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Posts Tagged ‘older people’

And it looks like we are losing the battle. According to “Healthcare expenditure statistics” from Eurostat, “[The] highest share [of total healthcare expenditure] of current healthcare expenditure [related to preventive care] in 2014 was recorded in Italy and the United Kingdom (both 4.1 %), while at the other end of the range, shares of less than 1.0 % were recorded in Romania (0.8 %) and Cyprus (0.6 %).” At the other end “curative care and rehabilitative care services incurred more than 50.0 % of current healthcare expenditure in the vast majority of EU Member States”

It may be that this is the right balance, but allow me to doubt it. And my doubts grow as I focus on the demographic change taking place in Europe. The baby-boomers are getting older and we are not doing anything about it, despite the fact that it is probably a generation ready to embrace a healthier and more active life than previous older generations.

I have been wondering, since I started working for the healthcare and social sectors, why it is that prevention does not get the attention of our policy makers.

Many explanations come to mind. Of course, simply saying “they are stupid” is the easy one but I refuse to fall for it. I strongly feel that anybody who has attained a position of responsibility may have many faults, but being stupid cannot be one of them; they would never have reached that position of responsibility.

The urgency of solving the immediate problem may be one of the reasons; after all, if somebody has an acute illness something urgent has to be done. It is a plausible explanation but, if that were the case, policy makers would never plan for the future building new roads or housing developments since they would be too busy repairing the existing road network or the old houses in inner cities.

I am afraid that highways are built because they make the news. I am afraid that most of the things that our policy makers do are geared towards a 30 second appearance in prime time national TV news. If that assumption is right, then it is clear that the opening of a new hospital (curative and rehabilitative care) is a better news item than the establishment of a prevention scheme that does not require any new buildings, or any new expensive and photogenic equipment. It requires only brains and hands, probably the least photogenic tools of the healthcare process and, probably too, the most ignored by policy makers.

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I was invited by The Economist to attend their conference on Ageing Societies, held in London (UK) during the 29th and 30th of November. I will not pretend to summarize one and a half days in this short post. I will try, nevertheless, to bring out those three interventions and a message that, to me, were more relevant.

Let´s start with the message. I have been involved with ageing for a long time. My first public intervention was at the London School of Economics in March 2011 although, previously, I attended the AAL Forum at Odense in 2010. Since then I have focused the problem on “older people”. No wonder, since I have worked with several hospitals dedicated to the rehabilitation of older people since 2006. Ten years make a mark on a person. So, the first realization was that at the conference we were not talking about “older people”; we were talking about “Ageing Societies”, which is completely different. The world population is ageing; from Asia to Europe and America and even in Africa. Societies are ageing. The socio-economic infrastructure was designed to care for a nice population pyramid, not for a population cylinder or, even worst, an inverted pyramid. Accordingly, we have to redesign the socio-economic infrastructure in general and the care infrastructure in particular so as to be able to handle an Ageing Society.

John Beard´s presentation (from the WHO) was a masterpiece introducing the importance of health care for the future of our societies. His presentation, based on the “Report on Ageing and Health”, highlighted two important aspects that we tend to forget. One is that older people are diverse. Probably because we are used to giving certain benefits linked to age, for example free entrance to museums or cheaper public transportation for over 65s, we put everybody over 65 into the same category. Of course this is not real and older people have very different functional capabilities. This was the second aspect. The category used to guide our efforts in dealing with an ageing society should be functional capability. The above mentioned report states that “burdens of disability and death arise from age related losses in hearing, seeing and moving, and non-communicable diseases”. So, it is my interpretation that we should move from focusing on age to focusing on those disabilities that hinder our functional capabilities. And it should be noticed that those kinds of disabilities do not come only with old age. They pop up at any time; how many young people need glasses?

It was mentioned by someone during the Focus on Asia interview that “the problem in an ageing society lies with the young people in their 30s”. Natalia Kanem (from the UN Population Fund) expanded on the same idea, and more. She introduced us, through the “The State of World Population 2016”, to the fact that “investing in 10-year-old girls could yield huge demographic dividends”. It all boils down to the same idea: prevention is the key to a successful design of our ageing societies. It is my belief that, unless we invest in our youth now, our societies are not going to be able to cope with the on-going demographic change.

