Early healthcare investment is our best chance at healthy ageing

The impact of COVID-19 has been substantial, tragic, and disruptive. It has also been revealing. The last year has been a visceral reminder that a healthy economy requires a healthy population. The willingness of governments to implement policies that save lives at considerable short term cost to gross domestic product (GDP) has also shown just how much society values health. Given how the mortality risk of COVID-19 rises with age it has been particularly revealing about ageing and health. Because many of the lives saved through economic lockdowns were older ones, it has shown how much society values older people.

The pandemic has also powerfully revealed the importance of public health and the value of preventive medicine. It has dramatically exposed the social determinants of health and the stark inequities of those most impacted by disease, from health, social, and financial perspectives. Given these extensive revelations several lessons can be drawn regarding the importance and urgency of investing in healthy ageing.

The most obvious is the need to prepare for future pandemics. As the saying goes, “Fool me once, shame on you. Fool me twice, shame on me.” The problem though is anticipating what form a pandemic will take, given the unpredictability of viruses and disease. However there is a set of diseases – age related noncommunicable diseases (i.e., dementia, cardiovascular diseases, cancer, diabetes, and chronic respiratory disorders) – whose arrival we can predict and whose incidence we know is set to increase dramatically across the world.

Noncommunicable diseases (NCDs) aren’t just a future threat, they already cause around 70% of all global deaths. Even in the middle of the pandemic, they will account for more deaths than COVID-19. We need to prepare for this global pandemic of age-related diseases which is even larger than COVID-19 in scale, as well as made worse by the pandemic. Emphasis needs to shift towards a health system that not only intervenes when illnesses occur, but focuses on preventive health and ageing well.

Global life expectancy has risen by more than a decade over the last 40 years to reach 73.2 years. It is also projected to increase in every country over the next 40 years, according to the United Nations, as mortality improvements shift from childhood to later ages. The result, combined with falling fertility, is an increasing older proportion of the population. Our collective future is therefore critically dependent on the health of these older people. Increasing life expectancies globally brings about a new health imperative – a focus on healthy ageing.

It is a mistake to think that healthy ageing is only about older people’s needs. In the early months of the COVID-19 pandemic, there was much talk about slowing down the rate of infections by “flattening the curve”. Healthy ageing requires flattening another curve – slowing down the rate at which disease and disability accumulate with age. That involves intervening across the life course – from prenatal to end of life. To assume that healthy ageing is about the medical treatment of older people is to akin to assuming that the best way to deal with COVID-19 is through intervening when people become ill. That has an important implication – healthy ageing is an imperative regardless of whether a country’s current population is predominantly young or old. We need to make the current young and middle-aged the healthiest old-age cohort in human history.

Investing in healthy ageing will require substantial resources but the preference of policymakers revealed during COVID-19 has shown just how valuable health and lives are. Consistent with that preference post-COVID-19, demands much larger health budgets are used to prepared for the global pandemic of age-related diseases.

Investing in healthy ageing will not just reduce future health costs and increase individual welfare but have positive impacts on GDP. In low-income countries, for instance, approximately 50% of those aged 65 years and over are in the labour force. In the G7 countries, in the decade before COVID-19, people aged 50 years and over drove 100% of employment growth. Post-COVID-19, when growth will be needed, a focus on healthy ageing to deliver a longevity dividend needs to be a priority.

Critically, productive ageing is not only about employment and GDP, but also the intrinsic value of living a long life in good health. Older people make large and valuable contributions to society through various social activities – intergenerational caring, wider community roles, etc – which healthy ageing can amplify.

Achieving healthy ageing goes beyond the health sector, as broader socioeconomic factors determine much of how we age. Just as major improvements in infant mortality require cross-departmental or multisectoral policy initiatives, so will achieving healthy ageing. Healthy ageing also represents an important component of tackling rising inequality, which tends to rise with age, multiplying disadvantages over a lifetime and magnifying the impact of health shocks. A focus on healthy ageing needs to target those whose health is currently weakest; doing so will help reduce inequality, especially given ageing societies.

The COVID-19 pandemic shows how much we value life and health and reveals the resources governments are prepared to spend to support them. The projection is for a huge increase in the global incidence of age-related diseases. While the world was unprepared for COVID-19, it does not have to be unprepared for an ageing society. Ageing is as old as human existence, and we can “flatten the curve” of disease and disability accumulating with age. With so many now living into older years there is a new health imperative to support healthy ageing.