Recently I had the honor of joining ministers of health from member states of the Pan-American Health Organization (PAHO) for a robust discussion on the future of long-term care. The symposium, appropriately held on the International Day of Older Persons, was the first technical meeting on long-term care among PAHO member-state health ministers.
The forum did not disappoint. It provided space for a vital discussion on the vision for long-term care in the Americas and created a dialogue about the urgency for taking action.
Common Challenges and Opportunities
As every expert at the forum understood, the world is rapidly aging. A demographic shift is happening in almost every region, from Europe and Asia to Latin America and North America. Low- and middle-income countries are seeing the most rapid shifts. Strikingly, about 80 percent of the world’s older people will live in low- and middle-income countries by 2050. Every region of the world needs to think about how to create, support, and sustain a long-term care system.
Experts at the event represented the United States, Japan, Europe, and Latin America. Discussing the challenges and opportunities were panelists including U.S. Assistant Secretary for Aging Lance Robertson; Kanako Kitahara from Japan’s Ministry of Health, Labour and Welfare; Pablo Ibarrarán from the Inter-American Development Bank; and Manfred Huber from the World Health Organization’s (WHO) Regional Office for Europe. Some of the common themes uncovered include the need to:
- Address the rising, prohibitive cost of care through the creation of a social insurance system and by implementing policies that allow individuals to receive services in their homes and communities for as long as possible.
- Address the fragmentation in the delivery of long-term care by ensuring that the system puts the individual and family at the center of care, and better integrates long-term care and medical care.
- Recognize and address the needs of family caregivers by providing support, training, respite, and other services.
Complexities and Ranges of Progress
In spite of existing commonalities among regions, the long-term care issue also contains great complexity. Each region must grapple with unique cultural, political, and economic realities, but we will all be better from sharing our experiences, challenges, and progress.
Even as we delve into the complexities of different regions, we see that there are similarities in trends. For example, we know there is a gender lens that emerges when we begin to talk about how long-term care systems significantly impact women. A policy brief by UN Women highlights that older women are more likely than men to report a disability and have difficulty in performing self-care. The report also shows that women provide vital unpaid care and “form the invisible backbone of all [long-term care systems].” In the United States our direct care workforce tends to be paid low wages and receive no benefits; the majority of this workforce is comprised of women, AARP has reported. By discussing these and other such complexities, we can forge new paths for addressing them.
AARP’s Aging Readiness and Competitiveness Initiative shows that countries are in different stages of development when it comes to long-term care. While some countries with more mature systems, like Germany, work on improvements and coverage expansion, others, like Costa Rica, are still very much in the beginning stages. We all benefit from listening to new and existing strategies as these programs and policies at different stages unfold.
PAHO has shown great leadership in elevating the global conversation on the urgency of population aging, health, and long-term care. For example, PAHO developed a Plan of Action on Health of Older Persons including Active and Healthy Aging, 2009-2018. In addition, PAHO’s regional mandates deserve credit for helping lay the groundwork for WHO’s aging and health actions and strategy.
I congratulate PAHO for hosting this historic discussion and look forward to the continued collective engagement of all the participants. As AARP expands our global thought leadership, we are eager to support PAHO and WHO with our insights and resources.
Jean Accius is senior vice president for AARP Thought Leadership and International Affairs. His areas of expertise include aging, caregiving and long-term care policy.