Age Discrimination in Healthcare

By Sondra Forsyth

Are you or your loved ones over 70? The United Nations Sustainable Development Goals (SDG) for 2016 to 2030 effectively discriminate against anybody older than 69. The SDG definition of “premature mortality” is deaths occurring among people aged 69 years old or younger. Consequently, the stated goal of reducing by a third “premature death” from non-communicable diseases such as cancer, stroke, heart disease, and dementia leaves out anybody who is a septuagenarian or beyond. According to experts on aging who published an article in the British Medical Journal on August 31st  2016, the concept of “premature mortality” needs to be either abandoned or redefined.

A release from the University of East Anglia notes that the authors argue that the 69 and younger target sends out a “clear and unambiguous statement” to UN member states that health provision for younger groups must be prioritized at the expense of people aged 70 or over.

They call on the World Health Organization’s (WHO) Division of Non-Communicable Disease, the lead global agency on this issue, to rethink the mortality target, saying that its use of premature mortality discourages research and data collection for older people. One example of this is the exclusion of older people from HIV targets. The team also points out that the target exacerbates and justifies existing levels of age discrimination in healthcare, and distracts attention from major challenges that especially affect older people, such as palliative care.

The release quotes the article’s lead author Peter Lloyd-Sherlock, professor of social policy and international development at UEA’s School of International Development, as saying, “The implications for all countries, the UK included, is that resources allocated to conditions such as cancer, cardiovascular disease and dementia should be diverted from older people in order to comply with this global target.

“The World Health Organization cannot continue to take this unethical and discriminatory approach. The SDGs are the key reference point for global health over the next 15 years and must jettison this ageist approach.”

Setting out their concerns and recommendations in the BMJ, Prof Lloyd-Sherlock and co-authors Prof Martin McKee and Prof Shah Ebrahim, from the London School of Hygiene & Tropical Medicine, say the premature mortality target “sends a strong signal in favor of discriminating against older people”.

They add: “Since the 1990s key aspects of health policy have been framed by explicitly ageist principles…The prominent role given to premature mortality thresholds shows that ageism is becoming increasingly blatant. It is inconceivable that global targets would similarly discriminate against other groups, such as women or people with disabilities.”

Proposing a less discriminatory approach, they conclude: “Engaging with ageism in health policy does not mean throwing the baby out with the bathwater. We still need mortality indicators…so long as they are interpreted with care. Additionally, policy-makers should explicitly assess how the choice of measure impacts on the priority given to each age group.

“Highly cost-effective health interventions exist for people of all ages. Improved surveillance increases the scope to capture the disease burden in older people…In 2015 WHO published a report on ageing and health, indicating that WHO itself is ready to jettison ageist concepts and champion a more ethical approach. It is important that such progress is not undermined by poorly considered global targets.”

Commenting on the issue, Chris Roles, managing director of the charity Age International, said: “There is a need to rethink how we measure progress on tackling non-communicable diseases in all parts of the world. A focus on premature mortality discriminates against older people and doesn’t move us towards more effective management of multiple conditions, which is a critical priority for many people in later life.”