A New U.N. Health Goal Targets Folks 69 And Under. Ageism Or Realism?
John W. Poole
In September, the U.N. will vote to adopt 17 Sustainable Development Goals (aka SDGs). They cover issues like poverty, health and climate change. The idea is to encourage the 192 U.N. member states to establish policies that will make the world a better place over the next 15 years.
At least one SDG is turning out to be a bit controversial.
This particular goal calls for a reduction in "premature mortality" from non-communicable diseases like cancer, stroke and dementia by half in people younger than 50 and by a third among people from 50 to 69.
What about people over 70? Shouldn't they get a shout-out?
Welcome to the under/over 70 debate.
Last week, British researchers wrote a letter in the The Lancet, accusing the "premature mortality" SDG of being "ageist."
"Imagine countries that are influenced by U.N. targets — low- and middle- income countries," says Peter Lloyd-Sherlock, a professor of social policy and international development at the University of East Anglia and co-author of the letter. "They would have to take resources away from people 70 and above [to accomplish this SDG]. I just don't quite get what's going on."
If Lloyd-Sherlock were in charge, he'd remove the phrase "premature mortality" as well as the age ranges. He'd use the phrase "age-specific mortality." People in their 50s, 60s, 70s and 80s all have different rates of death, he says, and health officials should aim to reduce the death rate in each age group.
Prabhat Jha, an epidemiology professor at the Center for Global Health Research in Toronto, thinks the critics are flat-out wrong. He co-authored the reply in The Lancet to the "ageist" letter.
First of all, he points out, there aren't a lot of people 70 and older in developing countries. "Life expectancy in low- and middle-income countries is still around 60 or so," he says. Thus, an effort to extend the life of people in the 50-to-69-year-old bracket would reach "a larger number of people" than a goal targeting even older folks.
And in his view, people in their 70s and 80s have a different perspective on disease. "At the individual level, people say, 'I want to have good quality of life until I'm old, and if I'm sick I want to die reasonably quickly and painlessly."
I put myself in the shoes of a septuagenarian and said: "If I were 71, I would feel a little bit left out by the U.N. goal."
"You shouldn't," Jha says. It's not as if people over 70 would be turned away at the clinic door. "The idea isn't to stop [treating patients] at age 69. The health system doesn't deliver aspirin just to people in their 50s." So anything done to help the 50-to-69-year-olds would be available to patients over age 70.
Jha and Lloyd-Sherlock do agree on one thing. When Britain's Telegraph newspaper wrote that the new U.N. goals would mean "elderly people [in Britain] will be treated like second-class citizens and denied medical care," well, that's just plain silly.
And maybe we shouldn't worry too much about the fate of the elderly in developing countries. Don't those places respect their elders a lot more than we do in the West?
"Nahhhh," Lloyd-Sherlock snorted. "The short answer is no."
He went on to explain that, in his view, "there's little systemic research of ageism among health care professionals in low- and middle-income countries, but there's a lot of anecdotal evidence that it's quite pervasive."
Lloyd-Sherlock notes that agencies and foundations gives lots of money to developing countries for "mother and child health and infectious disease control." The same can't be said about funding of conditions that affect older people.
"Imagine if you're running a primary health care clinic in Gambia," Lloyd-Sherlock says. "You have lots of money to do things for young people. An older person comes in suffering from urinary incontinence. That's not on your agenda."
Jha has an answer for that. With a SDG that focuses on older adults and not just mothers and children, "everybody benefits." Even people over 70.