Europe's aging population

BMJ 1996; 312 doi: (Published 08 June 1996) Cite this as: BMJ 1996;312:1442

The number of people dying annually in the European Union is set to increase by almost 20% over the next 30 years. Set that forecast against estimates that 60% of a person's health costs are concentrated in the year preceding death, and the scale of the challenge facing public health authorities starts to emerge. The European Commission estimates that demographic aging will increase the annual death rate in the 15 member states from 3 725000 in 1994 to 4 375000 by the year 2025. This calculation, says the commission, indicates the amount by which “health costs will be multiplied over the next 30 years solely as a result of the demographic effect.”

The scenario is set out in the commission's second examination of the demographic situation in the European Union. Unlike last year's pioneering effort, the latest report focuses on medium and long term perspectives in general and on the extent and acceleration of the aging process in particular. It indicates that the union's present population of 370 million is unlikely to increase substantially. Indeed, with only moderate immigration and fecundity continuing to drop, numbers may well fall. However, the commission identifies the emergence of a new category—people aged over 80, whose consumption of health services is well above average. It points out that 30 years from now there will be two to three times as many people in this age category as there are now

This aging element, predict the report's authors, will be a further pressure on health costs, which have tended to increase from two non-demographic factors—the use of more sophisticated medical techniques and a rise in the consumption of health care at all ages. This demographic aging will be particularly striking soon after the turn of the century, with the number of people who reach 60 increasing each year. From 4 million last year, this category will climb to 5.9 million by the year 2025. In contrast, the number of people reaching the age of 20 each year will fall from 5.1 million last year to 4.2 million by 2025.

The report warns that changes in policy are inevitable as countries adapt to the new age structure. But it is not meant to alarm policy makers in the union into making a “single track” approach to meet foreseeable demographic trends. The situations which different countries face are so varied that no one strategy would be equally suitable in all member states. For example, the average number of children per family varies from between 1.7 and 2.1 in northern countries such as Sweden and Denmark (now the highest in the union) to 1.5-1.8 in central countries (Britain and the Netherlands) and to 1.1-1.4 in the southern countries.

Similarly, the growth in the number of people aged over 60 will vary considerably among countries. Between 1995 and 2025, the increase will be greatest in the Netherlands (80%), followed by Ireland (68%) and Finland (67%), and lowest in Portugal (34%) and Sweden (38%). Britain will also have one of the lowest increases (44%).

However, all countries will face the phenomenon to a degree. An aging population will be an important factor as governments seek new ways to create jobs and to divide finite public spending among infinite demands.

Both are tasks now facing the European Union as a whole. On one hand, governments are committed to working closer together to reduce unemployment, which now stands near 20 million. On the other hand, they are all working to reduce public expenditure and budget deficits to meet the introduction of a single currency by 1999.

The European Commission intends to use this and future reports to increase scientific cooperation with national authorities both to stimulate debate on the consequences of demographic change and to develop an understanding of its impact on health, social, and employment policies.—RORY WATSON, deputy editor, European Voice

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