| Titre : | The politics of healthy ageing: myths and realities |
| Auteurs : | WHO Regional Office for Europe ; Scott L. Greer ; Julia Lynch ; Aaron Reeves ; et al. |
| Type de document : | Rapport |
| Editeur : | Copenhague [DNK] : Office des Publications du Bureau Régional de l'Europe, 2022/06 |
| Collection : | The economics of healthy and active ageing series |
| Langues: | Français |
| Mots-clés : | Vieillissement ; Personne âgée ; Grand âge ; Vieillissement en bonne santé ; Coût santé ; Politique vieillesse ; Politique santé ; Soins longue durée ; Service santé ; Donnée statistique ; Relation intergénération ; Parcours de vie ; Europe |
| Résumé : |
Societal ageing is often portrayed as fiscally unsustainable, creating a narrative of an intergenerational conflict over public spending
priorities. Ageing societies are a triumph of economic growth, health care, public health and social policy. They also create new policy conversations about how and how much policies need to change in order to adapt to societies with a higher proportion of older people. Yet, many in politics and public debate see ageing as a fiscal problem, creating unsustainable burdens on health systems and governments which require drastic actions that older voters will oppose. This is despite the lack of evidence that ageing societies necessarily create an unsustainable fiscal burden, particularly within health and long-term care (LTC) systems. Why does so much policy and political debate assume intergenerational conflict that can only be won by one side? Can this narrative be changed and how? What ageing societies mean for politics changes from country to country. The politics of ageing and health differ greatly between countries. Within Europe, there is enormous variation in everything from life expectancy to the health of older people to their ability to make ends meet to partisan trends in voting. Few narratives about the politics of ageing and health work in every country. Despite this nuanced picture, several popular myths promote a single narrative of intergenerational conflict that only one side can win. These myths are false: • The myth of unsustainability: There is little empirical evidence to support the claim that ageing societies’health care systems are unsustainable. The health care costs associated with ageing societies are relatively small and can be made smaller with appropriately recalibrated policy. In addition, older people contribute to society in many ways, including by providing an enormous amount of unpaid labour in caring roles and civil society. • The myth of the selfish generation: The belief that older people support getting more benefits for themselves at the expense of younger people is also false. Like anyother group of voters, older voters are divided in multiple ways by identity, ideology, income, and other factors –they do not vote as a monolithic block. People do not automatically change their political orientations as they age. In some countries, age predicts very little about voting behaviours. In particular, there is little evidence that older voters are particularly selfish. • The myth of pandering politicians: Politicians do not pander to older voters by offering additional government benefits. Voters are downstream of a complex policy development process. The policies that voters see reflect interest groups, partisan and coalitional politics, as well as policy-makers’ understanding of needs and constraints. Policies and political systems can shape the scale of intergenerational conflict and obscure other kinds of conflict. It is possible to enact policies that treat different generations differently, and policies in health and other sectors can create intergenerational tradeoffs. But they can also reduce them, and in many countries recent decades have indeed seen increased expenditure on working-age and younger people. What looks like intergenerational conflict about wealth or pensions, upon investigation, is often a more complex conflict within generations. Public expenditure prioritizing older people can coexist with considerable poverty among older people. Discussing health and social policy in terms of the age of beneficiaries obscures all manner of inequalities, including gender, income, wealth, nationality, ethnicity and racial ones. A focus on intergenerational conflict can thus disguise more important kinds of conflict and distributional decisions. Policies built on the life-course approach can benefit all generations and be electorally attractive Still, it is also possible to develop life-course policies which focus on investments that promote health and, therefore, people’s contribution to society at every age. Rather than looking for pandering politicians catering to the demands of an older people’s block vote, this brief argues that it is better to develop a supply-side approach to health politics. It is possible to forge coalitions of interest groups, parties, activists and others that invest in people across generations while offering benefits that voters find electorally attractive. The broad policy framework for developing such policies is ‘life-course analysis’, which understands policies and interventions in terms of their contribution to people during their entire lives, capturing the value of intervention at each state, whether in early childhood or in support for the healthy ageing and caring of older adults. Policies such as support for at-home care or investment in the health and social care workforce can be electorally beneficial to governments while making investments with clear benefits across generations |
| En ligne : | https://eurohealthobservatory.who.int/publications/i/the-politics-of-healthy-ageing-myths-and-realities |
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