SAGE)

Malaysia

Lao People's

Democratic

RepublicPhilip

pines

Viet Nam

100

80

60

40

20

0


Perc

enta

ge d

iagn

osed

w

ith a

ngin

a

Australia

China

China (SAGE)

Malaysia

Lao People's

Democratic

RepublicPhilip

pines

Viet Nam

100

80

60

40

20

0


Perc

enta

ge w

ho c

onsu

me

alco

hol

Australia

Australia (N

HS)China

China (SAGE)

Malaysia

Lao People's

Democratic

RepublicPhilip

pines

Viet Nam

32

28

24

20

16

12

8

4

0


Mea

n Bo

dy M

ass

Inde

x


3.2.3 Self-rated health, limitations in mobility and difficulty with self-care

At least half of the respondents in China, the Republic of Korea, the Philippines and Viet Nam rated their health as moderate, bad or very bad; while just over a third in Australia and Malaysia rated their health as moderate, bad or very bad. Age-standardized self-rated health was similar or better for men than women, except for the Philippines, where a larger share of men (62%) than women (53%) reported that their health was moderate, bad or very bad (see Figure 11).

Around 20–30% of participants from most countries reported moderate, severe or extreme difficulty moving around (Figure 12). China (SAGE) had the lowest age-standardized percentage of participants reporting moderate, severe or extreme difficulty in moving around (7.5% for men and 8.6% for women), with high rates of almost 50% for men and women in the Philippines. The greatest difference in this measure between men and women was seen in the Republic of Korea: 24% for men and 59% for women.

Overall, few respondents reported that they had moderate, severe or extreme difficulty with self-care (see Figure 13), although almost one third of respondents from the Philippines and 41% of women from the Republic of Korea had difficulty with self-care. However, it should be noted that the number of participants from the Republic of Korea was small. In other countries, difficulty with self-care was similar for men and women.

A comparative table of diagnoses and physical difficulty (limitations) is shown in Appendix D.

Falls and unintentional injuries

Unintentional injuries also contribute to a considerable burden of disability, both short-term (during recovery) and permanent. Unintentional injuries such as through falls are a key cause of mortality, morbidity and disability for older people and are a frequent, but often unrecorded, event (UNFPA and HelpAge International, 2012; Hua et al., 2013). The rates of falls and associated complications (such as hip fracture or head injury) rise steadily with age (Rubenstein, 2006).

The rate of falls varies across the Region and within countries, the incidence being significantly higher among women than men. In Japan, the annual rate of falls varies between 6.8% and 19.2% for older men and between 13.7% and 22.9% for older women, depending on factors such as place of residence and age (Hua et al., 2013). In China, the incidence of falls varies from as low as 6.5% in Beijing to 30.1% in Fuzhou. For older people in Shangdong province, for example, the average rate is 22.6% (15.9% for men, 28.4% for women). In Australia, 16.2% of people aged 60 years and above, and approximately one in three people aged 65 years and above, fall annually. Of these, 10% have multiple falls and over 30% experience injuries (such as hip or pelvic fracture and/or head injury) requiring medical attention.

In Singapore, rates are slightly higher, with 17.2% of people aged 60 years and above having a fall, two thirds of older people having single falls, and one third experiencing recurrent (multiple) falls within the previous 12 months (Hua et al., 2013). The rate of falls and associated injuries is even higher for older people in residential aged-care and acute-care settings (Hua et al., 2013).


Figure 11. Age-standardized self-rated health for men and women aged 60 years and above, by country

Figure 12. Age-standardized difficulty with moving around, for men and women aged 60 years and above, by country

Figure 13. Age-standardized difficulty with self-care, for men and women aged 60 years and above, by country

Figure 14. Age-standardized mean years of formal education for men and women aged 60 years and above, selected countries, Western Pacific Region

14

12

10

8

6

4

2

0

Australia

Republic of Korea

(MCSS) China

China (SAGE)

Malaysia

Lao People's

Democratic

RepublicPhilip

pines

Viet Nam


Year

s

95% Cl

Men

Women

100

80

60

40

20

0

Australia

Republic of Korea

(MCSS) China

China (SAGE)

Malaysia

Lao People's

Democratic

RepublicPhilip

pines

Viet Nam

Viet Nam

(SAGE INDEPTH)


Perc

enta

ge w

ho re

port

ed m

oder

ate,

seve

re o

r ext

rem

e di

f�cu

lty

Men

Women

95% Cl

100

80

60

40

20

0

Australia

Republic of Korea

(MCSS) China

China (SAGE)

Malaysia

Lao People's

Democratic

RepublicPhilip

pines

Viet Nam

Viet Nam

(SAGE-INDEPTH)

HIGH-INCOME


Perc

enta

ge w

ho re

port

ed

mod

erat

e, s

ever

e or

ext

rem

e di

f�cu

lty

95% Cl

Men

Women

100

80

60

40

20

0

Australia

Republic of Korea

(MCSS) China

China (SAGE)

Malaysia

Lao People's

Democratic

RepublicPhilip

pines

Viet Nam

Viet Nam

(SAGE-INDEPTH)

Men

Women


Perc

enta

ge w

ho re

port

ed

mod

erat

e, b

ad o

r vey

bad

hea

lth

95% Cl


Falls may be caused by poor health or illness, or by extrinsic hazards such as unsafe housing, poor lighting and slippery outdoor surfaces. In Japan, approximately one in two falls occurs inside the home, such as in the bedroom (29%) or common rooms shared with others (22%), on a porch (17%) and in restrooms (6%). By comparison, in China and Australia most falls occur in outdoor areas. In Australia, frequent sites of falls are streets and parks (25%), curbs (6%), and public transport (6%); within the home, 26% of falls included trips on stairs (Hua et al., 2013).

Falls are a common reason for older people to be admitted to the hospital, and may also lead to premature entry into aged-care accommodation (Rubenstein, 2006). In Japan, approximately 62–74% of falls result in injuries, 50% of which are intermediate to severe levels of injuries, over 40% are fractures, 31% are bruising, and 16% are cuts or scratches (Hua et al., 2013).

Following a fall, older people may experience loss of independence and autonomy, increased fear of falling (and hence restricted mobility and social participation), confusion, immobilization and depression (Hua et al., 2013; UNFPA and HelpAge International, 2012). Within the year following a hip fracture from a fall, 20% of older people will die (UNFPA and HelpAge International, 2012). Falls present a high burden of disease and health-care costs in all countries. Moreover, the greater number of people living to older ages potentially means the burden of disease disability and need for care resulting from fall-related injuries will increase substantially.

3.2.4 Sociodemographic influences on health

Sociodemographic influences play a key role in determining health across the life-course. Appendix E provides a detailed comparison of sociodemographic characteristics of a number of countries in the Western Pacific Region. This section discusses the roles of education, living in rural/urban areas, and marital status on health at older ages.

Older people in the selected countries varied in their education levels, reflecting the prevailing socioeconomic circumstance affecting populations over 60 years ago, rather than the current level of economic and social development of the countries.

The country where older people had the lowest number of years of formal education was the Lao People’s Democratic Republic, with an average of only 1.5 years of formal education, and the country where they had the highest was Australia (almost 11 years of education). Apart from Australia, China and the Republic of Korea (men), the age-standardized number of years of formal education for older people was generally six or less on average (see Figure 14).

For all countries except Australia, the age-standardized average number of years of formal education was lower for women than for men, although this sex difference was small for the Philippines and China (SAGE). Women in the Lao People’s Democratic Republic had an average of less than one year of formal schooling (age-standardized).

Corresponding with years of education, the highest level of education completed also varied between countries. Seventy per cent of respondents from the Lao People’s Democratic Republic and almost half (46%) from Malaysia had no formal schooling, compared to only 0.6% with no schooling in Australia.


