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7 graphics that explain: What is an ‘ageing population’?

This article will explain what an ageing population is, why they occur and the impact they can have on society, especially on health care systems, and what can be done to offset that impact.

What is an ‘ageing population’ — a definition

An ageing population is one where the proportion of older people is increasing. This is also known as ‘demographic ageing’ and ‘population ageing’.

Bar graph showing world population by age group in 1950, 2000 and projected for 2050 Bar graph showing world population by age group in 1950, 2000 and projected for 2050

The size and proportion of the global population as relates to age over time
Source: http://study-aids.co.uk/dissertation-blog/population-ageing/

How do we get an ageing population?

Population ageing is a result of people living longer and having fewer children.

Chart showing 62% increase in life expectancy and 96% decrease in deaths per 100,000 people between 1900-2000 Chart showing 62% increase in life expectancy and 96% decrease in deaths per 100,000 people between 1900-2000

Declining mortality (those related to infectious diseases) and rising life expectancy
Source: http://valueofinnovation.org/power-of-innovation/

Why do populations age?

Factors that can impact population age distribution include:

  • Life expectancy increases due to improved lifestyle (diet, exercise, not-smoking) and importantly, access to quality health care — drugs, treatments, expertise, surgical procedures, technology.
  • Birth rate decline itself is driven by a number of factors:
    • Improved availability, education and effectiveness of contraceptive measures
    • The rising costs of living influencing people’s decisions whether to have children and how many
    • Increasing number of women working
    • Changing social attitudes (for example acceptance of alternative lifestyles, including choosing not to have children)
    • The rise of individualism
  • Lack of inward migration (fewer younger people and families moving to a given country, thereby reducing the average age)
Chart showing life expectancy (ages 70-84) per health expenditure Chart showing life expectancy (ages 70-84) per health expenditure

A rise in health care spending correlates to the rise in life expectancy
Source: https://ourworldindata.org/the-link-between-life-expectancy-and-health-spending-us-focus

Which countries have ageing populations?

The proportion of the world population aged 65 and over increased from 5% in 1950 to 7% in 2000 and 13% in 2017. While this is the global average, Europe’s proportion increased to 15% in 2000 and 25% by 2017. Sweden were already at 10% in 1950, while Italy achieved 22% by 2015.

Countries with the most people over 65 years old

  1. Japan – 26.3 %
  2. Italy – 22.4 %
  3. Greece – 21.4 %
  4. Germany – 21.2 %
  5. Portugal – 20.8 %
  6. Finland – 20.5 %
  7. Bulgaria – 20.0 %
  8. Sweden – 19.9 %
  9. Latvia – 19.4 %
Chart showing G7 countries' working-age population percentage by year and by percentage of each country's population from 1990-2014 Chart showing G7 countries' working-age population percentage by year and by percentage of each country's population from 1990-2014

Source: https://www.stlouisfed.org/on-the-economy/2016/august/how-populations-shifting-developed-countries

For contrast, compare this with the countries with the highest percentage of population under 18:

  1. Niger – 56.9 % (11th poorest country in the world)
  2. Uganda – 55.0 % (14th)
  3. Chad – 54.6 %
  4. Angola – 54.3 %
  5. Mali – 54.1 %
  6. Somalia – 53.6 %
  7. Gambia – 52.8 % (9th)
  8. Zambia – 52.6 %
  9. Democratic Republic of the Congo – 52.6 % (7th)
  10. Burkina Faso – 52.3 % (16th)

What creates a young population?

These are some of the poorest countries in the world. The situation in Niger and Uganda is a combination of taboo around and lack of access to contraceptives and an inclination towards larger families. An average woman in Niger has around eight children.

Graphic showing male and female life expectancy at age 50 by the richest 10%, middle 50% and poorest 10% of the population Graphic showing male and female life expectancy at age 50 by the richest 10%, middle 50% and poorest 10% of the population

The richest countries have enjoyed prolonged life expectancy while those — especially women — in the poorest countries have either not grown or declined.
Source: https://www.weforum.org/agenda/2015/09/how-income-affects-life-expectancy/

What are the impacts of ageing populations around the world?