And finally, the last intervention that I would like to bring to you was about breaking silos. When talking about ageing and its related problems, there is a part of society which focusses almost exclusively on social and health factors. There are also other professionals that focus exclusively on economic and financial factors. To my knowledge, very little has been done to bring those two worlds together. And a token sample of that lack is the composition of the speakers in the panel: both of them were from the financial sector with no representative of the other silo: the care sector. Nevertheless, the point was made: silos have to come down and the financial aspects of an ageing society have to be intertwined with the care aspects. So far their courses have run parallel. Now they should start running together.

I could summarize that tackling the problems of our ageing societies needs an intervention in our youth of today, fostering the development of their own functional capabilities in a holistic way, combining the socio-health-financial aspects of every human being.

And this is my summary of one and half days of a very intensive and interesting event.

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e-Health has been around for a long time; we could even say it is an old feature in today’s world. But yet, who is really using e-Health today? Do you know of a friend, a neighbor, a relative using any of the many gadgets that are part of e-Health? Don’t focus only on the internet, that is not e-Health by itself. The internet provides information, albeit a lot more information than what we used to have at home. Certainly a lot more, and up-to-date, than the classic “Our bodies, ourselves” which probably a lot of my readers haven’t even heard about and that, by the way, has moved to the www.

Let´s go through the process that has brought us to this point in the history of e-Health. The first push came from the R&D organizations. More specifically, the European Commission, through its many R&D programs, has been financing research for years into what we know today as e-Health. Millions of euros have been lavished all over Europe to make e-Health a reality. As always, in the USA the private sector has been the driving force behind this endeavor. The result is a myriad, I could safely say even a milliard, of what is known as Personal Health Systems and other types of gadgets and integrated e-health systems.

The second lever for securing a wide permeability of e-Health is the people, i.e. the patient or the primary user. The use of ICT technology by the population is increasing by leaps and bounds. The older population, probably the strata that could most profit from the use of ICT tools to maintain their living standards, is changing radically. There is very little in common between the older population of today, and the future older population coming out of the baby boomers of the post-war. A recent study in Spain by Fundación Telefónica reveals that the population older than 55, is using internet for productive proposes (e.g. banking or filing taxes) at the same level as the rest of the population. And it is in these population strata in which the use of smartphones applications is having the biggest boost.

The secondary end user, the socio-health professional, is obviously an important lever for spreading the use of ICT socio-health applications. Although maybe a little dated, PwC released a study in 2012 on m-Health concluding that “Healthcare’s strong resistance to change will slow adoption of innovative m-Health”. A closer look at the study reveals that it is the skepticism of the professionals that hinders the extensive use of m-Health in particular and e-Health in general. Because I believe that unless professionals prescribe e-Health gadgets with the same confidence that they prescribe today a medicine or a treatment, e-Health will not take off.

But for that to happen, the fourth lever has to act. This is no other than the socio-health care system; in Europe led by the public sector. It is very telling that while one branch of the public sector is pouring money into R&D, the other branch is simply ignoring the fact that ICT tools could save a lot of money in taking care of the socio and health ailments of the population they are covering. Is it so difficult for the politicians responsible for R&D and those in charge of the socio-health system to talk to each other? Apparently so, but I would appreciate your views on the subject so that among all of us we could find a path to a better and more e-Health world.

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I have borrowed the title of this post from an article in the leading Spanish paper El País[1]. It reflects something I have been asking myself since the beginning of the actual crisis and, till now, I haven’t found an answer. Why? Of course there is always the excuse that we have the leaders that society deserves, but that answer is too sad to make it part of my outlook on life.

The challenges facing Europe, and (for that matter) a good part of the developed world, are well known. The most relevant is the demographic change that will make Europe, according to some apocalyptic analysis, a kind of geriatric ward. Following that analysis, the working population will not be able to sustain the increasing mass of retirees. Since older people are the main drivers of care costs, the only solution is to reduce entitlements linked to retirement as well as care benefits.

A clear and easy solution:  let´s cut costs by rationing the expense linked to those pillars of the welfare society that was built, precisely, to overcome the ills of a rapidly changing society in the aftermath of the II War World.

