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In this episode of the Reframing Healthy Ageing podcast, IFA’s Dr. Jane Barratt is joined by Ms. Nancy Brown, Chief Executive Officer of the American Heart Association and Co-chair of the World Economic Forum’s Global Health Equity Network and Prof. Sridhar Venkatapuram, Associate Professor in Global Health and Philosophy at the King’s College London Global Health Institute. Dr. Barratt and guests discuss the vexed topic of ensuring the right to healthy ageing for all, while bringing particular attention to how equity impacts health outcomes, access to care and prevention strategies for those with cardiovascular disease.

This podcast series is built around the fact that while life expectancy is increasing more of our lives are being spent in poor health.  Longer lives can be harnessed by increasing health span in addition to lifespan, hence the need to improve the lives of older people by protecting function and quality of life across the life-course.

We agree healthy ageing is a good thing, it supports individuals, communities, and economies. The ability for all to age in good health and well-being is something worth achieving. But why aren’t we all able to access the best health care, eat the healthiest foods, stay the most active or live in the happiest communities?

Factors such as where we’re born and live, the level of our education, gender, race, and socioeconomic status all impact various facets of health, including the ability to access care, receive health information or engage in healthy behaviors. While we agree that healthy ageing is a central priority, many are not able to access resources, services or social structures that make healthy ageing possible.

This episode of the Reframing Healthy Ageing podcast series takes a deeper look at the determinants that impact the ability to age well, the intersection of ageing and health equity, with specific attention to cardiovascular disease, and the injustices that older people face.

Understanding health equity in older people

According to the National Institute on Aging, health disparities are differences in health factors, such as disease burden, quality of life, access to care, diagnosis, or treatment, that exist among populations. Health disparities are impacted by a diverse array of factors, including age, race, socioeconomic status, geographic location, biology, and many others. Achieving health equity ensures that disparities are minimized, and individuals have the best opportunity to be healthy as they age.

To set the scene, Prof. Venkatapuram explained health equity and the specific challenges that older people face. “Our concern for health equity is trying to ensure that everybody reaches their full potential regarding their health and wellbeing. And we have a special concern for individuals that might the worst off, with an attention to social conditions,” says Prof. Venkatapuram.

Health disparities may occur because of age and older people often experience inequities in the form of discrimination, mistreatment and abuse which impact their health and well-being. The rights of older people are often de-prioritized in policies and communities, impeding their access to adequate and appropriate care or social support.

Additionally, a complex set of factors impact the ability to age well and the opportunity to grow older. Prof. Venkatapuram further explains, “For health equity among older people, what’s happened is that we have, I think, a very basic idea that somehow getting older means becoming less healthy. And getting older means somehow that we are less able to physically function. And that idea has been critiqued, shown to be not true, but nevertheless, it persists. But what we want to show, in regard to health equity is that when we look at older people, within countries and across countries, there’s remarkable differences in terms of which kinds of older people are able to do what, and how good a quality of life they have and what sort of good health they have.”

Good health in later years is possible, however it is greatly influenced by the environments and social conditions in which we live and age. There is a need to understand the specific challenges in the most at-risk groups and develop targeted solutions to ensure that all have access to a good quality of life and good health.

Cardiovascular disease as a case study

Cardiovascular disease (CVD) is the leading cause of mortality globally, resulting in an estimated 17.9 million lives each year. In the case of CVD, health outcomes are particularly influenced by social and economic status. Health equity must be prioritized to ensure at risk groups such as older people are prioritized, but also to ensure access and education on modifiable factors that play a role in preventing CVD.

Ms. Brown explains “It’s really critical that we prioritize the needs of older people who are managing cardiovascular disease, and we need to acknowledge their unique vulnerabilities to health inequities. We know that issues like access to quality health care, nutritious food, safe housing, transportation, and other resources are really critical to allow people to both manage their health and wellbeing but deal with cardiovascular diseases.  This of course impacts people of all ages, races, ethnicities, sexual orientations, but especially persons aged 65 or older, who are much more likely than younger people to suffer a heart attack to have a stroke or to develop coronary heart disease, and heart failure.”

To combat chronic diseases and particularly in the case of CVD, there is a need for investment in prevention, with particular attention to health equity, to reduce the burden of disease for individuals, families, communities, and systems. Ms. Brown explains “It’s really a shame that our governments hold investments in prevention to a different standard than investments in treatment and care. And if we could, switch that mindset, that if we could help all our populations, including our older populations, in preventing the risk of having these painful, expensive, and emotionally draining diseases as persons become older, it would be a wonderful world. We spend so much on treatment, and drugs and devices, you know, all that are necessary to help our populations live longer and healthier. But my goodness, if we could just focus on prevention earlier, we could save much of this human suffering.”

Reducing human suffering and protecting the right to health is the ultimate goal. To this end, there is a need to make the case across industries, sectors, and governments to invest in prevention and ensure equity.

Fostering multidisciplinary commitment on health equity

To advance health equity it takes a multisectoral commitment and allies in advocating for prevention and protecting the right to live in good health. It is increasingly important to make the economic case for prevention and demonstrate the importance of ensuring that all individuals can contribute to society.

The Global Health Equity Network at the World Economic Forum is one initiative aiming to promote wellbeing through systemic change. The goal of the network is to convene executive leaders to eliminate health disparities and promote equitable access to health care. Ms. Brown, who is also co-chair of the network, explains the importance of shared goals and cross-sector commitment. “I think it’s very clear, you take any critical issue that has been addressed, in the world, and it absolutely takes a multidisciplinary cross sector commitment to make it happen.  You know, companies cannot do on their own, governments cannot do on their own, people cannot do on their own. So, working together around a common unifying goal and NorthStar is really what it takes to make big social change happen. That is really, again, the way we’re focusing on this critical topic of health equity, and we believe that making sure that people know and understand both the issues, the barriers and potential solutions is really important.”

Recommendations from this episode

  • Every human being has the right to live in dignity which must be protected regardless of age, or other socioeconomic conditions.
  • Governments must increase investment in health promotion and prevention, through an equity lens, to ensure healthy ageing and reduce suffering.
  • Measures of progress are critical to improving health for all, including measurement of short-term and long-term health outcomes.
  • Shared goals and initiatives across sectors, including communities, government, civil society, and the private sector, are required to achieve reform and advance health equity.
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