Stephen Leeder: An age-old debate

WORLD Health Day is celebrated each year to mark the anniversary of the founding of the WHO in 1948. It is not a day that stops the nation — especially this year.

This year the topic for World Health Day was ageing and health with the theme “Good health adds life to years”. But the day (7 April) and the topic 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, with $1.2 billion to strengthen the aged care workforce, $268.4 million for dementia, and $54.8 million to support carers.

These proposals, which did get fairly widespread media coverage, 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.

An ageing population is not just a dilemma for Australia and other developed countries. It presents a particular 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.

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. A recent Lancet editorial, linked to World Health Day pointed 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% and 14% of older people in less- and least-developed settings are receiving antihypertensive treatment.

An ageing world, especially one that seeks to sustain health in old age, faces many policy challenges, but three stand out — context, content and cost of services.

Context is not straightforward because social attitudes towards older people vary widely. But even oriental concepts of filial duty will increasingly 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.

Content of care includes decisions about how resources for aged care will be used to best effect. That is true at the macro level but its importance is closer to the people we are aiming to help, making discussions on issues such as end-of-life 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 we now follow 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 and groups such as Alzheimer’s Australia are urging us to think, discuss and debate seriously the major policy elements within ageing.

The media might think getting old is boring but we can’t afford to ignore it.

Professor Stephen Leeder is the director of the Menzies Centre for Health Policy and professor of public health and community medicine at the University of Sydney.

Posted 14 May 2012