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Measurement and Health Information
The Greying of the World: Ageing Matters
Commission on Population and DevelopmentNew York, 10th April 2007
Somnath ChatterjiSomnath ChatterjiMeasurement and Health Information SystemsMeasurement and Health Information Systems
World Health OrganizationWorld Health OrganizationGenevaGeneva
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The world stands on the threshold of a demographic revolution called global aging.
Focus on Ageing
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Ageing Headlines!
• "Life expectancy in most European countries is increasing now by five hours a day"
• "Population ageing will fundamentally change the lives of Europeans"
• "The scale of change will be comparable to or greater than the effects of climate change or global terrorism"
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Ageing concerns
• Global leaders see a higher cost for social services, possible labor shortages, and higher costs for pensions, and health care as probable outcomes from a larger older population (AARP, 2004)
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Background
• Changing demography of the ageing population especially in the developing world
• Burden of chronic illness
• Issues of compression of morbidity
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Trends in Global Ageing
8% 9%10%
12%13%
14%16%
19%
23%
25%26%
4% 4% 4% 4% 4% 5% 6%8%
10%
13%15%
0%
5%
10%
15%
20%
25%
30%
1950 1970 1990 2010 2030 2050
Developed World Developing World
Percent of PopulationAged 65 & Over: History and UN Projection
Source: UN (2005)
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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
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Feminization of ageing
• NUMBERS• MORBIDITY • POVERTY
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Young vs. Old – trends in global ageing
Source: United Nations Department of Economic and Social Affairs, Population Division. World Population Prospects. The 2004 Revision. New York: United Nations, 2005.
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Projected Increases in Global Population by Age
Source: United Nations Department of Economic and Social Affairs, Population Division. World Population Prospects. The 2004 Revision. New York: United Nations, 2005.
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Increasing Burden of Chronic Non-Communicable Disease
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12.4
16.0
16.0
16.4
16.4
16.5
16.7
16.9
17.0
17.1
17.2
17.3
17.8
18.6
19.5
19.5
United States
Finland
United Kingdom
France
Croatia
Latvia
Estonia
Spain
Portugal
Belgium
Bulgaria
Sweden
Greece
Germany
Italy
Japan
The World’s 15 ‘Oldest’ CountriesPercent Age 65 or Older
•Source: United Nations, World Population Prospects, The 2004 Revision.
Measurement and Health Information
Number of Years for Percent of Population Age 65 or Older to Rise from 7% to 14%
* Dates show the span of years when percent of population age 65 or older rose (or is projected to rise) from 7 percent to 14 percent.Source: K. Kinsella and Y.J. Gist, Older Workers, Retirement, and Pensions: A Comparative International Chartbook (1995) and K. Kinsella and D. Phillips, “The Challenge of Global Aging,” Population Bulletin 60, no. 1 (2005).
26
45
45
47
53
65
69
73
85
115
Japan 1970-1996
Spain 1947-1995
United Kingdom 1930-1975
Poland 1966-2013
Hungary 1941-1994
Canada 1944-2009
United States 1944-2013
Australia 1938-2011
Sweden 1890-1975
France 1865-1980
More developed countries Less developed countries
41
27
26
25
24
23
22
21
20
19
Azerbaijan 2000-2041
Chile 1998-2025
China 2000-2026
Jamaica 2008-2033
Tunisia 2008-2032
Sri Lanka 2004-2027
Thailand 2003-2025
Brazil 2011-2032
Colombia 2017-2037
Singapore 2000-2019
Speed of Population Aging in Selected Countries
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15 10 5 0 5 10 15
Population Structures by Age and SexMillions
15 10 5 0 5 10 1515 10 5 0 5 10 15
1950 2000
Male Female Male Female
Age
Source: World Population Prospects: The 2004 Revision (2005).
