Globally, 2050, this age group is predicted to

Globally, there has been an exceedingly rising trend in ageing population
in all the six regions. Europe has the highest older adult population where the
percentage is predicted to reach 36.6% by 2050. However, the number of older
adults in less developed countries is estimated to rise even greater than 250%,
in comparison to a 71% increase in advanced countries. For instance, in 2010,
the Ghanaian adult population aged 60years and above was projected to hit 1.5
million, representing 6% of the total population and that was already a 220% increase
in adult population since independence. By 2025 and 2050, this age group is predicted
to increase to 2.5million and 6million respectively representing 14% of the
total population. And this drastic shift might not be too different in many if
not in all less and middle income countries.

The World Health
Organisation (WHO) indicates that about 23% of the total global burden of
disease is recorded within the adult population aged 60 years and above.
Following the trend of total global burden of disease among adult population,
WHO suggests that the swift shift in the leading cause of mortalities from
infectious diseases to non-communicable diseases (NCDs) is as a result of the
rapid increase in adult older population. Non-communicable diseases are now the
leading cause of mortalities globally. It is recorded that about 75 per cent of
these mortalities happen in less developed countries. This therefore leaves the
low and middle income countries in a complex situation to battle with the agony
of a double disease burden – communicable and non-communicable diseases. Another
terrifying situation is that about 80% of NCD mortalities occur in less developed countries. With these scenarios,
it is strongly conclusive that the emerging trend of NCDs would extremely
affect low- and middle-income countries due to the already existing several
other health challenges. By 2030, it is estimated that
greater than 60% of the ‘first Baby Boomers (those born between 1946 and 1964)’
will be having to manage more than 1 chronic disease condition. Further
research done on NCDs indicates that within developing countries,  the odds ratio of having a chronic disease
condition is twice on the minimum for those who live in rural areas compared to
urban areas. Another study conducted in Africa found out that about 49% of its
respondents had on the minimum three chronic disease conditions to manage.

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Studies have indicated that there are varying issues with regard to
rural and urban demographic differences in ageing. It is not surprising
therefore to note that overwhelming fraction of older adults in developed
countries live in urban areas while in developing countries the majority of
older adults live in rural areas. In 2000, the census figures indicated that there
had been a remarkable increase from 4.1% of the total older adults’ population
in 1960 to 7.9%. It further showed that there were older women than men in
rural Ghana. Until 2010, Ghana never had any national guiding policy on ageing.

The UN’s Sustainable Development
Goals (SDGs) are surrounded in the universal drive of “leaving no one behind”.
Therefore knowing today’s achievements and gaps for the health-related SDGs
should be paramount for decision formulators and global health governance as
they aim to advance global health outcomes. Sustainable Development Goal 3
specifically is to ‘ensure healthy lives and promote well-being for all at all
ages’ – young, youth and the aged. From lessons gathered within the era of the
MDGs, all nations have a mandate to embrace multiple sets of actions and
governance mechanisms that would promote health for all at all levels including
steps to address all inequities and barriers to health service utilization
especially for the marginalised and vulnerable groups – until then achieving
the objective of ‘leaving no one behind’ might be another mirage. The World Health Organization recognises
children as being predominantly vulnerable to
poor health outcomes. Also, in a similar analogy, senior citizens are
categorised as a vulnerable population. In developing countries, the attention
of most nationally and internationally funded health interventions has mostly been
on communicable diseases and maternal and child survival. As a result of that
many developing countries can now boost of a good reduction in the incidence of
infectious diseases, maternal and infant and child mortalities (Hill and
Pebley, 1989). Nevertheless, as children survive and grow, they are
increasingly exposed to the same several health threats associated with chronic
diseases. Studies have found that poorer health outcomes are normally characterised
with the vulnerable groups including the older adults as indicated above.
Health is a human right according to WHO yet most health systems especially in low and middle income countries do
not have adequately what it take to respond to the health and care needs of the
adult population.

Health systems in most developing countries are and
would be highly vulnerable to the shocks that the shift in demographics would
pose to health for all in the near future if remarkable mechanisms are not
integrated into the main stream of health systems now in preparedness for the
near future health demands. In recent times, health systems and global health
governance have been on high agenda in the quest to attain the Sustainable
Development Goals (SDGs). For instance, in April 2018, there is a scheduled
health conference in Oslo, Norway on health systems. Similarly, there would be
another conference in Bergen on SDGs. This points to the fact that health
systems requires greater attention in the bit to achieving the SDGs 3 by 2030. Several studies have indicated that the older population often struggle
to access health and care services they need due to: physical and financial
barriers; lack of appropriate services; low levels of awareness of health
conditions; lack of knowledge on their rights and entitlements; poor
utilization of health services; inadequate preparedness of the health workforce
to care for older people; Poor communication and lack of awareness about health
issues of elderly. Several studies have been
done on health and ageing mostly on self-reported health, stress related issues,
dementia and depression, determinants of health, cognitive functioning and
dementia, among others significantly correlating with healthcare utilization
among the older population and health systems. Through these studies, a lot of critical
findings have emanated either as facilitators or hindrance to healthy ageing
yet less has been done with reference to relooking deeply into why the current
health systems cannot integrate these essential evidenced based recommendations
and secondly how health systems could be strengthened thereafter designing a
health system model to integrate these issues in full support of healthy ageing
in low and middle income countries. Though resource constraints have been a
major hindrance to redefining the health systems, however it is very necessary as
a matter of urgency to set the pace now in tackling the emerging health
challenges through realigning health systems as the many predicted health
challenges that would emerge as a result of the ageing population can never be
a totally misleading prediction. Hence the earlier health systems in low and
middle income countries began to relook at their health systems in support of
healthy ageing the better.

As many countries are battling with measures to handle these emerging future
health problem, evidence based information requires a change in the present
health care system from one which focuses on diagnosis and treatment of disease
to a system that attends to the major issues that affect health and care needs
as well as quality of life of older adults. A study done in the USA on critical
areas influencing the quality of life of older Americans adults recommended the
following: providing resources to individuals to help manage chronic medical
conditions, assuring a sufficient number of primary health care providers
educated in geriatrics and gerontology, removing financial barriers to
accessing health care and medications, and changing the American cultural value
system that emphasizes disease treatment over providing emotional, educational,
and support resources. Developing long-term care systems for the
elderly has become an increasingly urgent policy issue in China also,
especially for the adult population in rural areas. It is because of this need that most countries in the developed
countries like the South Australia Health Care Authorities identified the need
to redefine its traditional service models to include systems that met the health
and care needs of the older population as well as making their health systems  ‘age friendly’ . Even though some countries in
low and middle income countries have piloted some mechanisms in support of
healthy ageing but these were not done through the main health systems but just
at the community levels. Hence limiting findings to community and social
levels. It therefore could be a challenge to transfer lessons from such pilot
projects to the main health systems considering the differences in characteristics
among other parameters.

In summary, the shift in
demographics has led to an increase in the prevalence of chronic diseases. These
conditions pose important challenges to health care systems especially in
developing countries. The concerns here are whether the health care systems in
less and middle income countries are robust enough to meet health care needs of
the older population. If not then in what ways can the structure and the
delivery mechanisms of health systems best adapt to the needs of older
populations considering the emerging rise of chronic disease conditions? Health
systems therefore need to be realigned in order to promote healthy ageing otherwise
we risk putting the older population in a situation where their quality of life
would experience worst outcomes by 2030 which would have defeated the UN goal
of leaving no one behind.

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