Conference Report SYMPOSIUM ON POPULATION AGEING AND AUSTRALIA’S FUTURE Shine Dome, Canberra, Tuesday 11 November 2014 by Kay Henderson

SYMPOSIUM ON POPULATION AGEING AND AUSTRALIA’S FUTURE Shine Dome, Canberra, Tuesday 11 November 2014

Background

The Symposium was sponsored by the Academy of Social Sciences in Australia (ASSA) in collaboration with the ARC Centre of Excellence in Population Aging Research (CEPAR).  The Symposium was held in conjunction with an Annual Meeting of FSSA that included a book launch and a lecture on income contingent loans by Prof Bruce Chapman, both held after the Symposium closed and each of which I also attended.

Much of the Symposium ranged well beyond health care, with general policy issues also covering social welfare, social and population change and economic issues.  However, health care consistently came up within the context of general discussion.  The Keynote Speech was given by the Age Discrimination Commissioner, Susan Ryan, who spoke on “The Longevity Revolution – Crisis or Opportunity?”   The other speakers at the Symposium were grouped into four “panels”:

1. Societal Ageing:  What it means and why it matters;
2. Population Ageing:  Global, Regional and Australian perspectives;
3. Improving Health and Wellbeing; and
4. Responses by Government and Families/Individuals.

Within the context of general discussion of the implications of an ageing population, two presentations had particular relevance to issues of health and the funding of health care.  One dealt with the enhancement of “cognitive capabilities” over an individual’s lifespan and the other with the interlinked issues of ageing, entitlement and the funding of health care.

Cognitive Capacities

Prof Kaaren Anstey has the dual titles of Director, Center for Research on Ageing, Health and Wellbeing, and Director, Dementia Collaborative Research Centre – Early Diagnosis and Prevention, ANU.  Her presentation covered what is known (in a preliminary sense) about what happens to people’s cognitive capacities as they age.  The term “cognitive capacities” refers to memory, thinking, reasoning, problem solving, planning and processing speed.

Once, it was thought by psychologists that “intelligence” was innate and relatively fixed throughout life.  Now, researchers view cognitive abilities in a much more fluid and dynamic way.  Environmental and genetic factors come into play, and the trajectory of cognitive abilities through life is not predetermined.

Prof Anstey focused on two elements in cognitive development over a lifespan.  The first, “cognitive reserve”, is the peak cognitive ability that an individual achieves and is a reflection of optimal brain development and education.  The second element is the rate of cognitive decline through adulthood and into old age.

There is growing evidence that the brain is far more plastic than previously realised.  Research on brain development combined with increasing longevity suggests that our perspective on education needs to change.  Participation in education at various points during adulthood may have influences on the brain we have not yet imagined.

There is still much to be learned about the cognitive capacity of the brain, particularly into old age.  Researchers are now examining whether there is a link between cognitive capacity and dementia.

Prof Anstey stressed that bringing all our knowledge together and creating the best possible public policy for cognitive health is likely to promote a genuine increase in the numbers of adults who age well and to reduce the incidence of late-life dementia.

Ageing, Entitlement and Funding

Jane Hall is Professor of Health Economics, Centre for Health Economic Research and Evaluation, UTS Business School.  Her presentation, co-authored with Kees van Gool, examines the phenomenon noted by the OECD that in developed countries health care expenditure increases at a faster rate than national income.  For Australia, health care expenditure is expected in the Commonwealth Government’s “Intergenerational Report” to grow more rapidly than Commonwealth Government spending on aged care and pensions.

Prof Hall noted that the Australian Institute of Health and Welfare regards an increase in the prevalence of chronic disease as Australia’s biggest health problem.  However, Prof Hall also notes that while ageing populations have resulted in a greater incidence of chronic diseases, treatment has changed in such a way for most diseases that patients expect to manage their conditions so as not to have to withdraw from normal life.  There is a substantial variation in health within all age groups.  Interestingly, almost half of the 85+ age group rate their own health as good to excellent.

While ill-health is variable within populations and particular age groups, public funding is designed around three main funding streams – for hospitals, pharmaceuticals and medical services – that are separate and inflexible.  Prof Hall postulates that greater flexibility in service delivery could result in savings in the health care system.  For example, in an internet-connected world many patients may get some health services without physically seeing an expensive doctor.  The last year of life is the most expensive time for health care provision. Half of Australians die in hospitals, which are expensive, while surveys show that most would prefer to die at home.

Prof Hall concluded that ageing per se is not a threat to the sustainability of the Australian health care system.  In particular, it is not a threat to the continued viability of tax-financed universal health care insurance.  Prof Hall maintains that universal coverage and high levels of public insurance must be part of the solution to the policy challenge of healthy ageing.  Because of the wide variation in health status and expenditure, policy reforms that are aimed at the average are likely to miss their target and have sub-optimal health and financial consequences.

Comment

While both presentations were by necessity delivered in very general terms, each highlights issues of relevance to the continued evolution of health status and health care delivery in Australia.  Research into “cognitive capacity” is still at an early stage, and as more is known there may be significant benefits for ageing portions of the population generally.   A move away from health care funding and service provision that is based on “average” needs towards one that targets those within the population who have the most intensive needs would decrease the likelihood that ageing will in itself result in greater public health care expenditure.

For both issues, “Watch this space!”

Prepared by Kay Henderson