Intended for healthcare professionals

Rapid response to:


Institutional ageism in global health policy

BMJ 2016; 354 doi: (Published 31 August 2016) Cite this as: BMJ 2016;354:i4514

Rapid Response:

Ageism or gerontocracy?

Lloyd-Sherlock et al claimed that goals to reduce premature mortality from non-communicable diseases reflects wider ageism (a process of systematic stereotyping and discrimination against people because they are old) in global health policy” but failed to provide evidence.(1)

Indeed, healthcare expenditures increase with age (average spending on 60 year olds is twice as high as the spending for 40 year olds, spending on 70 year olds is four-times as high and 80 year olds have on average six-times higher hospital expenditures than 40 year olds).(2) Moreover, reducing premature mortality may also be likely to reduce morbidity at an older age.

In fact, public health concerns must be about child poverty, first of all. Child poverty has been plateauing in UK since 2004/5 and for the first time in almost two decades it has started to rise in absolute terms (3 see Fig, 4). Child poverty and related social determinants of health negatively affect physical health, socioemotional development, and educational achievement.(5)

Our gerontocratic societies spend more and more to grasp and even extend an already very long end of life. It may get worse as the grasp response, a primitive reflex, correlates with dementia. No ageism since a long time ago Plato claimed, "it is for the elder man to rule and for the younger to submit" (6)

1 Lloyd-Sherlock PG, Ebrahim S, McKee M, Prince MJ.Institutional ageism in global health policy. BMJ 2016;354:i4514.

2 Melberg HO. Are healthcare expenditures increasing faster for the elderly than therest of the population? Expert Rev. Pharmacoecon. Outcomes Res 2014:14;581–583.

3 Pickett KE, Wilkinson RG. The ethical and policy implications of research on income inequality and child well-being. Pediatrics 2015;135 Suppl 2:S39-47.

4 Wickham S, Anwar E, Barr B, Law C, Taylor-Robinson D. Poverty and child health in the UK: using evidence for action. Arch Dis Child. 2016;101:759-66.

5 Hair NL, Hanson JL, Wolfe BL, Pollak SD. Association of child poverty, brain development, and academic achievement JAMA Pediatr 2015;169:822-9.

6 Plato in Bytheway B. Ageism. Buckingham. Open University Press. 1995. p. 45

Competing interests: No competing interests

06 September 2016
alain braillon
senior consultant
University hospital
80000 Amiens France