Failure to realise that the older generation also has huge potential will exacerbate global inequity, warns Des O'Neill
An asteroid is hurtling towards Earth. While astronauts struggle to destroy it with nuclear warheads, back on Earth contingency plans are being made to harbour a representative sample of the US population in deep mines to sit out the effects of impact. "Only those under 50" is the catch-cry for selection.
Yet if we did this in a global setting we would exclude Nelson Mandela, Mick Jagger, Louis le Brocquy, Mr Justice Fergus Flood, Seamus Heaney and many others.
At other times we would have excluded people at the height of their creativity: the Wagner of Parsifal, Janacek at his peak, the Frank Lloyd Wright of the Guggenheim, the great painter Jack B. Yeats. The list of contributions by older adults to society is almost endless.
While the asteroid of Deep Impact exists only on celluloid, in the prominent attention to global and development issues in Ireland recently we have been made aware of the catastrophe of global inequity which is the equivalent of an asteroid impacting on Earth.
Where do older people fit into this plan of things?
Stark images of babies and children from regions affected by famine often promote a misconception that population ageing is a phenomenon of the developed world. In fact, improvements in living standards have been associated with a welcome rise in those attaining old age. This growth is occurring at a faster rate outside the developed countries, so that in 2030 the majority of older people will be in the developing world.
Sadly, this increase in human potential may not be fully realised by the imposition of barriers to older people's participation in society, such as inequity based on age or a failure to adapt health systems to their specialised needs.
At its most extreme this discrimination can be seen in natural disasters and time of war, where older victims tend to be ignored or given low priority. They are triply compromised: by the disaster itself, by reduced access to emergency services and by the increasing frailty that accompanies later life.
Other global trends also selectively disadvantage older people, even climate change. In the great heat wave in Chicago in 1995, the majority of the 600 people who died were older people.
Mandatory retirement and financial disempowerment are almost universal in later life, and changes in pension systems from defined benefit to defined contributions all exacerbate this trend.
It is particularly important that we do not let ourselves succumb to the perverse notion that somehow or other older people have had a "good innings" and deserve a lower priority. Natural justice means providing for all of us at all ages.
The first task of any global initiative is to promote a sense of welcome to population ageing. Not only is the collective ageing of our populations a triumph, but it also represents an underrecognised and under-appreciated addition to society. The accumulated wisdom and life experience of older people is not only manifested by the great flowering of late-life creativity, but also by an extensive literature on the benefits of older workers.
All over the globe, older people also play a huge role as carers. This ranges from the statistic in the developed world that 40 per cent of those providing more than 50 hours of care a week are themselves over the age of 60, to those parts of Africa affected by the HIV/AIDS epidemic, where older people often assume a parenting role for their grandchildren.
Ageing is not so much part of the problem as part of the solution; but if we do not remove barriers to healthy and successful ageing we will suffer a double whammy. We will be deprived of the full potential of the contribution of older people but will also be presented with an unnecessary burden of social exclusion, age-related disease and disability.
The UN has emphasised the importance of including older people in the equation of global development. The Madrid Declaration of 2002 embraces three main principles: inclusion of older people in the development process, improving their health and wellbeing, and ensuring enabling and supportive environments.
It is an excellent and concise plan to include the contribution and needs of older people in global development. Sadly, the political impetus for its implementation seems to have faltered already. In a bitter irony, the Health and Ageing section of WHO Europe was closed down this year as a result of retrenchment and non-prioritisation of older people's issues.
The world needs champions to promote the implementation of the Madrid Declaration. Could Ireland fill this role? The influence of small countries cannot be underestimated: the Declaration arose largely as a result of pressure by a small non-aligned country, the Dominican Republic.
Although much needs to be done to improve the status of older people in Ireland, we have many infrastructural factors favouring an active role.
In addition to our long-standing history of interest in developmental matters, we have one of the first comprehensive policies for healthcare for older people in Europe. The Years Ahead, adopted as government policy in 1993, covers a spectrum of services, from housing through care in the community to specialist care. Not only has our health service invested in specialist healthcare for older people, but we are one of a small group of countries in the world that supports higher diplomas and master's degrees in this specialist care.
We have had one unique statutory body advising our Minister for Health on ageing, the National Council on Ageing and Older People (although its survival is threatened by recent reform proposals) and another official body, Age and Opportunity, which promotes a positive image of ageing.
Finally, we have extended the medical card to the over-70s, a very positive step which at a single blow widens social inclusion of older people.
These developments do not mean that we do not have problems, such as the extraordinary ageism of stopping breast cancer screening at 65, when Irish women are six times more likely to get breast cancer and six times more likely to die from it after this age. We also have difficulties in terms of access and quality to both community and long-term care services.
More ominously, the incomes of older Irish people have fallen between 1992 and 1997. But many of the answers to these problems are contained in the implementation of both national policy and the Madrid Declaration.
A concerted effort by the Irish Government, advocacy groups, professionals and academics to promote the implementation of the Madrid Declaration could have an enormous impact on inclusion of older people in both national and global development issues.
Failure to recognise and support the contribution of older people will cost us dear and have a direct personal impact on our own future as we age. We do not want to find out too late and too painfully the dictum of one of the great pioneers of gerontology, Bernard Isaacs: "If you design for the young, you exclude the old: if you design for the old, you include the young."
Des O'Neill is professor of medical gerontology at TCD, and consultant geriatrician at Tallaght Hospital. Madrid Declaration: www.un.org/ageing/documents