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28th Feb 2024

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Europe is getting older, but who cares?

  • "This is a human rights issue," explains Alfonso. "We talk about the European social welfare model. So let's make sure in the first place that we are supporting people in the best possible way." (Photo: Leaf)
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Across Europe, over the last 50 years, life expectancy has increased considerably. Europe is getting older, and people are living longer. By 2050, those aged 65 and over are expected to make up one-quarter of the population in Europe.

Most babies born since 2000 in France, Germany, Italy, and other developed countries are expected to live to celebrate their 100th birthdays. The projected population pyramid, as a result, will look top-heavy. As such, the health challenges faced by the population are going to see a dramatic shift.

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The paradox at play is that better health has been the main driver of increased longevity of people in Europe, while living longer comes with additional health problems such as cardiovascular disease, diabetes, lower-back complaints, arthritis, leg ulcers, hypertension, and asthma.

Diseases previously thought of as 'silent', such as type 2 diabetes, hypertension, and some cancers, now get diagnosed earlier and receive better treatment than before.

Overall behavioural changes in lifestyle over the years, including reduced exposure to carcinogens such as tobacco smoke have also contributed to increased longevity in the population.

This overarching shift means health systems now must focus less on acute care and the prevention of premature death to focus on providing a continuum of care that promotes health across the life course. With an ageing population, the 'care' in healthcare needs to become more prominent, experts say.

Confronting inadequacy

According to the World Health Organisation, within the European Region, 135 million people are living with disabilities, and nearly one in three older people cannot meet their basic needs independently.

"The lessons of the pandemic are clear. But are we better prepared now to face a challenge of this scale? What we know is that we need to invest more in our health systems, including in the way we deliver long-term care to those who need it," said Dr Natasha Azzopardi-Muscat, WHO Europe's Director of Country Health Policies and Systems.

The Covid-19 pandemic exposed the vulnerabilities of care systems, including inadequate long-term care services and poor integration with health-care delivery.

In the European Union alone, the initial waves of the pandemic resulted in approximately 200,000 deaths among residents of long-term care facilities.

"Medical care can't address the many issues that we are facing right now," explains Alfonso Lara-Montero, CEO of the European Social Network, a pan-European network for public authorities with responsibility for social services. "We need to put in place a system which as much as possible supports people in their communities, in their homes, and in their communities by creating an ecosystem of care".

Such demographic and epidemiological transitions that are taking place in Europe suggest a potential problem of resource allocation to the healthcare sector, and more concretely expose a current lack of staff in the service sector, with subsequent consequences for the future design of healthcare workforces and services.

Integrating care

In 2018, the European Commission undertook a study of national policies on long-term care.

The report found that in most countries, long-term care for the elderly is not a distinct social policy field, with provisions characterised by a fragmentation of responsibilities and consequently a lack of integration between health and social aspects of care provision. As such, there is a lack of formal long-term care facilities across much of Europe, leading to a high incidence of informal care.

Across Europe, many actors are pushing for more integrated delivery of care — when people can access the care they need in a timely and comprehensive way, with services ranging from prevention, treatment, and long-term care to rehabilitative or palliative care.

"Some choices have been made at a policy level to significantly invest in secondary and specialist health care, but not in community care. Community care includes both health and also social care," Alfonso explains. Investing in community care allows for more work on prevention, which in turn prevents older people from being hospitalised.

Within Europe, the split between formal, informal, community, and facility-based care differs from region to region. Homecare services and community-based care are often the most difficult to access, since they are underdeveloped in many countries.

Home and community-based services are most developed in the Nordic countries such as Denmark and Finland, while countries in the southern region face insufficient availability of home care provision. One of the consequences of the priority given to home care and community-based provision has been that the availability of residential care has been decreasing in several European countries over the past 25 years.

"A human rights issue"

Population ageing is often treated as a threat to the sustainability of health systems. As such, policies are often framed around reducing overall costs and the financial burden to states.

In 2021, the Economic Policy Committee produced a set of long-term projections of age-related expenditure, finding that age-related expenditure as a share of GDP is projected to increase in coming years, driven by long term care and healthcare.

However, analysis done by the European Observatory on Health Systems and Policies explored the possibilities of 'win–win' politics that produce good outcomes for people of all ages, with a focus on embracing social determinants of health and allowing economic productivity even at old age.

In order to keep healthcare systems affordable and sustainable, governments are increasingly taking into consideration the reliance on informal care provided by family members, friends, or neighbours.

The assumption is that more emphasis on this type of informal care will eventually alter societal norms towards more family responsibility in care provision, so that people will become more inclined to take care of ageing family members themselves.

Informal care has been estimated to have an economic value equivalent to 50 to 90 percent of the overall cost of long-term care across the EU. Researchers estimated that around 80 percent of all care received by people of all ages in the EU is provided by informal carers — of which two thirds are women.

Gender inequalities are a constant challenge in health delivery, and even more so in the context of ageing. The devaluation of care work and the fact that women deliver the majority of both paid and unpaid care are as a result of structural power imbalances that should be addressed in policy.

"This is a human rights issue," explains Alfonso. "We talk about the European social welfare model. So let's make sure in the first place that we are supporting people in the best possible way." That means providing the type and quality of care that best suits the individual — whether that is institutional, community, or informal care.

Author bio

Dr. Charles Ebikeme is a science writer based in London. He holds a PhD in Parasitology and has worked across science and policy.

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