Universal Health Coverage fit for an Ageing World

HelpAge International is the secretariat to a global network of organisations promoting the right of all older people to lead dignified, healthy and secure lives. HelpAge International joined UHC2030 officially in September 2019. The following Partner Insight is HelpAge International's perspective. 

"Universal Health Coverage is essential for ensuring all people, everywhere, can access quality health services with financial protection. By 2020 more than 1 billion people will be aged 60 and over. By 2050, this number will have risen to 2 billion and older people will make up 20% of the global population. If we are truly to leave no one behind, then UHC must be fit for an ageing world. 

Older people’s health and care needs

"For the first time in human history most people can expect to live into their 60s and beyond. However, there is little evidence to suggest that people can expect to live these extra years in any better health than previous generations, while systems in many countries are ill-prepared to cope with the increasingly complex health and care needs of people as they age. These include increased risk of multiple chronic conditions and the need for increased support with day to day tasks. In 2011, 75% of deaths from noncommunicable diseases in low- and middle-income countries were of people over 60. While disability among older people is four times higher than for the younger adult population in low-income countries.

"Older women and men also face multiple challenges when accessing services. Barriers range from poor physical access, lack of transport and prohibitive costs, to lack of access to essential medicines and assistive products, inadequate health provider skills, and age discrimination. 

“I spend most of my pension on the medication I need. I am lucky to have children who support me but others have to choose between buying food, having the gas or electricity at home or buying medicine”. Midiakan, Kyrgyzstan

“The hospitals say ‘We have no pill to treat old age’. We are not made to feel welcome”. Nora, South Africa

“[The health clinic] is too far for me to walk to. It takes a day to get there on foot and I don’t have enough money to go by bus.” Chaussauca, Mozambique

UHC and older people

"UHC presents a critical opportunity to re-orient health and care systems to meet the needs of increasing numbers of older people with a higher prevalence of chronic conditions and complex health and care needs. We (HelpAge International) welcome the inclusion of older people in the UHC Political Declaration which commits to “Scale up efforts to promote healthy and active ageing, maintain and improve quality of life of older persons and to respond to the needs of the rapidly ageing population, especially the need for promotive, preventive, curative, rehabilitative and palliative care as well as specialized care and the sustainable provision of long-term care, taking into account national contexts and priorities.” 

"Ensuring these commitments are realised will necessitate investing in age-inclusive models of UHC and the building blocks necessary to delivering them. These include:

• Service delivery that is person-centred, addresses older people’s health and care needs, and is not focused on single diseases in isolation
• Health workforces that have the skills to respond to the needs of ageing populations
• Health information systems that are not age-capped and that enable disaggregation by age, sex, disability and location as a minimum
• Access to essential medicines and assistive products for conditions common in old age 
• Services free at point of access for people of all ages
• The right to health and long-term care incorporated into national law with ageing and older people’s needs explicitly included.

"It will also mean making gender equity a central pillar of UHC, recognising the unequal burden faced by women in accessing and providing health and care across the life-course, including the unpaid health and care often provided by women. 

UHC accountability mechanisms – counting older people

"For older people to be included they must also be counted. Current measures of UHC, including the ‘access’ indicator (3.8.1) in the SDG indicator framework, do not include measures such as physical access to health facilities or staff skills, knowledge and attitudes – factors that are critical to understanding the barriers faced by older people.

"The UHC service coverage index includes measures of a number of essential health services of relevance to older people’s health needs, including for hypertension and diabetes. However, this indicator relies on age-limited data sources, including the WHO STEPS NCD Risk Factor Survey (STEPS), which usually only includes people up to the age of 64, and the Demographic and Health Surveys (DHS), which usually exclude women over the age of 50 and men over the age of 55. 

"Even where data is collected, it is rarely adequately disaggregated. To monitor UHC and understand who is being left behind, it is essential that data underpinning accountability mechanisms:

• is collected for all age groups, including older people
• captures barriers to access that are specific to older age
• is disaggregated by age, sex, disability and location as a minimum.  

Working together for people of all ages as part of UHC2030

"Following the UN High-Level Meeting, we are committed to working with our network members, partners and as an active member of UHC2030 to ensure Heads of State live up to the commitments they made in New York. We see UHC2030 as a critical movement for accelerating progress towards UHC and we hope that through our membership we can support this progress whilst also ensuring older people’s health and care needs, and the intersection of age with gender and disability, are better understood and addressed. Only by moving together in concerted, collaborative, multi-stakeholder action will we ensure governments properly fund and implement models of UHC that enable all people at all ages to access quality health and care services with financial protection." 

Photo credit: Ben Small/HelpAge International.