Health inequalities in ageing societies

Abstract

The age distribution of the world’s population is undergoing a profound transformation. As mortality and fertility have fallen, the age distribution has been shifting gradually to older ages (UN 2007). In the next 45 years, the global population aged 60 years and above will triple. By 2050, one-third of the European population will be aged 60 and above. In lowand middle-income countries, the proportion of older people is growing even faster than in highincome countries (WHO 2008). According to the WHO Commission on Social Determinants of Health, global population ageing makes exploring and understanding social determinants of health among older people an increasingly important challenge (WHO 2008). While this issue was neglected by social epidemiology for a long time, gerontological results indicating that old age is not a uniform phase of life, but characterised by social differences have led to an increasing interest. Today there are some studies describing health inequalities in older populations (e.g. McMunn et al. 2006). Overall, these studies indicate that there is also a social gradient in health among older people, although health inequalities tend to be smaller than among middle-age groups. In the following, three important open issues concerning health inequalities in ageing societies are outlined. First, it can be questioned whether standard measures of socio-economic position like education, occupational class, and income are appropriate for older people. There is an intense discussion in sociology of ageing about concepts and measures of social inequality in older ages. While this debate continues, it has been suggested that (a) studies should focus on a set of measures rather than a single indicator to explore the multi-dimensional nature of socioeconomic position in later life, and (b) studies should include indicators, such as assets or home ownership that can be expected to reflect economic advantages or disadvantages accumulated over the life course (Knesebeck et al. 2007; for a general discussion of measurement of social determinants see also McQueen 2009). Second, as it is still unclear how and why health inequalities vary with age, it seems important to intensify the integration of life course approaches into social epidemiology (Blane 2006; Power and Kuh 2006). These approaches highlight the role of the accumulation of disadvantage over the life course—combining the amount of time different people have spent in more or less disadvantaged circumstances. Health inequality between social groups in this regard is a result of inequalities in the accumulation of social, psychological, and biological advantages and disadvantages over time. Life course approaches help to understand how these social, psychological, and biological factors operating at different stages of the life course contribute to the development of health inequalities in later life. Third, while there are an increasing number of studies describing health inequalities in older ages, there is not much known about the specific factors contributing to these health inequalities. Moreover, it is not certain whether the Olaf von dem Knesebeck is head of the Department of Medical Sociology at the University Medical Center Hamburg-Eppendorf. He is interested in research on social determinants of health and health services research, both with a special focus on older ages and international comparisons.