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| EDITORIAL |
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| Year : 2017 | Volume
: 2
| Issue : 2 | Page : 27-29 |
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Next major challenge in global noncommunicable diseases
Arun Chockalingam
Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| Date of Web Publication | 18-Jul-2017 |
Correspondence Address:
Arun Chockalingam
University of Toronto, Toronto
Canada
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/2468-8827.211077
How to cite this article:
Chockalingam A. Next major challenge in global noncommunicable diseases. Int J Non-Commun Dis 2017;2:27-9 |
It is a well-known fact that life expectancy keeps improving in every country on the planet, thanks to the control and prevention of infectious diseases in the 20th century. The global average life expectancy at birth improved from 46.5 years in 1950 to 70.8 in 2015 and is expected to increase to 77.0 in 2050.[1] The World Health Organization (WHO) states that an aging population is a triumph of modern society. A population that has aged shows that social and health practices have been put into place that have extended life and reduced premature deaths earlier in the life course. As a result, at the turn of the millennium, there are more people living and the global population is growing.
The world is now facing a new challenge: soon, we will have a larger number of older people than children and more people at extreme old age than ever before. For example, there are more than 60,000 people in Japan alone who are over the age of 100. The comparator is to count the population between the ages of 0–4 (children) and those over the age of 64, globally. In 1950, there were 335 million children and just 131 million people aged 65 years or more. According to the United Nation's Population Division estimates for mid-2010, there were 642 million children and 523 million over the age of 65. The UN also projects that, for the 1st time in history, the 0–4 age group will decline between 2015 and 2020, having peaked at around 650 million. The 65+ population is projected to exceed the 0–4 population during that same 5-year period, rising from 601 million in 2015 to 714 million in 2020 although precisely when that happens will depend on birth rates in developing countries. In fact, it just happened in Canada in March 2017.
As both the proportion of older people and the length of life increase throughout the world, a major review done by the US National Institute on Aging and the WHO,[2] raises some key questions:
- What is the scope of aging population? Will it be accompanied by a longer period of good health, and sustained sense of well-being or will it be associated with more illness, disability, and dependency?
- How will aging affect the already strained health care and social costs?
- Is there any way we can act to establish an infrastructure “ both physical and social “ to foster better health and well-being in older age? In other words, are we prepared to meet the challenges of aging?
- What about population aging in low- and middle-income countries (LMIC), which is rapidly aging both in proportion and absolute numbers than their counterparts in the high-income countries?
To answer these and many other emerging questions, we need to look at the changing epidemiological transition combined with rapid demographic changes in all parts of the world. There are more people living with chronic noncommunicable diseases (NCDs) with an increased burden of disability to the individuals, their families, and the society at large. In older people, in addition to the conventional NCD such as cardiovascular, cancer, diabetes, and chronic respiratory diseases, the major issues are isolation, depression, and dementia.
In today's world, increasing chronic diseases can be attributed to changes in lifestyle and diet, as well as aging. The potential economic and societal costs of NCD of this type rise sharply with age and could affect economic growth of the countries.
Healthy aging is determined by the following four influencers: (1) Environmental: adequate housing, family composition, education level/economical level, infectious disease exposure, toxic substance exposure, radiation exposure, and violence exposure; (2) Health Care: the 3 A's - availability, accessibility, and affordability; (3) Lifestyle: tobacco use, unhealthy diet, inadequate activity, alcohol abuse, and risky behaviors leading to injuries; and (4) of course, Genetics: race, sex, and genetic make-up, of which we have little control.
All G7 countries - Canada, France, Germany, Italy, Japan, the United Kingdom, and the United States - recognized the implications of aging and have vested in the health of senior citizens to address the three influencers “ environment, health care, and lifestyle. Likewise, the Scandinavian countries have put in policies and programs in favor of healthy senior citizens. Can we adapt the lessons learned from these countries in other parts of the world, especially in the LMIC?
Active aging is the process of optimizing opportunities for health, participation, and security to enhance the quality of life as people age. In an age-friendly city, policies, services, settings, and structures support and enable people to age actively by recognizing the wide range of capacities and resources among older people; anticipating and responding flexibly to aging-related needs and preferences; respecting their decisions and lifestyle choices; protecting those who are most vulnerable; and promoting their inclusion in and contribution to all areas of community life.