Figure 15a. Age-standardized percentage of smokers aged 60 years and above for men by education tertile, selected countries, Western Pacific Region

Figure 15b. Age-standardized percentage of smokers aged 60 years and above for women by education tertile, selected countries, Western Pacific Region

Figure 16a. Age-standardized percentage of men aged 60 years and above reporting difficulty moving around, by education tertile, selected countries, Western Pacific Region

Figure 16b. Age-standardized percentage of women aged 60 years and above reporting difficulty moving around, by education tertile, selected countries, Western Pacific Region

Figure 17a. Age-standardized percentage of men aged 60 years and above reporting moderate, bad or very bad self-rated health, by education tertile, selected countries, Western Pacific Region

Figure 17b. Age-standardized percentage of women aged 60 years and above reporting moderate, bad or very bad self-rated health, by education tertile, selected countries, Western Pacific Region

95% ClLower twotertiles

Top tertile 95% ClLower twotertiles

Top tertile

100

80

60

40

20

0

Australia

Republic of Korea

(MCSS) China

China (SAGE)

Malaysia

Lao People's

Democratic

RepublicPhilip

pines

Viet Nam


Perc

enta

ge w

ho re

port

ed

mod

erat

e, s

ever

e or

ext

rem

e di

f�cu

lty

China

China (SAGE)

Malaysia

Lao People's

Democratic

RepublicPhilip

pines

Viet Nam

100

80

60

40

20

0


Perc

enta

ge w

ho s

mok

e

100

80

60

40

20

0

Australia

Republic of Korea

(MCSS) China

China (SAGE)

Malaysia

Lao People's

Democratic

RepublicPhilip

pines

Viet Nam

HIG-INCOME UPPER MIDDLE-INCOME LOWER MIDDLE-INCOME

Perc

enta

ge w

ho re

port

ed

mod

erat

e, b

ad o

r ver

y ba

d he

alth

100

80

60

40

20

0

Australia

Republic of Korea

(MCSS) China

China (SAGE)

Malaysia

Lao People's

Democratic

RepublicPhilip

pines

Viet Nam


Perc

enta

ge w

ho re

port

ed

mod

erat

e, b

ad o

r ver

y ba

d he

alth

100

80

60

40

20

0

Australia

Republic of Korea

(MCSS) China

China (SAGE)

Malaysia

Lao People's

Democratic

RepublicPhilip

pines

Viet Nam


Perc

enta

ge w

ho re

port

ed

mod

erat

e, s

ever

e or

ext

rem

e di

f�cu

lty

China

China (SAGE)

Malaysia

Lao People's

Democratic

RepublicPhilip

pines

Viet Nam

100

80

60

40

20

0


Perc

enta

ge w

ho s

mok

e


Among men and women, the prevalence of smoking was generally higher for those with lower education (see Figures 15a and 15b).

Men and women with lower levels of education had more difficulty in moving around compared to those with higher education (see Figures 16a and 16b). Men and women in the lower education tertiles were more likely to report worse health (see Figures 17a and 17b).

Marital status can also affect health and access to health-care in older age. Across all countries, men were more likely to be married than women (see Figure 18).

In Australia, married women were less likely to report moderate, bad or very bad self-rated health (28%) compared to unmarried women (43%), but self-rated health status was similar for married and unmarried women in other countries.

Most health measures were similar for married and unmarried men, but there were some exceptions. Unmarried men in China, according to the WHO World Health Survey (WHS), were more likely to smoke (63%) than married men (48%). Unmarried men in the Philippines were more likely to report difficulty with self-care (43%) compared to married men (28%), and to rate their health as moderate, bad or very bad (74%) compared to married men (59%).

There also were variations in health between urban and rural areas. While WHS studies in the Republic of Korea and Viet Nam were conducted only in rural areas, 11% of participants in Australia, approximately half in China, Malaysia and the Philippines (45–53%), and almost three fourths in the Lao People’s Democratic Republic and Viet Nam (71–75%) lived in rural areas.

Men in urban areas of China were less likely to drink alcohol (44%) than those in rural areas (57%), and less likely to smoke. Smoking among men was higher in rural areas in China (59%) than in urban ones (37%), in Malaysia (50% in rural areas, 33% in urban), and the Lao People’s Democratic Republic (79% in rural areas, 57% urban) (see Figure 19a).

Women in rural areas of China (16%) and Viet Nam (WHS, 6.9%) were more likely to drink alcohol than those in urban areas (5.5% in China and 0% in Viet Nam); women in rural areas of the Lao People’s Democratic Republic were more likely to smoke (21%) than urban women (2.4%) (see Figure 19b).

Figure 18. Age-standardized percentage of married men and women aged 60 years and above, selected countries, Western Pacific Region

Australia

China

China (SAGE)

Malaysia

Lao People's

Democratic

RepublicPhilip

pines

Viet Nam

Viet Nam

(SAGE-INDEPTH)

Men

Women

100

80

60

40

20

0

HIGH-INCOME UPPER MIDDLE-INCOME LOWER MIDDLE-INCOMEPe

rcen

tage

who

are

cur

rent

ly

mar

ried

95% Cl


Figure 19a. Age-standardized percentage of men aged 60 years and above who smoke, by rural and urban residence, selected countries, Western Pacific Region

Figure 19b. Age-standardized percentage of women aged 60 years and above who smoke, by rural and urban residence, selected countries, Western Pacific Region

Figure 20a. Age-standardized percentage of men aged 60 years and above reporting moderate, bad or very bad self-rated health, by rural and urban residence, selected countries, Western Pacific Region

Figure 20b. Age-standardized percentage of women aged 60 years and above reporting moderate, bad or very bad self-rated health, by rural and urban residence, selected countries, Western Pacific Region

Figure 21a. Age-standardized percentage of men aged 60 years and above reporting moderate, severe, or extreme difficulty moving around, by rural and urban residence, selected countries, Western Pacific Region

Figure 21b. Age-standardized percentage of women aged 60 years and above reporting moderate, severe, or extreme difficulty moving around, by rural and urban residence, selected countries, Western Pacific Region

95% ClRural Urban 95% ClRural Urban

China

China (SAGE)

Malaysia

Lao People's

Democratic

RepublicPhilip

pines

Viet Nam

100

80

60

40

20

0


Perc

enta

ge w

ho s

mok

e

China

China (SAGE)

Malaysia

Lao People's

Democratic

RepublicPhilip

pines

Viet Nam

100

80

60

40

20

0


Perc

enta

ge w

ho s

mok

e

China

China (SAGE)

Malaysia

Lao People's

Democratic

RepublicPhilip

pines

Viet Nam

100

80

60

40

20

0


Perc

enta

ge w

ho re

port

ed

mod

erat

e, b

ad, o

r ver

y ba

d he

alth

China

China (SAGE)

Malaysia

Lao People's

Democratic

RepublicPhilip

pines

Viet Nam

100

80

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Men in rural areas in Malaysia and Viet Nam had a higher prevalence of moderate, bad or very bad self-rated health than men in urban areas (44% in rural and 27% in urban Malaysia; 83% in rural and 62% in urban Viet Nam) (see Figure 20a).

Likewise, women in rural areas in Malaysia were more likely to report moderate, bad or very bad self-rated health (47%) compared to women in urban areas (29%). The urban/rural differences in self-rated health were less pronounced in other countries (see Figure 20b).

Relative to those living in urban areas, men and women living in rural areas were more likely to report difficulty in moving around (see Figures 21a and 21b).

There were few urban/rural differences in self-reported conditions, except for cataracts which showed inconsistent patterns according to rural/urban and sex differences (see Figures 22a and 22b).

Men in urban areas of China (SAGE) have higher mean BMI (mean BMI 25) than men in rural areas (mean BMI 23). Higher mean BMI in urban areas is also found in the Philippines. However, in Viet Nam, mean BMI is higher in rural areas (see Figure 23a).

Mean BMI was slightly lower for rural women than urban women in China, the Lao People’s Democratic Republic and Viet Nam. In Malaysia and the Philippines, mean BMI for women in urban and rural areas is relatively equal (see Figure 23b).

Figure 22a. Age-standardized percentage of men aged 60 years and above reporting cataracts, by rural and urban residence, selected countries, Western Pacific Region

Figure 22b. Age-standardized percentage of women aged 60 years and above reporting cataracts, by rural and urban residence, selected countries, Western Pacific Region

Figure 23a. Age-standardized mean BMI for men aged 60 years and above, by rural and urban residence, selected countries, Western Pacific Region

Figure 23b. Age-standardized mean BMI for women aged 60 years and above, by rural and urban residence, selected countries, Western Pacific Region

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4. Policy implications

Population ageing presents social, economic, cultural and political challenges to individuals, families, societies and the global community. Nevertheless, population

ageing presents important opportunities for development and increased human and social capital. The goal is to enable people to move through life-course stages in the best possible health, to ensure appropriate care for older people with health needs, and to support older people to remain as independent, involved and productive as possible, well into old age.

