Harvard School of Public Health, Boston, MA, USA.
WHO, Geneva, Switzerland.
Lancet. 2015 Feb 14;385(9968):649-657. doi: 10.1016/S0140-6736(14)61464-1. Epub 2014 Nov 6.
Between now and 2030, every country will experience population ageing-a trend that is both pronounced and historically unprecedented. Over the past six decades, countries of the world had experienced only a slight increase in the share of people aged 60 years and older, from 8% to 10%. But in the next four decades, this group is expected to rise to 22% of the total population-a jump from 800 million to 2 billion people. Evidence suggests that cohorts entering older age now are healthier than previous ones. However, progress has been very uneven, as indicated by the wide gaps in population health (measured by life expectancy) between the worst (Sierra Leone) and best (Japan) performing countries, now standing at a difference of 36 years for life expectancy at birth and 15 years for life expectancy at age 60 years. Population ageing poses challenges for countries' economies, and the health of older populations is of concern. Older people have greater health and long-term care needs than younger people, leading to increased expenditure. They are also less likely to work if they are unhealthy, and could impose an economic burden on families and society. Like everyone else, older people need both physical and economic security, but the burden of providing these securities will be falling on a smaller portion of the population. Pension systems will be stressed and will need reassessment along with retirement policies. Health systems, which have not in the past been oriented toward the myriad health problems and long-term care needs of older people and have not sufficiently emphasised disease prevention, can respond in different ways to the new demographic reality and the associated changes in population health. Along with behavioural adaptations by individuals and businesses, the nature of such policy responses will establish whether population ageing will lead to major macroeconomic difficulties.
从现在到 2030 年,每个国家都将经历人口老龄化——这是一种明显且史无前例的趋势。在过去的六十年里,世界各国 60 岁及以上人口的比例仅略有增加,从 8%增加到 10%。但在未来四十年,这一群体预计将从 8 亿增长到 20 亿,占总人口的比例将上升到 22%。有证据表明,现在进入老年的人群比以前的人群更健康。然而,进展非常不均衡,最健康(日本)和最差(塞拉利昂)国家的人口健康状况(以预期寿命衡量)之间存在巨大差距,现在出生时预期寿命相差 36 年,60 岁时预期寿命相差 15 年,这表明了这一点。人口老龄化给各国经济带来挑战,老年人的健康状况令人关注。老年人的健康和长期护理需求比年轻人更大,导致支出增加。如果他们不健康,他们也不太可能工作,并且可能给家庭和社会带来经济负担。和其他人一样,老年人既需要身体上的安全,也需要经济上的安全,但提供这些安全保障的负担将落在人口的一小部分身上。养老金制度将面临压力,需要与退休政策一起重新评估。卫生系统过去没有针对老年人众多的健康问题和长期护理需求,也没有充分强调疾病预防,因此可以以不同的方式应对新的人口现实和相关的人口健康变化。除了个人和企业的行为适应外,这种政策反应的性质将决定人口老龄化是否会导致重大的宏观经济困难。