“Who’s Left Behind?”: The Need to Recognize the World’s Ageing in the Sustainable Development Goals

Thursday, May 19, 2016
by Andrea Rishworth

Headshot of Andrea Rishworth in front of living wall in EV3
The newly implemented Sustainable Development Goals (SDGs) cover an impressive, yet controversial, 17 goals and 169 targets. With such breadth and diversity one could assume the majority of the world’s priorities would be recognized. Touted as goals that will “leave no one behind,” they ironically do just that. Who are they leaving behind? The world’s ageing population.

Recognized as a global megatrend with far reaching implications, blatant disregard of ageing populations in relation to sustainable development is cause for concern. With such apparent neglect, the United Nations seems to suggest that development strategies will be able to promote and meet such ambitious targets without considering the largest growing global demographic. While this ageism is not new to global policy, the new SDGs continue to perpetuate the Millennium Development Goals’ institutionalised marginalisation and discrimination against older people.

By 2050 there will be two billion people over the age of 60, with 80% expected to reside in developing countries — particularly sub Saharan Africa. The SDGs barely mention this changing demographic, merely lumping elderly in the category of ‘vulnerable’. This does little to suggest healthy active ageing but further perpetuates stereotypes of the feeble and weak. With such a large demographic expected to grow, one could surmise the goal to “ensure healthy lives and promote well-being at all ages” would include specific targets for ageing societies. While the health of ageing individuals can possibly be alluded to in target 3.4, they fail to directly mention ageing in any target.

Perpetual ignorance on this issue will have extensive repercussions. Some see worldwide population ageing and its impending burden on public health systems as a threat to worldwide economic stability. With increasing ageing populations, more individuals enter retirement and rely on government social security and pensions to provide support and assistance. This has led to controversial policy changes, such as curtailing costs of old age security pensions while severely undercutting health care transfers for this demographic. Ironically, this is one of the most vulnerable populations in need of health care services. 

Because longevity is increasing, non communicable diseases (NCDs) are now the leading cause of death worldwide (61%) and are projected to increase, with most occurring in low-and middle-income countries. Since chronic diseases are strongly linked to population ageing, disorders with a strong age dependent relation will increase in prevalence, parallel to growing numbers of absolute and relative older populations. This increase will inevitably lead to growing rates of NCDs further straining health systems.

 Significant investment has been made towards improving the health of this demographic, but results are inconclusive as to whether health expectancy has improved. Due to systemic neglect of ageing populations in health research, measures of health expectancy are limited in their ability to accurately reflect the health of this demographic, often revealing marked variation between self perceived health, disability and cognitive impairment. While Jagger et al. (2015) reveal improved self perceived health, Falk et al. (2014) found increased longevity corresponds with heightened disability. This leads one to wonder while longevity is increasing, are our later years spent in good health?

Answering this requires taking a broadly constructed approach to improve and measure health. While we may be living longer, there is a need to balance longevity with quality of life. Norman Cousins said, “Death is not the greatest loss in life. The greatest loss is what dies inside us while we live.” While populations are ageing, their desires, experiences, and understandings of health need proper consideration. With twenty-three references to young people and children in the SDGs compared with only three for older people, critical engagement is needed to make explicit policies and targets for this changing demographic.

In 2002 the Madrid International Plan of Action on Ageing called for the elimination of social and economic inequalities in access to health care for the needs of older people. Still, vehement age discrimination pervades global priorities. This raises questions about precedence and whose life is of value. Who counts? Is it a child who has their entire life to live and contribute to society or an individual in their later years? Upholding human rights requires recognition that all are entitled to live ‘free and equal in dignity and rights’ independent of age. Ghandi stated “A nation’s greatness is measured by how it treats its weakest members.” Global policy and national responses to ageing reveals our perpetual avoidance of ageing. We must accept ageing as an inevitability of life. This neglected agenda must be brought to the fore to alter the engrained age based, age blind policies so no one is left behind.