Changing old attitudes to aging and making aging well a global priority

This year's WHO World Health Day will be on healthy ageing, with the official launch on April 4 ahead of the actual World Health Day on April 7. Correspondence published Online First by The Lancet shows that not only must old attitudes to ageing be transformed, but attention must be shifted to dealing with non-communicable diseases in the elderly, which represent by far the largest burden of disease in this age group. The letter is by Dr Peter Lloyd-Sherlock, School of International Development, University of East Anglia (UEA), Norwich, UK, and colleagues.

The authors say: "Depictions of older people remain stereotyped and generalised, distorting public opinion and skewing policy debates. For example, the use of economic dependency ratios, one of the commonest measures of ageing, assumes that anyone aged 65 years or older is unproductive. Similarly, the use of disability-adjusted life years to capture the health of a population explicitly views older people as a social and economic burden. Yet many older people continue to make substantial social, economic, and cultural contributions, which can be enhanced by measures that improve their health and functional status." Furthermore, they point out that health spending and health-service use are more closely associated with how close one is to death than with chronological age. They add: "Indeed, it is often the case that less is spent on older people than on younger people with similar conditions."

Noting the variations in functional status of older people both between and within countries, the authors say substantial improvements in status can be achieved with relatively cheap and simple interventions such as the effective management of hypertension, diabetes, and high cholesterol, and the promotion of healthy lifestyles, in particular regular physical activity. The authors say: "Yet in most countries these interventions are not available to large sections of adult populations. The failure of national governments and international agencies to prioritise these cheap and effective treatments represents a missed opportunity to reduce mortality, illness, and disability on an unprecedented scale. Although the non-communicable disease (NCD) agenda has gathered some momentum in recent years, international health spending in low-income and middle-income countries remains heavily focused on infectious diseases and mother and child health."

They conclude: "If we do not challenge existing policy paradigms and the social attitudes that underpin them, population ageing might indeed lead to a crisis in the provision of health and welfare services. Instead, we should see it as a welcome opportunity to challenge outdated public perceptions, political priorities, and policy models."

A linked Lancet Editorial says that 5 years from now, for the first time in history, the number of people aged 65 years and older will outnumber children younger than 5 years.

The Editorial concludes: "This World Health Day, WHO is championing a life-course approach to healthy and active ageing, which includes: promoting good health for all ages to prevent the development of chronic disease; early detection of chronic diseases to minimise their impact; creating physical and social environments that foster the health and participation of older people; and changing social attitudes to ageing. Later this year, The Lancet will publish a Series on ageing. We hope that this Series, together with WHO's renewed commitments, will help create a new movement for healthy ageing for all."