A key issue is the number of people not working, and therefore relying on social support systems. This is exacerbated by the fact that many social/government schemes rely on growing populations, as the more people are needed to pay in than receive at any given time.

Graphic showing ratio of workers to pensioners in 1900, 2000 and 2025 (projected) Graphic showing ratio of workers to pensioners in 1900, 2000 and 2025 (projected)

The dependency ratio of Japanese workers to pensioners since 1990 shows that there are fewer working-age people to support the systems, care and needs of the elderly
Source: https://economictranscript.wordpress.com/2017/06/22/ageing-population-of-japan/

What are the impacts on individuals?

Aetna International’s Dr Stella George says:

“The recent report that a fifth of people in England cannot expect good health beyond their 30th birthday is alarming. Every day younger and younger patients are diagnosed with chronic conditions — be it serious mental illness, diabetes, asthma or cardiovascular disease. And it’s not just the UK — across the globe lifestyle related diseases are on the rise. This is particularly prevalent in developing countries, with burgeoning middle classes in Asia and the Middle East place strains on health systems not equipped to accommodate or educate them.

“The good news is that these diseases are treatable but we have to act quickly. Patients require unique treatment plans that works with their lifestyle and motivates them to change. It’s only then that we will start to see a change in these critical patterns.”

What are the impacts on health care systems?

As populations age, the prevalence of disability, frailty and chronic diseases rises, resulting in more people needing health care (combined with fewer people paying in, as described above). As the pressure of demand increases, services are strained — longer waiting lists, compromised care, readmissions – and global health costs increase.

Pharmacy Times reports that expected challenges to the health care system in the United States include:

  • Resource needs will continue to increase across all health care settings
  • The incidence of obesity will continue to increase
  • A shortage of health care professionals is expected
  • The diversity of care givers lags behind the growing diversity of patients
  • Care has been focused on a single disease, not a holistic approach to the individual
  • The sustainability and structure of federal programs in relation to the increasing ageing population
  • Changes in family structure may lead to fewer family caregivers

The United Nations and other international organisations have made recommendations to ease the consequences of population ageing, including:

  • Reorganisation of social security systems
  • Changes in labour, immigration and family policies
  • Promotion of active and healthy lifestyles
  • Cooperation between governments.

On the positive side, the health status of older people has been improving and the results of current anti-ageing studies may help extend the healthy and productive period of human life in the future.

Healthy retirees are also able to provide care to their grandchildren (especially to support working parents) and are more likely to be involved in community activities as well as support the arts and culture (concerts, theatres and galleries).

What can be done?

As Aetna International’s own white paper — Ageing Population: The Ticking Time Bomb — explains, health care systems must adapt, or else drown under a “silver tsunami” of patients.

In 2015, the International Society for Quality in Health Care (ISQua) — including representatives from 16 countries — met to discuss the implications of a rapidly ageing population. They called for major changes in:

  • the delivery of health services
  • the structure of health care organisations
  • the use of technology and systems to support health care delivery
  • the attitudes, expectations and competencies of care providers and patients.

Rather than a fragmented, provider-centric system focused on treating sickness, ISQua envisions an integrated, person-centric system focused on wellness.

Aetna International: our approach.

As a health care provider, Aetna International’s approach is holistic, proactive and preventative. This will help keep people healthier as they age, to reduce their primary health care needs. The key is not just to keep people alive for longer, but keep them healthier for longer.

That’s why we are deliberately transforming from a health insurer into a health and wellness partner, with a focus on community-based care models and on holistic health. We work with members to keep them healthy, not just treat them when they get ill.

This means our service goes far beyond simple payment-for-treatment. We include wellness programmes for low-risk individuals, coaching for those at risk of disease and injury and management of chronic diseases and health events.

By keeping people healthier for longer, they get ill less and need less treatment. And by reducing their health care needs, Aetna International can keep premiums as low as possible — it’s great when everyone benefits.

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