1. Successful Ageing Public Health aspects of Population Ageing Shah Ebrahim London School of Hygiene & Tropical Medicine CADENZA Symposium 2008

2. Population ageing – the challenges Size and rate of population ageing Increased burdens of chronic disease Appropriate and affordable health care and social support Inter-generational transfer of resources Pensions and income security for older people

3. The global picture: 2000 and 2050

4. Life expectancy, 2007

5. The demographic “time bomb”?

6. An ageing population Source: Buckingham Palace, Anniversaries Office

7. The rise in numbers of older people is the major challenge

8. Why has population ageing happened? The “rectangularisation” of survival

9. China’s rapid demographic transition: a political cause

11. The speed of population ageing in developing countries

12. Population ageing is associated with increase in chronic diseases Transition to chronic degenerative diseases Continuing burdens of infectious diseases Greater impact of human immunodeficiency virus

13. Omran, Milbank Mem. Quart 1971 Other Violence Stroke Heart Cancer [Infancy] Diarrhoea Infections TB

15. Compression of morbidity and disability? AB Years Percent

16. Percentage of life expectancy spent able to perform basic ADLs 8.6 4.8 11.26.1 Source: Bone et al Health Expectancy, 1995 MenWomen

17. Percentage of life expectancy spent able to get outdoors 8.64.8 11.26.1 Source: Bone et al Health Expectancy, 1995 MenWomen

18. The first big challenge for middle income countries Growing cost of health care –Population expectations for health care –Technological advances – Increased complexity of care delivery Who pays?

19. Trends in different sectors of health care costs, USA 1960 -1997 100 1000 10,000 Source: National Center for Health Statistics, 1999

20. Health policy Health promotion Free primary health care Geriatric/psychogeriatric services Community rehabilitation Respite care Nursing homes Training for family carers

21. What might help meet the challenge? Focus on prevention Cost-effectiveness approach to prioritising health care Self and family care Development of primary care infrastructure Health care financing

22. The second big challenge for middle income countries Will the family continue to support elderly people? Urbanisation –Young migrate leaving old behind Employment patterns –Working women Westernisation –Devaluing of older people

23. The effect of social factors: wild versus protected Protected Wild Survival Age

24. Jerry Morris (chair), Alan Dangour, Christopher Deeming, Astrid Fletcher, Paul Wilkinson, LSHTM, 2005 SingleCouple Estimated£123£193 Actual Pension £82£131 Policy Unit Age Concern England Minimum income for healthy living: older people

25. Social policies Pensions Housing Caring/disability allowances Transport Organisations for elderly people

27. The World Bank view The need for multi-pillar support systems –State pensions –Private sector pensions –Personal savings BUT – what is the evidence (CHILE) and who benefits most? Is the idiom of crisis appropriate?

28. Income security Inter-generational transfer of resources –Young to old –Old to young Pensions and income security –confined to civil servants –affordability Loans and community income generation –old age should not be a barrier

29. HelpAge International – role in promoting income security e.g. universal pensions in Laos…

30. Urbanisation and Modernisation Older people literally left behind in rural areas Under-valuation of verbal traditions, wisdom of old age Birthplaces and final resting places Housing in cities usually too small for extended families

31. Old style work but new industries

32. Employment prospects for older people?

33. Economic productivity % at each age classed as economically active

34. Maintaining extended family lifestyles The “family will cope” Housing Transportation Reciprocal contributions to household Child care and rearing Tax incentives

35. Malaysia: Mahathir’s 2020 vision …the needs of elderly people will be met by "a social system in which the welfare of the people will revolve not around the state or the individual but around a strong and resilient family system" Mohammad Mahathir. Vision 2020 In Malaysia: the way forward. Prime Minister Department of Malaysia, Kuala Lumpur 1991.

36. How do we ensure inter- generational support?

37. Housing fine for extended families is torn down to make way for housing suitable only for nuclear families Wu Ping and Yang Wu have been fighting off bulldozers in downtown Chongqing since 2004, when they were one of 280 households asked to make way for a redevelopment project in the booming southwestern city of nearly 28 million CNN News, 2 April 2007

38. The childless older people No family to cope 10-15% couples are infertile Adoptions may become more difficult Community support mechanisms required

39. The public health problems Ageing is a major challenge to integrity of populations Rate of ageing is rapid, policy making is slow Development programmes and aid agencies are not considering impacts on older people

40. How can we meet the social challenges? Ageing as central consideration in social policy (cf. gender, poverty, race) Incentives for families to care Move towards pensions for all Emphasise the economic productivity of older people Training and re-training for older people