WHO's proposal for a decade of healthy ageing

Abstract

WHO's draft proposal1WHOZero draft proposal. Decade of healthy ageing.https://www.who.int/ageing/decade-of-healthy-ageingDate: June 12, 2019Date accessed: July 27, 2019Google Scholar for a decade of healthy ageing signals an overdue scaling-up of global responses to population ageing. The proposal, however, does not go far enough to promote the integration between health services and long-term care, and could even deepen the existing division. The proposal lists three priorities: creating “age-friendly” communities, promoting person-centred health care, and providing long-term care. Individually, these priorities have much to commend them. However, the statement that “these three action areas are strongly interconnected” falls well short of treating health services and long-term care as a single, integrated system rather than separate, albeit complementary, endeavours.2Harvey G Dollard J Marshall A Mittinty MM Achieving integrated care for older people: shuffling the deckchairs or making the system watertight for the future?.Int J Health Policy Manag. 2018; 7: 290-293Crossref PubMed Scopus (25) Google Scholar Structural integration enhances resource allocation, service coordination, and person-centred care.2Harvey G Dollard J Marshall A Mittinty MM Achieving integrated care for older people: shuffling the deckchairs or making the system watertight for the future?.Int J Health Policy Manag. 2018; 7: 290-293Crossref PubMed Scopus (25) Google Scholar In high-income countries, belatedly merging services developed independently over decades has proved very challenging.3Charles A Wenzel L Kershaw M Ham C Walsh N A year of integrated care systems: reviewing the journey so far. The King's Fund, Sept 20, 2018https://www.kingsfund.org.uk/publications/year-integrated-care-systemsDate accessed: July 27, 2019Google Scholar Low-income and middle-income countries could benefit from these lessons while services are at earlier stages of development. Integration will require fundamental changes to models of training, provision, and professional behaviour, without which provision will become increasingly unsustainable and inefficient. In Brazil, which is broadly representative of middle-income country experiences, 31% of inpatient hospital spending on people aged 60 years and older between 2000 and 2013 was for conditions suited to ambulatory treatment. This spending amounted to US$275 million in 2013.4de Souza DK Peixoto SV Estudo descritivo da evolução dos gastos com internações hospitalares por condições sensíveis à atenção primária no Brasil, 2000–2013.Epidemiol e Serviços Saúde. 2017; 26: 285-294Crossref PubMed Scopus (15) Google Scholar The leading causes of admissions were urinary tract infections, falls, and poor management of chronic conditions—much of which is avertable through effective care in other settings.5Dias RD de Barros JV Burden of hospitalisation among older people in the Brazilian public health system: a big data analysis from 2009 to 2015.J Epidemiol Community Health. 2019; 73: 537-543Crossref PubMed Scopus (6) Google Scholar Brazil has also seen a proliferation of fragmented, weakly regulated private social care. The current paradigm, a binary distinction between health-service provision and social care for frail older people, is obsolete and largely an accident of history. This paradigm reflects fixed notions about how things are done—settings where care is provided, and the types of people who provide it—rather than intrinsic differences in user needs. It is more helpful to think of a spectrum of needs (from acute episodes to more complex, chronic conditions) and a spectrum of responses (from single treatments to more continuous support) where distinctions between health needs and social care needs are largely meaningless. How can structural integration be achieved? The experiences of high-income countries highlight the need to overcome professional, cultural, and institutional disconnects across health care and social care. Doing so will require a fundamental reconfiguration and revaluing of the roles played by health professionals and care professionals, as well as family carers. Structural integration is an ambitious global and national agenda, whose systemic and cultural effects go beyond specific concerns about very old people. The WHO decade of healthy ageing represents a once-in-a-generation opportunity to launch this project. We declare no competing interests. 2020: a crucial year for neglected tropical diseasesThe inaugural World Neglected Tropical Diseases Day will be marked on Jan 30, 2020. “#BeatNTDs: For good. For all” is the slogan aiming to gather support and build momentum for a decisive year of action against neglected tropical diseases (NTDs). Jan 30 is the anniversary of the 2012 London Declaration on NTDs, which did much to bring together policy makers across countries and to encourage investment to commit to control and elimination of NTDs. Full-Text PDF