When The Lancet, The Economist Intelligence Unit, and the WHO Agree…

By Michael Hodin

Even as we emerge from the Covid-19 pandemic, not least courtesy of miraculous vaccine innovation, it’s worth pausing to reflect on the global community’s historic recognition of the full launch of the UN Decade of Healthy Ageing. Just in the last few weeks, two globally respected publications — The Lancet and The Economist Intelligence Unit — both released reports on the profound impact of aging for 21st century life. When The Lancet and The Economist Intelligence Unit both roll out stories on the same topic, it is clear that we are onto something big.

The Lancet’s “Ageism: a social determinant of health that has come of age” discusses how ageism “impacts all aspects of older people’s health,” while The Economist Intelligence Unit’s (EIU) white paper, “Integrated care pathways for bone health: an overview of global policies,” focuses on strategies to build integrated care for bone health. The unifying thread for both is the WHO/UN Decade of Healthy Ageing’s metric of “Functional Ability” — a critical, if not the central measure of how we define achievement, progress, and success in a world shaped by 100-year longevity and the parallel more old than young across all societies as they modernize.

Indeed, while The Lancet article might not per se focus on any particular disease, their description of the key platforms of the Decade of Healthy Ageing, including integrated care, links directly to Mary Bussell and the EIU’s wonderfully written, powerfully argued, and carefully researched report on the nexus of bone health, aging, and integrated care pathways.

Surely, we can see that bone health — an increasing health challenge as we age, with devastating impact, not least on the 60+ demographic subject to fragility fractures from osteoporosis — is a visible and real example of The Lancet’s main point:

“Ageism impacts all aspects of older people’s health. For instance, it shortens their lifespan, worsens their physical and mental health, hinders recovery from disability, and accelerates cognitive decline. Ageism also exacerbates social isolation and loneliness and reduces access to employment, education, and health care, all of which impact health. As the Global Report on Ageism shows, ageism places a heavy economic burden on individuals and society, including in health-care costs. Annually, ageism accounts for US$1 in every $7 — or $63 billion — spent in the USA on health care for the eight conditions with the highest health-care costs among people aged 60 years and older.”

This connection to Dr. Bussell’s core focus — the social and economic burden of poor bone health — is itself a near perfect health policy case for the WHO and the UN to address during the Decade of Healthy Ageing. As that work rolls out, here are a few key insights to keep in mind:

· Osteoporosis and fragility fractures are critical health and economic challenges. The EIU’s report spotlights the staggering impacts of leaving osteoporosis and fragility fractures underprioritized. To name a few: globally, one-in-three women and one-in-five men 50+ will have a fracture caused by osteoporosis. For women, this leads to more days in the hospital than diabetes, heart attacks, or breast cancer. The costs are also immense: osteoporotic fractures cost in the US alone is estimated at $52 billion, which is expected to grow 83% by 2040, aligned near perfectly with increased citizens in older age. And more than half of people with hip fractures become dependent on a family caregiver. Clearly, this is an issue worthy of attention and action by policymakers, providers, and the public.

· Bone health requires proactive, integrated responses. Despite these impacts, responses to osteoporosis are still often fragmented, uneven, de-prioritized, or rife with service gaps. Therefore, the EIU report calls for integrated care pathways — a clear goal The Lancet reminds us of The Decade of Healthy Ageing itself — which bring together primary care, secondary care, and action by the public, payers, and policymakers. How about adding to that elder caregiving, which has been made even more apparent during our Covid experience. This unified approach would equip providers with the risk assessment tools, data, guidelines, and training to identity those at-risk and direct them to appropriate resources — all driven and supported by the right incentives, reimbursement, health policies, and proven care programs.

· End ageism to ensure healthy aging. However, as The Lancet notes, ageism stands in the way of not only better and more effective approaches to bone health, but all aspects of healthy aging. If people — even doctors and policymakers — continue to believe that osteoporosis itself and its consequent fragility fractures are a “natural part of aging,” then it will be difficult to make progress on this challenge. As outlined by the Decade of Healthy Ageing, we need a robust effort to confront and end ageism wherever it occurs, and especially when it impacts older people’s health and lives. Its impact on the economy is a parallel incentive to treat bone health and fragility fractures themselves different.

· A good place to start is the Integrated Care Pathways Dr. Bussell calls out, especially for the 80% of those “first fractures” where we know who they are. Better, more effective integrated treatment and rehabilitation for those with first fractures could dramatically avoid the second fracture where the majority of the poor health outcomes and adverse economic impact occur. And, since we have in place the “Fractures Liaison Services” precisely to address this gap between first and second fractures, we have direct policy conclusions that can serve in aging societies from super-aging Japan to the UK, Thailand and so much of aging Asia to the U.S. and Canada.

· We need this approach across a range of age-related conditions. And it’s not just bone health. Ageism — and the resulting lack of urgency to prevent, diagnose, and treat age-related conditions — affects people with a wide range of age-related conditions, from Alzheimer’s to heart failure to vision health. This underscores the importance of addressing ageism as the root of many of the most harmful and costly health challenges that we face today.

The imperative for our aging global society is clear: end ageism and evolve our health responses for the needs of today’s longevity. As The Lancet, The Economist Intelligence Unit, the UN, the WHO, and other prominent global institutions have all pointed out, we cannot afford inaction. Here’s to the hard work and collaboration of the Decade ahead.