Countries in the Western Pacific Region are undergoing rapid demographic, epidemiological, social and economic transition, although they are at quite different stages in the transition. As a result, they vary significantly in their capacities to respond to these shifts, although all countries face capacity constraints to a greater or lesser degree (UNFPA, 2011; UNFPA and HelpAge International, 2012).

4.1 Population ageing presents challenges, but also opportunities

Population ageing in the Western Pacific Region poses challenges due to cultural, economic, political and sociodemographic diversity between and within countries, and also between sexes. Social determinants across the life-course, such as sex and educational level, have important implications for health, including that of older people, as well as for the experience of ageing. In countries with limited resources, socioeconomic development may not have kept pace with the rapid speed of population ageing and growth (UNFPA and HelpAge International, 2012; UNFPA, 2011; World Health Organization, 2001).

Feminization of ageing also presents policy challenges. Although women live to older ages, many of these years are spent with increasing disability. The growing disability increases women’s dependence on financial support, housing and transportation, as it does enhance their need for care and support with activities of daily living, such as cooking, cleaning and shopping. Many older women also outlive their partners and do not tend to remarry as often as widowed men (http://www.who.int/world-health-day/2012/en/index.html). Older women are particularly vulnerable to poverty, homelessness and isolation due to women’s generally lower incomes and lower workforce participation across the life-course, disruptive work histories due to childbirth and caring responsibilities, domestic violence and abuse, gender discrimination and widowhood (United Nations Statistics Division, 2012).

Women and others who are carers, such as extended family members, are also at increased risk of poverty and isolation; their care responsibilities are likely to reduce their workforce participation and adversely affect their educational attainment. For those employed in caring occupations, wages can be very low, with little scope for advancement (United Kingdom Department of Health, 1999; Doran et al., 2003; Legg et al., 2012; Palmer and Eveline, 2012).

Population ageing also presents unique opportunities for individuals and communities. Greater life expectancy means that societies can potentially benefit from increased human capital: through greater numbers of women and older people entering or remaining in the workforce, increased financial investment in education of children and

4

Policy implications 25

higher standards of living (Bloom et al., 2010). Longer life expectancies also promote higher rates of saving and wealth accumulation by older people living and working longer to finance themselves in retirement and old age (Mason and Kinugasa, 2008; Mason et al., 2008). Older people may also strengthen intergenerational ties and provide support in families and communities (Warburton and Chambers, 2007).

4.2 Older people are valuable social, political and economic resources

Older people are valuable social, political and economic resources in services such as paid employment, unpaid and volunteer work, education, leadership roles, civic engagement, care giving (for example, caring for grandchildren and others in the community), and domestic care, such as cooking and cleaning (UNFPA and HelpAge International, 2012; National Seniors Productive Ageing Centre, 2009; Ju-Hyun Kim, 2013). Many older people contribute financially to their families. For example, in the Philippines, 67% of older parents provide financial assistance to their children (UNFPA and HelpAge International, 2012), and in Viet Nam, many older people are economically active in household businesses and agriculture, and contribute substantially to household duties (Evans and Harkness, 2008).

Workforce participation of people aged 60 years and above varies between countries, in part due to government policies regarding age of retirement, and availability of superannuation savings, pensions or social security to support older persons following retirement. Many older workers have been retrenched, became unemployed or lost work as a result of the global financial crisis, and have not been able to find new employment due to age-related discrimination. In developing countries, where there are heavy demands on manual labour, older people in poorer health may not be able to physically cope, and so may need to retire from the workforce at earlier ages. Industrial accidents may also contribute to loss of work through disability. Older agricultural and informal workers may not generally be covered by social security or pension. There may also be lower work opportunities for older men as a result of changing labour trends and technological progress such as information industries (United Nations DESA Population Division, 2009; Van Minh et al., 2010; Bloom et al., 2012).

In all countries, men comprise a higher proportion of the workforce than women in the age group of those over 65 years. This could be attributed to women’s gender roles across the life-course and into older ages, which give women more responsibility for care of children, family and ageing relatives than men, but also to men’s gender roles which see men as the main breadwinners or providers in families (United Nations, 2012; United Nations DESA Population Division, 2001; United Nations Statistics Division, 2012).

Table 7 shows workforce participation for older men and women aged 65 years and above in selected countries and areas of the Region. In 2010, the workforce participation of men and women aged 65 and above in the Western Pacific Region ranged from 3.9% in Australia to 53.7% in Solomon Islands (United Nations, 2012). In Solomon Islands, both men and women maintain relatively high participation in work (61.1% of men, 46% of women), despite having the lowest statutory retirement age in the Region (50 years). The lower workforce participation rate in Australia may reflect the higher socioeconomic status of the country, and substantial investments made towards superannuation-funded retirement and social security pension supports.

Older rural adults have significantly higher workforce participation rates (many in agricultural activities) than those in urban areas. Higher workforce participation was also found among older people living in households with an older head or comprised of


only older people (Giang and Pfau, 2007). Lower employment rates were found among older people living in urban areas, widows and other women, those 70 years and above, and people living as household dependents (Giang and Pfau, 2007). In some countries, including Japan, labour force participation among older people has increased: from 71% for men aged 60–64 years in 2006, to 77% in 2009 (Bloom et al., 2012).

Older people’s continued participation in the labour force enables their financial security, reduces health inequities stemming from poverty and social isolation and can promote well-being. Older people from poorer households are often forced to continue working, especially those engaged in the informal sector.

Table 7. Workforce participation rates for men and women aged 65 years and above, and as a proportion of the population, by country income classification group16, selected countries and areas, Western Pacific Region, 2010

Source: United Nations Department of Economic and Social Affairs Population Division (2001).


Country/Area Men WomenTotal people 65 years and

above

High-income

Australia 6.5% 1.9% 3.9%

Hong Kong (China) 17.9% 6.8% 12.1%

Japan 27.2% 13.4% 19.4%

Macau (China) N/A N/A N/A

New Zealand 7.7% 3.2% 5.2%

Republic of Korea 29.3% 14.5% 20.5%

Upper middle-income

China 22.9% 7.2% 14.5%

Malaysia 35.8% 15.7% 24.7%

Lower middle-income

Fiji 42.4% 12.5% 26.5%

Lao People’s Democratic Republic 50.7% 25.1% 36.5%

Micronesia, Federated States of N/A N/A N/A

Mongolia 33.3% 19.6% 25.8%

Papua New Guinea 42.3% 30.5% 35.7%

Philippines 50.1% 24.1% 36.0%

Samoa N/A N/A N/A

Solomon Islands 61.1% 46.9% 53.7%

Tonga N/A N/A N/A

Vanuatu N/A N/A N/A

Viet Nam 40.0% 24.8% 30.8%

Low-income

Cambodia 37.9% 25.7% 30.2%


The valuable contribution of older people to their communities through unpaid care giving and volunteer work is also notable (World Health Organization, 2002;WRVS, 2011; Access Economics, 2010; Lee, 2001). Older people are valuable sources of historical, spiritual and cultural knowledge, traditions and language, and can also provide important role models and expert knowledge for younger generations (Warburton and Chambers, 2007; UNFPA and HelpAge International, 2012, Ju-Hyun Kim, 2013). Many are also politically and socially active (UNFPA and HelpAge International, 2012).

Public health and social policies should support and enable older people’s good health, well-being, and participation in community, occupational, cultural, and social networks to ensure communities continue to benefit from the important contributions of older people (UNFPA and HelpAge International, 2012).

Older people’s associations are groups that enable older people to participate in and contribute to their communities. These association provide older people with (1) micro-credit to establish small businesses, (2) mutual care and support, and 3) information to understand and claim their rights and entitlements. The businesses might include sewing clothes, running a pharmacy, or building a power plant to generate electricity for the whole village. People’s continued participation in society throughout older age is essential if countries are to meet the challenges of population ageing and reap the demographic dividend (Chomik and Piggott, 2013).

