11TH WORLD CONGRESS OF PUBLIC HEALTH
GLOBAL AGEING:
IMPLICATIONS FOR PUBLIC HEALTH
Alexandre Kalache
WHO, Ageing and Life Course
Ageing and Life Course
Global Ageing
Ageing and development
Active Ageing Policy Framework
ALC activities
Ageing and Life Course
The world population is ageing
Population Pyramid in
1995 and 2025
Age
80+
70-74
FEMALE
MALE
60-64
50-54
40-44
30-34
20-24
10-14
00-04
300
200
100
Ageing and Life Course
Millions
100
200
300
UN Population Division, 1998 Revision
The population in developing countries is
fast increasing - particularly the aged
Population
(in billion)
2000
2025
2050
Total
6.0
7.8
8.9
More
developed countries
1.2
1.2
1.2
Less
developed countries
4.7
6.6
7.8
60+
0.6
1.2
2.0
More
developed countries
0.2
0.3
0.3
Less
developed countries
0.4
0.9
1.7
Ageing and Life Course
Population 60 years and over as Percentage of
total Population in selected Developing Countries
% of total population
Nigeria
20
Thailand
South
Africa
Indonesia
15
10
Mexico
Brazil
5
India
0
China
1975
Ageing and Life Course
2000
2025
Source: UN, 2000
Life expectancy at birth is
increasing in all regions
90
Japan
80
Years
70
60
Sierra Leone
50
40
30
1950-55
1970-75
Africa
Asia
Europe
Ageing and Life Course
1990-95
2010-15
Latin America and Caribbean
2030-35
Northern America
Source: UN Population Division, 1998 Revision
Women live longer than men life expectancy at birth 2000-05
Japan
USA
Mexico
China
Brazil
Indonesia
India
Pakistan
Bangladesh
Russian Fed.
Nigeria
0
20
40
Men
Ageing and Life Course
60
Women
80
100
Life Expectancy at the Age of 60 in
Selected Countries
COUNTRY
France
Japan
USA
UK
Cuba
Mexico
China
Russ. Fed.
2000-05
Women
30.0
27.0
23.9
23.3
22.5
22.0
20.1
18.7
2025-30
Women
31.9
31.1
26.1
25.9
24.1
23.9
22.7
21.4
2000-05
Men
20.0
21.4
19.5
19.4
20.3
19.6
16.3
13.5
2025-30
Men
22.1
23.9
21.7
21.6
21.3
20.8
18.6
16.2
Source: UN, Population Data-Base, up-date 2001
Ageing and Life Course
Inequalities – global extremes
Ageing and Life Course
HALE
LEB
Inequalities – global extremes
Japan
Sierra Leone
Total
81.9
34.0
Male
78.4
32.4
Female
85.3
35.7
Japan
Sierra Leone
Total
75.0
28.6
Male
72.3
27.2
Female
77.7
29.9
Ageing and Life Course
Years of LEB lost to ill-health
Lost to
ill health
Japan
Sierra Leone
Total
6.9
8.4%
5.4
16.0%
Male
6.1
7.8%
5.2
15.9%
Female
7.6
8.9%
5.8
16.3%
Ageing and Life Course
Social inequalities
São Paulo, Brazil
Ageing and Life Course
Ageing and Life Course
7
Total fertility rates are decreasing
6
5
4
3
2
1
0
1950-55
1970-75
Africa
Europe
Northern America
Ageing and Life Course
1990-95
2010-15
2030-35
Asia
Latin America and Caribbean
Source: UN, 1998
More and more countries have
total fertility rates below replacement level
121
68
22
1970
Ageing and Life Course
2000
2020
Source: UN , 1998
Ageing in the development agenda
“Ageing is a
development issue.
Healthy older persons
are a resource
for their families,
their communities
and the economy.”
WHO Brasilia Declaration on Ageing,
July, 1996
Ageing and Life Course
Older people are the
principle carers for AIDS patients and
AIDS orphans in Africa
Photo:
UNICEF
Ageing and Life Course
The role of non-contributory
pensions in Brazil and
South Africa
Ageing and Life Course
The Burden of Disease
Spain, 2002
Total number of hours (in millions)/year
spent on providing care
Health care professionals
588
Community
4300 (88%)
Ageing and Life Course
(12%)
Total number of hours (in millions)/year spent on
providing non-paid health care, Spain 2002
Men
Women
Caring for others
52
199
Self-care
140
108
Total
192
307
Ageing and Life Course
Average number of minutes/day spent by the head of the
household in providing health-related care, Spain 2002
Age Group
Household with
a sick person
18 - 29
23
30 - 49
50
50 - 64
154
64 - 74
201
75- 84
318
85 +
61
Total
122
Ageing and Life Course
The population dividend
Ageing and Life Course
South Korea: Population Pyramids
Source: United Nations World Population Prospects, 2000 Rev.
Male
Female
1970
2000
2025
Ageing and Life Course
2050
China: Population Pyramids
Source: United Nations World Population Prospects, 2000 Rev.
Male
Female
1970
2025
Ageing and Life Course
2000
2050
Brazil: Population Pyramids
Source: United Nations World Population Prospects, 2000 Rev.