Active aging depends on a variety of influencers or determinants that surround individuals, families, and nations. They include material conditions as well as social factors that affect individual types of behavior and feelings. These factors and the interaction between them play an important role in affecting how well individuals age. Many aspects of urban settings and services reflect these determinants and are essential characteristic features of an age-friendly city.[3]
Elements of an age-friendly city are housing, social participation, respect and social inclusion, civic participation and employment, communication and information, community support and health services, outdoor spaces and buildings, and transportation. In fact, many of the Western countries have put programs in places to have age-friendly healthy cities in their urban development plans. In fact, in Canada, the main discussion is around affordable housing, particularly to seniors, who in general have reduced income. Most G7 and Scandinavian countries have a social security system that protects the seniors to have adequate economic support to sustain for the rest of their lives. In Canada, three sources of economic security to the seniors are (1) Canada Pension Plan, based on the number of years one has contributed, during the working years, to the plan; (2) those who are over the age of 65 and below a certain threshold of income qualify for Old Age Security; and (3) those whose income from all sources is below a certain threshold level are entitled to Guaranteed Income Supplement, which brings them well above the national poverty line.[4] Similar arrangements have been reported in the Western European countries of Italy, Germany, France, Norway, Sweden, Denmark, and Finland.
Combined with Universal Health coverage and guaranteed minimum income for seniors, they can live independently as long as they could and then move into an assisted living facility and finally transfer to nursing homes.
In the context of rapidly aging population worldwide, the health care of the elderly has become a major concern. To meet the needs of the growing elderly population worldwide, the WHO has restructured its program on the health of the elderly and named it Ageing and Health as early as 1977.[5] Rather than focus upon a static age group apart from the rest of the population, efforts were made to view aging as merely one stage during individuals' lives. Program activities approach aging as part of the lifecycle, promote long-term health, observe cultural influences, adopt community-oriented approaches, recognize gender differences, and strengthen intergenerational links.[5]
When dealing with the functional capacity of individuals, the WHO suggests that people should perform above a disability threshold. During the very early life “ growth and development phase “ the functional capacities continue to increase until the adult life and begin to decline as people age and feel severe shortage of functional capacity in the older ages. Practicing healthy lifestyle during adult ages along with proper nutrition could prevent a rapid loss of functional capacity and will prevent rapid decline of health in older ages. The supporting programs such as rehabilitation and ensuring quality of life have been proven to maintain independence and to prevent disability during the older ages.
With the attempted universal health care in most countries of the world, plans must be in place to deal with aging and aging-related diseases. Italy is the country with highest resource allocation for seniors and their care at 15.6% of its gross domestic product (GDP) in 2010. Most Western European countries and North America, except Mexico, spend over 10% of GDP among senior citizens. The two most populous countries on the face of this planet China and India spend relatively less GDP at present. For example, in China, the current expenditure is at 3.4% of GDP and the planned increase to 2050 is at 10.0%, almost in par with most Western European countries. Whereas India is spending only 1.0% of GDP now and is expected to reduce to 0.7% in 2050.[1]
When the International Monetary Fund[6] evaluated the Old Age Dependency Ratio (OADR), defined as the number of people older than 64 per 100 working age people (15–64 years) and compared between 2010 and 2050, the ratios are staggering. In all countries studied, the rise in OADR was almost double. For example, in the United States, OADR went up from 19% in 2010 to 36% in 2050. Similar increases for Brazil (10%–36%), Mexico (9%–32%), Turkey (11%–34%), Germany (32%–60%), France (26%–44%), Italy (31%–62%), India (8%–19%), China (11%–39%), Japan (36%–72%), and South Korea (15%–66%). The lowest OADR is in India “ both in 2010 and 2050. The highest jump in OADR from 2010 to 2050 was observed in South Korea, >4 times or 400%. Thus, aging is clearly an economic issue which needs to be dealt with.
Many countries are grappling with this imminent burden in different ways according to its economic levels and culture. There are a number of programs which are successful and cost effective that can be transported to many of the countries in economic transition. The sooner the country's administration recognizes the impending aging tsunami, better it is to cope up.
| References | |  |
| 1. | |
| 2. | The WHO and the National Institute of Aging 2011. Global Health and Aging. NIH Publication No. 11-7737.  |
| 3. | |
| 4. | |
| 5. | Kalache A, Kickbusch I. A global strategy for healthy ageing. World Health 1977;50:4-5. |
| 6. | Clement B, Cody D, Eich F, Gupta S, Kangur A, Shang B, et al. The challenges of Public Pensi Reforms in Advanced and Emerging Market Economies. International Monetary Fund, Occasional Paper 275; 2012. |
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