Does the world need silver handles?
21 October 2013
At home in the Västergötland’s farming community a cane with a silver handle was the classic 60th birthday present for hardworking farmers. Hard work and poor living conditions meant it was needed. The development of working life, education, health and welfare programmes in the 20th century has made public health so much better that today's 60th birthday present if anything would be walking poles and an adventure holiday.
Instead, it is those over 80 we refer to as old, and in general we expect we will not need a walking stick, or its modern variant the walking frame, until we have passed 80. We live longer and healthier lives, and hope to add more life to the years through medical advances and individualised advice based on genetic analysis.
But where do the world’s 80 year olds live? Is it in the aged populations of Japan and Sweden? A look at the UN Population projections shows that already today there are as many 80 year olds and older living in middle and low-income countries as in high-income countries. And that development is moving fast - in 2050, there will be twice as many there as here. But how will they feel? And those 60 or older, have become four times more there than here?
Higher age often leads to a chronic disease. Linked to improved economy and changes in dietary and lifestyle habits, the world's poorer parts are facing an “epidemic” of chronic diseases, like heart disease and diabetes. Already, East Africa has as much vascular disease as Eastern Europe in the corresponding age groups.
Weak health systems get a “double” burden of disease, as women and children continue to die. What can we transfer from our healthcare service to those who have less than one per cent of our healthcare budget? “Personalised medicine” based on genetic analysis? Maybe, but more likely things that built the good public health standard in Sweden; general efforts towards the entire population. We always prevent more cases of disease by influencing the entire population’s living patterns than by identifying high-risk individuals.
I wonder if this also applies to us, in our ever increasing individualised society. Will we tax sugar and potato crisps before we get genetic analysis to see how sensitive we are to obesity?
Stefan Swartling Peterson, Professor of Global Health