Male
Female
1970
2025
Ageing and Life Course
2000
2050
Ageing world-wide: contrasting realities
Ageing and Life Course
The reality in the developed world
• Cohorts of future older persons quite
different – the ‘baby boomers’ effect
• Contributions of biotechnology and new
pharmaceuticals affordable by most
• Awareness
• Disability rates declining
• Dependency ratios inappropriately calculated
Ageing and Life Course
Evidence from the US:
disability rates are declining
Chronically disabled Americans 65 years and older
10
in Millions
9
8
7
6
5
4
1982
1989
1994
1996
1999
27 million
33 million
35 million
Projected numbers
Actual numbers
Source: US National LTC Survey, NY Times, May 2001
Ageing and Life Course
The reality in the developing world
• “poor raw material”
• prevailing poverty
• fast ageing in parallel with rapid social
changes
– urban vs. rural ageing
– changes in family structure
– AIDS epidemic in Africa
Ageing and Life Course
In a nutshell:
The developed world became rich
before it became old.
Developing countries are
becoming old
before they become rich.
Ageing and Life Course
High Specificity of ageing from a public health
perspective
•Increased NCD risk
•Multiple pathology
•Iatrogenic factors
•Drug interactions & dosage
•Socio-economic factors
•Emphasis on quality of life
•Community based health approaches
Ageing and Life Course
WHO’s response
The WHO
Ageing and Life
Course Programme
Ageing and Life Course
Ageing and Life Course - programme
components
Information
dissemination
Capacity
building
(research and
training)
Global Strategy for
Active Ageing
Policy
development
Ageing and Life Course
Advocacy
WHO’s approaches and perspectives on Ageing
•
•
•
•
•
•
•
life - course
development
gender
cultural
cohort
intergenerational
primary health care/
community based
Ageing and Life Course
Life Course
Ageing and Life Course
Life Course Perspective
“A life course approach offers an
interdisciplinary framework for guiding
research and policy on health, human
development and ageing ”
Ageing and Life Course
A Life Course Approach to Active Ageing
Early Life
Adult Life
Older Age
Growth and
development
Maintaining highest
possible level of
function
Maintaining independence
and preventing disability
Disability threshold
Rehabilitation and
ensuring the quality of
life
Age
Ageing and Life Course
Source:Kalache and Kickbusch, 1997
Scope for NCD Prevention
Fetal
Life
SEP;
birth
weight,
maternal
nutrition
status
Infancy and Adolescence
Childhood
Adult Life
SEP, established adult
behavioural/biological
risk factors
SEP
diseases
growth rate
high
obesity
lack of PA
smoking
Accumulated
Risk
(Range)
low
PA: physical activity
Ageing and Life Course
Age
SEP: socio-economic position
Source: Aboderin and Kalache. WHO,2002
2 billion older people in
2050
For those already aged 20+
an exclusive focus on
children and the youth is
already too late: by 2050
they will be 65+
Ageing and Life Course
It is time for a new paradigm,
one that views older people as
active participants in an ageintegrated society and as active
contributors as
well as beneficiaries of
development.
Ageing and Life Course
Active
Ageing:
A Policy
Framework
Ageing and Life Course
“Active Ageing” – WHO definition:
Active ageing is the process of
optimizing opportunities for health,
participation and security in order to
enhance quality of life as people age.
Ageing and Life Course
Determinants of Active Ageing
Ageing and Life Course
Three pillars of a policy framework
for Active Ageing
Ageing and Life Course
The time to plan and to act is now
In all countries, and in developing
countries in particular, measures to
help older people remain healthy and
active are a necessity, not a luxury.
Ageing and Life Course
A culture of ageing is a culture
of solidarity
Ageing and Life Course
Solidarity between
• Rich and poor
• Public and private
• North and South
But, above all,
Ageing and Life Course
Solidarity between...
Young and old
Ageing and Life Course
ALC Main
Activities
Ageing and Life Course
1. The INTRA project:
Integrated Health
Systems in rapidly
ageing developing
countries –
Ageing and Life Course
INTRA's ultimate aim
Strengthening family
and community care
through the PHC
sector
Ageing and Life Course
INTRA I: quantitative
INTRA II: qualitative
(PHC users)
INTRA III: qualitative
(non-users)
Ageing and Life Course
INTRA I
Chile
Jamaica
Botswana
Lebanon
Thailand
Korea
INTRA II INTRA III
Peru
T& T
Ghana
Syria
Sri Lanka
China
Ageing and Life Course
Bolivia
Suriname
Kenya
Pakistan
India
Malaysia
INTRA I
Chile:
national teams
country profile
coordinators
steering committee
methodology
field work
Ageing and Life Course
report
INTRA II
Chile
Peru
national teams;
coordinators;
country profile
steering committee
methodology
field work
Ageing and Life Course
report
INTRA III
Chile
Peru
national teams;
coordinators;
country profile
Bolivia
steering committee
methodology
field work
Ageing and Life Course
report
INTRA Features
Capacity building
Bottom up
Exchange of knowledge/
Experiences/models
South to South
Regional hubs
Sustainability
Ageing and Life Course
2. Age-friendly
PHC Centres
Ageing and Life Course
WHO main staircase
Ageing and Life Course
Ageing and Life Course
Ageing and Life Course
Ageing and Life Course
3. A gender perspective
to ageing:
Women, ageing and
health
Ageing and Life Course
4. Prevention of elder
abuse through the
PHC sector
Ageing and Life Course
5. Older persons in
emergency
situations - their
needs and strengths
Ageing and Life Course
6. Preventing falls in
older age at
community level
Ageing and Life Course
7. AIDS and Ageing in
Africa - older
persons as carers
Ageing and Life Course
8. Age-friendly
urban settings
Ageing and Life Course
photo by: Stefan Andersson
Ageing and Life Course