The World Health Organization has a role in inspiring governments and citizens to rethink ageing, and to begin to see ageing as a social and economic resource. Many countries in the Western Pacific Region are young in terms of the mean age of the population, but have rapidly ageing populations. Countries must plan for a healthier older population, considering how they will meet the needs of people as they age, and how they will turn ageing into a resource for economic and social development.

4.3 Recognizing and reducing burden of disease among people 60 years and above in the Western Pacific Region

This report shows that the burden of noncommunicable disease and disability is projected to increase across the Region as populations age, and emphasizes the need to minimize the impact of this burden on individuals and societies. As people age, they are more likely to develop and live with chronic illnesses such as cardiovascular disease, cancer, diabetes and arthritis, as well as sense organ diseases, including vision and hearing problems and dementia. Moreover, ageing people are increasingly likely to have several co-morbid conditions that may interact with each other and complicate approaches to treatments. For instance, in one Australian study of men and women aged 70 years and above, the median number of conditions per person was 7.0 (Byles et al., 2005). Population statistics often do not recognize the prevalence of co-morbidity among older people. For instance, deaths and DALYs are enumerated according to the primary cause and contributing causes are often omitted.

In addition, conditions affecting older people are associated with a range of functional limitations such as cognitive impairment, mobility restrictions, increased risk of falls and injury, and urinary incontinence. Under-nutrition, particularly loss of lean body mass, commonly underlies and exacerbates many conditions affecting older people, even in settings where food supplies are reliable and plentiful (Hickson, 2006; Watson et al., 2006; Lipsky, 1995). This constellation of illness and disability is sometimes considered


collectively a geriatric syndrome, or “frailty”, a term that is commonly used to describe older people who are at risk of poor outcomes due to diminished adaptive reserve and accumulation of a broad range of limitations and deficits. Frailty can involve exhaustion, weight loss, weak grip strength, slow walking pace, and low energy expenditure (Fried et al., 2001; Lacas and Rockwood, 2012).

Older age can be associated with greater morbidity but poor health disease can be prevented or treated with appropriate measures and therapies (World Health Organization Regional Offices for South-East Asia and the Western Pacific, 2008). These preventive approaches need to be effected across the life-course, and across health and social sectors. Health and disability at older ages arise from socioeconomic and health factors that accumulate across the life-course (World Health Organization, 2002), beginning in utero and in childhood. Favourable early life factors, including childhood nutrition and education, are important for building capacity for healthy ageing in future generations.

From a public health and policy perspective, the late-life health of each generation is influenced by both period and cohort effects (Guillot, 2011). “Cohort effects” are the risks of disease and mortality that accumulate across the life-course for a group of individuals born at the same point in time. “Period effects” are risks experienced by many cohorts at the same time, such as a catastrophe or conflict. The combined effects of period and cohort influences also vary for each generation. People are unique in terms of how they age, and what influences their health and their late-life health capacities.

Gains in population health may be achieved by reducing the prevalence of risk factors associated with major diseases (such as tobacco use, excess alcohol consumption, obesity and hypertension), and by increasing focus on factors that protect health and well-being across the life-course, such as increasing and maintaining physical activity, improving oral health, and improved screening and preventive interventions. Increased public awareness about risk factors such as diet, alcohol and tobacco use are vital to ensure sustained reductions in the burden of cardiovascular disease and diabetes (World Health Organization and World Economic Forum, 2011; World Health Organization, 2011).

Screening for disease risk factors and early onset of conditions such as diabetes and cancer is another approach to illness prevention. For example, hypertension is a major risk factor for stroke across the Western Pacific Region, and is the third leading risk factor for burden of disease after tobacco and alcohol. Globally, the greatest number of deaths and DALYs due to sequelae of hypertension (stroke and heart disease) occur in the Western Pacific and South-East Asia regions. Effective programmes to detect and reduce hypertension will have a major impact on reducing burden of disease among older people, particularly from stroke.

Other cardiovascular disease risks can also be reduced through chemoprophylaxis, using low-cost generic medicines such as aspirin and statins which significantly reduce the likelihood of death or vascular events (World Health Organization, 2011; World Health Organization and World Economic Forum, 2011).

For people who do develop chronic conditions, appropriate monitoring and management can prevent complications and optimize health outcomes. For instance, management of diabetes and cardiovascular disease with appropriate medication, foot and eye care, treatment of cardiovascular disease risk factors such as hypertension


and high cholesterol, and education about the role of lifestyle factors in increasing or reducing risk are all effective public health interventions, and have been shown to reduce disease burden (World Health Organization, 2011; World Health Organization and World Economic Forum, 2011). Diabetes surveillance and monitoring of population health should be prioritized as many individuals at risk of diabetes are not often diagnosed and lack specialized treatment and follow-up care (World Health Organization Regional Offices for South-East Asia and the Western Pacific, 2008).

Likewise, arthritis is a major cause of morbidity at older ages, particularly for women, causing pain and lack of mobility. Treatment of this common chronic condition using non-steroidal and other pharmacotherapies can reduce this burden of illness and improve quality of life and functional capacity (World Health Organization and World Economic Forum, 2011; Australian Institute of Health and Welfare, 2010).

People with disabilities such as vision impairment can be assisted to regain capacities through interventions such as cataract surgery. Interventions aimed at diagnosing and treating glaucoma, macular degeneration and cataract blindness are an avenue for public policy interventions that will enable older people to remain living independently for longer and maintain working and caring roles. The provision of spectacles and assistive aids for low vision, such as white canes and Braille devices, can also provide important public health benefits.

Falls interventions have been shown to have positive public health benefits such as reduced cost of care and hospitalization (Gillespie et al., 2012; Hua et al., 2013; Rubenstein, 2006). Falls interventions are focused on both personal and environmental factors, and require a multidisciplinary health response. Personal interventions include strength and balance training such as occupational therapy, tai chi, and exercise with small weights to improve balance and gait, reduction in psychotropic medications, visual interventions such as removal or cataracts or wearing glasses, as well as addressing underlying medical conditions such as malnutrition, low blood pressure and syncope (fainting). Loose, ill-fitting footwear such as slippers can also contribute to falls among older people. Environmental interventions are aimed at reducing the risk of falls to unsafe environments both within and outside the home. In the home, bathrooms are a high-risk area for falls (Byles et al., 2012). The introduction of non-slip tiles and shower recesses, grab rails over baths, toilets and showers, and improved lighting can help to reduce falls incidence. Outside the home, grab rails and ramps can reduce the risk of falls on stairs. Unsafe and uneven trip hazards, such as footpaths, kerbs and steps, and slippery floor surfaces are other targets for falls prevention (Gillespie et al., 2012; Hua et al., 2013; Rubenstein, 2006; Byles et al., 2012).

As populations age, there will also be increased demand for rehabilitation, longer-term follow-up and long-term care services for those with disability (Bloom et al., 2012), and increased need for palliative care for older people with cancers and other chronic painful conditions (WHO Regional Office for Europe, 2004; Wright et al., 2008). Assistive devices and aids such as upper and lower limb prostheses, orthopaedic footwear, assistive devices for toileting and bathing, walking sticks and frames, wheelchairs, lifting hoists (for lifting people in/out of bed, for example), and adaptive transport are key items which can assist in mobility and increased independence of older people with disability (Down and Hanley, 2013). Environmental features (such as wheelchair ramps, wheelchair-friendly transport, homes, offices and buildings, ample seating, and safe footpaths) can also enable older people with disability to move around within their communities (Down and Hanley, 2013; Buffel et al., 2012; World Health Organization, 2007).


Dementia in particular is projected to become more prevalent among older populations and will place increased demand on health systems and family and social networks. However, in some countries, family and community networks are breaking down due to economic and social factors (Bloom et al., 2012). Globally, dementia is the second greatest cause of disability with, on average, one new case of dementia occurring every four seconds in the world today (UNFPA and HelpAge International, 2012). Dementia is projected to increase due to population ageing, particularly among the oldest age group (80 years and above), and in those countries experiencing demographic transition. Currently, the burden of disability from dementia is slightly more in developing countries (7 million) compared to developed countries (6.2 million) (UNFPA and HelpAge International, 2012). The prevalence of dementia is projected to increase from 35.6 million in 2010, to 65.7 million in 2030, and to 115.4 million by 2050. Worldwide, in 2010, it is estimated that the total costs of dementia amounted to US$ 604 billion, and it could be expected that this figure will rise in line with population ageing (UNFPA and HelpAge International, 2012). The increased cost of medical care, formal and informal, and the accompanying rise in disability that is associated with dementia-related decline, poses considerable challenges for countries undergoing rapid demographic transition (UNFPA and HelpAge International, 2012).

