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Healthy ageing

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Published 16 December 2004, updated 03 August 2007
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healthcare social security

Europe has to face enormous economic challenges (pensions, health care systems) due to its ageing population and shrinking workforce. At the same time, population ageing also poses social problems. The social context is gradually changing (more women at work, dispersed families) and old people are often left to face social exclusion. Differences in financing structures result in health inequalities among European countries, which diversity will further increase with upcoming rounds of EU enlargement.

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Summary

According to the 2002 UN World Population Prospects, the European continent is the only region in the world whose population is set to decrease in the years to come, with a growth rate of -0.28 per cent. The proportion of children is projected to decline from 17 per cent in 2000 to 15 per cent in 2050. At the same time, by 2045-2050, people will live longer as life expectancy in Europe is expected to rise to 80.5 years from the currently estimated 73.2 years. There will also be more elderly people as one-third of Europe's population will be at least 60 years old by 2050.

The European Union is tackling the economic, employment and social implications of ageing as part of an "overall strategy of mutually reinforcing policies", launched at the Lisbon European Council in March 2000, and confirmed at subsequent European Council meetings in Nice, Stockholm, Göteborg and Laeken. 

The Social Policy Agenda, annexed to the Nice European Council conclusions, lists EU policy priorities in employment and social affairs, outlining how Member States can deal with the wider social and work life-related implications of ageing through mutually reinforcing employment, social protection and economic policies. Active ageing policies and practices are being encouraged, including life-long learning, working longer and retiring more gradually, being active after retirement, and engaging in health sustaining activities.

Responding to a request from the Gýorg European Council, the Commission presented a communication in December 2001, entitled "The future of health care and care for the elderly: guaranteeing accessibility, quality and financial viability". The Communication proposes three common EU objectives for healthcare and care for the elderly: accessibility, improvement of quality and financial viability.  These objectives were identified after considering the main challenges of national care systems in the EU. Public expenditure on health care is to increase between 0.7 and 2.3 GDP points, or even more, for the period 2000-2050 considering the emergence of more unstable family structures that could undermine family care. While technical progress entails large benefits for citizens it also raises the question of funding and of who is to bear the burden of expenditure. In view of the spread of the new information technologies, medical information should be made more widely available.

Issues

To improve the overall health of the population, it is necessary to have a good health care system in place, guarantee an adequate standard of living and better education, to encourage healthier lifestyles and adopt a prevention-based attitude. Public health policies need to promote social participation, care, self-fulfilment and dignity of older people to encourage healthy ageing. Healthy ageing practices may support cost-efficient ways to the supply of informal care and expand formal health and care provisions, as well as progress in aids and assisting technologies.

Charities such as Help The Aged provide advice and information for older people on issues from health conditions to work and pensions, and do extensive campaigning work in the arena of healthy ageing.  

The ageing of Europe's population raises a number of important questions, notably:

  • Managing the economic implications of ageing;
  • adjustment to an ageing and shrinking workforce;
  • ensuring adequate and sustainable pensions;
  • securing access to high quality health care for all, and;
  • ensuring the financial viability of health care systems.

Positions

The European Union Geriatric Medicine Society hails the collective ageing of our population as one of the most significant triumphs of the 20th century. However, the organisation warns that much remains to be done to better promote the development of geriatric medicine. For instance, geriatric medicine is not represented in three countries of the EU and the majority of medical students in the Union do not have formal exposure to geriatric medicine in the course of their training. The Geriatric Medicine Society would encourage the creation of a department of geriatric medicine in each general hospital in the EU and would support the creation of a geriatric medicine department in each medical school across the Union.

The European Forum for Good Clinical Practice has warned policy-makers in the EU to better prepare for the dramatic demographic development that will occur to avoid elderly people becoming "increasingly vulnerable, increasingly orphan". Geriatric populations have particular medic al needs, with specific dosage requirements and appropriate instructions for the use of medicines. The EFGCP recommends that new ethical and regulatory guidance be prepared for clinical research in ageing persons. Appropriate incentives are needed for the development of medicines that meet the needs of an ageing population, for both public and industry sponsored research.

The European Federation of Pharmaceutical Industries and Associations says that even though better health is the one thing that Europeans feel would most improve the quality of their lives, gap remains between Europeans' legitimate expectations to lead longer and more productive lives and society's preparedness to meet current and future health needs. EFPIA asks policy-makers to improve access to better healthcare, including innovative medicines; to rethink healthcare models in Europe which (in their view) are essentially driven by cost, rather than responding to an ageing population's demands for the highest quality healthcare. 

The International Longevity Centre-UK criticises the fact that health promotion and public health campaigns tend to focus on changing behaviours only in younger people. It states that "prevention is for older people too" and lists a healthy diet, non-smoking, physical exercise and moderate alcohol use as the main factors of healthy ageing.

The European Older People's Platform - AGE states that "discrimination against older people in health and care services must be addressed. It must be recognised that a healthy older age is the product of healthy lives and that people of all ages should have access to health advice and preventative services. In addition, older people should have fair access to operations and treatments and in situations where they require intensive support, such as in residential or nursing care, they should be treated as individuals with dignity and sensitivity".

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