The Lancet
Oct 17, 2015 Volume 386 Number 10003 p1509-1598 e18-e20
http://www.thelancet.com/journals/lancet/issue/current

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Editorial
Ageing and health—an agenda half completed
The Lancet
DOI: http://dx.doi.org/10.1016/S0140-6736(15)00521-8
The unprecedented increase in longevity across the world is a dividend from investment in health and progressive socioeconomic policies. It should be the source of celebration and pride; yet, the very systems that fostered longevity now risk squandering that success—and shaming themselves—because they are not aligned to the challenges and opportunities of older populations. To make healthy ageing a reality, radical changes are required in the education, organisation, and delivery of health care. The Lancet Series on ageing, published in 2014, outlined the challenges; now WHO’s World report on ageing and health, published Sept 30, guides the public health response.

The report avoids rigid age-definitions that perpetuate discrimination. Instead, it emphasises the heterogeneity of individuals and the importance of functional ability, rather than chronological age. Key domains that optimise functional ability are basic needs, autonomy, mobility, relationships, and contribution to society. Much of the diversity observed in older age is a consequence of social determinants and the advantages and disadvantages that accumulate across an individual’s life course. The authors consider how these factors can be influenced through environmental strategies, the delivery of health and long-term care, and policy.

Environment is formed not only by physical location, but also by government policies and societal attitudes. Environments are dynamic and can modify the trajectory of functional ability in older age by influencing an individual’s physical and mental capacity as either a facilitator or barrier to healthy ageing. They go beyond housing (which should be affordable, safe, and accessible), to include transport, cultural and community factors, opportunities for physical activity, and exposure to tobacco and other harmful materials.

Historically, health-care systems were designed to address isolated acute episodes of illness, rather than to manage the chronic multimorbidity that becomes increasingly common with age. So disappointed with their experience of care was one WHO sample of older patients from high-income countries, that it dissuaded almost a quarter of them from seeking care at a subsequent episode. A total change is called for, from improving the skills and understanding of health-care providers to a more age-friendly, holistic, integrated, sustainable, and dignified approach that focuses care across a range of services on common priorities identified by the individual. While such a role might seem tailored for primary care, it requires underpinning from adequately supported centres of expertise in geriatric care and a cadre of trained care-providers. A further weakness of current approaches is that non-clinical carers are often inadequately prepared, resourced, and respected for their role.

Changes are also necessary in the organisation of health care. Just as it seems unimaginable to deliver equitable care of high quality to older people in the absence of universal health coverage, some form of integrated and affordable social support in old age will also be required. To demonstrate the simultaneous acuteness and distance of that goal, the UK released figures on Oct 6 showing that only a minority of the 1·85 million requests for social services in the previous financial year, 72% of which came from people aged older than 65 years, could be supported by local councils.

The report is a welcome catalyst for much-needed research in the care of older people. The messages are relevant to all practitioners and health systems, particularly in middle-income and low-income countries where, by 2050, 80% of people aged older than 60 years will live. To translate the report into action, WHO is working with Member States to develop a global strategy and action plan, which is open for a web consultation until Oct 30. Engagement at high levels is important, including linkage with the Sustainable Development Goals for inclusiveness and wellbeing. However, just as older people will each have unique needs and preferences, so, too, countries will need to adapt their own health systems to local needs and circumstances.

At present only one country, Japan, has more than 30% of its population aged older than 60 years. By 2050, there will be many, including Chile, China, Iran, and Thailand. Opportunities for shared learning abound, such as the ongoing Joint Research Network on Ageing and Health in Asia, a multidisciplinary, multicountry collaboration, organised jointly by Mahidol University and the University of Tokyo that meets in Bangkok on Oct 22. Sharing perspectives and ideas in similar gatherings will create the environment from which local innovative solutions arise.

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Comment
Maternal, newborn, and child health and the Sustainable Development Goals—a call for sustained and improved measurement
John Grove, Mariam Claeson, Jennifer Bryce, Agbessi Amouzou, Ties Boerma, Peter Waiswa, Cesar Victora, Kirkland Group
DOI: http://dx.doi.org/10.1016/S0140-6736(15)00517-6
Immunisation is one of the great global health successes of the past century, with millions of lives saved.1 Ensuring vaccination of millions of children is complex, but is made possible by one fundamental task: systematic counting at multiple levels and at frequent intervals. From charts in thousands of rural health posts, to databases in ministries of health, to standardised surveys and global reports from WHO, UNICEF, and GAVI, the Vaccine Alliance, a robust interconnected system of data collection and use enables health workers, programme managers, and global actors to track who is vaccinated and make course corrections as needed to improve performance, policies, and programmes…

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