Exploding common myths about ageing
Active Ageing – issue of World Health Day 1999
Population ageing presents new challenges for many national health systems. From a public health perspective, the biggest challenge will be how to ensure that a maximum number of people maintain or even regain health at older ages.
One common myth about old people is that most of them live in industrialised societies. In fact, 60% are to be found today in developing countries and in 25 years the proportion will be over 75%. This has prompted the remark, 'the developed world became rich before it became old, while developing countries are becoming old before they become rich.'
The rapid growth in absolute and relative numbers of older people in both developed and developing countries means that more and more people will reach an age when the risk of developing certain chronic diseases will be significantly higher. One projection for developing countries suggests that by 2020, three-quarters of all deaths could be ageing-related, non-communicable diseases, such as cancer, diabetes and circulatory diseases.
One encouraging development in industrialised societies is the decline in severe disability among older people. The most recent findings put this drop in the United States at 1.5% per year. If current trends continue, it is predicted that the number of severely disabled elderly people in the USA will fall significantly between 2000 and 2050 in spite of a substantial increase in the population over age 65.
"Traditional attitudes in many societies towards older people reflect a large dose of myth and prejudice," says Alexandre Kalache, the Brazilian doctor who heads WHO's Ageing and Health Programme. "Let me cite a few common erroneous notions: all old people are frail, they really have nothing to contribute to society, and we cannot afford their medical care.
"In point of fact, the vast majority of older people remain physically fit well into later life and maintain high 'functional capacity.' How fast their physical and mental capacities decline depends on external factors such as their adult life-style, smoking, alcohol consumption, diet, and social class -- rather than on ageing per se.
"The belief that old people are unable to work because there are fewer of them in paid jobs is another myth. The fact that there are fewer old people in paid jobs is more often due to disadvantages in education and training, and especially to 'ageism,' that is, age discrimination. Substantial contributions are made by older people in unpaid work, for example, farming, the informal sector and in voluntary tasks. Many economies in the world depend to a large extent on these contributions. The economic input made by older citizens often passes unnoticed, undervalued, and unappreciated.
Kalache says that "two concurrent developments have contributed to the myth that older people are an unaffordable burden on society, particularly in regard to the high cost of health care. One is the growing realisation of the sheer numbers of citizens who will be living to older ages in the 21st century. The other is the greater emphasis on market forces in almost all parts of the world, and the related debate about the proper role of the state in providing income security and health care for its citizens. Unfortunately, this debate has put the entire emphasis on the cost to society of providing pensions and health care to old people rather than on their continuing and significant contributions to society.
"Our purpose in promoting the health of older people," says Kalache, "is to increase their well-being at older ages and to ensure that they will continue to be active contributors."
The Meaning of Active Ageing
To describe this new strategic approach to population ageing the phrase 'active ageing' is increasingly being used. What does the World Health Organization mean when it promotes "active ageing"?
Active Ageing refers to the process of seizing and optimising opportunities for physical, social and mental well-being throughout the entire life course in order to extend healthy life expectancy. Action for active ageing should be taken by the individual who can make choices with regard to healthy life-styles as well as by policy-makers who can make well-informed decisions about the policies that will keep the largest number of people productive and healthy at older ages. The future emphasis of public policy should be on active and healthy ageing rather than on a disease-oriented approach.
Most of all, getting older is good for individuals and societies, the alternative of dying prematurely is certainly not.
"There is much the individual can do to remain active and healthy in later life. The right life-style, involvement in family and society, and a supportive environment for older age all preserve well-being. Policies that reduce social inequalities and poverty are essential to complement individual efforts towards active ageing. Older people are often viewed as persons who no longer contribute to their families and society, and may even be a burden. The truth could not be more different," says Dr. Gro Harlem Brundtland, WHO's Director-General.
Living in an ageing world will require four 'adjustments.' First, people of all ages will have to acknowledge older people as a valuable resource and oppose discrimination because of age. Second, society should provide adequate health care and appropriate health promotion throughout the life span. Third, solidarity among generations must be strongly encouraged. Fourth, older citizens should be enabled to be active participants in the development process.
Living longer is both an achievement and a perpetual challenge. The challenge for the quality of life calls for older people to be able to enjoy independence, entertain social relations, get involved in community life, and have access to affordable health care. Communities need to perceive ageing not as a catastrophe but as a natural process.