This Week

6 May 1995

Ageing world heads for health crisis

OLD people are getting a raw deal. While their numbers are increasing the world over, less money is being allocated to caring for them, particularly in the poorest countries. In the World Health Report 1995, published this week, the WHO suggests for the first time that the burden of ill-health on the world should be assessed not just by looking at particular diseases, but also by looking at how the impact of illness changes with age.

While many see improved life expectancy as a triumph of social development and public health, the WHO’s message is that this success is bringing crisis to many parts of the world. Even in the richest countries, longevity can sometimes seem more of a punishment than a blessing, with healthcare for the old near the bottom of the list of priorities. Ageing populations are no longer a phenomenon of the rich world alone, and even the poorest countries are having to deal with the problems of old age. So development agencies will have to rethink their programmes and policy makers acknowledge that a longer life is not necessarily a healthy life.

In the past five years the world’s population has grown by 1.7 per cent a year, while the number of elderly people has increased by 2.7 per cent. And although Europe, Japan and the US still have the largest proportions of older people, developing countries expect a fourfold increase in the number of people over 65 by 2025.

The WHO’s strategy for tackling the health of the elderly includes a shift in emphasis and a subtle change of name. Its “Health of the Elderly” programme has become “Aging and Health”, and it will focus on what happens as people age rather than the problems people face once they are old.


The WHO says that it wants to help the elderly to realise their full potential and offer them a satisfactory quality of life. “We all age every day, so we can’t wait until we are old before taking any action,” says Alex Kalache, the new head of the programme.

Thanks to the boom in health technology, more children are surviving to adulthood and people are living longer. But aid to the developing world does not reflect the changing population structure. Most help is still devoted to the young. At the same time, societies that used to care for their elderly are changing fast. The concept of the extended family is disappearing as younger members move into the cities in search of work. In countries such as Brazil and Bangladesh the elderly are often left to fend for themselves both physically and financially.

The solution, says Kalache, is to convince the world that older people can contribute to society rather than being a drain on it. This requires the cooperation of other international organisations, such as the International Labour Organisation.

“The WHO can’t do anything alone. Not only do we need to change our own attitudes, but we also need to encourage enthusiasm in other WHO regions and galvanise other agencies such as the ILO,” says Kalache. They are important, he says, because if poverty is a major risk to a nation’s health, then providing employment will keep young people in their own communities where they can help to care for their families. “Governments that ignore this issue will simply have a chronic problem on their hands, which won’t disappear.” Mark Gorman from HelpAge International agrees. “The explosive increase of elderly populations is a totally predictable demographic shift, and we’ve got time to do something about it.” Gorman says it will be vital to convince governments that spending money on their elderly is economically viable. He says this is “best done by tapping into existing community resources (see Table).

Improving life for the elderly worldwide