Experts discussed the need for a culture of health, the role of the care-taker, and conceptions of retirement
For sustainable health systems we need a “culture of health”
For too long, in too many countries, promotion of health has focused on acute care delivered in hospitals. This is the most costly point of care, and if we are to support an aging society, with all the ensuing co-morbidities, we need to find a more sustainable approach to health care.
For many of the speakers and participants on the panel on “Designing Sustainable Health and Care Systems,” the answer was not an overhaul of the system or a major new innovation. “Do we need more innovation or to simply better implement what we already know?” asked one panelist.
We need a “culture of health” and a greater sense that “we’re all in it together,” posited another speaker.
This culture of health means moving away from the acute, institutional and most costly care, and investing more in “self-care”, informal care from family caregivers [see adjacent article], and community care. This includes promoting health – rather than just health care – to enable more people to live more healthily for longer. The longer we live, the more co-morbidities we will suffer; our health is not just a series of incidents which require immediate, one-off interventions, but often ongoing, interrelated conditions, exacerbated in old age by conditions such as dementia.
This investment needs to come not only from the state, but also from individuals themselves, their families, communities and the businesses they work for. Individuals need to adopt healthier lifestyles. Businesses can also help though simple measures such as installing (or in some cases, re-installing) water coolers, offering their workers a healthier alternative to sugary sodas from the vending machine. This is in businesses’ interests as a healthier workforce can be more productive and ultimately work for longer, rather than retiring early [see next article].
This culture of health needs people to also think outside of the box and include communities beyond immediate families. One such suggestion has been to train the doormen in high-rise apartment blocks in Copacabana; not only are they able to notice when Mrs. Silva doesn’t pick up her mail, but perhaps provide a link between the home and emergency care.
The “New Normal” – Who cares for our aging societies?
As we age, we face not only the question of how will we pay for our retirement and our health care, but also who will provide day-to-day care?
Traditionally this care has been provided within families, especially daughters, with elderly relatives moving in with their children in the later years of their life. However, smaller and more dispersed families means fewer people able to care for their elders. “It is assumed families should just get on and do it – but that is becoming less possible,” remarked on participant. There is a growing “care gap” with the number of people needing care far outstripping the number of people who can give care.
In the UK, as with many Western nations, if you’re poor, care is paid for by the state; if you’re rich, you are likely able to pay for your own care – but what do we do about the majority of people who are in the middle?
Even for those who are able to live with younger family members, they often remark on the sense of isolation they continue to feel, especially those who are immigrants and disconnected from the unfamiliar suburbs they find themselves spending their empty days.
Increasingly, these family caregivers are not just middle-aged stay-at-home daughters caring for their elderly parents. One in four carers in the US is a millennial, 40% are men. 22% of family caregivers are offering more than 20 hours of care with an average of 61 hours – often also working a paid job.
One option is to increase the number of people working in the care profession, especially encouraging more men into caregiving jobs, but in many countries these services are poorly regulated and workers poorly trained. As more of us need care as we age, this issue needs to be urgently addressed.
What sort of retirement do we want? And how will we pay for it?
As life expectancy increases, so too does the time most people will spend in retirement. But how do we want to spend this time and how will we pay for whatever it is we do?
“You can’t go on a cruise for 30 years, but I don’t want to watch TV every day either,” remarked one participant at the panel-led discussion “The Future of Retirement: How can Pensions Schemes Remain Viable?”
The decline in manual labor means many more jobs are suitable for people to continue working beyond 65 – an age that has “stubbornly” stuck around since Bismarck, and in most countries is not a mandatory retirement age but the age at which people can collect state pensions. Ending age discrimination and wrong-headed policies that favor younger workers over older professionals could help more people work longer, should they choose to do so. Some pensioners are finding alternative employment in the so-called “Uber economy”, driving their cars for Uber or renting out their homes or spare rooms for Airbnb.
For some over 65s this participation in the informal workplace is a way to keep busy and maintain a purpose. For others it is a necessity as their own savings or private pension schemes have proven insufficient to live on after the end of their formal job.
People are not saving enough for their own retirement. £30,000 of savings for a retirement which might last 30 years leaves only £1000 to live on. “Do we need more paternalism?” asked one Fellow; should the state intervene and take more in taxes specifically to pay for pensions? It would be a bitter pill to swallow for many taxpayers, especially in countries where 20-year-old workers are being told that their retirement at 65 and a state pension is no longer guaranteed. Greater reassurance that this support will still exist in another 40 years might help reduce this inter-generational conflict, maintained one speaker.
But knowing what plans to put in place now to deal with retirement in 40 years is tough; mortality is easy to forecast, morbidity is not. Experiments and innovations will have to continue.
The Salzburg Global session Aging Societies: Advancing Innovation and Equity is part of the multi-year series Designing a Social Compact for the 21st Century. The session is being hosted in partnership with Wirtschaftskammer Österreich and is sponsored by TIAA-CREF Financial Services and Tsao Foundation. More information on the session can be found here: www.salzburgglobal.org/go/540. For more information on Designing a Social Compact for the 21st Century, please visit: socialcompact.salzburgglobal.org
