How to meet the challenge of ageing populations [original]

How to meet the challenge of ageing populations

EU countries need to work together with health professionals and other stakeholders

Nick Fahy consultant and researcher on European health issues 1, Martin McKee professor of

European public health 2, Reinhard Busse professor of healthcare management 3, Emily Grundy

professor of demographic gerontology 2

1Nick Fahy Consulting, Tunbridge Wells TN1 2HX, UK; 2London School of Hygiene and Tropical Medicine, London, UK; 3Technical University of

Berlin, Berlin, Germany

The EU partnership aims to add two years of healthy life

to the European average by 2020

One of the main arguments used to justify major reform of the

NHS is the potential cost of an ageing population. The United

Kingdom is not alone; the number of people aged over 65 in

the European Union will almost double over the next 50 years,1

and there will be only two people of “working age” for each

person over 65 compared with four today. It is estimated that

this could cost EU countries as much as 15-40% on top of

current expenditure to maintain existing health services. So how

is Europe collectively responding?

EU leaders (including those from the UK) are pinning much

hope on “innovation”—speeding up the process of bringing

new ideas from research to practical application.2As part of this

“innovation union” initiative, the European Commission has

proposed a “pilot partnership on active and healthy ageing.”3

By bringing together government officials, industry, health

professionals, and other stakeholders from across Europe, the

commission hopes to find ways of removing bottlenecks and

speeding up the application of science in practice. The first

meeting of the partnership’s steering group was held in May;

its concrete priorities for specific research, development, and

deployment, and the necessary support, are due later this year.

These could include better tools for early diagnosis of heart

disease, for example, or using remote monitoring to help people

with chronic conditions take care of themselves more

independently.

The proposed benchmark for this partnership is to add two years

of life in good health to the European average by 2020. Long

term trends of improving life expectancy suggested that this

was likely to be achieved with no additional intervention.4

However, the commission’s recent figures are not encouraging,

with the most recent data published in March 2011 showing a

fall in average European healthy life expectancy by 0.3 years

for women and 0.6 years for men between 2007 and 2008.4

The most important element of this benchmark, however, is not

the precise figures or even whether they are achieved. It is the

commitment by all EU countries to work together with health

professionals and other stakeholders to meet the challenge of

ageing. This does not change the primary responsibility of

countries for their own health systems. Nevertheless, the

partnership’s public consultation (which ran from November

2010 to January 2011) identified common problems, such as

fragmentation of funding (for example, between health and

social care), lack of clear and accessible evidence about which

new innovations work, complex regulatory requirements (such

as uncertainty over which legislation applies to new technologies

such as telemedicine), and failure to involve patients and

professionals in the development of the new solutions they will

be using.5Each country can then use the collective European

effort as a basis to tackle the local and specific challenges of

their ageing population.

What already exists can offer a great deal. Apart from any new

solutions that this EU partnership may help to generate, there

is already much scope for cross European learning to help health

systems respond to healthy ageing.6The European Observatory

nick@nickfahyconsulting.eu

Reprints: http://journals.bmj.com/cgi/reprintform Subscribe: http://resources.bmj.com/bmj/subscribers/how-to-subscribe

BMJ 2011;342:d3815 doi: 10.1136/bmj.d3815 Page 1 of 2

Editorials

EDITORIALS

on Health Systems and Policies (a collaboration of international

organisations, governments, and universities that supports

evidence based policy making7) has summarised evidence

showing where European systems should focus for maximum

improvement.8This includes better coordination of care across

health and social services, as well as within health systems; the

targeting of priority conditions that create the greatest burden

of ill health, such as hypertension, stroke, and dementia; better

management of hospital admissions; and encouragement of

better self care. It also highlights the scope for

prevention—again, tackling the burdens from heart disease and

stroke, flu immunisation, smoking and alcohol misuse, injuries

from falls, healthy diet and nutrition, and inappropriate

combinations of drugs for older people with multiple conditions.

It also emphasises the importance of linking policies in the

health sector to those in other sectors to create appropriate

housing and living environments, and keeping people in work

and involved in their communities.9At a practical level, the

observatory is sharing evidence through a summer school this

July on the response of the health systems to the ageing crisis

(www.observatorysummerschool.org).

Although efforts are being made to deal with the problems across

Europe and beyond, no single country has the answers, as the

recent reports of the Care Quality Commission on failures in

care for older people have highlighted clearly.10 While debates

continue in England about the future organisation of the NHS,

Europe is facing the same underlying challenge of ageing. Rather

than focusing on the structure of the health service, England

could benefit from applying good practices from other countries

to close the gap in funding for its ageing population.

Competing interests: All authors have completed the ICMJE uniform

disclosure form at www.icmje.org/coi_disclosure.pdf (available on

request from the corresponding author) and declare: NF, RB, and EG

are co-directors of the Observatory Summer School 2011; NF was

formerly head of unit for health information in the European Commission;

MM and RB are directors of the European Observatory; no other

relationships or activities that could appear to have influenced the

submitted work.

Provenance and peer review: Commissioned; not externally peer

reviewed.

1 European Commission. 2009 Ageing report. 2009 http://ec.europa.eu/economy_finance/

publications/publication14992_en.pdf.

2European Council. Conclusions. 2011. www.consilium.europa.eu/uedocs/cms_data/docs/

pressdata/en/ec/119175.pdf.

3 European Union. Europe 2020 flagship initiative Innovation Union. 2010. http://bookshop.

europa.eu/uri?target=EUB:NOTICE:KI3110890:EN:HTML.

4 European Commission. Heidi data tool. Health expectancy: healthy life years (HLY) from

2004 onwards. http://ec.europa.eu/health/indicators/echi/list/echi_40.html#main?

KeepThis=true&TB_iframe=true&height=450&width=920.

5 European Commission. Synthesis report on the public consultation on the European

innovation partnership on active and healthy ageing. 2011 http://ec.europa.eu/research/

innovation-union/index_en.cfm?section=active-healthy-ageing&pg=consultation.

6 Doyle YG, McKee M, Sherriff M. A model of successful ageing in British populations. Eur

J Public Health 2010: published 29 September; doi:10.1093/eurpub/ckq132.

7 European Observatory on Health Systems and Policies. www.euro.who.int/en/home/

projects/observatory.

8 Rechel B, Doyle Y, Grundy E, McKee M. How can health systems respond to population

ageing? WHO, 2009. www.euro.who.int/en/what-we-do/data-and-evidence/health-evidence-

network-hen/publications/2009/how-can-health-systems-respond-to-population-ageing.

9 Ståhl T, Wismar M, Ollila E, Lahtinen E, Leppo K. Health in all policies: prospects and

potentials. Ministry of Social Affairs and Health, 2006.

10 Care Quality Commission. Dignity and nutrition for older people. 2011. www.cqc.org.uk/

reviewsandstudies/inspectionprogramme-dignityandnutritionforolderpeople.cfm.

Cite this as: BMJ 2011;342:d3815