Report: Preventive Care and Healthy Ageing: A Global Perspective
Source: Economist Intelligence Unit (EIU), sponsored by Pfizer
The report “concludes that when governments increase investment in healthy ageing, healthcare costs go down. The report, which sheds light on ways countries are promoting preventive healthcare, suggests preventive care can pay dividends for cash-strapped governments…(and) provides a deep dive on Brazil, China, India, Japan, Russia, South Africa, the United Kingdom, and the United States, highlights compelling insights about the factors contributing to this global healthcare challenge:
- Age-related, infectious diseases such as pneumonia and influenza, as well as noninfectious chronic diseases like heart disease and stroke, are affecting older adults for longer periods of time,1 adding to healthcare costs and severely impacting a person’s productivity and need for support1
- Global healthcare reforms, increased mobility and evolving attitudes mean that governments must foot the bill for caring for their older citizens,1 and these governments are finding it difficult to keep up with the rise in chronic conditions since, to date, most healthcare systems have focused on treating acute illness1
- Immunization is highlighted in the report as one of the most cost-effective preventive measures for older people, but that measure is vastly underused due to structural and social barriers.
In developing countries, where they struggle with basic medical services, preventive care measures are seen as unaffordable luxuries.
Vaccines: The low-hanging fruit
Vaccines offer a quick, cost-effective and easy way of reducing infectious disease. But adult immunisation rates remain low in both developed and developing countries. Why is this highly effective preventive measure under-used?
Older people with chronic conditions such as respiratory diseases, heart disease, kidney failure and diabetes are more susceptible to infectious diseases. Adults aged 60 years or older continue to be the highest-risk group for tetanus, while those older than 50 years are at greater risk for death and severe disability from influenza than younger people. In the UK, between 3,000 and 4,000 people die from influenza each year, and large numbers are hospitalised owing to the disease. More than 85% of influenza-related deaths occur in individuals over the age of 65 years. Thus, vaccination can significantly lower the risk of influenza-related hospitalisation and death and reduce the associated costs of the disease. A Spanish study showed that for older people with cardiac disease, influenza vaccination reduced the risk of winter mortality by 37%.
Despite its proven benefits, vaccination for ageing populations remains below the rate recommended by the World Health Organisation. As a result, millions of people worldwide continue to die from vaccine-preventable diseases. Although a vaccine against hepatitis B was developed in 1981, around 600,000 adults died from the disease in 2002 (latest available figure).
In developing countries, overstretched healthcare systems that struggle to meet immediate needs have tended to underfund immunisation programmes, which are sometimes perceived as burdensome. For example, vaccines require an extensive infrastructure to ensure the “cold chain” that extends from manufacturing through shipment to final distribution and administration. They also require careful waste management and specific medical training. Once established, however, vaccination programmes are highly cost-effective.
Furthermore, existing programmes rarely target older people. In India, for example, the government does not have an adult immunisation strategy; vaccination schemes are limited to children. By contrast, in Brazil the government has successfully used the country’s passion for soap operas to increase awareness and immunisation rates among the elderly (see Country perspectives).
Meanwhile, developed countries have also struggled to achieve universal adult immunisation. The problem is often a lack of awareness. “One of the biggest challenges of implementation and delivery is to develop a vaccine mindset for adults,” says Pierce Gardner, who served for many years as the American College of Physicians’ liaison representative to the Advisory Committee on Immunization Practices at the Centers for Disease Control and Prevention.
Developed countries have had some success in using the private sector to increase immunisation rates. In the US and the UK, retailers have created profitable flu vaccination business lines that help to bring shoppers into their stores and pharmacies.
Community pharmacists can also act as vaccination advocates. In Japan, a 2009 study showed that pharmacists who provided information about influenza risks and vaccination benefits to their elderly customers had a take-up rate of 82%, compared with 70% in a control group…”