Food contamination and food insecurity are also threats to health for vulnerable older people (World Health Organization Regional Offices for South-East Asia and the Western Pacific, 2008). Food contamination occurs through environmental pollutants, humans living in close proximity to food animals (such as poultry), and lack of hygiene (World Health Organization Regional Offices for South-East Asia and the Western Pacific, 2008). Policies are needed to strengthen capacity of individuals, and community and health-care services including hospitals to prevent and control foodborne infections, including standard hygiene precautions and infection control procedures (World Health Organization Regional Offices for South-East Asia and the Western Pacific, 2008).

Gains in population health may also be realized by increased focus of public health policy on assessing and meeting the immediate nutritional and food needs of older people. Prevention of malnutrition among older people has been shown to have positive health outcomes such as reduced susceptibility to disease and complications arising from co-morbid conditions and falls, and reduced costs to health systems including reduced length of hospital stay, and fewer re-admissions to care (Barker et al., 2011; Stechmiller, 2010; Johansson et al., 2009; Australian and New Zealand Society for Geriatric Medicine, 2009).

Maintaining optimum oral health and equitable access to dental services is also vital for nutritional health, and overall physical, social and psychological well-being at older ages (Petersen et al., 2005).

As well as physical health, mental health conditions can have an impact on people’s health in older age. There are a number of reasons to expect that people will experience poorer mental health in late life, due partly to psychosocial stressors and loss but also due to increasing frailty and physical illness. Psychosocial stressors can include bereavement, as well as financial stress, loneliness, isolation and lack of social support. There is also a theory of terminal decline whereby people with relatively stable mental health throughout life experience sudden onset of psychological morbidity towards the end of life (Gerstorf et al., 2010).

There is also a strong correlation between depression and co-morbid physical conditions, and as populations age and chronic disease rates increase, mental health conditions will


also rise. Consequently, it is projected that depression will be the second leading cause of global disease burden by the year 2020 (Moussavi et al., 2007).

Overall, many strategies and approaches can be applied to achieve optimal health in older ages and across the range of conditions affecting older people. Investment in health-promoting approaches can reduce demands on acute and long-term services. Health is a key determinant of economic performance; thus, improving the health of the population contributes to higher economic growth and alleviation of poverty (Bloom et al., 2007). Policies to improve health and reduce social isolation and exclusion will enable all population groups to contribute to societal development and reap the positive benefits of demographic transition and population ageing (Bloom et al., 2007).

4.4 Strengthening health systems and social protection

As the burden of noncommunicable diseases rises across the Region and older people present with chronic and complex co-morbid health conditions in increasing numbers, health systems and policies will need to adapt. Total health spending will need to increase and services be reoriented towards treating noncommunicable diseases such as cardiovascular disease, chronic pulmonary disease, diabetes and cancer, which typically require many years of treatment and care, often until death (Bloom et al., 2012).

Strengthening health systems to enable them to respond to the health needs of older people requires increased commitment as well as policies to systems dimensions such as essential medicines and health technologies, disability aids and services, human resources (for example, training of health personnel), health infrastructure, and health-care financing (World Health Organization, 2008; World Health Organization Regional Offices for South-East Asia and the Western Pacific, 2008).

Better coordination will be needed between primary health-care and social services. Health and social systems should place emphasis on health promotion, disease prevention and the provision of cost-effective, equitable and dignified long-term care of ageing populations (World Health Organization, 2002).

Older people are particularly vulnerable to health inequalities. In the absence of social protection, reliance on out-of-pocket payment for health-care adversely affects those with low-income households (World Health Organization, 2008). Countries in the Western Pacific Region have some of the highest levels of dependence on out-of-pocket expenditure to finance health services. Reforms to move towards universal health coverage, improve service delivery (such as person-centred care) and reduce barriers to access to services can improve health equity for older people (World Health Organization, 2008). Also, universal health coverage needs to include ways to identify and target vulnerable and excluded population groups and tailor programmes towards greater inclusiveness (World Health Organization, 2008).

Many older people face financial barriers to accessing medicines and so delay or suspend treatment. Access to medicines is hampered by inefficiency of drug supply and distribution systems. The sale of counterfeit drugs due to poor quality assurance systems is also a major health risk. Policies and programmes are needed to promote the availability and affordability, strengthen regulation, quality assurance, and supply and distribution of medicines (World Health Organization Regional Offices for South-East Asia and the Western Pacific, 2008).


Global trends such as increased migration have led to shortages of skilled workers in many low- and middle-income countries, undermining these countries’ capacities to meet the health needs of their older people (Bloom et al., 2012). A highly mobile health workforce with significant health worker migration is now an established phenomenon in the Western Pacific Region, with large resulting imbalances in health worker skills, quality and density, particularly among Pacific island countries. Australian aged-care facilities draw many of their staff from Pacific island countries. Singapore draws on health workers from Indonesia and the Philippines to provide services for an ageing population. This in turn drains health workers from countries which themselves are confronted with major health workforce shortages for health service provision, including to an ageing population. The fewest workers are often found where need is greatest (World Health Organization Regional Offices for South-East Asia and the Western Pacific, 2008).

Inadequate salaries, lack of incentives and poor supervision affect performance, motivation and retention of health personnel. Instituting scholarships for health-care training that are conditional on post-training service (either in-country or rural areas) is one strategy for attracting and retaining health-care workers in areas of high need (Bloom et al., 2012). Improved health workforce planning and management are crucial to ensure appropriate workforce size and skills mix, quality improvement, performance, worker retention, and geographical distribution (World Health Organization Regional Offices for South-East Asia and the Western Pacific, 2008).

Many countries in the Western Pacific Region lack appropriately trained health workers. Training in geriatrics and palliative care is particularly relevant for health workers engaged in the health needs of older people. With the inclusion of the health dimensions of ageing, especially in chronic diseases management, pre- and in-service training can increase the skills of health professionals on how to manage the health needs of older people. Such training needs to include prevention and early detection, quality of life, as well as treatment strategies and palliative care. As ageing is a lifelong process, a life-course approach to health is paramount (Bloom et al., 2012). Also, human resources policy and strategy can be more reliably informed by increased collaboration between public and private stakeholders and education providers, improved quality accreditation, monitoring of basic and in-service training, well-designed research, and analytical capacity (World Health Organization Regional Offices for South-East Asia and the Western Pacific, 2008).

Many rural areas lack adequate health services. Mobility and disability aids that could improve functioning, independence and quality of life are either unaffordable or unavailable, and therapists or technicians to customize or maintain the devices are lacking. Mobile resources such as telecommunications can overcome geographical distances and obstacles, and provide access to specialist information for workers in the field (World Health Organization, 2008). Collaborative approaches between communities (such as the Healthy Islands Initiative launched in Fiji in 1995) can also enable isolated communities to secure infrastructure, technology and health personnel resources at manageable costs (World Health Organization, 2008).

Social protection is a major area of government activity closely related to the concepts of human rights, and is aimed at ensuring that vulnerable population groups, such as older people, receive appropriate and effective public support (Bloom et al., 2012). Social protection in the form of income and housing support, availability and affordability of transport, and access to high-quality health-care (preventive and treatment) is crucial for enhancing health and quality of life. Older women are particularly vulnerable due to


gender roles across the life-course and the likelihood of being widowed (Bloom et al., 2012).

As health and the experience of ageing share strong associations with socioeconomic factors such as income and education, public health policies need to cover a broad range of interventions. Many older people who have experienced long-term unemployment, intermittent work histories or low-paid seasonal work, disability that affects the ability to work, or who have disrupted work histories due to family and caring commitments or ill-health, may have been unable to accrue adequate savings, assets or superannuation over their lifetime, and so be unable to support themselves in old age. Retirement policies also impact on financial security in later life, as lower statutory retirement ages reduce savings capacity.

