Intended for healthcare professionals

Rapid response to:


How to meet the challenge of ageing populations

BMJ 2011; 342 doi: (Published 20 June 2011) Cite this as: BMJ 2011;342:d3815

Rapid Response:

How to meet the challenge of ageing populations: Ageing alongside and outside EU borders

The challenges and contributions of ageing populations extend beyond
EU borders1(Fahy N, et al. BMJ. 2011;342: d3815 doi: 10.1136/bmj.d3815) to
middle and lower income countries where the majority of older persons
worldwide reside. As of 2011, 63% of the world's 537 million persons aged
65-plus years lived in countries in less developed regions.2 About 121
million older persons live in Europe as compared to 37 million in Africa,
287 million in Asia, and 42 million in Latin America and the Caribbean.
By the year 2031, the population aged 65-plus globally will exceed 1
billion, with 71% living in less developed countries. This translates into
168 million persons in Europe, 73 million in Africa, 587 million in Asia,
and 88 million in Latin America and the Caribbean. Clearly, ageing is
poised to become the next public health challenge globally and not just
for the EU.

Without comparable health data, much less information about the
impact of ageing populations on health care and social support systems, we
use life expectancy as a proxy for population health. Life expectancy and
the years of healthy life expected (HALE) is considerably lower in less
developed countries than in more developed countries.

The most recent World Health Organization estimates for healthy life
expectancy at birth (2007) reveals a mean of 66.8 years for persons in its
European region, 45.4 years in its African region, 56.8 years in the South
-East Asian region and 67.3 years in its American region.3 The
differences are less pronounced for persons aged 60 years, with HALEs of
16.0 years for older persons in Europe, 10.6 years in Africa, 11.6 years
in South-East Asia, and 16.4 years in the Americas. Regardless of where
you live, if you reach 60 years, you have considerable time remaining in
good health, contributing to your family and community. Recent reports
from the United Kingdom and New Zealand suggest a considerable net
positive contribution to society from populations aged 65 years and
older,4 or at least a decoupling of the attribution of rising health care
costs to ageing populations.5 This accounting of contributions in higher
income countries include pension costs, something accessible to only a
minority of persons in many lower income countries suggesting a larger
positive contribution in lower income than higher income regions. The
challenge will be to maintain subsequent cohorts of older adults in good
health for extended periods of time through lifestyle interventions such
as better nutrition through the life course, engaging in adequate amounts
of physical activity, stopping tobacco use and the harmful use of alcohol,
the early detection and management of hypertension and chronic
noncommunicable diseases and promoting well-being.

Adding two years to healthy life expectancy is a significant
challenge, even for European countries with well-funded health systems and
adequate health care force. Countries in Europe as well as in other
regions would benefit substantially from speeding up the application of
science to practice, but with a very different starting point in lower
income countries. Health infrastructure and health worker retention
remains a concern in many countries.6 Access to health care and health
professionals are required before health technologies can be applied. A
concerted multi-sectoral effort that goes beyond health systems
strengthening will be required. The United Nations High Level Summit on
Non-Communicable Diseases7 in September 2011 will be an opportunity to
highlight the role of ageing as the major driver of this epidemic and the
need to have a life course perspective if real gains have to be made.

Access to timely information is crucial to establishing the baseline
from which to measure improvements or interventions that would increase
the healthy years added to life expectancy. Recent data collection
efforts across middle and lower income countries, like the Study on global
AGEing and adult health (SAGE),8 along with several national and multi-
country studies on ageing, have established baseline health levels,
determinants and outcomes as well as health care utilization.3 The use of
common methodologies will allow valid cross-national comparisons. This
should also be coupled with enhanced geriatric training and retention of
health care professionals.6,9 The innovative partnership in Europe on
healthy ageing, a welcome initiative, could be informed by evidence from
outside the boundaries of the EU and could, in turn, provide the impetus
for similar efforts in low and middle income countries where the challenge
of ageing also looms.


1. Fahy N, McKee M, Busse R, Grundy E. How to meet the challenge of
ageing populations. BMJ. 2011 342:d3815; doi:10.1136/bmj.d3815

2. United Nations Population Division. World Population Prospects:
The 2010 Revision. New York: United Nations. 2011.

3. World Health Organization. World Health Statistics 2011. Geneva:
WHO. 2011.

4. WRVS. Gold age pensioners. Valuing the socio-economic contribution
of older people in the UK. Cardiff: United Kingdom. 2011.

5. Bryant J, Sonerson A. Gauging the cost of Aging. Finance and
Development. 2006;43(3).

6. World Health Organization. The World Health Report 2006: Working
Together for Health. WHO: Geneva. 2006.

7. General Assembly of the United Nations. High-level Meeting on Non-
communicable Diseases. 2011.

8. World Health Organization. Study on global AGEing and adult health

9. International Federation of Medical Students' Associations, World
Health Organization. Teaching Geriatrics in Medical Education II. Geneva:
WHO. 2005.

Competing interests: No competing interests

15 July 2011
Paul Kowal
Somnath Chatterji
World Health Organization, Multi-Country Studies unit