This talk gives an overview of the global ageing situation and also highlights important risk factors associated in later life. Some policy issues are also discussed

Khan, Hafiz T.A.

English

UWL Repository

Population Ageing in a Globalised World: Unequal risks in later life?Hafiz KhanProfessor of Public Health & Statistics The Graduate SchoolUniversity of West London, UKwww.uwl.ac.uk6 March 2020PHWT Public Seminar in GermanyOutline• Global population ageing• Drivers of population ageing • Unequal distribution of risks in later life – Burden of disease in old age  – Financial security in later life – Familial resources for elderly care– Care workforce for ageing society• Some policy implicationsYear Population (billions)1950 2.52000 6.1            2050 9.72100 11.2World populationChange of population structure(China 1950-2050)Population ageingPopulation change is quite dramatic in many places. The sheer number of older people is increasing faster than what we often thought.By 2030,  A quarter of the population in Asia will be over 60 years. A quarter of the population of the developed world will be over 65 years.Percent of population over age 60 years up to 10% 10 to 19% 20 to 24% 25 to 30%% of population aged 60+ years,  1996Source: UN Population Ageing 2006% of population aged 60+ years, 20501950-2050  population 80+ (millions)0501001502002503003504001950 1980 2000 2025 2050WorldMore DevLess DevEurope1950-2050  population 80+ %0123456789101950 1980 2000 2025 2050WorldMore DevLess DevEurope15.615.514.514.414.213.812.812.411.811.711.511.211.210.710.410.310.310.2109.5910111213141516% 80+ population, 2050Years lived with disability per 100,000 population (Public Health England, 2017)Global ageing (1980-2050)From pyramid 1980        to bell 2015        to barrel 2050Japan - The super ageing societyDrivers of population ageingFertilityMortality MigrationFertility 1950-2050012345671950-55 1980-85 2000-05 2020-25 2045-50WorldMore DevLess DevEuropeLife expectancy 1950-205001020304050607080901950-55 1980-85 2000-05 2020-25 2045-50WorldMore DevLess DevEuropeExpectation of life at birth, UKProportion of persons surviving to successive ages, UK0.00.10.20.30.40.50.60.70.80.91.00 10 20 30 40 50 60 70 80 90 100 110AgeProportion surviving18511871189119111931 19511971199120112031Number of centenarians increase at a faster rate. The number will reach some half a million by 2066.The prevalence of disability rises with age:6%     Children16%   Working age adults45 %  State pension age+Currently over 11 million disabled people in the UK (18%), costing around £80 billion per annum.The UK situation  At birthMalesAt birthFemalesAt age 65MalesAt age 65FemalesLife expectancy 79.5 83.1 18.7 21.1Healthy Life expectancy63.4 64.1 10.5 11.2Number of years in poor health16.1 19.0 8.2 9.9% of life in poor health20.3 22.9 43.9 46.9Proportion of life spent in poor health at age 65, England (2013 - 2015) Migration • Migration plays an important role. • It can slow down the process of ageing.  • Uncertainty in future migration.  Net annual migration, years to 2050UN projectionsRegion Net annual migration assumed for UN projectionsAsia -1,200,000Latin America & Caribbean -750,000Africa -400,000USA & Canada +1,300,000Europe +850,000Australia +100,000Global trends in population ageing• Population ageing is unprecedented –the 21st century will witness rapid ageing than ever before.• Population ageing is pervasive –a global phenomenon will affect everyone.  Countries that started the process later will have less time to adjust. • Population ageing is enduring –we will not return to the young populations anymore that our ancestors knew.Key risks of global ageingWhat are the key challenges of global ageing with regard to the way it shapes our lives? – Burden of disease in old age – Financial security in retirement– Familial resources for elderly care– Care workforce for elderlyBurden of disease• Epidemiological transition – changes in leading causes of deaths from acute and infectious diseases to chronic and non-communicable ones. • Non-communicable diseases are big threats such as Heart disease, Stroke, Cancer, Diabetes and Dementia.• These are also linked with disability, dependency & long-term care needs. • Highly likely to suffer from multi-morbidities.Causes of deaths in adults 70+ years, World 2016 (millions)Global scenario of dementiaBurden of diseaseComplex multi-morbidities+Ageing =Double burden for carersA big challenge for global public healthFinancial securityFinancing wellbeing is a big challenge in old age• Savings for later life such as PAYG. • Work pension & Mandatory Provident Fund  (MPF) • Pension provides financial security to retired workers.• In 2000, work pension scheme covered more than 90% of workforce in OECD countries. • Poverty and vulnerability are issues in old age.• Social pension (non-contributory pension) is introduced under social protection scheme. Financial security• A centaury ago, workers in Europe would be lucky to reach their retirement age. Today, people are expected to live 20 to 30 years after the retirement. • Ageing is a threat to pension system (number of pensioners are increasing relative to contributors). • The Equality Act 2010 gives protection to older people. • State Pension age (65 for men, 60 for women) would increase to 68 between 2037 and 2039.