Globally, there has been an exceedingly rising trend in ageing populationin all the six regions.
Europe has the highest older adult population where thepercentage is predicted to reach 36.6% by 2050. However, the number of olderadults in less developed countries is estimated to rise even greater than 250%,in comparison to a 71% increase in advanced countries. For instance, in 2010,the Ghanaian adult population aged 60years and above was projected to hit 1.5million, representing 6% of the total population and that was already a 220% increasein adult population since independence. By 2025 and 2050, this age group is predictedto increase to 2.5million and 6million respectively representing 14% of thetotal population. And this drastic shift might not be too different in many ifnot in all less and middle income countries.
The World HealthOrganisation (WHO) indicates that about 23% of the total global burden ofdisease is recorded within the adult population aged 60 years and above.Following the trend of total global burden of disease among adult population,WHO suggests that the swift shift in the leading cause of mortalities frominfectious diseases to non-communicable diseases (NCDs) is as a result of therapid increase in adult older population. Non-communicable diseases are now theleading cause of mortalities globally. It is recorded that about 75 per cent ofthese mortalities happen in less developed countries. This therefore leaves thelow and middle income countries in a complex situation to battle with the agonyof a double disease burden – communicable and non-communicable diseases. Anotherterrifying situation is that about 80% of NCD mortalities occur in less developed countries. With these scenarios,it is strongly conclusive that the emerging trend of NCDs would extremelyaffect low- and middle-income countries due to the already existing severalother health challenges. By 2030, it is estimated thatgreater than 60% of the ‘first Baby Boomers (those born between 1946 and 1964)’will be having to manage more than 1 chronic disease condition.
Furtherresearch done on NCDs indicates that within developing countries, the odds ratio of having a chronic diseasecondition is twice on the minimum for those who live in rural areas compared tourban areas. Another study conducted in Africa found out that about 49% of itsrespondents had on the minimum three chronic disease conditions to manage.Studies have indicated that there are varying issues with regard torural and urban demographic differences in ageing.
It is not surprisingtherefore to note that overwhelming fraction of older adults in developedcountries live in urban areas while in developing countries the majority ofolder adults live in rural areas. In 2000, the census figures indicated that therehad been a remarkable increase from 4.1% of the total older adults’ populationin 1960 to 7.9%. It further showed that there were older women than men inrural Ghana. Until 2010, Ghana never had any national guiding policy on ageing.The UN’s Sustainable DevelopmentGoals (SDGs) are surrounded in the universal drive of “leaving no one behind”.Therefore knowing today’s achievements and gaps for the health-related SDGsshould be paramount for decision formulators and global health governance asthey aim to advance global health outcomes.
Sustainable Development Goal 3specifically is to ‘ensure healthy lives and promote well-being for all at allages’ – young, youth and the aged. From lessons gathered within the era of theMDGs, all nations have a mandate to embrace multiple sets of actions andgovernance mechanisms that would promote health for all at all levels includingsteps to address all inequities and barriers to health service utilizationespecially for the marginalised and vulnerable groups – until then achievingthe objective of ‘leaving no one behind’ might be another mirage. The World Health Organization recogniseschildren as being predominantly vulnerable topoor health outcomes. Also, in a similar analogy, senior citizens arecategorised as a vulnerable population. In developing countries, the attentionof most nationally and internationally funded health interventions has mostly beenon communicable diseases and maternal and child survival. As a result of thatmany developing countries can now boost of a good reduction in the incidence ofinfectious diseases, maternal and infant and child mortalities (Hill andPebley, 1989). Nevertheless, as children survive and grow, they areincreasingly exposed to the same several health threats associated with chronicdiseases.
Studies have found that poorer health outcomes are normally characterisedwith the vulnerable groups including the older adults as indicated above.Health is a human right according to WHO yet most health systems especially in low and middle income countries donot have adequately what it take to respond to the health and care needs of theadult population. Health systems in most developing countries are andwould be highly vulnerable to the shocks that the shift in demographics wouldpose to health for all in the near future if remarkable mechanisms are notintegrated into the main stream of health systems now in preparedness for thenear future health demands. In recent times, health systems and global healthgovernance have been on high agenda in the quest to attain the SustainableDevelopment Goals (SDGs). For instance, in April 2018, there is a scheduledhealth conference in Oslo, Norway on health systems. Similarly, there would beanother conference in Bergen on SDGs.
This points to the fact that healthsystems requires greater attention in the bit to achieving the SDGs 3 by 2030. Several studies have indicated that the older population often struggleto access health and care services they need due to: physical and financialbarriers; lack of appropriate services; low levels of awareness of healthconditions; lack of knowledge on their rights and entitlements; poorutilization of health services; inadequate preparedness of the health workforceto care for older people; Poor communication and lack of awareness about healthissues of elderly. Several studies have beendone on health and ageing mostly on self-reported health, stress related issues,dementia and depression, determinants of health, cognitive functioning anddementia, among others significantly correlating with healthcare utilizationamong the older population and health systems. Through these studies, a lot of criticalfindings have emanated either as facilitators or hindrance to healthy ageingyet less has been done with reference to relooking deeply into why the currenthealth systems cannot integrate these essential evidenced based recommendationsand secondly how health systems could be strengthened thereafter designing ahealth system model to integrate these issues in full support of healthy ageingin low and middle income countries. Though resource constraints have been amajor hindrance to redefining the health systems, however it is very necessary asa matter of urgency to set the pace now in tackling the emerging healthchallenges through realigning health systems as the many predicted healthchallenges that would emerge as a result of the ageing population can never bea totally misleading prediction. Hence the earlier health systems in low andmiddle income countries began to relook at their health systems in support ofhealthy ageing the better.
As many countries are battling with measures to handle these emerging futurehealth problem, evidence based information requires a change in the presenthealth care system from one which focuses on diagnosis and treatment of diseaseto a system that attends to the major issues that affect health and care needsas well as quality of life of older adults. A study done in the USA on criticalareas influencing the quality of life of older Americans adults recommended thefollowing: providing resources to individuals to help manage chronic medicalconditions, assuring a sufficient number of primary health care providerseducated in geriatrics and gerontology, removing financial barriers toaccessing health care and medications, and changing the American cultural valuesystem that emphasizes disease treatment over providing emotional, educational,and support resources. Developing long-term care systems for theelderly has become an increasingly urgent policy issue in China also,especially for the adult population in rural areas. It is because of this need that most countries in the developedcountries like the South Australia Health Care Authorities identified the needto redefine its traditional service models to include systems that met the healthand care needs of the older population as well as making their health systems ‘age friendly’ . Even though some countries inlow and middle income countries have piloted some mechanisms in support ofhealthy ageing but these were not done through the main health systems but justat the community levels. Hence limiting findings to community and sociallevels. It therefore could be a challenge to transfer lessons from such pilotprojects to the main health systems considering the differences in characteristicsamong other parameters. In summary, the shift indemographics has led to an increase in the prevalence of chronic diseases.
Theseconditions pose important challenges to health care systems especially indeveloping countries. The concerns here are whether the health care systems inless and middle income countries are robust enough to meet health care needs ofthe older population. If not then in what ways can the structure and thedelivery mechanisms of health systems best adapt to the needs of olderpopulations considering the emerging rise of chronic disease conditions? Healthsystems therefore need to be realigned in order to promote healthy ageing otherwisewe risk putting the older population in a situation where their quality of lifewould experience worst outcomes by 2030 which would have defeated the UN goalof leaving no one behind.