16th Sep 2019


Ageing Europe forcing change to EU health services

  • The increase in older people will require a greater focus on community and primary health care (Photo: European Commission)

Europe is steadily greying. Already the oldest continent in the world, figures for the EU's 27 member states show that by 2060, the ratio of people of working age to those over age 65 will be two to one.

By the same year, the EU's population will have increased by around 69 million compared to 2008 and the over-80s are likely to be the fastest growing population segment. In five years time, the number of deaths will be greater than the number of births, while overall fertility rates are declining.

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Aside from the general social pressures this puts on society, the changing demographics have important implications for healthcare across the union.

With older people more likely to suffer from chronic illnesses such as cancer or heart disease, and increased longevity set to result in higher numbers of people with severe disability, health care will have to adapt accordingly.

Experts say it will mean far greater emphasis will be put on community and primary care, as, counterintuitively, an older population does not necessarily mean a great surge in pressure on hospitals.

"As the population ages, it always appears that it is old people who are using hospitals, but actually it is people at the end of life who are doing that. The evidence actually shows that in most countries, the pressure on hospitals is when people die young more than when people die old," says Professor Charles Normand, a health policy expert, at Trinity College in Dublin.

"The big effect is going to be in the need for chronic disease services mainly outside hospitals," he told EUobserver.

This will imply a change in education policies too. More people will have to be trained in geriatric care, while member states will have to ensure that a greater number of young people are entering the healthcare profession.

This is both to counter the fact that there are more elderly people to look after but also that doctors and other care professionals are themselves getting older.

Two percent of GDP rise

The European Commission predicts that healthcare spending will rise by two percent of GDP by 2050. According to Professor Normand, this will also be in part due to a change in expectations rather than just demographics.

"If you think back to your grandparents, they probably would have said: 'If I am getting a bit older and I've got a bit of a problem, I just have to learn to live with it.' Now people would be saying: 'Well, hell, I want the treatment! I may be 82, but I still think I ought to have my cataracts done'."

There is another facet to the issue too. Unhealthy lifestyles now are storing up problems for later. No one is quite sure what the surge in obesity or the general trend toward sedentary lifestyles are going to mean for future health care.

"What is significant in the EU is that there is a rather steady increase in life expectancy but there is no parallel increase in healthier lifestyles. That means that people live for a long time, but they are facing illness or chronic diseases or disabilities also for a longer period of time," says Ann-Sophie Parent, director of the European Older People's Platform (Age).

But in more recent years, there have been steps to change this thinking. Some member states, particularly Nordic countries, but also France, Germany, Austria and UK have moved towards a longterm view on health care, including focusing on illness prevention and providing community care.

Economic rationale

The EU, which has few powers in health policy, tackles the issue through public health policy, where it does have power, underlined by an economic rationale.

It has taken to emphasising health promotion and prevention of illness, suggesting that tackling obesity, promoting exercise, and disease screening will have its economic benefits in the long run.

"If we can help people age in better health today, we can save billions in healthcare spending tomorrow. Projections show that if we can increase the years of life without disease, the rise in healthcare spending due to ageing could be cut by half," said Androulla Vassiliou, until recently the EU's health commissioner.

In addition to prevention, experts also say that member states need to focus on promoting healthcare as a career in schools, consider bringing more ethnic diversity into the profession as well as providing health training for the over 55s who are still able to contribute to the workforce.

The future challenges to Europe's healthcare system now appear against the stark backdrop of the current economic crisis.

"Europe was already facing a public health challenge in view of the changing demographic situation, even before the worst economic crisis in decades struck. Now, pressure on public health budgets is being exacerbated by higher public borrowing, rising unemployment and lower tax receipts," said Ms Vassiliou.

Ms Parent, from Age, suggests this will mean that prevention and health promotion are the areas that will be cut because they do not seem like urgent needs.

"Although, as we keep saying, it may seem like the obvious place to cut for the moment but it will be at a high price in the long term."

However, others believe the economic crisis may force a more honest debate about the realities of future healthcare.

To date, says Professor Normand, there has been "very limited serious engagement," adding: "When times are harder, you may well get people able to make more radical changes that set you up better in the longer run."

EUobserver's special focus section delves into the challenges confronting healthcare, this most cherished element of the European welfare state. See more: Health Focus

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