Pension coverage varies greatly across countries. Pensions may be supplied through the private or public sector, but only those pensions provided by the government fall under social protection (Bloom et al., 2012). For those countries with at least basic levels of pension support, pension reform needs to be a high priority as pensions funded from current government revenues are likely to become increasingly difficult to sustain, due to changing age structures in the population (Bloom et al., 2007).

Older people need to be enabled and supported. They need encouragement to participate in the community to the extent that they wish, and be involved as volunteers, workers or care providers for as long as they are able. Policies that promote and enforce anti-discrimination, flexible work practices, employee training, upgrading of skills and qualifications and lifelong learning opportunities can provide important gains for both older people and employers. They will result in increased self-esteem, intergenerational exchange, mentoring, financial security, and reduced reliance on government pensions. However, occupational hazards and injuries account for a considerable burden of disease, and so occupational safety standards that protect older persons from injury and the modification of formal and informal work environments also need to be enforced (World Health Organization, 2002).

4.5 Supportive environments for older people

Action is needed to tackle the social determinants of older people’s health inequalities and provide them with supportive environments that promote and protect health, such as through safe housing and age-friendly cities (Buffel et al., 2012; World Health Organization, 2007; Byles et al., 2012).

Age-friendly and supportive environments are those that promote physical, social and cultural participation of older people in the community (Shearer and Fleury, 2006; World Health Organization, 2001; World Health Organization, 2007; Bowling, 2011). For example, provision of safe, affordable and accessible transport including adequate seating and shelter from the weather at bus stops and train stations enables older people to safely mobilize within their community. Supportive communities assure access for people with disabilities or functional limitations by such means as ramps and footpaths for wheelchair access, accessible toilet facilities, Braille and hearing adaptive technologies, and wide corridors in public buildings and areas. Supportive housing, which can facilitate and enable independence and ageing in place and is conducive to socialising with family and friends, is important for maintaining health, well-being and quality of life (Byles et al., 2012). Support services such as home-based nursing and personal care, help with household duties and shopping, and transport services can also help older people maintain independence, dignity, life satisfaction, reciprocity and


important social networks (Byles et al., 2012; Hjorthol, 2012; Kendig et al., 2012). Age-friendly communities promote social, cultural, political and occupational participation of all people, enable lifelong learning and opportunities for social participation, and recognize the valuable significance of older people (World Health Organization, 2007; World Health Organization, 2001; Ju-Hyun Kim, 2013; Shearer and Fleury, 2006; Bowling, 2011).

There is also a need to support older people in the event of natural disasters and other emergencies (Inter-Agency Standing Committee Working Group, WHO, 2008). Older women are particularly vulnerable during wars, natural disasters or famines, because they generally control fewer economic resources, and also because much of the care of children and other vulnerable people falls to older women.

4.6 Regional and country-specific policy issues

The preceding sections discussed a range of general health and multisectoral approaches to improving health and care for older people in the Western Pacific Region. This section lists specific issues and observations relevant to selected countries and areas.

Developed economies• Strengthen existing policies and public health interventions with latest evidence to

support lifestyle changes and risk factor prevention and improved health outcomes and decrease disease burden in both middle-aged and older-aged adults.

• Undertake further research to inform policies and public health interventions, especially with regard to human behaviour, to support lifestyle changes and risk factor prevention and improved health outcomes and to understand why existing evidence has not been translated into policy and practice.

• Establish mechanisms to ensure that all new public policy, not just health, takes ageing as a key consideration.

• Devise strategies to improve the quality of data on monitory groups and populations and adopt policies to address the needs of ageing members of these groups.

Emerging / transition economies• The development of an effective surveillance system for noncommunicable diseases

(which should include older adults) is a policy priority.• Countries and areas lack quality data on monitory groups and populations and

policies to address the needs of ageing members of these groups.• Public health efforts to support lifestyle changes and risk factor prevention are

effective measures to improve health and decrease disease burden of both middle-aged and older-aged adults.

• The inclusion of ageing and health issues in both pre-service and ongoing training for health professionals is an effective means of increasing awareness and quality of practice in treating older persons.

Developing economies• The development of an effective surveillance system for noncommunicable diseases

(which should include older adults) is a policy priority.• Public health efforts to support lifestyle changes and risk factor prevention are




Polynesia and Micronesia • Countries and areas in the Western Pacific Region are currently in the midst of a

diabetes epidemic.• The development of an effective surveillance system for noncommunicable diseases

(which should include older adults) is a policy priority.• Public health efforts to support lifestyle changes and risk factor prevention are



Melanesia• Ageing transition will be later than other countries due to the continuing high

burden of tuberculosis, malaria and HIV. Countries and areas are also experiencing a rapid emergence of noncommunicable diseases.

• Communicable disease control policy and strategies need to address ageing populations as disease burden from communicable diseases reduces, due to increased life expectancy from antiretroviral agents, tuberculosis control, etc.

• The development of an effective surveillance system for noncommunicable diseases (which should include older adults) is a policy priority.



5. Health data and need for further research

This report has found that the quality and accessibility of routine health data and survey data for older people vary greatly across countries. Accurate health data

from countries, quantifying and monitoring exposures and risk factors, trends in noncommunicable diseases by age and sex, as well as health outcomes and evaluation of health service use and responsiveness, are vital as an evidence base for the planning and provision of health services and public policy in the context of rapid population ageing (World Health Organization, 2011).

While it is a useful starting point, research from other countries must be used with caution in making general policies, given the large variation in social, cultural and political contexts in the Western Pacific Region.

This report also found a lack of research on the social, economic and health status of ageing populations in many countries of the Western Pacific Region. Further research is needed to understand the social, economic and health implications of an ageing population so as to bring evidence to policy in this area of increasing importance.

Efforts are needed to strengthen the capacity for the collection and reporting of disaggregated data, to enable the identification of inequities in health status and access to needed services. The meaning and definition of ‘old age’ varies between countries and between surveys, such that data about older people may refer to those aged 50 years and above, 60 years and above or 65 years and above. It is important therefore to disaggregate age groupings to allow for more in-depth analysis.

There is a significant gap, indeed a complete lack in many countries, in collection of reliable data to inform policy decisions on ageing within minority and subpopulation groups such as gay and lesbian, migrant, rural versus urban, ethnic and language groups. Not only is there a need to address this gap in data, but also the current lack of policies to address the needs of ageing members of these groups. This is particularly important given the sociodemographic, geographical and cultural diversity of countries in the Western Pacific Region.

Effective mechanisms are also needed to facilitate links between health information, research and policy. Also, evidence-based policy needs to be strengthened to support more informed policy-making (World Health Organization Regional Offices for South-East Asia and the Western Pacific, 2008).

5

Appendix 37

Appendix A. World Health Organization burden of disease classification groups17

17 WHO Global Burden of Disease Estimates 2004, 2008 Update (2009).

Group I Communicable, maternal, perinatal and nutritional conditionsA. Infectious and parasitic diseases

TuberculosisSexually transmited infections excluding HIV: (a) Syphilis; (b) Chlamydia; (c) GonorrhoeaHIV/AIDSDiarrhoeal diseasesChildhood-cluster diseases: (a) Pertussis; (b) Poliomyelitis; (c) Diphtheria; (d) Measles; (e) TetanusMeningitisHepatitis B; Hepatitis CMalariaTropical-cluster diseases: (a) Trypanosomiasis; (b) Chagas disease; (c) Schistosomiasis; (d) Leishmaniasis; (e) Lymphatic filariasis; (f) OnchocerciasisLeprosyDengueJapanese encephalitisTrachomaIntestinal nematode infections: (a) Ascariasis; (b) Trichuriasis; (c) Hookworm disease;

