The difference between life expectancy and healthy life expectancy, and why it is important to reduce the burden of cardiovascular disease (CVD) on populations in the APAC region. by John Battersby, Regional Account Director
In the previous article, we outlined the major challenges faced by the region’s healthcare services, and offered an outline for changes in our general approach to improving healthcare systems in the region.
In this instalment, we go a little deeper into two of those challenges; namely increasing healthy life expectancy as much as we have overall life expectancy, and the almost exponential increase in healthcare costs that loom in our near future.
Life expectancy Vs Healthy life expectancy
For the first time in recorded human history, the number of people aged 60 years and older now outnumbers the number of children under 5 years. By 2050, the number of people aged 60 years and older will outnumber those under 15 years. The percentage of elderly in the population is growing, and it is doing so faster than ever before. The developed countries of Northern Europe aged slowly through the 20th century. It took well over a century for the percentage of their populations over 60 years to grow from 10% to 20%, but that change is occurring much more quickly in 21st century Asia-Pacific countries. The populations of China, India and many other countries in the region will experience the same change in little more than 20 years.
Currently the world’s more developed, high-income economies, like those of Western Europe, Taiwan and Japan are home to the majority of the world’s over 60 years population; however by 2050, 80% of older people will be living in low- and middle-income countries; and 1.3 billion of those will be in APAC.
More of the elderly population will be reaching greater ages than ever before. Currently, there are around 125 million people in the world aged 80 years or older. By 2050, the number of people in that age range will have grown to 434 million; with more than half of them living in the APAC region.
Those staggering figures are due to us having become much better at increasing life expectancy; at keeping people alive for much longer.
Unfortunately, we have not got much better at improving healthy life expectancy, that is the average number of years that a newborn can expect to live in full health unhampered by disabling illnesses or injuries.
Instead, as life expectancy has increased, so has the gap between it and healthy life expectancy. In 2016, the WHO calculated that the average life expectancy at birth of the global population was 72.0, but the healthy life expectancy at birth was noticeably lower at 63.3 years globally that year. Meaning, the average person could expect some nine years hampered by ill health at the end of their life span, with many of those mobility impaired or bedridden.
In some wealthy developed countries, that period is even longer. The UK data for 2016 indicates that life expectancy at birth has now reached 79.5 years for males, and 83.1 years for females. However, the latest data on healthy life expectancy shows that it is now 63.4 for males and 64.1 for females; 16 and 19 years of ill health respectively.
This trend will be one of the most impactful social changes in the 21st century. It will affect everything from the size of the labour force and tax revenues, to the kinds of housing and transport that will be needed. But the biggest single impact is likely to be on our national healthcare systems.
The rising cost of healthcare
In nearly all ASEAN nations, even before the Covid-19 pandemic, the growth of cost in healthcare per capita has been outpacing the growth in GDP per capita, meaning that ultimately the burden of healthcare cost is growing faster than the economic power to sustain them.
According to one WHO white paper; if the cost of healthcare continues to rise at present rates it will outpace both GDP and population growth. This could lead to estimated total healthcare cost for ASEAN’s leading six economies (Indonesia. Malaysia, Philippines, Singapore, Thailand, and Vietnam) alone to exceed US$750 billion by 2025.
The Solidiance report concluded that in order to avoid a future crisis, healthcare policy makers will need to develop a more efficient healthcare model that addresses some key issues, including:
Streamlining healthcare spending and reducing administrative bottlenecks, and
Re-allocating resources towards intensified prevention and reduced disability
The impact of cardiovascular disease on ageing citizens
Cardiovascular diseases (CVD) in particular will have a major impact on the region's healthcare systems as the number of seniors living with CVD across the region continues to rise.
Responsible for over 17 million deaths worldwide annually, with half of them occurring in Asia, CVDs are the largest non-communicable disease (NCD) by morbidity and mortality, and are a key area of high unmet medical need.
Living with CVD can be challenging for seniors, their families and caregivers, and this burden increases exponentially if they suffer serious events such as heart attacks or strokes.
Embracing innovation in medication and technology which supports the shift from costly acute care to preventive, along with value-based care for chronic conditions such as atrial fibrillation (AF), coronary artery disease (CAD) and peripheral artery disease (PAD), will be essential for relieving the burden CVD imposes on the region’s ageing populations, healthcare systems and society at large.
The economic impact of CVD goes far beyond the cost of healthcare; it also affects a nation’s economic output by taking patients, and often their caregivers too, out of the workforce.
A study by the World Economic Forum and Harvard School of Public Health concluded that globally, between 2011 and 2030, CVD will be responsible for US$15.6 trillion worth of lost economic output. That is more than the next three most prevalent NCD categories (cancer, chronic respiratory diseases [CRD] and diabetes) combined.
We know that CVDs are the number one cause of death worldwide, that CVDs are leading the NCD cost of lost economic output, and that CVDs are also now recognised as having connections to other age-related conditions, from Alzheimer’s disease and diabetes, to frailty and even mental health. But it is precisely because the impact of CVDs on individuals, healthcare systems, and society at-large is massive, that spending to support cardiovascular health and healthy ageing must be a priority if we are to cope with rapidly ageing populations.
Cardiovascular health represents a powerful leverage point for advancing the region’s healthy ageing agenda. Action now can change the trajectory of CVD impact, and pave the way to healthier lives.
This article is part two of a six-part series by Bridges M&C discussing healthcare systems and cardiovascular disease in the APAC region.