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11 TH WORLD CONGRESS OF PUBLIC HEALTH GLOBAL AGEING: IMPLICATIONS FOR PUBLIC HEALTH

11 TH WORLD CONGRESS OF PUBLIC HEALTH GLOBAL AGEING: IMPLICATIONS FOR PUBLIC HEALTH . Alexandre Kalache WHO, Ageing and Life Course. Global Ageing Ageing and development Active Ageing Policy Framework ALC activities. Age. 80+. MALE. FEMALE. 70-74. 60-64. 50-54. 40-44. 30-34.

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11 TH WORLD CONGRESS OF PUBLIC HEALTH GLOBAL AGEING: IMPLICATIONS FOR PUBLIC HEALTH

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  1. 11TH WORLD CONGRESS OF PUBLIC HEALTHGLOBAL AGEING:IMPLICATIONS FOR PUBLIC HEALTH Alexandre Kalache WHO, Ageing and Life Course

  2. Global Ageing Ageing and development Active Ageing Policy Framework ALC activities

  3. Age 80+ MALE FEMALE 70-74 60-64 50-54 40-44 30-34 20-24 10-14 00-04 Millions 300 200 100 100 200 300 The world population is ageing Population Pyramid in1995and2025 UN Population Division, 1998 Revision

  4. Population 2000 2025 2050 (in billion) Total 6.0 7.8 8.9 More developed countries 1.2 1.2 1.2 Less developed countries 4.7 6.6 7.8 60+ 0.6 1.2 2.0 More developed countries 0.2 0.3 0.3 Less developed countries 0.4 0.9 1.7 The population in developing countries is fast increasing - particularly the aged

  5. Nigeria 20 Thailand South 15 Africa Indonesia 10 Mexico Brazil 5 India 0 China 1975 2000 2025 Source: UN, 2000 Population 60 years and over as Percentage of total Population in selected Developing Countries % of total population

  6. Life expectancy at birth isincreasing in all regions Japan Sierra Leone Source: UN Population Division, 1998 Revision

  7. Women live longer than men - life expectancy at birth 2000-05

  8. Life Expectancy at the Age of 60 in Selected Countries Source: UN, Population Data-Base, up-date 2001

  9. Inequalities – global extremes

  10. Inequalities – global extremes

  11. Years of LEB lost to ill-health

  12. Social inequalities São Paulo, Brazil

  13. Total fertility rates are decreasing Source: UN, 1998

  14. More and more countries have total fertility rates below replacement level 121 68 22 Source: UN , 1998

  15. Ageing in the development agenda “Ageing is a development issue. Healthy older persons are a resource for their families, their communities and the economy.” WHO Brasilia Declaration on Ageing, July, 1996

  16. Older people are theprinciple carers for AIDS patients and AIDS orphans in Africa Photo: UNICEF

  17. The role of non-contributory pensions in Brazil and South Africa

  18. The Burden of Disease Spain, 2002 Total number of hours (in millions)/year spent on providing care Health care professionals 588 (12%) Community 4300 (88%)

  19. Total number of hours (in millions)/year spent on providing non-paid health care, Spain 2002 Men Women Caring for others 52 199 Self-care 140 108 Total 192 307

  20. Average number of minutes/day spent by the head of the household in providing health-related care, Spain 2002 Age Group Household with a sick person 23 50 154 201 318 61 122 18 - 29 30 - 49 50 - 64 64 - 74 75- 84 85 + Total

  21. The population dividend

  22. South Korea: Population Pyramids Source: United Nations World Population Prospects, 2000 Rev. 1970 2000 Male Female 2050 2025

  23. China: Population Pyramids Source: United Nations World Population Prospects, 2000 Rev. 2000 1970 Male Female 2025 2050

  24. Brazil: Population Pyramids Source: United Nations World Population Prospects, 2000 Rev. 1970 2000 Male Female 2050 2025

  25. Ageing world-wide: contrasting realities

  26. The reality in the developed world • Cohorts of future older persons quite different – the ‘baby boomers’ effect • Contributions of biotechnology and new pharmaceuticals affordable by most • Awareness • Disability rates declining • Dependency ratios inappropriately calculated

  27. Evidence from the US: disability rates are declining Chronically disabled Americans 65 years and older 27 million 33 million 35 million Source: US National LTC Survey, NY Times, May 2001

  28. The reality in the developing world • “poor raw material” • prevailing poverty • fast ageing in parallel with rapid social changes • urban vs. rural ageing • changes in family structure • AIDS epidemic in Africa

  29. In a nutshell: The developed world became rich before it became old.Developing countries are becoming old before they become rich.

  30. High Specificity of ageing from a public health perspective • Increased NCD risk • Multiple pathology • Iatrogenic factors • Drug interactions & dosage • Socio-economic factors • Emphasis on quality of life • Community based health approaches

  31. WHO’s response The WHOAgeing and Life Course Programme

  32. Capacity building (research and training) Information dissemination Global Strategy for Active Ageing Policy development Advocacy Ageing and Life Course - programme components

  33. WHO’s approaches and perspectives on Ageing life - course development gender cultural cohort intergenerational primary health care/ community based

  34. Life Course

  35. Life Course Perspective “A life course approach offers an interdisciplinary framework for guiding research and policy on health, human development and ageing ”

  36. Early Life Growth and development Adult Life Maintaining highest possible level of function Older Age Maintaining independence and preventing disability Functional capacity Disability threshold Rehabilitation and ensuring the quality of life Age A Life Course Approach to Active Ageing Range of function in individuals Source:Kalache and Kickbusch, 1997

  37. Scope for NCD Prevention FetalLife Infancy andChildhood Adolescence Adult Life SEP, established adult behavioural/biological risk factors SEP; birth weight, maternal nutrition status high Development of NCD obesity lack of PA smoking SEP diseases growth rate Accumulated Risk (Range) low Age PA: physical activity SEP: socio-economic position Source: Aboderin and Kalache. WHO,2002

  38. 2 billion older people in 2050 For those already aged 20+ an exclusive focus on children and the youth is already too late: by 2050 they will be 65+

  39. It is time for a new paradigm, one that views older people as active participants in an age-integrated society and as active contributors aswell as beneficiaries of development.

  40. Active Ageing:A Policy Framework

  41. “Active Ageing” – WHO definition:Active ageing is the process ofoptimizing opportunities for health, participation and security in order to enhance quality of life as people age.

  42. Determinants of Active Ageing

  43. Three pillars of a policy framework for Active Ageing

  44. The time to plan and to act is now In all countries, and in developing countries in particular, measures to help older people remain healthy and active are a necessity, not a luxury.

  45. A culture of ageing is a culture of solidarity

  46. Solidaritybetween Rich and poor Public and private North and South But, above all,

  47. Solidarity between... Young and old

  48. ALC Main Activities

  49. The INTRA project: Integrated Health Systems in rapidly ageing developing countries –

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