FRAMEWORK

This short introductory chapter gives insight into the world’s population and ageing demographics. The challenges are discussed from the authors’ examination of four countries, two of which have relatively well developed systems of health and social care and two who have still evolving support structures. The contrasts are diverse in culture and available resources. However, the need for older people to be seen as productive and continuing to live at home drives policy in all countries. Support for families who provide the major care in all countries is varied and the need for older people to provide care for their adult children and grandchildren in AIDS/HIV affected countries is causing serious problems in health and wellbeing for the older age group. The issues of health and social support for older people across the four countries discussed is similar in some ways but because of differences in government approaches and distribution of resources there will need to be a major shift in thinking for developing countries to deliver quality care to their older age group. [RN, SG]

The ageing of the world’s population is a global phenomenon but Kalache (2008) contends that the way in which older age is experienced differs markedly, with there being unacceptable variations in overall quality of life and in the quality of care and support available to those in most need, dependent largely upon where one lives. As the above quote suggests, the distribution of wealth is a major contributory factor to such variation, and differences in quality of life are likely to become even more apparent over the coming decades. This becomes abundantly clear when the future demographic projections are considered. Between 2000 and 2050 the world’s total population is expected to increase from approximately 6 billion to 8–9 billion but this increase will be disproportionately experienced in the developing world. The total population in the developed world will remain more or less static over the next 50 years at approximately 1.2 billion, whereas that in the developing world is expected to increase from 4.7 billion to 7.7 billion. The increase in the relative proportions of people aged 60+ is even more marked.

The numbers of people aged 60+ globally are expected to grow from 600 million globally to 2 billion between 2000 and 2050, but as with the population as a whole the number of people aged 60+ in the developed world will increase relatively modestly from 200 million to 300 million between 2000–2050, whereas the numbers of such people in the developing world will grow from 400 million in 2000 to 1700 million (1.7 billion) by 2050 (Kalache 2008).

The impact of these changes in population on services is particularly acute in the developing world because, unlike the developed world where increasing numbers of people are reaching advanced age without disability, the same cannot be said to be true in the developing world. To compound matters, factors such as the HIV/AIDS epidemic mean that in the developing world older women are increasingly being required to support their dying children and then to provide a home for orphaned grandchildren (Kalache 2008). If this situation is to improve, Kalache (2008) argues that a policy promoting active ageing is essential in order to ensure that as many older people as possible remain above the disability threshold. This suggests the need for a life course perspective to policy and practice in which there is a culture of solidarity and recognition that a combination of self-care and care provided by the family will continue to be the major factors supporting frail older people (Kalache 2008).

In this short chapter we reflect briefly on the challenges that the ageing population poses by contrasting the situation in four quite different countries, two of which have relatively well developed systems of health and social care (Sweden and the UK) and two of which have less advanced systems that are still evolving support structures for older people to achieve a good quality of life (Thailand and Myanmar [Burma]). Such contrasts are often sharp but the challenges faced are broadly similar, albeit experienced at a varying pace and with markedly different resources.

For example, whilst it took 100 years for the population of England and Wales to double the number of its population aged 60+ this has occurred in just 30 years in Thailand. Therefore there has been far less time to prepare the welfare structures necessary to support such an increase in the proportion of older people. Nevertheless, Thailand has constructed two National Plans for older people, the most recent addressing the period between 2002–2021. This plan focuses on assisting people to prepare for advanced age and ensuring adequate support for such individuals (Jitapunkul et al 2002). Below we explore some of the demographics of ageing in the four countries and consider the shared challenges that they face.

Sweden and the UK already have an aged population with Sweden being the oldest in the European Union with 17.3% of its population aged 65+ and 5.3% aged over 80. The proportions are broadly similar in the UK. In contrast, only about 10.5% of the population of Thailand is over 60, although the figure is expected to reach 17% by 2020 due to a combination of falling birth rates and improvements in health care. Current figures for Myanmar suggest that approximately 7.5% of the population are aged 60 or over. However, as noted above, whilst the factors that precipitated the change in demographics are similar, Sweden and the UK have had over 100 years to respond to and develop health and social care support, whereas Thailand and Myanmar are having to do so in 20 years or less, and with considerably fewer resources.

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