Ladies and Gentlemen,
We are here to celebrate one of humanity's great
achievements and face one of its greatest challenges: The increasing
ageing of our global population.
Our celebration is of an average increase in
life expectancy of more than 30 years over the last century.
Through better sanitation, better nutrition, the
discovery and use of antibiotics and through safer and healthier
environments, we have managed to revolutionize the human condition.
Many of us who live today would not have lived to
see our fifth birthday if we had been born a century earlier. The
drastic reduction of infant mortality over the last 100 years is a
great success of public health.
Our challenge is to turn this seismic shift
into a full benefit for society. It will demand tremendous changes in
the way we organize our work places, our living arrangements and our
concept of care for those who cannot live on their own. We will have
to reconsider the way we define how people contribute to society and
how we measure productivity itself.
There is very limited evidence about what effect
the growing number of older persons will have on our health systems.
This is particularly true for developing countries.
Let me, however, sum up some of what we do
know. In rich countries, the number of people over 65 who will require
medical care, is expected to increase by between 50% and 120% from
1995 to 2025. Not only is the number of aged people increasing
rapidly, but health expenditures per person per year increase with
age. One survey found that people older than 75 accounted for nearly
30% of total health expenditures despite comprising only five per cent
of the population.
Without any changes in the structure and priorities
of our health systems, it is likely that total health expenditures for
the aged will rise rapidly.
However, the evidence also suggests that the
pessimistic predictions are based on an assumption that we will simply
continue to expand health services in their current form.
There is considerable scope for changes in our
health system. The first and most important one is to invest in
prevention and early detection.
In people over 65, health expenditures are 7 times
higher among the chronically disabled. With reduction in tobacco use,
improved screening and early treatment of cancer, development of new
genetic detection of risks, improved environments and nutrition and
increased awareness in the population, we may be able to drastically
reduce the need for treatment and care in people over 65.
We must look not only at lifestyles but also at the
genetic determinants, using our knowledge to predict and counter the
likely burden of disease. The frontiers of biological ageing and what
we can learn from it in maintaining high levels of health has just
begun to be explored.
We must also re-organize the way we provide care
and treatment. Now, many older persons are kept in expensive but
inhuman hospital environments when they with a few adjustments could
be cared for at home or in institutions that cater for their needs and
ensure their dignity.
The greatest challenge lies in the developing
While developed countries grew affluent before they
became old, developing countries are growing old before they get
affluent. The insufficient investment in health in many of these
countries causes disease to become a drag on their ability to develop.
While in Europe we have seen the demographic shift
towards an older population take place gradually over a period of a
century, the pace of the shift taking place in the developing
countries far outstrips these countries' socio-economic development.
Many destitute older people live in squalor and
poverty. Up to 90 per cent of the population in Sub-Saharan and South
Asian countries still live on less than two dollars a day. Even within
some of the richest countries, social class, ethnicity, and geographic
location can cause differences in life expectancy of as much as 40
Women bear the brunt of this burden. Of the world's
poorest billion inhabitants, 70% are women. Girls and women often
experience discrimination at some stage in their life related to
health care, nutrition, education, social support, or access to
resources with which to improve their lives. Cultural and social
practices, as well as legal systems, exacerbate their disadvantaged
position. When divorced or widowed, they often have little or no
Let me make it clear: this is unacceptable.
To contribute to this process of change, we have
been developing with partners a contribution to the work of this
Assembly. It is a new policy framework called "Active
We want to stress that healthy ageing includes more
than the mere absence of disease. Our goal is that everybody can enjoy
a good quality of life and have a recognized role to play as full and
useful members of society.
Many of the major determinants of better health lie
outside the health system. Knowledge. Clean environments. Access to
basic services. Equitable societies. Fulfilled human rights. Good
government. Enabling people to make decisions relevant to their lives,
and to act on them.
For people to have the power to be healthy, they
need knowledge that helps them to make the best choices and to
implement them. As we see from the recent trends of reduction in heart
diseases and cancers in several industrialized countries, up to date,
applicable knowledge is a pre-requisite for better health.
But knowledge is not enough. People must be
empowered to make the healthy choices for themselves - and stick to
them. This means local, national - and even international - policies
that give people the freedom to do what they want, and need, to stay
For individuals to enjoy health in old age and
societies to reduce the burden of caring for those who are chronically
ill, we need to adopt a life course perspective. That means beginning
with today's children, with the young and those just reaching middle
Ladies and Gentlemen,
This Assembly brings us together to deliberate the
international plan on action of ageing. I am optimistic that the
health sector will rise to the challenge of turning the plan into