Despite universal access to healthcare, there are disparities in older people’s health status in developed countries. These inequalities are rooted in lifelong differences in social and economic status. Government policies to assist older people may end up reinforcing these inequalities if they fail to create a buffer against their effects. However, best case practices and WHO guidance show that policies can also mitigate against the effects of lifelong disadvantage in older age. There is opportunity to design initiatives for older people in Canada that lessen the disparities in health outcomes that we currently see

Quesnel-Vallée, Amélie

Reiter-Campeau, Sandra

Willson, Andrea

English

Scholarship@Western

Population Change and Lifecourse Strategic Knowledge Cluster Centre for Population, Aging and Health, Western University, London, ON N6A 5C2 Website: http://www.pclc-cppv.ca Email: pclc-cppv@uwo.ca Policy Brief No. 23 May 2015 This brief is based on Amélie Quesnel-Vallée, Andrea Willson, and Sandra Reiter-Campeau (2015) Health Ine-qualities among Older Adults in De-veloped Countries: Reconciling Theo-ries and Policy Approaches, PCLC Discussion Paper 3(1):6.  This brief summarizes policy options that can reduce health inequalities in older adults and sociological theories explaining health disparities in older people.  This also highlights implica-tions for further sociological re-search. For more information, please contact Amélie Quesnel-Vallée, McGill Uni-versity. Target Audience About the Brief  Policymakers  Service planners for older people  Sociological researchers D espite universal access to healthcare, there are disparities in older people’s health status in developed countries.  These ine-qualities are rooted in lifelong differences in social and economic status.  Government policies to assist older people may end up rein-forcing these inequalities if they fail to create a buffer against their effects. However, best case practices and WHO guidance show that policies can also mitigate against the effects of lifelong disad-vantage in older age. There is opportunity to design initiatives for older people in Canada that lessen the disparities in health out-comes that we currently see.  Initiatives to support older people, such as increasingly privat-ized pension schemes, may serve to reinforce lifelong socioec-onomic inequalities that underlie health disparities in old age.   Universal access to acute services fail to consider that older people are increasingly expecting (and expected) to stay in their own homes for longer.  Thus, only the wealthiest people are able to meet all of their needs for support to stay independ-ent.  World Health Organization (WHO) policy guidance addresses the need to buffer against socio-economic status disparities and to design targeted services.  Few countries have successful adopted WHO recommendations, but Finland and France provide strong case examples of the potential for policies that reduce health inequalities among older people.  Further sociological research exploiting natural policy ex-periments and determining the best indicators to measure policy impact on older people will help to provide evidence for policymakers. Summary Key Findings Health Inequalities Among Older Adults: Reconciling Theories and Policy Approaches    1Quesnel-Vallée et al.: Health Inequalities Among Older Adults: Reconciling Theories and Policy ApproachesPublished by Scholarship@Western, 2015Population Change and Lifecourse Strategic Knowledge Cluster Centre for Population, Aging and Health, Western University, London, ON N6A 5C2 Website: http://www.pclc-cppv.ca Email: pclc-cppv@uwo.ca  2  W hile we all might start our lives at an equal status, socio-economic (SES) (dis)advantage can cause us to follow different trajectories to end up where we are today. Theories in sociology have attempted to explain disparities in people’s social/health status:  (Dis)advantage accumulates over our lives be-cause investment into resources like education compound themselves.   Disparities arise from an interplay between genes, reproduction, environment and child-hood, as well as people’s own actions (Ferraro and Shippee 2009).    Sociological Theories on Health Disparities G overnment policies such as welfare state initi-atives can mitigate against the effects of life-long inequalities (Briggs 2000). But government policies can also reinforce the effects of lifelong dis-parities if access to schemes they promote, such as tax-free savings plans, depend on pre-existing means. For example:  The increasing trend towards privatizing pen-sion schemes results in retirement income that depends on the amount people are able to contribute throughout their lives (OECD 2013).   There is an increasing emphasis on older people maintaining independent lives in the com-munity, rather than being institutionalized.  As home services are not universally covered, peo-ple end up paying out of pocket. The result is that only the wealthiest are able to meet all their support needs (Carriere 2006).     