Global Health and Healthcare Issues: Global Health of the Older Adult

Increasing the human lifespan is one of the greatest achievements of the 20^th century. Such an increase became possible due to a variety of factors. Thus, in developing countries, the reduction of infectious diseases and a sharp decrease in child mortality have played a major role. In large-income states, the increases of lifespan are attributed to declining mortality among senior people. The extent of older people’s contribution in society highly depends on their health. Constant declines in physical and mental abilities can severely limit seniors’ abilities. Longevity accompanied with a good health is one of the ultimate priorities of medicine and health protection. Considering trends in the modern world, people aim to reduce mortality, morbidity, and disability levels across the world.

According to the United Nations (2015) report, “between 2015 and 2030, the number of people in the world aged 60 years or over is projected to grow by 56 per cent” (p. 2). At the same time, the World Health Organization (2015) has defined an ‘older person’ as someone “whose age has passed the median life expectancy at birth” (p. 230). This trend is global since the percentage of the older people in the total population increases worldwide. Nevertheless, the process of aging is more distinct in developed countries, where the quality of life started a rapid growth more than a century ago. The extent of aging in some way depends on the financial development of the country. For example, according to the United Nations (2015) report, “Older persons comprised 22 per cent of the population of high-income countries in 2015, 13 per cent of upper-middle-income countries, 8 per cent of lower-middle-income countries and 5 percent of low-income countries” (p. 27). The global aging is the result of the changing fertility and mortality numbers. Moreover, “Economic and social rise, popularization of sex equality and family planning facilitated to reduction of birth rates” (United Nations, 2015). Nevertheless, the disability-free life expectancy grows slower than life expectancy in general, which creates the issue of increasing the need in medication support, primary care, and the treatment of chronic illnesses.

Poverty is another factor that contributes to old people’s health deterioration. In African and some Asian countries, low living standards largely impede the healthcare process; consequently people lose their health because of an inadequate supply of drinking water and poor levels of hygiene. At the same time, poverty rates among older people in relation to other groups can vary largely too. For example, “in most countries in Northern and Western Europe, poverty rates among older persons are lower than for the overall population… In Eastern and Southern Europe, older persons tend to be less poor than average” (United Nations, 2015, p. 71).

Medical workers have documented that some groups of people suffer more from particular illnesses and diseases, and this phenomenon is called health disparities. One of its reasons is the poor integration of this group into the healthcare system. These groups can be shaped based on such factors as language, ethnicity, sex, age, citizenship status, etc. Moreover, the mentioned characteristics are not mutually exclusive. The direct reasons of these disparities could be the absence of insurance coverage, the low quality of medical services, or biological predispositions, but they have numerous contributing factors. These can be biases, cultural, language barriers, financial policies, or properly adapted laws. Health care disparities cost much because of the resulting loss of working productivity, additional costs, and premature death. For example, according to the World Health Organization (2015), the American Indian population and Alaska native population are approximately twice more likely to suffer from Type-2 diabetes than non-Hispanic white people. If large ethnical or age groups suffer from the burden of similar diseases this can negatively affect the level of integration of this group in society. The importance of coping with health disparities lies in the human basic rights for effective care regardless of any racial or cultural characteristics. Moreover, if these groups of people are not treated properly now, the government will be obliged to spend much more money on coping with pandemics that could be provoked by such policies. Finding a solution to the problem requires its proper examination and the development of some strategies. For example, the risk reduction policy of the Centers for Disease Control and Prevention have ensured the reduction of STD-risk behavior among the people of Hispanic origin. Appropriate initiatives should address disparities at all levels, from federal and state to community and health service providers. Thus, health disparity elimination is one of the goals of the program Healthy People 2020.

Healthy People 2020 is the wide government program, developed not only to achieve particular medical goals or general health care improvement but also track the goal to create a social environment, promote the quality of life and healthy behavior. The first Healthy People program was introduced in 1979 with the aim to reduce controllable potential health risks.  One of the distinctive features of this program is gathering socio-demographic data related to healthcare and publishing it on the Internet. Various information about income, age, gender, education, and race helps detect health disparities and take steps towards their elimination. Data collecting is combined with data sharing, one of the goals of this program is to increase the public awareness of the reasons and consequences of diseases, the opportunities to maintain one’s health, and achieve the progress in recovery. One can monitor the program’s execution by means of regular reports. The program’s performance is measured with the help of Leading Health Indicators – important health issues that, if eliminated, will reduce the levels of illnesses and diseases. According to the report presented by the US Department of Health and Human Services (2014), 53.9% of LHIs have shown positive trends or achieved their targets. In particular, injury-related deaths (age adjusted, per 100,000 population) reduced to 57.1%, while the percentage of adult people getting colorectal cancer screening has increased up to 59.2% (U.S. Department of Health and Human Services, 2014).

