Towards a comprehensive public health response to population ageing.
Towards a comprehensive public health response to population ageing.
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DOI：
10.1016/s0140-6736(14)61461-6
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发表时间：
2015-02-14
期刊：
影响因子：
--
通讯作者：
Bloom DE
中科院分区：
文献类型：
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作者：
Beard JR;Bloom DE
在世界范围内，人口正在迅速老龄化。这种人口结构的转变既带来了机遇，也带来了挑战。大多数人渴望健康长寿，老年人(出于研究目的通常被定义为60岁或65岁以上)可能是宝贵的经济、社会、文化和家庭资源(附录)。然而，人口老龄化也可能与劳动力萎缩和对医疗保健、社会护理和社会养老金的需求增加有关。与人口老龄化有关的许多挑战可以通过改变行为和政策来解决，1特别是那些促进老年人健康的改变。然而，到目前为止，关于如何最好地实现这些变化的辩论范围一直很窄。2、3针对老年人的需求、能力和愿望以及他们所处的不断变化的环境，需要一种应对人口老龄化问题的综合公共卫生办法。有几个因素使制定老龄政策变得困难。首先，构成和影响老龄化的变化是复杂的。4这些变化仅大致对应于按时间顺序变化的年龄，并以稳定的速度变化，而与衰老有关的功能变化既不平稳也不明确。5因此，个体间功能差异很大是老年人口的一个特点；因此，满足老年人需要的政策应考虑许多不同的亚群。例如，尽管一些老年人可能希望继续像年轻人一样参加社会和职业活动，但同一年龄段的健康状况较差的人可能需要大量的保健和社会护理，而且几乎没有参与社会活动的能力。将这种多样性包含在一个简单的政策框架中是困难的。其次，这种多样性不是随机的。大约25%的老年人健康和功能的异质性是由基因决定的，6其余的受健康行为和整个生命过程中的不平等的累积影响很大。7因此，出生在受教育机会有限的贫困家庭或被边缘化的文化群体的人，很可能在年老时健康状况不佳，死亡率较低。最近的发现表明，在老年人建立财务保障的能力与保持健康行为的决策之间甚至可能存在关联。8政策制定者需要确保他们的干预不会加剧这些不平等。例如，对预期寿命延长的一个常见政策反应是提高领取养老金的年龄。这一反应与美国一项调查的结果一致，该调查显示，相当大比例的人希望在传统退休年龄之后从事某种形式的工作，更喜欢工作场所的灵活性。然而，在老年人就业方面普遍存在障碍，包括一些雇主的消极态度和获得新技术培训的机会受到限制。如果不解决这些障碍，提高领取养老金的资格年龄可能会消除一个关键的金融安全网。对于社会经济地位较低的老年人来说，延迟领取养老金可能尤其具有挑战性，他们除了更有可能出现严重的健康问题外，往往从事对身体要求最高的工作，而且替代工作机会最少。在制定应对人口老龄化的公共卫生对策方面，确保经济可持续性和卫生公平将是一项艰巨的挑战。这些复杂的挑战因重大的知识差距而加剧。例如，尽管…中的预期寿命
Worldwide, populations are rapidly ageing. This demographic shift presents both opportunities and challenges. Most people aspire to live a long and healthy life, and older people (often defined for research purposes as older than 60 years or 65 years) can be valuable economic, social, cultural, and familial resources (appendix). However, ageing populations may also be associated with a shrinking workforce and higher demand for health care, social care, and social pensions. Many of the challenges associated with population ageing can be addressed by changes in behaviour and policy, 1 especially those that promote good health in older age. However, so far, the debate on how best to achieve these changes has been narrow in scope. 2, 3 A comprehensive public health approach to population ageing that responds to the needs, capacities, and aspirations of older people and the changing contexts in which they function is needed. Several factors make development of a policy on ageing difficult. First, the changes that constitute and affect ageing are complex. 4 These alterations only loosely correspond to chronological age, which changes at a steady rate, whereas the variations in functioning linked with ageing are neither smooth nor well defined. 5 As a consequence, great inter-individual functional variability is a hallmark of older populations; thus, policies to meet the needs of older people should consider many different subpopulations. For example, although some older people might wish to continue to participate in social and occupational activities to a similar extent to younger people, less healthy individuals in the same age group might need substantial health and social care and have little capacity for social engagement. Encompassing such diversity in a simple policy framework is difficult. Second, this diversity is not random. Roughly 25% of the heterogeneity in health and function in older age is genetically determined, 6 with the remainder strongly affected by the cumulative effect of health behaviours and inequities across the life course. 7 Thus, someone born into a poor family with limited access to education, or in a marginalised cultural group, is likely to have poor health in older age and earlier mortality. Recent findings suggest that there might even be an association between the ability to build financial security in older age and decision making that maintains healthy behaviours. 8 Policymakers need to ensure that their interventions do not reinforce these inequities. For example, a common policy response to increasing life expectancy has been to raise the age at which pensions can be accessed. This response is consistent with findings from a US survey9 suggesting that a substantial proportion of people want some form of work beyond traditional retirement ages, with a preference for workplace flexibility. However, there are widespread barriers to employment at older ages, including negative attitudes of some employers and restricted access to training in new technologies. If these barriers are not addressed, increasing the pension eligibility age might remove a crucial financial safety net. Delayed access to a pension might be particularly challenging for older individuals of low socioeconomic status who, in addition to being more likely to have substantial health problems, often work in the most physically demanding jobs and have the fewest alternative job opportunities. Ensuring both economic sustainability and health equity will be a formidable challenge in the development of a public health response to population ageing. These complex challenges are exacerbated by major knowledge gaps. For example, although life expectancy in …