Friday interview: Alexandre Kalache, head, Ageing and Life Course, WHO, Geneva
Alexandre Kalache, WHO, Ageing and Life Course programme
International Day of Older Persons is 1 October.
This is the second in a series of articles on aging. Kalache and others were interviewed during the World Ageing & Generations Congress at the University of St. Gallen, Switzerland, 26-29 September.
Getting older is nothing to sneeze at, especially as so many of us are doing it.
The facts are startling: 600 million people in the world are over the age of 65 today, but by 2025 that number will double. The challenges faced by policy-makers everywhere are difficult and the World Health Association is no exception. How, in the face of such a large older population, will the world be able to cope with health care needs?
Alexandre Kalache is head of the Ageing and Life Course Programme at the WHO. His manner is energetic, quick and straightforward, as is his answer: improve primary health care. He wants to see people growing older while remaining as active and energetic as possible. He is a good advertisement for an active life for people over 50: Kalache looks like he is under 40, but he mentions inching towards retirement and the now-obligatory retirement age of 60 in the United Nations system, which leaves many people who want to be active out of work.
He points out that 95% of all older people (the UN and other organizations often use age 60 for the line) live in communities out in society rather than in institutions where health care is provided. "Aging issues are not just about geriatrics," he insists. "It's also grief when your children leave home, and it's menopause, for example." The medical community needs to focus on helping people earlier.
"Even if everything is done right, with age you become more vulnerable," he says. The goal therefore must be to help people "optimize opportunities for maximum health in order to be sure they are not excluded." Once they reach that point, health care systems must be able to support their needs.
This is more than just a message about preventive health care. Society must ensure that primary health care givers are better trained to take a holistic approach to patients, says Kalache. This is a problem all countries share: it is equally true in places with socialized medicine, Britain and Canada, for example, as in countries like the United States and Switzerland, with private systems.
Kalache, who is Brazilian, studied for his medical and advanced degrees in the UK. He became interested in aging issues while working on a masters degree in social medicine at the University of London, then wrote his PhD thesis at Oxford on breast cancer epidemiology.
"Let me talk about Britain, which I know because I did my studies and practice there, and my research there. General practitioners, GPs, are often seen by young people going into medicine as somewhat second-grade - they are not specialists like neurologists. Also, doctors go into general practice with the idea that they will be treating babies, young children, mothers expecting babies. Healthy people.
"In fact, the reality is that they have virtually no training to deal with the health problems we have. They don't know how to deal with adolescents or men - we don't know how to talk about health problems because we are supposed to be so macho!" and Kalanche's easy laughter surfaces.
Countries share the problem of inadequate training, but they differ widely in the way they spend health care money. In a country like the US, where 15% of GDP goes for health care, says Kalache, more money goes into the high technology end and some of the world's best medical services may be available but "the outcomes, all the indicators for health [life expectancy, infant mortality, for example] show huge inequalities."
Reports this week, based on US federal forecasts, show this could climb to 20% of GDP in the United States in the coming decade. The media in the US reports frequently on the injustices of the system and the number of uninsured Americans.
In Britain, on the other hand, people might complain about the length of time it takes to receive services or that some parts of the country or certain diseases receive more money but, he notes, "You don't even know what it is to be insecure about your health."
Britain spent 8.6 % of GDP on health care, of which 7.1% was public spending for the nationalized health system.
Alexandre Kalache, head of WHO aging programme, Geneva. Photo, Augustine Saleem.
The WHO organized, with other UN agencies and health care groups, the first Year of Older Persons in 1999. Three years earlier Kalache was active in organizing a huge Global Embrace of Active Aging event with 3,700 cities throughout the world participating. Rio di Janeiro, Brazil and Geneva, Switzerland, served as the models. The Copacabana, which is a stretch of beach in Rio, had young musicians at one end and older ones at the other, to show that active aging starts young. Brazilians were invited to walk, run and dance their way from one end to the other. The beach's 4km correspond to the distance a person needs to walk daily to maintain good health.
Geneva's events were organized by a group called Gina, for Geneva International Network on Ageing. If the name reminds you of the most beautiful and very active older woman in the world, that is no accident. Gina today promotes active aging and policy debates, while one of its most important activities is providing a network for this cross-disciplinary field.
Policymakers need to encourage active aging by ensuring good primary health care, Kalache insists, but they also need to reinvent "retirement" which should not be limited to retiring from active life. "Here in Switzerland we need to have four pillars," he says. Three already exist: AVS, company pensions and the option to have a third or private retirement fund.
The fourth pillar, which would be a strong encouragement to healthy, active aging is work. Let older people who want to work do so, he says, smiling broadly at the idea of reinventing himself once he retires, something which research shows a growing number of older people would like to do.
Coming next in the series of article on aging: how AARP, an American group with 37 million members over the age of 50, is changing the face of old age in the US.