Elsevier

Social Science & Medicine

Volume 51, Issue 6, 15 September 2000, Pages 887-895
Social Science & Medicine

Population ageing in developed and developing regions: implications for health policy

https://doi.org/10.1016/S0277-9536(00)00068-XGet rights and content

Abstract

Population ageing is now recognised as a global issue of increasing importance, and has many implications for health care and other areas of social policy. However, these issues remain relatively under-researched, particularly in poorer countries, and there is a dearth of specific policy initiatives at the international level. For example, the 1994 International Conference on Population and Development agreed to 15 key principles for future policy, but none of these even make indirect mention of the aged (International Conference on Population and Development, 1995, Documents. Programme of action of the 1994 International Conference on Population and Development. Population and Development Review, 21(2), 437–461). This paper seeks to highlight some of the key issues arising from population ageing. It begins with a brief overview of international trends in demographic ageing, and considers the health needs of different groups of older people. It sketches out some implications for policy, paying particular attention to the financing and organisation of health services. The final part of the paper contains a discussion about how older people have been affected by, and have adapted to, processes of social, economic and political change. Given the wide scope of these concerns, it is not possible to discuss any issue in detail, and the paper does not claim to give the subject matter a comprehensive or global treatment. It must be stressed that patterns of ageing and their implications for policy are highly complex and variable, and, as such, great care should be taken in generalising between the experiences of different groups of older people, and between different settings.

Section snippets

Definitions, meanings and trends

There is general dissatisfaction with defining old age in purely chronological terms, but there would appear to be no universally appropriate alternatives to this approach. Old age is perceived and understood in a multitude of different ways, often with important cultural variations. These may refer to physical appearance, key life events (for example retirement or some other form of disengagement), or social roles (grandparenthood, or ceremonial duties) (Midwinter, 1991). Since old age can

Health needs of older people

There is still debate about whether increased longevity means an extension of healthy active lives or an extension of morbidity. Studies from the UK and USA suggest the former is occurring (Fries, 1980, Manton et al., 1997). However, this finding is not universal (Sidell, 1995), and data for developing countries are particularly inconclusive. A survey in Mexico reported that ageing was associated with extended periods of morbidity, and that diagnoses were being made earlier, which further

Financing and organising health services

In every country, levels of health spending are considerably higher for the aged than for younger age groups (OECD, 1996). As such, it might be expected that population ageing will inevitably lead to increased expenditure on health services. Nevertheless, it is dangerous to draw too close a relationship between the two. For example, a study from the US, where the total spend grew by about 8 times between 1940 and 1990, calculated age differentials in spending rates and found that demographic

New policy frameworks

In order to optimise the impact of social policies, it is essential to take a holistic and inter-sectoral approach to the welfare of the aged. Health policies should not be considered in isolation, but within a broader quality of life framework, which also includes older peoples’ economic and social well-being. At the same time, policy must recognise that they often make substantial contributions to their own welfare and to that of other people. As part of an objective to promote active,

Old age in a changing world

Tremendous advances in technology and the development of health services mean that the great majority of older people enjoy a far better health status and a longer life expectancy than at any time in the past. However, these undeniable benefits must be placed in the context of other impacts which multiple processes of change and modernisation may be having on quality of life of the aged. Historical research has largely scotched the myth of a “golden age”, when older people were the objects of

Key challenges for the future

This paper has attempted to cover a large number of often quite complex, inter-connected issues relating to health policies for older people. As such, it may be useful to identify a number of key themes and lessons which emerge from this compressed review. To begin with, it is essential that the aged are not considered as a homogeneous group, and that the variety of experiences, needs and capabilities of different older people is recognised in health policy. In a similar vein, health care must

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