Intended for healthcare professionals


Meeting the challenge of population ageing

BMJ 2009; 339 doi: (Published 05 October 2009) Cite this as: BMJ 2009;339:b3926
  1. Yvonne Doyle, regional director of public health1,
  2. Martin McKee, professor of European public health23,
  3. Bernd Rechel, researcher23,
  4. Emily Grundy, professor of demographic gerontology3
  1. 1NHS South East Coast, Horley, Surrey RH6 7DE
  2. 2European Observatory on Health Systems and Policies
  3. 3London School of Hygiene and Tropical Medicine
  1. Correspondence to: Y Doyle yvonne.doyle{at}
  • Accepted 16 September 2009

Increased longevity poses a challenge to the welfare state, but the problems can be overcome, argue Yvonne Doyle and colleagues

The welfare state is based on a life course that no longer matches current experience. It assumes that people, or at least men and unmarried women, spend their early years in education and then go on to a long period in work followed by a short period in retirement, when they live off the pension accumulated while in work or, more usually, the tax and pension contributions of those still in work. At a time when many people did not survive to draw their pensions or, if they did, survived for only a few more years, welfare systems coped reasonably well. It is less clear whether they will be able to do so in the future. The scale of the challenge is shown by a single stark statistic. If there is no change in work and retirement patterns, the ratio of workers to older inactive persons in the countries that were European Union member states in May 2004 (the EU-25), now at 3:1, is projected to increase to 1:1 in 2050.1

Threat or opportunity?

Do ageing populations pose a fundamental threat to the sustainability of welfare states, as many media commentators argue?2 3 Or can we adapt in ways that can accommodate ageing populations without abandoning the social solidarity that has prevailed in the post-war period? Much will depend on whether we can create societies that enable people to remain healthy, employed, and economically secure.4 Such societies would embrace the principles set out in the 2002 United Nations International Plan of Action on Ageing, which encourages governments to release the potential of older people by maximising their participation in society.5 However, if this is to be achieved, many policies …

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