Prospects, strategies and consequences

The 20th century rise in life expectancy is one of the great successes of public health, but has contributed importantly to the aging of western populations (Caselli & Vallin 1990; Wilmoth 1998). Aging poses great challenges to the modern welfare state, not only by threatening the sustainability of pension systems but also by inducing a greater demand for social services, including health care (Lubitz 1995; OECD 2006). There is an urgent need for developing strategies which can help to alleviate the societal consequences of the aging of populations. Unfortunately, the ill-health which tends to accompany aging is often seen as an ‘independent variable’ only, leading to higher rates of morbidity, work disability, and demand for health and social care services.

There is good evidence to suggest that many manifestations of ill-health at advanced ages are amenable to intervention, e.g. prevention by lifestyle improvement or early detection, treatment by drugs or surgery, and functional rehabilitation by training and devices (Fries 1989; Vita et al. 1998). The health care system should therefore not only be seen as part of the problem, but should be used to become part of the solution. Developing a strategy to alleviate the societal consequences of aging of the population is not an easy task, however.

The main challenge is to delay morbidity and/or its consequences (functional decline, disability, dependence on health and social care services, …) until a later moment in the human life span (Fries 1980; Fries 1989). Such a ‘compression of morbidity’ will not only have enormous benefits for population health, but will also help to increase labour force participation among the elderly (which is essential for the sustainability of pension systems), and to reduce health and social care costs (Lubitz et al. 2003). It is currently unclear which health policy strategies will be effective to achieve a ‘compression of morbidity’. This is mainly because of the complexity of the relationships involved (e.g. many effective prevention programs will not only reduce the incidence of morbidity but also that of mortality, so that the net effect on years lived with morbidity is not immediately clear (Nusselder 2000; Franco et al. 2005)), and because data on these relationships which have become available in large-scale epidemiological studies have not yet been adequately analysed.

This Netspar theme aims to contribute to the development of health policy strategies which will, through a ‘compression of morbidity’, help to alleviate the societal consequences of the aging of populations. It brings together expertise from a range of disciplines which are all required for addressing these issues (public health, epidemiology, demography, health care policy and management, economics, econometrics, …). It will make use of the unique datasets which are available in the Netherlands, and which have hitherto not been fully used to answer these questions (epidemiological cohort studies including the ERGO study in Rotterdam and the GLOBE study in Eindhoven, as well as linked registration data in Netherlands Statistics ‘Gezondheids Statistisch Bestand’ ). Finally, it will use mathematical modelling of population health as an integrative device to link the various components of the theme.

Its main objectives are:

To identify entry-points for reducing morbidity and its societal consequences in aging populations.

To explore the potential effects of health policy strategies on morbidity and its societal consequences in aging populations.

To develop innovative approaches to financing of health care and pension systems which help to alleviate the societal consequences of the aging of populations.