Looking back, Europe was able to manage a similar demographic change when, in the 60’s, the working mass was able to pay for the health and education of an outpouring of new born kids –the baby boomers-. Maybe it was because the extra hands needed for paying for that were allowed to migrate, so that Europe could take advantage of the surplus labor of other countries; just the opposite that certain populist leaders are suggesting these days.

But of course, those were different economic times. Europe was devastated and the needs of the reconstruction created a demand and subsequently an economic bonanza. Today there is no bonanza; as a matter of fact our very non-intelligent leaders have been able to create not one, but two economic crisis in a row. That was quite predictable. If the main “customer” – that is, the State – responsible for 49.4%[2] of the national demand drastically reduces its level of expenditure, what could the result be other than a recession?

And why? Because in their narrow mindedness there is only one mantra: ration. They think, and are proud of saying out loud, that they are like a “good housewife”; they spend only what they have. But I don´t want a “good housewife” leading my country, or any other country! A country is by far more complex than my house, than any house! Leading Europe in such simplistic terms is what has brought us to this sorry state. We need leaders capable of transforming our society, not a bunch of nerds in a position of command, blaming “Brussels” for all ills, hiding the fact that “Brussels” is them.  What comes out of Brussels is their collective will: if you put rubbish in, rubbish comes out.

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Last year an official at the Ministry of Health from the UK, addressing a conference on business developments in technology for disabled and older people said, “I see more pilots in this gathering than in British Airways”. And yes, he hit the nail on the head. For some reason, most developments financed under the AALJP, or for that matter under any other EU program directed at ameliorating the living conditions of older people, have foundered and have never gotten off the ground.

Why is it that most of those ideas that have been found valuable, not only by their promoters but also by the EU agencies in charge of selecting them, have not made it to the market? Why haven’t they become success stories?

The obvious answer can be found in their faulty business models. Answering the typical questions of “What is the real need?”, “How big is the need?” or “Why should this particular product or service come on the market” do not serve our purpose of achieving a successful business model.

“What is the real need?” and “How big is the need?” focuses obviously on needs, and let me say that one thing is “need” and a very different thing is “demand”. People are ready to pay for their demands, whether these correspond to their needs or not. In the marketplace only products or services that meet a demand will have a chance of success, regardless of the real needs of the population to which the product or service is directed.

“Why should it come to the market?” surreptitiously means that there is already a product or service, and we will look to the market for the possible demand. It is a top-bottom driven question. Our investigation should be bottom-up driven. What we should be doing is to ask first what the market demands are and, only then, investigate how to meet the demand with a product or service.

There is a second problem. Most of us assume that the public purse is going to foot the bill of a product or service directed at the older population. This is based on the belief that we can demonstrate that, for society as a whole, our solution is cost effective. What we really mean is that our product or service will save health care services, social care services, families and individuals huge amounts of money and/or time.

But really, who is going to pay? The health care service, the private health insurer, the municipality in charge of social care, the family, the individual, an NGO, who? Because the truth of the matter is that each of the previous possible payers has an independent budget. Why should, for instance, a health care service foot the entire bill for something that is going to save money for the social care services of a municipality that may even be governed by a different political party?

Out of the previous list of possible payers, there is only one that is going to benefit in full from our product or service: the individual. He or she is the only one paying the bills anyway, through direct payment, indirectly via taxes that finance public services, or by premiums that pay for private insurance care schemes.

There is another group that could benefit from a product or service designed to meet the needs of older and disabled people. It is the vast array of providers that cater for them. We are referring to shops, restaurants, entertainment, transportation, and the like. This group, mostly SMEs, could profit by establishing a special bond with the world’s ageing population.

The point is that, given that individuals are the end users of our services and products, we have to be brave and recognise that they will have to pay for it directly or indirectly. If, on top of that, a broad base of providers can benefit from the result of our investigation, we will have the support of other actors interested in paying for their use. Put together the interest and demands of those two big target groups and you will have a success story. That will be the moment to address a simple question “How much would you pay for this?” Needs and cost for the end users and providers, kept in balance, should be at the core of our development strategy and of our business model.

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