B. Respiratory infections: (a) Lower respiratory infections; (b) Upper respiratory infections; (c) Otitis media.C. Maternal conditionsD. Perinatal conditions: (a) Prematurity and low birth weight; (b) Birth asphyxia and birth trauma; (c) Neonatal infections and other

conditionsE. Nutritional deficiencies: (a) Protein-energy malnutrition; (b) Iodine deficiency; (c) Vitamin A deficiency; (d) Iron-deficiency

anaemia

Group II Noncommunicable diseasesA. Malignant neoplasms: (a) Mouth and oropharynx cancers; (b) Oesophagus cancer; (c) Stomach cancer; (d) Colon and rectum

cancers; (e) Liver cancer; (f) Pancreas cancer; (g) Trachea, bronchus, lung cancers; (h) Melanoma and other skin cancers; (i) Breast cancer; (j) Cervix uteri cancer; (k) Corpus uteri cancer; (l) Ovary cancer; (m) Prostate cancer; (n) Bladder cancer; (o) Lymphomas, multiple myeloma; (p) Leukaemia

B. Other neoplasmsC. Diabetes mellitusD. Endocrine disordersE. Neuropsychiatric conditions: (a) Unipolar depressive disorders; (b) Bipolar disorder; (c) Schizophrenia; (d) Epilepsy; (e) Alcohol

use disorders; (f) Alzheimer and other dementias; (g) Parkinson’s disease; (h) Multiple sclerosis; (i) Drug use disorders; (j) Post-traumatic stress disorder; (k) Obsessive-compulsive disorder; (l) Panic disorder; (m) Insomnia (primary); (n) Migraine

F. Sense organ diseases: (a) Glaucoma; (b) Cataract; (c) Refractive errors; (d) Hearing loss, adult onset; (e) Macular degeneration and other

G. Cardiovascular diseases: (a) Rheumatic heart disease; (b) Hypertensive heart disease; (c) Ischaemic heart disease; (d) Cerebrovascular disease; (e) Inflammatory heart diseases

H. Respiratory diseases: (a) Chronic obstructive pulmonary disease; (b) AsthmaI. Digestive diseases: (a) Peptic ulcer disease; (b) Cirrhosis of the liver; (c) AppendicitisJ. Genitourinary diseases: (a) Nephritis and nephrosis; (b) Benign prostatic hypertrophyK. Skin diseasesL. Musculoskeletal diseases: (a) Rheumatoid arthritis; (b) OsteoarthritisM. Congenital anomaliesN. Oral conditions: (a) Dental caries; (b) Periodontal disease; (c) Edentulism

Group III InjuriesA. Unintentional injuries: (a) Road traffic accidents; (b) Poisonings; (c) Falls; (d) Fires; (e) Drownings; (f) Other unintentional injuriesB. Intentional injuries: (a) Self-inflicted injuries; (b) Violence; (c) War


Appendix B. Diagnoses and conditions for men and women aged 60 years and above, selected countries, Western Pacific Region18, 19

18 Countries shown are those for which health survey data were made available for the purposes of this study.

19 A full description of data collection and analysis is provided in the Data Book published separately on the WHO website.

High-income Upper middle-income Lower middle-income

Aus

tral

ia

Chin

a

Mal

aysi

a

Lao

Peop

le’s

D

emoc

rati

c Re

publ

ic

Phili

ppin

es

Viet

Nam

WHS

(2

002)

NHS

(2

007–

2008

)

WHS

(2

002)

SAG

E W

ave

1 (2

007–

2010

)

WHS

(2

002)

WHS

(2

002)

WHS

(2

002)

WHS

(2

002)

Characteristic Sex n=876 n=4423 n=791 n=7560 n=825 n=463 n=1097 n=456

Asthma diagnosed (%)

Men 11 (8, 15)

13 (11, 14)

6.9 (4.4, 9.3)

3.5 (2.9, 4.1)

9.3 (6.2, 12.4)

11 (6, 15)

13 (10, 17)

4.6 (1.8, 7.3)

Women 16 (12, 19)

18 (16, 20)

4.3 (2.3, 6.3)

2.9 (2.4, 3.5)

10 (7, 13)

3.5 (1.2, 5.7)

9.5 (7.2, 11.8)

2.2 (0.1, 4.2)

Back pain (%) Men 40 (35, 45)

. 20 (16, 23)

. 23 (19, 27)

41 (35, 48)

56 (52, 61)

40 (33, 47)

Women 43 (38, 48)

. 31 (26, 35)

. 35 (30, 39)

47 (41, 53)

51 (47, 55)

58 (51, 64)

Been diagnosed with arthritis (%)

Men 37 (32, 42)

41 (39, 43)

21 (17, 25)

. 20 (16, 24)

19 (13, 24)

35 (31, 39)

14 (9, 20)

Women 55 (51, 60)

58 (56, 60)

31 (26, 35)

. 31 (27, 35)

20 (15, 25)

40 (36, 44)

23 (18, 29)

Diagnosed in last 5 years with cataract (%)

Men . . 30 (21, 39)

8.5 (7.6, 9.5)

32 (24, 39)

19 (4, 33)

30 (23, 37)

15 (7, 24)

Women . . 43 (33, 52)

16 (14, 17)

35 (28, 43)

10 (0, 24)

29 (24, 35)

32 (21, 43)

Diagnosis of angina pectoris (heart disease) (%)

Men 18 (14, 22)

. 5.3 (3.1, 7.5)

9.1 (8.1, 10)

11 (8, 15)

5.8 (2.4, 9.3)

11 (8, 13)

7.1 (3.8, 10.4)

Women 8.7 (6.2, 11.1)

. 7.4 (4.8, 10)

13 (12, 14)

12 (9, 15)

7.8 (4.4, 11.3)

16 (13, 19)

10 (6, 14)

Pain or discomfort in chest (%)

Men 18 (15, 22)

. 11 (8, 15)

11 (10, 12)

18 (14, 22)

12 (7, 17)

32 (28, 36)

13 (8, 18)

Women 16 (12, 19)

. 15 (10, 19)

14 (13, 16)

21 (17, 25)

13 (9, 18)

34 (30, 38)

16 (11, 22)

Pain, aching, stiffness or swelling (%)

Men 46 (41, 51)

70 (68, 72)

10 (7, 13)

29 (27, 30)

21 (17, 26)

21 (15, 27)

47 (43, 52)

13 (8, 18)

Women 52 (47, 57)

76 (74, 78)

14 (11, 18)

39 (37, 40)

27 (23, 31)

21 (16, 26)

49 (45, 53)

16 (12, 21)

Appendix 39

Appendix C. Health risk behaviours among men and women aged 60 years and above, selected countries, Western Pacific Region20, 21



High-income Upper middle-income Lower middle-income

Aus

tral

ia

Chin

a

Mal

aysi

a

Lao

Peop

le’s

D

emoc

rati

c Re

publ

ic

Phili

ppin

es

Viet

Nam

WHS

(2

002)

NHS

(2

007–

2008

)

WHS

(2

002)

SAG

E W

ave

1 (2

007–

2010

)

WHS

(2

002)

WHS

(2

002)

WHS

(2

002)

WHS

(2

002)

Characteristic Sex n=876 n=4423 n=791 n=7560 n=825 n=463 n=1097 n=456

Body Mass Index (mean)

Men 27 (27, 28)

27 (27, 28)

22 (22, 22)

24 (24, 24)

24 (23, 25)

21 (21, 22)

22 (21, 22)

20 (19, 20)

Women 27 (26, 27)

27 (27, 27)

22 (22, 22)

24 (24, 24)

23 (23, 24)

21 (20, 21)

22 (21, 22)

20 (19, 20)

Drink alcohol (%)

Men . 91 (89, 92)

38 (33, 43)

51 (49, 52)

18 (14, 22)

59 (52, 66)

60 (56, 65)

53 (45, 60)

Women . 79 (77, 80)

9.4 (6.5, 12.4)

10 (9, 11)

3.4 (1.6, 5.1)

23 (18, 28)

22 (18, 25)

4.7 (1.7, 7.8)

Smoke (%) Men . 12 (10, 13)

49 (44, 54)

48 (46, 49)

41 (36, 46)

73 (67, 79)

51 (47, 55)

37 (30, 44)

Women . 11 (9, 12)

6.9 (4.4, 9.4)

4.8 (4.2, 5.5)

6.6 (4.2, 8.9)

16 (11, 20)

23 (19, 26)

5.2 (2.3, 8.2)


Appendix D. Limitations in mobility and difficulties in self-care among persons aged 60 years and above, selected countries, Western Pacific Region22, 23



