World health report

Global life expectancy reaches new heights but 21 million face premature death this year, warns WHO

Population ageing

In the next 25 years, the population aged 65 and above is likely to grow by 88% - almost a million people a month - compared to an increase of 45% in the working age population.

This implies that a relative decline in the number of people in the productive age group will have to provide for an expanding number of older dependants, not merely in the form of direct support to older relatives, but also through taxation for the provision of health and social services, and social security. Most countries are now seeking alternative types of welfare packages, such as combinations of public sector and private sector health insurance and pension schemes, funded by direct or indirect taxation and voluntary contributions, that will ensure longterm care for older people.

"Maintaining health and quality of life in ageing populations will be vitally important, socially and economically. In the 21st century, postponing the adverse effects of old age for as long as possible will be a major political and personal preoccupation. Healthrelated policies are needed for those already in old age and those who will be the older people of the future," the report says.

"As people live longer they must plan throughout life to take better care of themselves, on the assumption that a large proportion of their lives will extend beyond what have traditionally been regarded as their most productive years.

"Individuals therefore must take greater responsibility for their health at the earliest opportunity. This means adopting habits such as a healthy diet, adequate exercise and avoidance of tobacco early in life and maintaining them for the rest of their years."

The report gives special emphasis to women's health. "Today, the social status and wellbeing of countless millions of women worldwide remains tragically low. As a result, human wellbeing in general also suffers, and the prospects for future generations are dimmed," it says. As the global population ages, there will be more females among the older population.

To ensure that longer lives for women are also years of quality, policies aimed at ensuring the best possible health for women as they age, should be geared to the problems that begin in infancy or childhood, and should cover the whole lifespan, through adolescence and adulthood into old age.

The report says the vision of the 21st century that it presents should prompt governments, international agencies and organizations towards radical reorientation of health systems in the early years of the 21st century.

Dr Nakajima says: "The progress and achievements of the past 50 years are solid foundations for a healthier and better world. It is already time to build on them. Life in the 21st century could and should be better for all. We can pass no greater gift to the next generation than a healthier future."