With relatively little fanfare, the World Report on Ageing and Health (iti.ms/1jzmaa4), one of the most important World Health Organisation (WHO) documents in recent years, was launched in New York last week. It represents an historic change of emphasis for an organisation whose focus, in the past, centred largely on infectious disease and childhood.
However, in a changing world with reduced child mortality and a major shift in disease patterns, noncommunicable diseases such as heart disease, stroke, cancer and traffic accidents now represent the major threat to global health.
In addition, although ageing is often perceived as an issue for the developed world thanks to advances in social conditions and public health, for more than a decade the majority of older people now live in low- and middle-income countries.
This increase in longevity is a major advance comparable to the fall in child mortality in the early years of the 20th century. However, it has not brought in its train either a significant global support apparatus, such as we see with Unicef for children, or the same widespread recognition that the healthcare needs of older people require specialist approaches analogous to paediatrics for children.
Indeed, in striking contrast to the warm welcome for the reduction in child mortality – few spoke of the advance in terms of a demographic time bomb or as a drain in terms of resources – the reception for our increase in lifespan has been more muted, largely through unthinking ageism and short-sightedness.
Demolish the myths
So, a main challenge of this report was to demolish many of the encrusted myths surrounding ageing and, in particular, to direct this towards a readership in many countries in which not only mass ageing into later life is a relatively new phenomenon but where few in positions of influence in government and healthcare are versed in gerontology, the sciences of ageing.
In a report that is both wide-ranging and concise, the authors establish the concept of the longevity dividend, the increasing evidence that we have gained hugely from this increase in our lifespan. For example, in the UK older people make a net contribution of £40 billion (€54 billion) to the economy.
The key barrier to realising this longevity dividend arises from chronic disease and inequitable health systems rather than from ageing. This is elegantly illustrated in the disparity between increasingly ablebodied older people in the developed world and higher levels of disability among older people in low- and middle-income countries.
We are then led through the elements that make healthcare for older people different, including increased diversity with age: there is no typical older person. This diversity is not random, but fuelled by income, health services, environment and inequality, all factors amenable to change. We are also reminded that old age is not synonymous with dependence, either physical or economic.
A further myth is that the ageing of our populations is a major drain on our healthcare resources: to date this has not been established. For example, in the US between 1940 and 1990 – a period of significantly faster population ageing than has occurred since – ageing contributed only about 2 per cent to the increase in health expenditures, while technology- related changes were responsible for between 38 per cent and 65 per cent.
These arguments built convincingly to the proposition that expenditure in older populations is an investment, not a cost. Using a bottom-up approach from the experiences of older people and carers around the world, the four elements of a new public health approach to our ageing society are presented: aligning health systems to the older populations they now serve; developing systems of long-term care; creating age-friendly environments; and improving measurement, monitoring and understanding of age-related disease and disability.
These changes all rely on a major investment in training and education in gerontology, geriatric medicine, old-age psychiatry and gerontological nursing in the health system. Ireland has made strides in some of these areas, in addition to the 2013 national strategy on ageing and the activities of Age-Friendly Ireland to develop age-friendly communities, but this report is a wake-up call to redouble our efforts. Just as the report should influence other UN activities, we should also insist on synergies between Irish overseas aid and ageing programmes to ensure that we too play our part in nurturing the global longevity dividend. Des O'Neill is a consultant physician in geriatric and stroke medicine and a professor of medical gerontology at Trinity College Dublin and Tallaght hospital. He is a former president of the European Union Geriatric Medicine Society and was an external reviewer for some chapters of the WHO report. A version of this column appeared as a BMJ blog.