High-income

Upper middle-income Lower middle-income

Aus

tral

ia

Chin

a

Mal

aysi

a

Lao

Peop

le’s

D

emoc

rati

c Re

publ

ic

Phili

ppin

es

Viet

Nam

WHS

(2

002)

WHS

(2

002)

SAG

E W

ave

1 (2

007–

2010

)

WHS

(2

002)

WHS

(2

002)

WHS

(2

002)

WHS

(2

002)

SAG

E IN

DEPT

H (2

007)

Characteristic Currently married

n=488 n=397 n=3974 n=447 n=253 n=629 n=245 n=3275

Difficulty moving - None/mild (%)

No 74 (68, 79)

83 (77, 90)

91 (89, 92)

83 (78, 88)

71 (64, 78)

51 (46, 56)

71 (62, 80)

84 (82, 86)

Yes 83 (78, 88)

79 (74, 85)

91 (90, 93)

87 (81, 93)

75 (66, 84)

51 (45, 57)

72 (61, 83)

86 (84, 88)

Difficulty moving - Moderate/severe/extreme (%)

No 26 (21, 32)

17 (10, 23)

9.5 (7.6, 11.4)

17 (12, 22)

29 (22, 36)

49 (44, 54)

29 (20, 38)

16 (14, 18)

Yes 17 (12, 22)

21 (15, 26)

8.6 (7.4, 9.8)

13 (7, 19)

25 (16, 34)

49 (43, 55)

28 (17, 39)

14 (12, 16)

Difficulty self-care1 - None/mild (%)

No 90 (86, 94)

88 (82, 95)

95 (94, 97)

96 (93, 98)

91 (86, 95)

72 (68, 77)

91 (87, 96)

94 (93, 95)

Yes 95 (93, 98)

87 (81, 92)

96 (96, 97)

94 (90, 99)

91 (85, 97)

71 (65, 77)

86 (81, 92)

95 (94, 96)

Difficulty self-care - Moderate/severe/extreme (%)

No 10 (6, 14)

12 (5, 18)

4.5 (3.2, 5.9)

4.4 (1.8, 7)

9.4 (4.6, 14.1)

28 (23, 32)

8.6 (3.8,

13.5)

5.6 (4.5, 6.6)

Yes 4.5 (1.6, 7.5)

13 (8, 19)

3.6 (2.8, 4.4)

5.7 (1.2, 10.1)

8.7 (2.6, 14.9)

29 (23, 35)

14 (8, 19)

4.8 (3.6, 6)

Difficulty vigorous activity - None/mild (%)

No . 31 (21, 41)

47 (44, 51)

47 (40, 53)

41 (33, 49)

41 (36, 46)

40 (31, 50)

24 (21, 27)

Yes . 33 (28, 39)

51 (50, 53)

56 (48, 63)

45 (35, 55)

43 (37, 49)

54 (42, 66)

26 (24, 29)

Difficulty vigorous activity - Moderate/severe/extreme (%)

No . 69 (59, 79)

53 (49, 56)

53 (47, 60)

59 (51, 67)

59 (54, 64)

60 (50, 69)

76 (73, 79)

Yes . 67 (61, 72)

49 (47, 50)

44 (37, 52)

55 (45, 65)

57 (51, 63)

46 (34, 58)

74 (71, 76)

Self-rated health - Very good/good (%)

No 57 (50, 63)

33 (23, 43)

23 (20, 27)

62 (56, 69)

51 (43, 59)

48 (42, 53)

12 (5, 18)

11 (9, 13)

Yes 72 (66, 78)

32 (25, 38)

27 (25, 29)

61 (54, 68)

48 (38, 59)

45 (39, 51)

11 (6, 16)

10 (8, 12)

Self-rated health - Moderate/bad/very bad (%)

No 43 (37, 50)

67 (57, 77)

77 (73, 80)

38 (31, 44)

49 (41, 57)

52 (47, 58)

88 (82, 95)

89 (87, 91)

Yes 28 (22, 34)

68 (62, 75)

73 (71, 75)

39 (32, 46)

52 (41, 62)

55 (49, 61)

89 (84, 94)

90 (88, 92)

Appendix 41

Appendix E. Sociodemographic characteristics of men and women aged 60 years and above, selected countries, Western Pacific Region24, 25

24 Countries shown are those for which health survey data was made available for the purposes of this study.


High-income Upper middle-income Lower middle-incomeA

ustr

alia

Repu

blic

of

Kore

a

Chin

a

Mal

aysi

a

Lao

Peop

le’s

D

emoc

rati

c Re

publ

ic

Phili

ppin

es

Viet

Nam

WHS

(2

002)

MCS

S (2

000–

2001

)

WHS

(2

002)

SAG

E W

ave

1 (2

007–

2010

)

WHS

(2

002)

WHS

(2

002)

WHS

(2

002)

WHS

(2

002)

SAG

E IN

DEPT

H (2

007)

Characteristic Sex n=876 n=209 n=791 n=7560 n=825 n=463 n=1097 n=456 n=5303

Currently married (%)

Men 72 (68, 77)

. 82 (79, 86)

87 (86, 88)

85 (81, 88)

82 (77, 87)

76 (73, 80)

87 (82, 92)

90 (89, 91)

Women 45 (40, 50)

. 63 (59, 68)

70 (69, 71)

42 (38, 47)

40 (34, 46)

44 (40, 47)

56 (49, 62)

51 (49, 52)

Education level 1 - No formal schooling (%)

Men 0.8 (0, 1.6)

. 15 (11, 18)

0 (0, 0)

26 (22, 31)

49 (42, 56)

9.1 (6.5, 11.7)

7.4 (3.2,

11.5)

2.3 (1.7, 2.9)

Women 0.6 (0, 1.3)

. 40 (35, 44)

0 (0, 0)

63 (59, 68)

87 (83, 91)

10 (7.6, 12.3)

18 (13, 23)

15 (14, 16)

Education level 2 - Primary, high school (%)

Men 67 (62, 72)

. 75 (71, 79)

91 (90, 92)

69 (64, 74)

51 (44, 58)

85 (82, 89)

82 (76, 88)

98 (97, 98)

Women 80 (76, 84)

. 54 (49, 59)

94 (93, 95)

36 (32, 40)

13 (9, 17)

83 (80, 86)

79 (74, 85)

85 (84, 86)

Education level 3 - University, college, postgrad (%)

Men 33 (28, 37)

. 10 (7, 13)

9.4 (8.3, 10.4)

4.6 (2.5, 6.8)

0.5 (0, 1.4)

5.5 (3.5, 7.6)

11 (7, 15)

0 (0, 0)

Women 19 (15, 23)

. 6.1 (3.6, 8.6)

5.8 (4.8, 6.8)

0.7 (0, 1.5)

0 (0, 0)

6.8 (4.8, 8.8)

2.1 (0.2, 4)

0 (0, 0)

Rural (%) Men . . 50 (45, 55)

49 (48, 51)

50 (45, 55)

30 (23, 36)

50 (46, 55)

21 (16, 26)

.

Women . . 58 (53, 63)

53 (52, 55)

44 (39, 48)

29 (23, 34)

56 (52, 59)

28 (22, 34)

.

Years of education - top tertile (%)

Men 44 (39, 49)

51 (44, 59)

51 (46, 56)

31 (29, 33)

45 (41, 50)

55 (48, 62)

55 (51, 59)

64 (57, 70)

.

Women 29 (25, 33)

14 (3, 25)

32 (27, 37)

20 (18, 21)

19 (15, 22)

17 (13, 22)

52 (48, 56)

29 (23, 35)

.

Years of formal education completed (mean)

Men 11 (11, 12) 9.8 (9.1, 10.4)

6.5 (6, 6.9)

7.5 (7.3, 7.6)

4.9 (4.5, 5.3)

2.6 (2.2, 3.1) 6 (5.6, 6.3) 6.2 (5.7, 6.7)

.

Women 11 (10, 11) 5.7 (4.6, 6.8)

4.2 (3.7, 4.6)

6.8 (6.7, 7)

2.2 (1.8, 2.5)

0.7 (0.5, 0.9) 5.7 (5.4, 6) 3.6 (3.3, 4)

.


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