Ageing, health and society

‘Will you still need me, will you still feed me, when I’m 64?’ Lennon and McCartney wrote this line in 1967. Average life expectancy at birth for a man in England was 68, but it is now 75 years and rising at the rate of 2 months every year. The rise in the oldest old has been even more dramatic amongst very old people and is best exemplified by the number of people reaching 100 years of age. In the UK, it is the custom for the Queen to send these people a congratulatory telegram (Table 1). The Queen now sends a card by express mail as the telegram service no longer exists. How long before she just sends an e-mail? This issue of the International Journal of Epidemiology contains a series of papers concerned with ageing. For each of us individually, having survived long enough to be reading this, our chances of reaching old age are high. And yet, the myths surrounding ageing are legion. Our commentators make an excellent job of highlighting and demolishing many of them. Demographic alarmism The ticking of the demographic time-bomb and associated chaos for public services has been a prevalent theme. Averting the ‘crisis’ of very large numbers of older people has been used as a lever to promote questionable policy changes, 1 which have failed. Gee contextualizes current concerns about the ageing of populations with earlier eras of demographic alarmism: fertility control in Canada in an attempt to preserve and improve the ‘White race’; massive western (largely US) funding for birth control to slow the ‘population bomb’ of the rapidly growing populations of the South, which still continues. 2 Both were misguided and ultimately such policies fail. In commenting on the impact of demographic change on health and social care, both US and European perspectives highlight the fact that it is not demographic factors that will determine the affordability of care, but rather it is politics and social organization. 3,4 While the whole world is ageing, there is marked heterogeneity between countries in the rate of ageing. Palacios suggests, controversially, that the differences in both the numbers of aged and the economic status of different countries may promote migration that would enable the long-term care needs of elderly people in high-income countries to be met and would lead to the economic growth of poorer countries. 5 Although it is frequently emphasized that the majority of the world’s elderly people live in low- to middle-income countries, it is the speed with which these populations are ageing that is of greater significance. In the rich North, a century of economic growth change enabled slow and steady development of the infrastructure necessary to support the health and social needs of growing numbers of elderly people. It took over 100 years for Belgium to double the proportion of its 60+ population from 9% to 18%. China will take 34 years and Singapore only 20 years to achieve the same population ageing. Projections suggest that the net world monthly gain in people aged 65 years and over by 2010 will be 1.1 million every month, 6 from a current level of about 800 000 every month. In the poor South, it will be difficult to implement adequate support systems, given their economic status and the lack of political will.