Ageing and Life Course 11 TH 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 Millions Age MALEFEMALE UN Population Division, 1998 Revision

Ageing and Life Course The population in developing countries is fast increasing - particularly the aged Population (in billion) Total More developed countries Less developed countries More developed countries Less developed countries

Ageing and Life Course Population 60 years and over as Percentage of total Population in selected Developing Countries % of total population Source: UN, 2000 Nigeria Thailand South Africa Indonesia Mexico Brazil India China

Ageing and Life Course Life expectancy at birth is increasing in all regions Source: UN Population Division, 1998 Revision Japan Sierra Leone

Ageing and Life Course Women live longer than men - life expectancy at birth

Ageing and Life Course Life Expectancy at the Age of 60 in Selected Countries Source: UN, Population Data-Base, up-date 2001

Ageing and Life Course Inequalities – global extremes

Ageing and Life Course Inequalities – global extremes

Ageing and Life Course Years of LEB lost to ill-health

Ageing and Life Course Social inequalities São Paulo, Brazil

Ageing and Life Course

Total fertility rates are decreasing Source: UN, 1998

Ageing and Life Course More and more countries have total fertility rates below replacement level Source: UN,

Ageing and Life Course Ageing in the development agenda “Ageing is a development issue. Healthy older persons are a resource for their families, their communities and the economy.” WHO Brasilia Declaration on Ageing, July, 1996

Ageing and Life Course Older people are 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 Health care professionals588(12%) Community 4300(88%) Total number of hours (in millions)/year spent on providing care

Ageing and Life Course Total number of hours (in millions)/year spent on providing non-paid health care, Spain 2002 MenWomen Caring for others52199 Self-care Total192307

Ageing and Life Course Average number of minutes/day spent by the head of the household in providing health-related care, Spain 2002 Age GroupHousehold with a sick person Total

Ageing and Life Course The population dividend

Ageing and Life Course 1970 South Korea: Population Pyramids Source: United Nations World Population Prospects, 2000 Rev Male Female

Ageing and Life Course 1970 China: Population Pyramids Source: United Nations World Population Prospects, 2000 Rev Male Female

Ageing and Life Course Brazil: Population Pyramids Source: United Nations World Population Prospects, 2000 Rev Male Female

Ageing and Life Course Ageing world-wide: contrasting realities

Ageing and Life Course The reality in the developed world Cohorts of future older persons quite different – the ‘baby boomers’ effect Contributions of biotechnology and new pharmaceuticals affordable by most Awareness Disability rates declining Dependency ratios inappropriately calculated

Ageing and Life Course Source: US National LTC Survey, NY Times, May 2001 Chronically disabled Americans 65 years and older Evidence from the US: disability rates are declining 27 million33 million35 million

Ageing and Life Course The reality in the developing world “poor raw material” prevailing poverty fast ageing in parallel with rapid social changes –urban vs. rural ageing –changes in family structure –AIDS epidemic in Africa

Ageing and Life Course In a nutshell: The developed world became 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) Policy development Advocacy Global Strategy for Active Ageing

Ageing and Life Course WHO’s approaches and perspectives on Ageing life - course development gender cultural cohort intergenerational primary health care/ community based

Ageing and Life Course Life Course

Ageing and Life Course Life Course Perspective “A life course approach offers an interdisciplinary framework for guiding research and policy on health, human development and ageing ”

Ageing and Life Course A Life Course Approach to Active Ageing Range of function in individuals Age Functional capacity Early Life Growth and development Adult Life Maintaining highest possible level of function Older Age Maintaining independence and preventing disability Rehabilitation and ensuring the quality of life Disability threshold Source:Kalache and Kickbusch, 1997

Ageing and Life Course Scope for NCD Prevention Age Development of NCD Fetal Life Adult Life AdolescenceInfancy and Childhood SEP diseases growth rate obesity lack of PA smoking SEP; birth weight, maternal nutrition status Source: Aboderin and Kalache. WHO,2002 PA: physical activity SEP: socio-economic position Accumulated Risk (Range) high low SEP, established adult behavioural/biological risk factors

Ageing and Life Course 2 billion older people in 2050 For those already aged 20+ an exclusive focus on children and the youth is already too late: by 2050 they will be 65+

Ageing and Life Course It is time for a new paradigm, one that views older people as active participants in an age- integrated society and as active contributors 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 IINTRA IIINTRA III ChilePeruBolivia JamaicaT &TSuriname BotswanaGhanaKenya LebanonSyriaPakistan ThailandSri LankaIndia KoreaChinaMalaysia

Ageing and Life Course INTRA I Chile:national teams country profile coordinators steering committee methodology field work report

Ageing and Life Course INTRA II ChilePeru national teams; coordinators; country profile steering committee methodology field work report

Ageing and Life Course INTRA III Chile PeruBolivia national teams; coordinators; country profile steering committee methodology field work report

Ageing and Life Course 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

3. A genderperspective to ageing: Women, ageingand 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