• Compulsory retirement at age 65 is fully abolished as of 6th April 2011. Retirement in Japan and South Korea: The past, the present and the future of mandatory retirementEdited by Masa Hingo and Thomas Klassen (2005), RoutledgeFamilial resources for elderly care • Family has been known as the main sources of informal care in many countries, particularly in Asia.• Changes in family size and structure. • This has reshaped living arrangements in the household. • Older people quickly become vulnerable within the household. Living arrangements of people aged 65+ in JapanCare cost in JapanThe increase in the number of elderly people will put a strain on costs for medical and nursing care services.Medical service costs for people aged 75+ run to average of £6,090 per year.Nursing care service costs for people aged 75+ works out an average of £3,572 a year.Total annual cost per person aged 75+ is £10,000. Traditionally, covering cost of elderly care was part of  family responsibility. Is it sustainable any more? If not, Who is going to pay the cost of care in old age?  Is it the Individual, or the Family, or the Government?Attitudes Towards Bearing the Cost of Care in Later Life Across the World Hafiz T.A. Khan, George W. Leeson, University of OxfordHelen Findlay, Sir William Beveridge Foundation, LondonAbstractThe aging population is recognized by many as a unique globalphenomenon and has become a subject of interest among multidisciplinaryprofessionals. Perhaps one of the most common key concerns amongindividuals and family members in many countries today is to meet theincreasing demand for elderly healthcare, particularly the real challengesand crisis in old age morbidity and health. As the socioeconomic,demographic and cultural context of populationsIllness, Crisis & Loss, Vol. 21(1) 49-69, 2013Persons aged 15-64 years to support  per 65+4 4 4 4 55 5 67810 10 1012 12 13131517 17221 23 2 33 2 3 2 2 2 23 35 434 5760510152025Inverse Dependency RatioYear 2000 Year 2050The current generation (G4) may need to take care of max of 14 people GGFGGMGGFGGMGGFGGMGGFGGMG1GFGFGMGMG2FatherMotherG3Son / DaughterG48           +            4            +          2                       1Care burden• New generation has an increasing care responsibility. • Care responsibility usually shared by siblings within families. • The lower the number of sibling the higher degree of care responsibility goes to them.• Childlessness in the household may be a big concern for future care provision. Healthcare workforce for elderly• Healthcare workforce include doctors, dentists, nurses as well as a host of allied health professionals involved in the healthcare.• Growing demand for adequate number of care workforce for ageing population. • Production of healthcare workforce for treatment. Number of nursesNumber of doctors0Production Function7 35  20  60  CDQ0 = 1 000 treatmentsHospital might be able to produce a maximum of 1000 treatments per year if it employs 60 nurses and 7 doctors, as at point C. However, it could produce the same amount in a technically efficient way with 20 nurses and 35 doctors, as at point D. The rising demand for care• Rapid growth in the number of the oldest old• More and more experience of multimorbidity, disability and dependencies • Obesity and complex health in old age  • In 2010 an estimated 35.6 million people are living with dementia – this is projected to double every 20 years, reaching 115.4 million in 2050 • Increase in labour force participation by women & growing migrationWhy this mattersLong-term chronic illness and the need for long-term care have major impacts on individuals and householdspsychological stress – for older people and caregiverseconomic burden – producers become consumers of care societies and economiesloss of productivity, lost development Lack of data available on workers’ employment related to healthcare for older adults and there cross-country comparison is almost difficult. However, it is felt that such statistics are needed to monitor the progress of a country’s positive attitude towards challenging issues related an ageing society. Statistics on healthcare workforce for older adultsGlobalisation Globalization is  the increased diffusion of worldwide connections between people.The world is now increasingly interdependent in many ways – socially, economically, and environmentally. What happens when various actors of world economy do not play their role on trade, free movement of labour etc.?The ageing population presents many challenges and ignoring these could undermine the potential benefits of living longer.Ageing should not be just considered as a problem because of unmanageable size, care burden and cost. There are also huge opportunities of ageing as older people makes an increasing contribution to society as workers, volunteers, taxpayers, and carers. Concluding remarksPHWT Research Project TeamProfessor Hafiz KhanHafiz.Khan@uwl.ac.uk Question & Answer 

Population ageing in a globalised world: unequal risks in later life?

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Population ageing in a globalised world: unequal risks in later life?

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