The average age of populations around the world is rising: improved medicine and greater wealth leads to increased longevity and lower population growth at the same time. The number of old people is rising rapidly, and this at a time when technologies for treating aging as a medical condition are just around the corner, given sufficient funding and support. The World Health Organization (WHO) recently released their report on aging and health for 2015, and I have to say it makes for very strange reading. You might find the exexcutive summary (PDF) easier going than the full report (PDF). As I worked my way through the summary, I became increasingly incredulous that at no point in the document was medical research discussed. Not a single mention. This stands out as an exceptional omission in an otherwise sensible and coherent position statement. Take this for example:
The changes that constitute and influence ageing are complex. At the biological level, ageing is associated with the accumulation of a wide variety of molecular and cellular damage. Over time, this damage leads to a gradual decrease in physiological reserves, an increased risk of many diseases and a general decline in the intrinsic capacity of the individual. Ultimately, it results in death. But these changes are neither linear nor consistent, and they are only loosely associated with a person's age in years.
This report defines Healthy Ageing as the process of developing and maintaining the functional ability that enables wellbeing in older age. Central to this conceptualization of Healthy Ageing is an understanding that neither intrinsic capacity nor functional ability remains constant. Although both tend to decline with increasing age, life choices or interventions at different points during the life course will determine the path - or trajectory - of each individual.
Yet at every point in the report where technological progress in medicine might be mentioned, there is silence on this topic. Where lists are provided of ways to help people retain functional ability as they age, they focus on compensation for disability, on lifestyle choices, on greater availability of services for the elderly, but say nothing on the improvement of therapies to treat aging and age-related conditions. In fact, right up front in the preamble you can find this:
The report aims to move the debate about the most appropriate public health response to population ageing into new - and much broader - territory. The overarching message is optimistic: with the right policies and services in place, population ageing can be viewed as a rich new opportunity for both individuals and societies. The resulting framework for taking public health action offers a menu of concrete steps that can be adapted for use in countries at all levels of economic development.
In setting out this framework, the report emphasizes that healthy ageing is more than just the absence of disease. For most older people, the maintenance of functional ability has the highest importance. The greatest costs to society are not the expenditures made to foster this functional ability, but the benefits that might be missed if we fail to make the appropriate adaptations and investments. The recommended societal approach to population ageing, which includes the goal of building an age-friendly world, requires a transformation of health systems away from disease-based curative models and towards the provision of integrated care that is centred on the needs of older people.
In the context of the report as a whole, I read this as "more coping, less medicine." This seems like well-spoken insanity to me. You can't talk about age-related frailty and disability outside the context of medical research into aging and the development of new and better therapies. You can't herald a world in which growing numbers of people are living longer without talking about the ongoing advances in medicine that have enabled this outcome. Yet here is this policy document, doing just that. Calling for greater accommodation of the consequences of aging while ignoring medical science and the great rate of change in biotechnology is perhaps a manifestation of the instinct to conservatism in all political bodies: the urge to see stasis in the world, even against all the evidence, even in an age of rapid, accelerating progress. Only within a worldview in which aging is set in stone, never to be changed, can this document make any sense to anyone. Yet it clearly acknowledges change throughout, in every other aspect.
In any case, I stand amazed at this output of the bureaucratic process.