China’s Age Distribution
80+ 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14
5-90-4
Age
2050
Female
80+ 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14
5-90-4
Male
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Inequalities – global extremes
Japan Sierra Leone
Total 81.9 34.0
Male 78.4 32.4
Female 85.3 35.7
Japan Sierra Leone
Total 75.0 28.6
Male 72.3 27.2
Female 77.7 29.9
LE
BH
AL
E
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4
5
6
7
8
9
10
1982 1989 1994 1996 1999
in M
illio
ns
Projected numbers Actual numbers
4
5
6
7
8
9
10
1982 1989 1994 1996 1999
in M
illio
ns
Projected numbers Actual numbers
Source: US National LTC Survey, May 2001
Chronically disabled Americans 65 years and older
Evidence from the US: disability rates are declining
27 million 33 million 35 million
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Population projections: three scenarios
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
9,000
2000 2005 2010 2015 2020 2025 2030 2035Year
Pop
ulat
ion
(mill
ions
)
UN Population Projections(2002 revision)
Baseline scenario
Pessimistic scenario
Optimistic scenario
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Broad trends in Mortality for Group II causes
0
5
10
15
20
2002 2006 2010 2014 2018 2022 2026 2030
Group II deaths
0
20
40
60
2002 2006 2010 2014 2018 2022 2026 2030
Year
Dea
ths
(mill
ions
)
Other
Digestive
Respiratory
Cancer
CVD
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Global Mortality projections for selected causes
0
2
4
6
8
10
12
2000 2010 2020 2030
Year
Pro
ject
ed
glo
ba
l de
ath
s (m
illio
ns)
Malaria
Cancers
HIV/AIDS
Road traffic accidents
TB
IHD
Stroke
Other infectious
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Decomposition of
-10
0
10
20
30
HIV/AIDS Other Group I Group II Group III
Dea
ths
(mill
ions
)Total change
Population growth
Population ageing
Epidemiological change
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Global projected tobacco-attributable deaths
0
1
2
3
4
5
6
7
8
9
10
2000 2005 2010 2015 2020 2025 2030 2035
Year
Tob
acco
-cau
sed
deat
hs (
mill
ions
)
Medium and low income countries
High income countries
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WHO Study on Global Ageing and Adult Health SAGE
The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. © WHO 2005. All rights reserved
•Mexico•South Africa•Ghana
•China•India•Russia
•Kenya•Tanzania•Bangladesh
•Viet Nam•Indonesia
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SAGE Objectives
• To obtain reliable, valid and comparable data on levels of health on a range of key domains for older adult populations
• To examine patterns and dynamics of age-related changes in health using a longitudinal design
• To supplement and cross-validate self-reported measures of health and the anchoring vignette approach to improving comparability of self-reported measures, through measured performance tests for selected health domains
• To collect data on health examinations and biomarkers to improve reliability of data on morbidity, risk factors and monitor effect of interventions
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SAGE Objectives
• Follow-up to study intermediate outcomes, monitor trends, examine
transitions and life events, and address relationships between
determinants and health and health-related outcomes;
• To develop a mechanism to link survey data to data from demographic
surveillance sites - INDEPTH
• To build linkages with other national and cross-national ageing studies
– SHARE, ELSA, KLoSA, MHAS, Chile, Argentina
• To provide a public-access information base for an evidence based
policy debate amongst all stakeholders
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Living arrangements of the elderly
Percentage of Single member Households of all households with at least one person aged 65 or more by World Bank category
0
5
10
15
20
25
30
35
40
45
50
GR
C
ES
PIT
A
AU
S
GB
RF
RA
DE
U
NLD
SW
E
ZA
F
MY
ST
UR
MU
S
ME
XE
ST
RU
S
MA
RLK
A
CH
N
BR
AB
IH
GE
O
UK
RIN
D
PA
K
BG
DE
TH
GH
A
KE
NT
CD
High Upper-Middle Lower-Middle Low
World Bank category
Percent
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Health Status by Age
50
60
70
80
90
50
60
70
80
90
18-49 50-59 60-69 70-79 80+ 18-49 50-59 60-69 70-79 80+
High Upper Middle
Lower Middle Low
Female Male
(He
alth
Sco
re)
Age Group
Source: WHS 2002
Health Score by Sex and Agegroup, according to World Bank Categories
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Tobacco Use
Tobacco Use by World Bank categories and age groups
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
50-59 60-69 70-79 80+Age groups
Percent
High Upper Middle Lower middle Low
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Physical Activity
Insufficient Physical Activity by World Bank categories and age groups
0.0
10.0
20.0
30.0
40.0
50.0
60.0
50-59 60-69 70-79 80+
Percent
High Upper middle Lower middle Low
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Chronic Conditions
Percentage of respondents with one or more chronic condition using standard algorithms by age group and World Bank categories
0
10
20
30
40
50
60
70
50-59 60-69 70-79 80+
Percent
High Upper-middle Lower-middle Low
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Stress and Satisfaction
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Summary Results
• Older populations in worse off health• Low income countries worse than high
income countries• Worse health associated with less
satisfaction, high stress and presence of chronic illness
• Worse health correlated with difficulties with work and household activities
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Ageing Matters
• Focus on functioning
• Improve health and well-being
• Decrease disease and death