Dr Eileen Burns has been a geriatrician in Leeds since 1992 and is President of the BGS. She is currently Clinical Lead for integration in Leeds and Chairman of the BGS Community Geriatrics Special Interest Group. She tweets @
I was fortunate enough to attend and speak at a Global Summit on Aging held in Shanghai recently. It was a fascinating event, with speakers from an enormous variety of backgrounds- from the US Embassy in Beijing, the World Health Organisation, and the United Nations Population Fund, as well as numerous Chinese Government office holders.
The summit was jointly organised by Columbia University, USA (under the auspices of the wonderful Professor Linda Fried) and Fudan University in China.
The subject areas spanned public health, including healthy aging and opportunities in science (including pharmaceuticals) in enabling longer and healthier lives. The issues around prolonging disability -free life were much discussed- all issues with which as geriatricians we are familiar.
However, a fascinating part of the programme was that around the economics of aging. An Economist from the Max Plank Institute for Social Law and social policy (Professor Axel Borsch Supan) along with Maurizio Bussolo from the World Bank analysed prospects. They were breezy about the future- if only all women worked full time and we all carry on working till our mid-70s then the funding issues would be solved…! I did wonder who was going to look after the children and older people with disability or frailty. And the economists themselves recognised that such measures would tend to worsen income and health inequalities, as those in professional or managerial jobs would be likely to be physically fitter and therefore able to continue to work, as well as being in a position to save for their old age. Those in manual jobs were likely to have poorer health, and be physically less able to continue to do their manual work into old age, as well as having a lower income and therefore fewer savings. Maybe not such a simple solution after all?
However, some of the most interesting reflections came from conversations with Chinese people I met outside of the conference.
The Chinese government department speakers were clear that the prime responsibility for caring for older people lies with the family not the state. I met a tour guide who told me that she worried constantly about the issue of payment for medical care. She told me that for her generation, private health insurance is required. In some occupations this is part of the employment package, but for others working in smaller organisations this is not so. She had to pay a significant proportion of her income for this. Even so, only some procedures and treatments would be covered. Her parents, coming from a generation who had different experiences and had worked in farming did have some cover from the state, but this was not comprehensive. She told me movingly of her father’s terminal illness the previous year when she and her mother paid for additional analgesia as she had been told it otherwise would not be available for him “of course we wanted him to have the best care, doctor”.
In contrast a young professional non-medical delegate at the conference reported that her doctor (whom she saw through private medical insurance) advised her to have twice yearly MRI scans top to toe- advice which (of course) she followed.
Whilst I saw very few obese people wandering through Shanghai in the evenings I saw many, many western fast food outlets which have recently sprung up. Another local Shanghai-ian told me that it’s very hard to resist the children’s requests for trips to such places as MacDonalds and KFC as they are seen as exotic and desirable. It seems unlikely that at least in the major cities, the Chinese will be able to avoid following in our footsteps towards an obesity epidemic. Alongside this lifestyle concern Chinese people continue to be heavy smokers.
This was my first visit to China, and it left me with many reflections. I couldn’t help but feel that the Chinese people were potentially in the worst possible place with regard to their healthcare system- moving from a service which was low tech but universal, and with a life style which (aside from smoking, a deeply ingrained part of daily life it seemed) was healthy, to some of the worst features of an American-style system. It seemed to me that there was manipulation of people to believe that the unhealthy options of a western diet were desirable. Pollution was increasing- there were traffic jams on the streets, not the legions of cyclists one saw on documentaries of Chinese cities from the recent past. Healthcare appeared to be available in the basis of ability to pay rather than need, and those consumers who could pay (whether directly or via insurance) were directed to interventions they didn’t need.
I hope my impressions were wrong- time will tell!