The moral aspect of aging as a phenomenon also should not be omitted. Under the influence of observing their aged family members and neighbors, people often develop a prejudiced attitude towards the elderly. Many people can notice changes in their relationships with parents or grandparents and explain such an attitude by the influence of aging. A negative past experience often plays the role of a foundation to the biased attitude towards the older people and even contributes to the rise of ageism as a new type of discrimination. Like any type of discrimination, this one is based on myths and misconceptions, while the existence of such a phenomenon in the 21^st century shows once again the need in a proper education for the general public and, especially, for healthcare workers. 

The ethical and moral problem of medical errors is also acute. Not only can these errors influence a single patient in the case of wrong medications prescribed or an inappropriate performance of healthcare workers, but also even large groups of people might suffer when the hospital’s staff failure to sterilize medical instruments in a proper way. People have the right to know the truth, but the disclosure of medical errors can lead to the violation of trust towards the healthcare system, which in turn might cause the deterioration of the population’s health level. Any mistake must be investigated, and particular measures should be taken to ensure that these errors never happen again.

There are plenty of discussions around the ethical sides of palliative care and life-sustaining treatment, substitute decision-making, and waiting lists. Medical authorities definitely should not ignore these issues, and, therefore, an extensive social agreement is required. The majority of the population in any society is healthy, and people often have misbeliefs that they will be healthy all the time, while serious illnesses will happen to someone else. Such misconceptions can cost not only much money but, unfortunately, many lives as well.

Health care productivity can be estimated as inputs related to outcomes. Inputs can include financial and physical resources, labor. The treatment of a specific disease can be counted as an outcome. Healthcare can be perceived as the production process. Therefore, governments have two ways of improving the healthcare system by raising spending and by improving the productivity of it. Additionally, the allocative efficiency cannot be equal to the productive one. In other words, the state can effectively use limited money but provide a very low level of healthcare to the population overall. Traditionally, medicine is perceived as the low productivity field. In medicine, care can depend on one’s attention, which puts the quality of this service at risk. Care and the development of the interpersonal connection between a doctor and a patient have a high value, but they can be barely measured. In reality, for example, the productivity of a physician would be measured by the number of patients seen. The speed of service is valued as well. At the same time, the concierge type of physicians, who usually see fewer patients per a working shift, spend more time with each one of them, which results in better patient outcomes. The Physicians Foundation’s data shows that patients, who have been serviced with the concierge-type of medical practice, experience 70% less hospitalizations while having quite high (92%) renewal rates. If one were to make the most effective investment, they should pay attention to the preventive care because it is cheaper to prevent an illnesses than treat it.

The global aging has contributed to distinguishing the gerontological nursing a separate field of medicine. A specialized education is essential because the elderly people are more likely to have some chronic health conditions such as cardiovascular diseases, diabetes, or dementia. Moreover, one’s drug metabolism can change with age. Gerontology studies the biopsychosocial aspects of aging, and it has social, financial, rehabilitative, psychological, and others sub-fields. A gerontological nurse should be more than just a nurse with the enhanced knowledge of older people. Such a nurse should be in some way a teacher, sometimes, a manager, or even an advocate to promote the interests of a patient. Nevertheless, the nurse should not forget about being a care provider. For instance, health promotion is an inalienable part of treatment. Many diseases can be prevented with the help of changing one’s nutrition habits, increasing physical activity, and quitting smoking. Therefore nurses should have all necessary skills to prepare valuable information and present it in a digestible format. The other side of being a gerontological nurse is a constant balance between patients, their relatives, nursing, and the team of coworkers. In this case, such skills as leadership, time management, and communication may be useful. At the same time, the nurse should support the patient`s autonomy in decision-making since the patient should have the possibilities to exercise their political rights. Explaining medical procedures or helping to choose the best nursing home is common for the gerontological staff. Nurses should not forget that they ought to be always familiar with the latest scientific literature, provide ideas to clinical researches, and foster their apprenticeship. The participation in specialized seminars, obtaining certification, and being a research consumer will improve the quality of care sufficiently. A current situation requires the increase of gerontological compound in nursing educational programs and providing access to extra education, such as specialized courses or certification for general nurses, as the provision of care to the older people has all chances to became a core nursing activity in the nearest future. 

