The Pharmaceutical Journal
Vol 269 No 7218 p489
5 October 2002

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British Pharmaceutical Conference 2002 summary

Population change: Ageing population will bring many challenges but they should be affordable

The world's population is expected to peak at around nine billion people during the middle of this century before beginning to fall again, Professor LES MAYHEW, City University, London, told the Conference. However, an increasing proportion of this population will be aged over 65 years.

Although large increases in population are expected in many developing countries over the next 50 years, the population of Europe is expected to fall by 5 per cent over the same period. "Many countries have already seen changes from high to low mortality rates and from high to low birth rates, with birth rates falling below 2.1 children per couple — the level needed for population increase." Where this happens, countries pass through first an economic "golden age" where the number of people working increases but then move into an "ageing era" as the number of elderly people increases.

"Ageing will drive up the costs of health care. Older people consume between eight and nine times as much health care as younger, healthy people," Professor Mayhew said. "In the past it was population growth that drove increases in the cost of health care. In the future it will be ageing that is the main driver." He noted that increases in spending would also be needed on old age pensions.

Life expectancy at birth is increasing. In Japan the number of females older than 50 years is now higher than it is in Europe and North America. It might be thought that increases in life expectancy might compensate for a falling birth rate, but figures from Japan suggest that this is not the case. The Japanese population is expected to peak in 2025. "People would have to live to 125 to compensate for the low birth rate, and life expectancy is only increasing by two or three years a decade," he said.

Other factors could affect population sizes. For example, there are now estimated to be 40 million people infected with HIV, of whom around 28 million live in sub-Saharan Africa. Population growth estimates for India over the next 30 years suggest that, depending on the prevalence of AIDS, the population could either increase from its current one billion to around one-and-a-half billion or alternatively fall to only 750 million.

Professor Mayhew said that unless it was tackled, AIDS could have a devastating effect on the population of a country.

The social context

By 2025, around one-quarter of the British population will be over 60 years and half of those will be over 75 years, MIKE LAKE, director, Help the Aged, said. This will affect families, communities, education, transport, housing, politics and the way we work and shop.

"The ageing of the population has brought skills shortages and dependency problems. It is estimated that around a third of all men aged between 50 and 65 years old do not work. This is partly motivated by early retirement and pension incentives and partly by age discrimination by employers. Regardless of the form of pension provision in the future, we cannot sustain this early withdrawal of labour. Such early retirement will lead to both unsustainable pension costs and increased health and social care costs."

Mr Lake said that a range of Government schemes were aiming to address this problem, but, he said, "there has been some hesitation on the part of politicians and too much short-termism".

The social context of an ageing population could not be ignored either. Social markers such as the age at first marriage and the age when the first child is born are all increasing. "This will also increase the age at which we become grandparents." Increased longevity may mean that individuals spend longer being spouses, parents of non-dependent children or a brother or sister. Other roles, such as being the parents of dependent children, may decrease as people have fewer children. Families groups will become smaller with fewer brothers, sisters, aunts, uncles and cousins.

"Perhaps most important in this context is the impact of these changes on the provision of care for older people. We know that the vast majority of all care for older people is provided by family members. The impact of divorce, particularly older divorce, will also have an impact."

Rapid increases in ageing are also being seen in the populations of developing countries, particularly in Asia and Latin America. At the same time there is a move from rural to urban locations. Rural economies provide some means of economic subsistence in old age. Although urban living and service economies are less physically demanding on the old, they also require new skills that they may not be able to acquire.

More older people

According to the Government's own estimates, the number of people aged 65 years and older in the United Kingdom will almost double from around nine million today to around 15 million by 2036, JOHN APPLEBY, director of health systems programme, King's Fund, said. Among these, the number aged 85 years and older will double from one million to two million. As the total population is expected to remain stable, the proportion of older people will rise from 15 to 25 per cent of the whole.

Despite predictions about increasing strain on the NHS caused by an ageing population, Mr Appleby believes that actual costs involved are easily within the capacity of the economy to absorb. A range of studies has estimated that the NHS will need to spend an additional 0.1–0.8 per cent a year in real terms to cope with the increased number of elderly people. However, the recent report on the funding of the NHS by Derek Wanless (PJ, 27 April, p564), which was endorsed by the Government in its spending plans, suggested that total spending on the NHS would rise by 5–6 per cent a year for the next few years. The economy is currently growing at around 2.25 per cent a year as a whole.

Mr Appleby said that there were lots of uncertainties in such calculations but "no one is predicting a cost time-bomb for health care due to ageing — these cost increases are easily affordable".

Asked whether such cost predictions for the next 25 to 50 years were useful, bearing in mind that they were equivalent to someone in 1948 trying to predicting current NHS costs, Mr Appleby replied that they created a framework for discussions. The decisions were political ones, he said.