An age-old debate*

World Health Day is celebrated on 7 April to mark the anniversary of the founding of WHO in 1948.  It is not a day that stops the nation – no sweeps and no light switched off, especially this year.

What is it?  The WHO web site states that: ‘World Health Day is a global campaign, inviting everyone – from global leaders to the public in all countries – to start collective action to protect people's health and well-being.’ 

This year the topic was Ageing and health with the theme "Good health adds life to years". Noting the theme of World Health Day this year, a recent Lancet editorial http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2812%2960518-2/fulltext points out that while the biggest causes of years of life lost among people aged 60+ years are ischaemic heart disease and stroke, only between 4-14% of older people in less- and least-developed settings are receiving antihypertensive treatment.

April 7 received zero media coverage.  Old age is boring.  It is not news.

Shortly after World Health Day, in Australia, $3.7 billion of reforms to aged care over five years were announced by the federal government. http://www.theaustralian.com.au/national-affairs/at-a-glance-aged-care-reforms/story-fn59niix-1226334312515

• $1.2 billion to strengthen the aged-care workforce.
• $268.4 million for dementia.
• $54.8 million to support carers.

These proposals are linked to existing aged care support and include $880.1 million over next five years to expand home care with 80,000 new home-care packages by 2012.  The ageing of the world’s population is a special challenge for nations still undergoing economic growth such as China and India. The population aged 65+ years in those countries will, according to UN projections, double between 2000 and 2020 and quadruple — to 900 million people — by 2040. The number of older citizens in more-developed countries by 2040 will be only one-third that of those in the less-developed countries. The economically-advanced world thus holds no monopoly on old age.

In China where a one-child-per-family has operated since 1978 and applies to 40% of families, family for older parents will be very challenging, especially if the one child lives in a city and the parents live rurally.  Whereas now there are 10 million people in China aged 80 or over, by 2050 there will be, according to current estimates, 100 million.

In old age, as the WHO theme suggests, it is the disease burden rather than age itself that is the biggest problem. 

It is also among older people that attention should be lavished on the modifiable factors that multiply absolute risk of death and disability. Treating blood pressure, for instance, is more, not less, important in the individual older patient than it is in a younger person in the prevention of stroke and heart disease, as the Lancet implies.

The policy challenges for an ageing world, especially one that seeks to sustain health in old age, concern the context, content and cost of services.

The context is not a straightforward policy component because social attitudes towards older people vary widely. Oriental concepts of filial duty will confront the practicalities of distance, time, and new lifestyles.  In some cultures, the wisdom of the elders is prized while in others it is ignored. In multicultural Australia, sensitivity to cultural variations is critical to the effective provision of support for older people. Different cultural attitudes to institutional, home and respite care all need to be respected.

The content of care includes the technicalities and includes decisions about how resources for aged care will be used to best effect.  That is true at the macro level but closer to the people we are aiming to help, end-of-life discussions are a valuable part of a patient-centred aged care policy.

When it comes to cost, we must ask if the welfare model of health service provision that we follow at present is sustainable in the light of population ageing, and if it needs modification. How will this be achieved without doing violence to notions of equity and bankrupting the nation? Questions such as these have been addressed partially in the financial arrangements in the new federal aged care proposals.

As grey demand increases, the attitude of younger taxpayers cannot be assumed to one of selfless generosity towards meeting the costs of care and support of ever more older people. This makes the development and protection of superannuation and personal savings a huge political priority right now.

Ageing is not like HIV or bird flu — it is entirely predictable and susceptible to rational examination, prediction and policy formation. The Productivity Commission http://www.pc.gov.au/projects/inquiry/aged-care/report and groups such as Alzheimer’s Australia http://www.fightdementia.org.au/dementia-an-economic-and-fiscal-disaster-waiting-to-happen.aspx are urging us to think, discuss and debate seriously the major policy elements within ageing.

*Published in MJA Insight Magazine