Ageing world brings health challenges
SA banks on economic growth to square the ominous arithmetic
● The department of health is confident that SA’s future economic growth will be robust enough to fund health care for an increasingly old population.
But if the stubbornly high unemployment rate persists, it is unclear how a small tax base will fund not only National Health Insurance (NHI) but the additional costs associated with an ageing population.
Many countries are feeling the strain on their health systems brought about by changing demographics that result in more elderly people and a smaller tax base of working younger people to support them.
In Japan, the estimated population fell by 264,000 last year and deaths outnumbered births by an average of 1,000 a day, according to the International Monetary Fund (IMF). This has had an impact on the labour force, which the IMF expects will plunge by almost 24-million people by 2050.
Japan is a snapshot of what is coming for many other countries, including SA.
According to the World Health Organisation (WHO), by 2050 — just 26 years after the scheduled implementation of NHI in SA — there are expected to be 2-billion people aged 60 and older in the world, compared with 900-million in 2015.
The dramatic increase in the ageing population is narrowing the time left for countries to adapt.
France had almost 150 years to adapt to its changing population, with the percentage of people over 60 taking that long to grow from 10% to 20%. But countries such as China, India and Brazil will have only a little over 20 years to witness a similar change.
The WHO also notes that though this ageing population shift started in high-income countries, it is now low- and middle-income countries that are going through the biggest change. Eighty percent of the world’s 2-billion elderly will be found in these countries by 2050.
SA’s population is 57.73-million, according to the 2018 midyear Stats SA estimate. Children aged younger than 15 years account for 29.5%. People aged 60 and older account for 8.5%. But Stats SA notes that the proportion of people above 60 is increasing.
As people grow older, they require increased levels of health care, especially in managing and treating noncommunicable diseases such as strokes, hypertensive heart disease, cancers, depression and dementia.
The health-care needs of the elderly are likely to increase the burden on younger taxpayers.
And with SA’s unemployment rate at 27.2%, this poses a steep challenge. The NHI will also have to factor in the disease burden that comes with an ageing population.
The NHI bill has put mandatory tax contributions on the table as a source of funding, but this will depend on how much the tax base grows.
Dr Anban Pillay, deputy director general of the NHI, said: “We anticipate that with the economic growth that SA will experience, by the time we get to people living 10 to 20 years longer than they are currently, we would be in a much better place economically in terms of being able to finance health care.”
Pillay said countries that have universal health care are generally developed countries with the benefit of higher economic growth than SA has.
The widespread roll-out of antiretrovirals in SA had resulted in people living longer, but the mortality rate is still not at the same level as Europe, he said.
Speaking at a recent Hospital Association of SA conference, Marjorie Ngwenya, immediate past president of the Institute and Faculty of Actuaries, said people would have to consider how they would manage their health and finances over longer lifetimes. Policymakers will face the challenges of providing care for the elderly and changing employment practices.
This will happen “as governments look for new ways to restructure spending to meet the evolving needs, demands and expectations of a changing population”, Ngwenya said.
She said the prevalence of disabilities in people aged 65 to 74 is almost 45% and the rate grows to more than 84% among those aged 85 and above.
Older adults, said Ngwenya, constitute the world’s only increasing natural resource, but cognitive decline such as dementia is also prevalent in people who live longer. This presents a challenge since it robs them of the ability to make critical decisions.
Although Sub-Saharan Africa is likely to see only 10% of its population live to 65 and above over the next 30 to 50 years, SA’s government should be using this forecast to plan.
This is because an ageing population presents a raft of problems, including a reduced labour force and increased health-care costs, she said.
Ngwenya said the WHO estimates that about 38% of South Africans between 65 and 74 already struggle to eat, bathe, dress, use the toilet and get in and out of bed independently. She said about 7% of SA’s elderly suffer from dementia.
Based on the Stats SA estimates, life expectancy at birth for South Africans is estimated at 61.1 years for men and 67.3 years for women.
For the South African Medical Research Council, the national strategic plan for noncommunicable diseases needs to be operational in all provinces to avoid the ageing population putting strain on the health-care system.
“Early detection of disease and management of disease will result in reducing the complications from living with a noncommunicable disease.
“In short, we need to invest in the health care of South Africans now to have gains in the future — both financially and in terms of health status.
“Apart from health care, addressing the social factors that contribute to poor health will also contribute to reducing the disease burden.”