Linking Theories to Policies for Older People  Health Inequalities in Older Adults Policies that are accessible regardless of SES status Policies where accessibility follows SES status Lifecourse model of SES inequalities 2Population Change and Lifecourse Strategic Knowledge Cluster Research/Policy Brief, Vol. 1, No. 6 [2015], Art. 8https://ir.lib.uwo.ca/pclc_rpb/vol1/iss6/8Population Change and Lifecourse Strategic Knowledge Cluster Centre for Population, Aging and Health, Western University, London, ON N6A 5C2 Website: http://www.pclc-cppv.ca Email: pclc-cppv@uwo.ca  3 T he World Health Organization (WHO) has two key approaches to policies (‘Health in All Policies’ and ‘Age-Friendly Environments Program’) that support reducing disparities and providing targeted services to older people. The Advantage Initiative Model was adopted in an area of Washington state and experienced success by focusing on outreach to isolated seniors.  WHO Guidance and Case Examples of Policies Table 1. Example policies and programs  favourable to reducing health disparities and creating targeted services for older people Health Inequalities in Older Adults Policy Description Implementation &  Evaluation ‘Health in All Policies’  Advocates intersec-toral partners across government levels coordinating actions towards a common goal (WHO, 2014b).  To date, largely focused on early-life to prevent dispar-ities in life trajectories.  However, Finland has adopted this approach to support older people.  The effectiveness remains to be evaluated. ‘Age-Friendly Environments Program’    Checklist of age-friendly aspects to community design based on focus groups with older people, like proper housing and transportation Can reduce inequalities be-cause social, economic and physical features cause dif-ferences in life expectancy, functional capacity and health among older adults (WHO, 2007). Advantage Initiative Model Outreach program in Western Washington involving information distribution to low-income and isolated older people Between 2003 and 2004, there was a 2.5 times in-crease in the number of older people seeking help through this program(Hanson & Emlet, 2006). 3Quesnel-Vallée et al.: Health Inequalities Among Older Adults: Reconciling Theories and Policy ApproachesPublished by Scholarship@Western, 2015Population Change and Lifecourse Strategic Knowledge Cluster Centre for Population, Aging and Health, Western University, London, ON N6A 5C2 Website: http://www.pclc-cppv.ca Email: pclc-cppv@uwo.ca  4 P olicies designed to support older people might worsen disparities in health if they do not consider cumulative social disadvantage.  In particular, policies that rely on individuals’ means to contribute can further inequalities in old age.  Government policies can embed means to less-en these inequalities.  Such policies and pro-grams could revolve around cross-working be-tween government departments and local agencies, incorporating age-friendly design into communities, and/or creating targeted outreach programs for vulnerable older people. Policy Implications Briggs, A. (2000). The welfare state in historical perspective. The Welfare State Reader, 2.  Carrière, G. (2006). Seniors’ use of home care. Health reports/Statistics Canada, Canadian Centre for Health Infor-mation= Rapports Sur La santé/Statistique Canada, Centre Canadien D’information Sur La Santé, 17(4), 43. Ferraro, K. F., & Shippee, T. P. (2009). Aging and cumulative inequality: How does inequality get under the skin? The Gerontologist, 49(3), 333–343. Hanson, D., & Emlet, C. A. (2006). Assessing a community’s elder friendliness: a case example of The AdvantAge Initiative. Family & Community Health, 29(4), 266–278. OECD. (2013). Pensions at a Glance 2013: Retirement-Income Systems in OECD and G20 Countries.  http://www.oecd.org/pensions/pensionsataglance.htm World Health Organization. (2007). Global age-friendly cities: a guide. WHO. http://www.who.int/ageing/publications/Global_age_friendly_cities_Guide_English.pdf World Health Organization. (2014b). WHO Age-friendly Environments Programme. WHO. http://www.who.int/ageing/age_friendly_cities/en/ References Health Inequalities in Older Adults F urther sociological research can help to sup-port policymakers by providing evidence on the most effective approaches to supporting old-er people.  Two key areas to develop are: 1. Natural policy experiments using methods such as difference-in-difference to identify the impact of policies. 2. Indicators research: what are the best indi-cators to capture the impact of policies for older people? Sociological Research to Support Policy 4Population Change and Lifecourse Strategic Knowledge Cluster Research/Policy Brief, Vol. 1, No. 6 [2015], Art. 8https://ir.lib.uwo.ca/pclc_rpb/vol1/iss6/8

Policy Brief No. 23 - Health Inequalities Among Older Adults: Reconciling Theories and Policy Approaches

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Policy Brief No. 23 - Health Inequalities Among Older Adults: Reconciling Theories and Policy Approaches

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