The term ’old’ can be associated with a variety of meanings. According to the report of the World Health Organization (2015), aging can be viewed as “a biological process whereby accumulating molecular and cellular damage leads to gradual deterioration of function over time.” Moreover, some 80-year-old people possess physical and mental states as high as in their 20s (World Health Organization, 2015). At the same time, many people have all chances to experience a serious decline with age. They will require any help to perform basic activities. Therefore, appropriate policy responses should focus on both large groups of older people, thus preventing any polarization between the perspectives of ageing.

One the one hand, the old age can be seen as the period of vulnerability and the decrease of activity. Based on this perspective, the decline in health seems inevitable, and the care of old people is portrayed as the one that demands huge medical resources. On the other hand, society can emphasize the importance of a social engagement in the senior age. It is possible to overcome stereotypes and create society that is capable of accepting the older people`s contribution. Although many people continue to develop as a person, some disengage. Some possess satisfactory and good health, but others require a substantial care. Therefore, the framework of healthcare should be relevant to all categories of older people.

However, the reason of such a diversity remains disputable. Moreover, it seems random only from the first glance. Despite the issue of genetic inheritance, much is driven by the factors that arise from one’s physical and social environment, which can have a direct effect or it can be achieved through the incentives and limitations that affect behavior and decisions. The impact of the family one has been born into or their ethnicity can lead to health inequalities, which can be avoided.

 Again, the report of the World Health Organization (2015) states that, “by the age of 60, person risks to experience losses in hearing, chronic respiratory disorders, pressure problems.” However, the presence of some heath conditions has a very low influence on one’s life. With the help of medications, it is possible to control the blood pressure; people with visual impairment can regain a full functioning with the help of contact lenses or glasses. At the same time, some chronic conditions can cumulatively influence a person.  Moreover, each illness could have its own trajectory of development, which should be considered by the medical staff. The whole complex of older people`s needs should be viewed in an integrative way for the nurses to perform more effectively instead of simply reacting to specific diseases individually.

Nowadays, the term ‘healthy aging’ is used more and more often. The most common meaning is getting older in a disease-free state. However, it is difficult to define how it should be measured or where the line between a healthy and an unhealthy state is to be drawn. People often have health conditions (one or few) that have a very little influence on their abilities (World Health Organization, 2015). Therefore, the WHO`s treatment of healthy aging is more holistic and based on functional perspectives.

The notion of a healthy aging offers maintaining intrinsic capacity at the high level until the end of life, considering all factors in lifestyle choices and developing habits. The public heath strategy should have different approaches to the people at different stages of healthy aging. For those with a high and stable capacity, it is important to prevent chronic conditions and provide their early detection. Those with the declining capacity require its timely detection, which will help reverse or slow it down with a supporting or capacity-enhancing behavior. During the last stage, people require managing chronic conditions and ensuring a dignified life. Global aging poses numerous challenges for health systems, and changes are the matter of time and will. When older people deal with a healthcare system, they realize that it is not designed for their needs. Modern healthcare has achieved a great progress in diagnosing and curing time-limited health issues. This means that it is vital to find a problem and solve it. Acute conditions and communicable diseases are a priority, while a long-term healthcare is overshadowed; however, the aging population`s needs are complex and long-term. The risk of non-communicable diseases rises with age; comorbidity is not an exception but the norm for older people (World Health Organization, 2015). Therefore, this complex requires the new ways of providing healthcare, and they should be different from those that are created to cope with more acute problems.

Moreover, it is necessary to pay attention to lack of coordination between numerous professionals involved in care. Thus, older people should not gather and analyze important health information by themselves. In the case of involving various specialists, all levels of treatment should be constantly coordinated to prevent undesirable consequences.

All new systems lose their effectiveness significantly with the presence of ageism among healthcare workers. Patronizing behavior, negative attitudes toward older people, failing to consult or discouraging in the case of asking some medical interventions are widespread in many countries. Medical students are solely trained to cope with multiple problems of aging people; so, ageism is reinforced during medical education. Physicians often fail to initiate a dialog about older person`s care preferences. Such medical workers should understand that the elderly people`s contribution to the socio-economic development of the country has allowed medical services to be created.

In conclusion, it is necessary to focus on the global nature of the issue under discussion. All people have the right to receive a qualitative medical help in time. Global aging is another challenge to face. Demographical changes require the modernization of healthcare systems worldwide, and enhancing long-term care systems is one of the basic tasks. The health of the older population encompasses several spheres, and this problem is more than just a medical issue. It also contains economic, legal and moral aspects. Poverty, inequality, and discrimination impede current improvements, but the collaboration on the global scale will help develop new approaches to make the life of older people not only longer but also better.