1. Ageing Challenges for the Caribbean Kenneth S. M. George (Dr) SMOH NCDs Monday, 6 th of May, 2013 Hotel Pommarine Marine Gardens, Hastings. Christ Church

2. The Caribbean

3. Facts About the Caribbean 1 st explored in 1492 - Christopher Columbus Archipelago of islands from Cuba and Bahamas in the North, to Trinidad and Tobago in the South In addition Guyana, Surinam and Belize are on the mainland of South and Central America Descendants of African, East Indian and Europeans Estimated population 34 million (UN 2007)

4. Commonalities Independent states that share the same geographic space, cultures and ethnic groups Members of CARICOM (17 states) Multiparty democracies Low to moderate economic growth Fragile economies – agriculture, tourism, manufacturing Similar health challenges in provision of universal health care

5. International Trends Globalization Free movement of people, services and goods (Treaty of Chaguaramas) Industrialization Urbanization Technological development Advances in health care

6. The concept of Active Ageing Active ageing is the process of optimizing opportunities for health, participation and security in order to enhance quality of life as people age. It applies to both individuals and population groups. Emphasizing a life course approach (WHO website)

7. Epidemiological Transition

8. Falling death rates Falling birth rates Decreasing fertility rates Major improvements in public health –Potable water and improved sanitation, –Immunization –Access to basic primary health care A change in infectious and communicable diseases to non-communicable diseases over the last 50 years (HIV/AIDS is a potential threat)

9. Terms and definitions Ageing Index (Elder Child Ratio) –Number of persons ≥ 65 per 100 youth <15 years old Active Ageing Index Life Expectancy –The number of additional years a person is expected to live if current mortality for that age is maintained Age Dependency Ratios –Ratio of those not in the labour force to those in the labour force. i.e. persons < 15 and 65 and greater to those 15-65 years Median age of the population

10. Future projections Life expectancy is rising in all Caribbean states, including Haiti By 2030 the aging index is projected to exceed 100 in all developed countries (UN 2007 Report) Increasing median age of the population 24.2 in 2000 to 39.2 by 2050 (Eldimire Shearer 2008) Dependency ratios have been increasing

11. Future projections In the English Speaking Caribbean (ESC) the elderly now represents 10 – 13 per-cent –10% in Jamaica –11% in Trinidad and Tobago –13% in Barbados Life expectancy in the Caribbean rose from an average of 50 in the late 40’s to and average of 70 for men and 73 for women in most ESC countries Women out-live men in all Caribbean territories

12. Life Expectancy in Select Caribbean Countries (Harewood 1960 and PAHO 1990 and 2007) 196019902007 Barbados6275.677.5 Jamaica6273.672.7 Trinidad and Tobago 6271.670.1 Haiti -- 61.3

13. Observed and Forecasted Percentage of the Population, age 65 and Over Regions/ Countries 195020002050 World5.26.919.3 Africa3.23.36.9 LAC3.75.416.9 Europe8.214.729.2 USA8.312.321.1 Japan4.917.236.7 India3.35.214.8

14. Magnitude and Speed of Population Growth

15. Ageing and Gender Women make up a significant majority of the older population and increasingly so with age Studies have identified higher levels of poverty in older females and lower levels of literacy In 2000, at age 80 the ratio of males to females was 7:10 compared to 8.5 to 10 for the age group 60+ and 1:1 at birth ‘Feminization of the older population’

16. Population 60 and > (CAREC Jan 2010) CountryMalesFemales Barbados17,70024,485 Grenada5,7707,373 Guyana27,97632,566 Trinidad (2005)64,37976.497

17. Socio-Economic Issues Chronic poverty, especially in women Lack of economic security and independence Lack of health insurance and low pensions Changing cultural norms and values Changing family unit and structure Social isolation Limited opportunities for housing

18. Health and Ageing Goal of successful ageing is not only the prolongation of life but the extension of life in good health (concept of healthy life expectancy) Definition of Health –Mental, physical, spiritual, emotional and socio- economic health Can be achieved through the tenants of health promotion –creation of supportive environments, community empowerment etc Adopting healthy public policy to support the elderly

19. History of the World’s Health

20. Health and Aging Highest prevalence of NCDs in the Region of the Americas High obesity rates, especially in women Burden of Alzheimer's Disease and the other dementias Limited psycho-geriatric opportunities for care and treatment Limited home and community based policies for managing the elderly

21. Looking to the Future Embrace the concept of healthy ageing through the life-course Age friendly primary health care – moving from episodic to continuous care Age and disability friendly cities Integration of elderly care services into NCD prevention and control and mental health services

22. Looking to the Future Collaborative effort to address the elderly that harnesses inter-sectoral and multidisciplinary approaches –Civil society, the private sector and academia Support research through public health and social science approaches Training and skill development in the area of public policy and gerontology Exploration of new models of care e.g. independent and assisted living

23. THANK YOU