Prevention of NCD across the life course: Towards healthy ageing

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Prevention of NCD across the life course Towards
healthy ageing

• Alexandre Kalache, Coordinator
• Ageing and Life Course Programme
• World Health Organization
• Geneva

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Life Course Perspective

• NPH Paradigm
• biological, behavioural and psychosocial factors
• critical periods of exposure
• effective and appropriate NCD Prevention and
  Health Promotion policies

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Life Course Perspective

• A life course approach offers an
  interdisciplinary framework for guiding research
  and policy on health, human development and
  ageing
• as such,
• it is the underpinning paradigm guiding NPHs
  work

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Scope for NCD Prevention
FetalLife
Adult Life
Adolescence
Infancy andChildhood
SEP,established adult behavioural/biological risk
factors
obesity lack of PA smoking
high
SEP birth weight, maternal nutrition status
Development of NCD
SEP diseases growth rate
Accumulated Risk (Range)
low
Age
PA physical activity SEP
socio-economic position
SourceAboderin et al., 2002
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An agenda on Ageing is an agenda on NCDs
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The world population is ageing
Population Pyramid in 1995 and 2025
UN Population Division, 1998 Revision
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The population in developing countries is fast
increasing - particularly the aged
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For those already aged 18 a focus on children
and the youth is already too late by 2050 they
will be 65
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The increase of older population in developing
countries is much higher than that in developed
countries
increase in elderly population between 1990 and
2025
Indonesia Colombia Kenya Thailand Mexico
Zimbabwe Brazil India China US Germany
France UK Uruguay Sweden

Source U.S. Bureau of the Census, 1995
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Percentage of Population age 60 and over in
developing countries
Population 60 years and over as Percentage of
total Population in selected Developing Countries
of total population
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Life expectancy at birth isincreasing in all
regions
Japan
Sierra Leone
Source UN Population Division, 1998 Revision
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Total fertility rates are decreasing
Source UN, 1998
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More and more countries have total fertility
rates below replacement level
Number of Countries with Total Fertility Rates
below Replacement level
121
68
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Source UN , 1998
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The population dividend
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Ageing in the development agenda
Ageing is a development issue. Healthy older
persons are a resource for their families,
their communities and the economy.
WHO Brasilia Declaration on Ageing, July, 1996
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The Burden of Disease
Spain, 2002
Total number of hours (in millions)/year spent on
providing care
Health care professionals 588 (12) Community
4300 (88)
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Total number of hours (in millions)/year spent on
providing non-paid health care, Spain 2002
Men Women Caring for others 52 199 Self-c
are 140 108 Total 192 307
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Average number of minutes/day dedicated by the
head of the household for providing
health-related care, Spain 2002
Age Group
Household with a sick person
23 50 154 201 318 61 122
18 - 29 30 - 49 50 - 64 64 - 74 75- 84 85
Total
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Ageing world-wide contrasting realities
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The reality in the developed world

• Disability rates declining
• Dependency ratios inappropriately calculated
• Cohorts of future older persons quite different
  the baby boomers - effect
• Contributions of biotechnology and new
  pharmaceuticals

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Evidence from the US disability rates are
declining
Chronically disabled Americans 65 years and older
27 million
33 million
35 million
Source US National LTC Survey, NY Times, May 2001
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The reality in the developing world

• poor raw material
• prevailing poverty
• fast ageing in parallel with rapid social changes
• urban vs. rural ageing
• changes in family structure
• AIDS epidemic in Africa

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GDP per Capita in Developing Regions and
High-income Countries, 1990 and 2030
Source World Bank WDR, 1992
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In a nutshell
The developed world became rich before it became
old.Developing countries are becoming old
before they become rich.
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High Specificity of ageing from a public health
perspective

• Increased NCD risk
• Multiple pathology
• Iatrogenic factors
• Drug interactions dosage
• Socio-economic factors
• Emphasis on quality of life
• Community based health approaches

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A culture of ageing is a culture of solidarity
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WHOs action

• The WHOAgeing and Life Course Programme

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Ageing and Life Course - programme components
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WHOs approaches and perspectives on Ageing

• life - course
• development
• gender
• cultural
• cohort
• intergenerational
• primary health care/ community based

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Life Course
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A Life Course Approach to Active Ageing
Range of function in individuals
SourceKalache and Kickbusch, 1997
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It is time for a new paradigm, one that views
older people as active participants in an
age-integrated society and as active contributors
aswell as beneficiaries of development.
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Active AgeingA Policy Framework
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What is Active Ageing?Active ageing is the
process ofoptimizing opportunities for health,
participation and security in order to enhance
quality of life as people age.
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Determinants of Active Ageing
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Three pillars of a policy framework for Active
Ageing
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The time to plan and to act is now

• In all countries, and in developing
• countries in particular, measures to help older
  people remain healthy and active are a necessity,
  not a luxury.