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Demographic change

Specific health problems

by Michael Bünte

In depth

In Africa,  many grand parents become surrogate parents, raising grandchildren  whose parents died of AIDS.

In Africa, many grand parents become surrogate parents, raising grandchildren whose parents died of AIDS.

In 1950, planet Earth had 200 million people who were over the age of 60. In 2050, there will be around two billion. For the first time ever, senior citizens will out­number the age group below 15 worldwide, and 80 % of the aged will live in developing countries. Whereas the industrial nations became rich before they got old, the developing ones are ageing before they have escaped poverty. Senior citizens often suffer particular hardship – and they have specific health problems. By Michael Bünte

Efforts have long been made to enshrine rights of old people in international law, including the rights to social security and participation in social life. At the UN World Assembly on Ageing in 2002, the participating countries adopted the second International Plan of Action on Ageing. The document included commitments by 159 governments to do more to promote the interests of older people – and to prevent discrimination.

Sadly, implementation leaves a lot to be desired, as a recent report by UN Human Rights High Commissioner Navanethem Pillay showed. She calls for a new UN convention to protect the rights of older people. In a similar sense, HelpAge and other international advocacy groups are pressing for urgent and serious attention to the needs of old people in developing countries. Their right to a dignified life must be fulfilled.

At the initiative of Latin American governments, the UN started the debate on a new convention as well as other measures, for instance the appointment of a special rapporteur for the elderly. The Council of Europe is discussing the issue too, but seems half-hearted at best about supporting the call for a new UN convention. The UN has an Open-ended Working Group on Ageing, and in this context, the EU’s stance tends to be dismissive. Germany’s Federal Government acknowledges the need for protecting the aged, but does not see sufficient reason to draft a new UN convention. There can be no denying, however, that demographic change will have far-reaching consequences. International development agencies must take them into account see box on p. 35 – not only, but particularly in regard to health care.

Health care challenges

Non-communicable diseases are silent killers. UN Secretary-General Ban Ki-moon calls them a “creeping catastrophe” in the health sector. Strokes, heart attacks, cancer, diabetes and dementia cause nearly two-thirds of all deaths worldwide. Of these, 80 % – 38 million fatalities a year – are registered in developing and newly industrialising countries.

Developing countries urgently need health policies that address the needs of an ageing population. At present, large parts of health budgets are spent on controlling infectious diseases such as AIDS and malaria as well as on family planning programmes. International development agencies and private donors encourage this narrow focus.

Two important reasons why old people’s needs are not met adequately, however, are insufficient funding for the treatment of chronic illness and health workers’ lack of training and sensibility in age-related matters. Age discrimination occurs on a regular basis at many health care facilities. Few countries have a fully developed system for gerontological and geriatric staff training.

Chronic ailments

The fact that older people are disproportionately affected by non-communicable diseases requires no explanation. The phenomenon is particularly apparent in the case of blindness and visual impairment. More than 80 % of sufferers are over the age of 50. The World Health Organisation WHO believes that the majority of cases of visual impairment could easily be treated if sufficient funding was available. The provision of glasses would solve many people’s problems. In general, treatment costs can be recouped fast. A simple cataract operation can produce a 1500 % return on investment within a year because it restores a patient’s capacity to work.

According to WHO figures, 3 million people worldwide died of diabetes in 2000. This disease claimed the same number of lives as HIV/AIDS. The statistics also reveal that adult-onset diabetes is particularly relevant. Two-thirds of the 117 million people who are affected by this type of diabetes live in developing countries.

Similarly, two-thirds of the people with Alz­heimer’s disease live in the developing world – and 98 % of them are over the age of 65. Their problems are currently completely ignored by policymakers, though they pose massive challenges for families as well as institutional care systems.

Women are particularly affected by age-related complaints. Because they live longer than men on average, they also account for more illness. Every year, blindness strikes two-and-a-half million women who could be helped if appropriate screening and treatment were available. Moreover, aged women feel the consequences of numerous pregnancies and hard physical work.

The international community is only slowly becoming aware of age-related gender disadvantages. In 2010, for example, the UN Committee on the Elimination of Discrimination against Women approved a recommendation for the protection of older women’s human rights.

Older people also need to be considered in the HIV/AIDS crisis. Nearly 3 million over-50s worldwide are thought to be infected. Few of them are targeted by awareness raising campaigns and support projects.

Disaster medicine

Climate change, natural catastrophes and displacement present a particular threat to old people because of their specific health issues and their social isolation. According to the Red Cross, 26 million elderly people a year are affected by natural disasters. As the Internal Displacement Monitoring Centre and Help­Age noted in a recent report, 30 % to 65 % of internally displaced people are over the age of 60 – significantly more than their share in the general population. Accordingly, disaster medicine needs to address the specific problems of these age cohorts – something it hardly does so far. Less than one percent of international emergency and disaster funding is used for the benefit of old people. Yet in refugee camps, for example, older people often assume great responsibility, for instance for children who have been orphaned or whose parents are unable to look after them. Action needs to be taken to ensure that old people remain as able-bodied as possible in disaster settings.

Even in developing and newly industrialising countries, health policy must increasingly focus on facilitating ageing whilst staying active. One aspect is that health systems need to take a long-term perspective, taking account of a person’s entire life span. Investing in the health of young people and promoting a healthy lifestyle lead to lower health care expen­diture when people get old.

Until new policies can be implemented and bear fruit, however, millions of old people will continue to suffer from non-communicable diseases. Ensuring that they receive appropriate health care is one of the most important tasks in the near future. The development community must take note.

Access to adequate health care needs to be provided to all. For this reason, HelpAge internationally campaigns for the Social Protection Floor, an instrument the UN wants to become a platform for the provision of free basic healthcare. Without meaningful action, poor people’s right to health and health care will never be ensured.