Global health needs are changing as populations age
Share this
A focus on:
Populations around the world are ageing – more people are living longer, and they represent a greater proportion of the total population. However, living longer doesn’t necessarily mean being healthy for longer and increasing numbers of people are spending their later years coping with one, and increasingly, multiple health conditions. This multimorbidity in later life has not only economic but also societal costs, and current models of addressing it are becoming increasingly unsustainable.
Our vision:
Poor health in later life is largely avoidable if disparities between the most and least advantaged socioeconomic groups can be reduced, starting with a paradigm shift in the ecosystem that develops and delivers healthcare.
Looking to the future:
Healthcare systems should focus on preventing the onset of multimorbidity, slowing its progression, and working collaboratively to tackle complexities in later life health.
Dr Mei Chan
Senior Statistician
Population ageing increases the prevalence of (multi) morbidity and consequently changes in global health needs
There is both good news and bad news in population ageing. The good news is that people are living longer. The bad news is that many more of those extra years are typically spent living in poor health. Healthy life expectancies (HLEs) are increasing at a slower pace than life expectancies (LEs).
Population ageing is not just evident in measures of overall health but also in the burden of disease. For example, between 2010 and 2019, mortality from cardiovascular disease (CVD) fell by a third, yet CVD prevalence nearly doubled to 523 million globally.
An ageing population naturally leads to growth in demand for healthcare, but simply providing more of the same is not enough. Healthcare costs are growing primarily due to the needs of ageing populations, and the problem is growing: 1 in 4 people are expected to be age 65+ by 2050 in the UK and other high income countries (Figure 1), with 65 year olds in the UK now expected to live for more than another 20 years. Slowing the effects of ageing such that LE increases by one year is worth US$38 trillion globally.
Figure 1: UN population projections for under 65s and over 65s for 1950-2100, by region
Source: UN Department of Economic and Social Affairs, World Population Prospects 2022
At the same time, there has been a steady increase in multimorbidity prevalence (Figure 2), particularly complex multimorbidity, which doubled between 2004 and 2019. Inequalities in HLE and multimorbidity accumulate over a lifetime, although early signs of inequalities in ageing can be detected via biomarkers in middle age. In addition, disparities in HLE between the most and least advantaged socioeconomic groups clearly demonstrate that poor health in old age is largely avoidable
Figure 2: Population projections by age group and number of health conditions (multimorbidity count) for 2020-2100 in UK, if health does not improve
Note: These projections utilised Office for National Statistics (ONS) population projections for the UK and applied age-specific multimorbidity prevalences from a representative Scottish study
From the wider societal perspective, health needs have expanded and evolved as retirement ages around the world have risen, while employment transitions, employment options and caring responsibilities are becoming more varied. Healthcare provision and treatments need to be redesigned to meet changing demands and to avoid a situation where healthcare becomes inappropriate or unaffordable.
A lot of hope is riding on discovering a wonder drug that will 'solve' ageing.
A paradigm shift in healthcare
A lot of hope is riding on discovering a wonder drug that will ‘solve’ ageing. There may be many drugs that could help ameliorate the effects of ageing, but the whole health ecosystem would need to progress and pivot to facilitate and broaden access to healthcare innovations.
Tackling ageing within the next few decades consists of three main components:
- preventing multimorbidity onset, through secondary prevention of key chronic conditions and joint risk factors;
- preventing multimorbidity progression from simple (e.g. multiple cardiovascular conditions) to complex (chronic conditions affecting multiple body systems); and
- shifting from curative to preventative healthcare, along with reducing the impact of living with chronic conditions.
The life sciences sector could meet the demands of ageing and increasingly multimorbid populations, not just in terms of expanding volumes and types of therapeutics and treatment pathways for complex medical conditions. The sector could also meet these demands by demonstrating more favourable long-term outcomes, including the wider population health and societal and economic outcomes that would follow from a healthier population.
Companies and organisations could be incentivised to reduce unmet need, including amongst the oldest and those with multiple health conditions, who tend to have lower participation rates in medical trials. Action on this front, to include relevant tools and regulatory and operational frameworks, would be for the greater good and would also explore untapped healthcare markets.
The main health-related missions in the UK Government’s Levelling Up white paper are to narrow the gap in HLE, which is currently highly variable, by 2030 and to increase HLE by five years by 2035. While ambitious given the current political and economic climate, it is a worthwhile target for long-term health outcomes. In the UK, the Office for National Statistics (ONS) and academic and public policy institutions frequently monitor HLE so progress can be tracked. In other countries, especially outside Europe, HLE is less well-defined as consensus on what it means to live healthily is lacking. For example, there are different perspectives on functional independence, life-limiting chronic conditions, and whether mental or neurological conditions should be considered, which depend on socio-cultural contexts and the access to medicines and healthcare.
The UK Government's main health-related missions are to narrow the gap in HLE and to increase HLE by 5 years.
Calls to action to address the problems associated with population ageing
Look for solutions that recognise complexity in health profiles in later life
Life science companies should expand efforts on drug repurposing and targeting non-specific biomarkers in the discovery phase.
- This would capitalise on emerging research on interlinked biological pathways of multiple age-related diseases, and new technologies for monitoring health.
Life science should quantify and characterise the secondary benefits, contraindications and lifetime benefits of therapeutics, through precision medicine techniques.
- This requires more sophisticated modelling, e.g. using high-dimensional statistical and AI techniques, which take into account fine-grained patient characteristics and unlock the potential of real world evidence (RWE).
- This also requires an understanding of different sociocultural contexts and health systems, and how participation in health studies and consultations is affected.
Investigate and implement more inclusive and collaborative ways of working
Life science and health systems should facilitate evidence generation on how different disease areas and health risk factors are interlinked.
- This can be put in practice by joining up business functions and commissioning multi-outcome and multidisciplinary studies (in vitro, in vivo and in silico).
- This evidence is particularly important as patterns of health risk factors and multimorbidity substantially affect health outcomes, healthcare costs and prescribing patterns.
Healthcare and life science organisations should assess approaches to target treatment earlier in life.
- This should utilise emerging knowledge on biomarkers of ageing and lifetime disease trajectories.
- Additionally, organisations could focus on and invest in preventative treatments to prevent health inequalities accumulating earlier in life.