Europe is the only region in the world whose total population is projected to shrink by 2050. The “old continent” is also ageing faster than any other region, with the number of working-age people expected to decline steadily in relation to the elderly population. A recent World Bank report indicates that this demographic trend is particularly strong in Central Europe and the Baltics, where some countries have already been experiencing a declining population since the 1990s.
According to current trends, some of Europe’s strongest economies – including Germany, Austria, and the Netherlands – could experience severe labour shortages by 2050. The strains on pension and healthcare systems could also increase substantially, as Europeans live longer than ever before.
One of the countries feeling this trend most strongly is Latvia. Due to a combination of low fertility rates and high emigration, Latvia’s population has been shrinking since 1990. Latvia’s former Minister for Health, Ingrida Circene, has argued in an article in Europe’s World that confronting this issue should be one of the top priorities of EU policymakers.
In light of these challenges, our sister think tank, Friends of Europe, convened a Health Working Group in 2013 and 2014 in order to address the much needed changes to Europe’s health systems and policymaking. The final report outlines 21 policy recommendations to improve the health of Europe’s citizens in an evolving Europe.
But what do citizens think? We had a comment sent in by Bastian arguing that, while Europeans are living longer, they won’t necessarily be healthier. Bastian argues that health risks such as obesity are increasing among young people and, in future, Europe’s population could end up older and unhealthier than ever before.
To get a response to Bastian’s concerns, we spoke to Francesca Colombo, Head of the Health Division at the OECD. How would she respond to Bastian?
The evidence we have is that, for the moment, people are living longer but in addition they’re also living in better health. So, for example, if we look at the trends for disability among the population, we see that disability among the elderly population is not getting worse, it’s getting better or staying the same.
However, the difficult part is that this applies to the elderly population of today. What happens in the future is pretty much an open question, and Bastian is right – there are some stresses, particularly with growing obesity levels. Obesity is responsible for the growth in certain chronic conditions that tend to kick off more in a middle or old age population. So, there is indeed a question mark over whether we will be able to sustain the gains not just in life expectancy but also in a life free of disabilities because of some of the challenges from the lifestyles of the population.
To get another reaction, we also spoke to Vytenis Andriukaitis, EU Commissioner for Health and Food Safety. Is Bastian’s grim scenario, of Europeans being older and unhealthier than ever before, a realistic assessment of the situation?
Will Europe’s healthcare systems be able to cope with the strain? We had a comment from Nikolai arguing that, given healthcare budgets are being cut in many countries, we may need to reduce expectations about what health systems can deliver:
Ultimately in order to support the aging populations, pensions and medical care et al., which are at the heart of many national systems, there will need to be a young working, tax paying population large enough to support all the elderly living ever longer – unless expectations on the state are reduced.
To get a reaction, we spoke to Kathrin Komp, Assistant Professor at the Population Research Unit of Helsinki University and Chair of the Research Network on Ageing in Europe. How would she respond?
Old people should not automatically be seen as a burden on healthcare systems. Many older people are also healthy and active, so more older people does not necessarily mean more frail people. Also, many old people are also contributing to overall healthcare and social care, because they are looking after their family members, including grandchildren, or looking after their partners who may need help or support. So, many elderly people actually improve the situation in healthcare and social care.
On the other hand, we might also need a different way of looking at healthcare. We might need to put more emphasis on prevention, so we start to support positive living habits in youth or middle age and we don’t bump into those problems when we people are older.
To get another response, we also put Nikolai’s comment to Francesca Colombo, Head of Health Division at the OECD. What would she say?
It’s a very timely question. It’s timely because, obviously there is an economic and financial crisis and all of the countries are facing tough fiscal circumstances, and in some countries they’ve had to cut budgets, including in health. So, obviously, there are more demands on health systems to deliver better value for money, and to deliver better improved outcomes in tough fiscal circumstances.
It’s true that we cannot expect the health budget to continue to grow at the rate it has before the crisis, where health budgets were largely outpacing the growth of the economy. It might be that countries will need to reconsider allocations between health and other parts of the economy. At the same time, spending on health and what health delivers to citizens is something that people value a lot. There is a very strong willingness to pay, and there is a consideration that health is delivering very good results and that investment is worthwhile…
We also put the same question to Vytenis Andriukaitis, EU Commissioner for Health and Food Safety. How would he respond to Nikolai?
Finally, we had a comment sent in by Rita, arguing that more public money should be invested in prevention. At the moment, roughly 3% of total healthcare budgets in Europe are being spent on prevention. Instead of spending more money on hospitals, doctors and pharmaceuticals, should we be investing more in public health campaigns, free exercise structures in parks, more bike lanes, etc? How would Kathrin Komp respond?
I would absolutely agree with her. Because research shows that many of the habits you pick up over your life will influence your situation in old age. Which means that what you do as a child and a young person can already shape your health status in old age.
So, if you want healthier older people then we need to start working towards that goal when people are children or middle aged. We need to encourage people to develop healthy lifestyles and habits, such as doing sports, being outdoors, and maybe also having healthier eating habits. That’s something that needs to start earlier, so I would definitely agree with that.
Are we ready to cope with an ageing Europe? Let us know your thoughts and comments in the form below, and we’ll take them to policymakers and experts for their reactions!