Global Health & Global Aging

The contributors to Global Health & Global Aging are characterized by their eminence and wide range of experience in governmental and international organizations. While Global Health & Global Aging shares those features with the first text in this series, Critical Issues in Global Health (edited in 2001 by former US Surgeon General C. Everett Koop), this is much less of an introductory overview and is more candid in suggesting reforms to the US health care system. A brief survey of the 31 chapters suggests the breadth and quality of this work.

In part 1, “The World and its Aging Population,” Mary Weinberger (a United Nations demographer) details the trends in mortality and fertility that will lead to 40% of many populations likely being older than 60 years by the mid-21st century. Alexandre Sidorenko (former chief of the United Nations Programme for Aging) reviews the Madrid Plan of Action for a society of all ages in which elderly individuals receive not just financial and health service support but also protection from violence and discrimination, along with encouragement to contribute to society. Alex Kalache, director of the World Health Organization Ageing and Life Course Programme, discusses a variety of different World Health Organization active-aging programs that are likewise similarly focused.

Part 2, “Countries with High Rates of Longevity,” begins with arguments by Bjarne Hastrup (chief executive of DaneAge) calling for a national action plan for aged health, drawing on the strong political consensus in Danish society that the tax system should support equitable access to health services. Pekka Puska details how the North Karelia Project (which he directed for 25 years) achieved an 82% reduction in mortality between 1972 and 1997 among men younger than 65 years, chiefly through reduction of cholesterol levels from 6.9 mmol/L to 5.7 mmol/L, rates of smoking from 52% to 31%, and blood pressure from 149/92 mm Hg to 140/88 mm HG. Ulla Schmidt, Federal Minister of Health of Germany, discusses the Berlin Aging Study, which found that 96% of the sample of 516 individuals (average age, 85 years; range, 70-103) had been diagnosed with at least 1 mild to severe internal, neurologic, or orthopedic disease and 30% with at least 5 severe physical illnesses.

Shigeo Morioka, president of the International Longevity Center, outlines how Japan's health system ensures free access to medical institutions, yet costs only 7.8% of gross domestic product (in the United States, health care costs 13.9% of gross domestic product) and ensures the highest average life expectancy in the world (74.5 years). Clemence Ross-Van Dorp, former state secretary for health, welfare, and sport in the Netherlands, details how that government bases policy for aged health on objective measures such as numbers of elderly persons exercising regularly, number of fractures as a result of falls, employment rate among persons aged 55 to 64 years, and number of homes adapted to increase mobility and safety. Jose Zapatero, president of Spain, discusses the Act to Promote Personal Autonomy and Care for Dependent Persons, passed by the Spanish Parliament in 2006 to establish the rights of any elderly citizen to have access to services needed to accomplish everyday activities. Barbaro Westerholm, chairperson of the Swedish Parliamentary Committee on Housing for the Elderly, evaluates the Swedish system, in which taxes allow elderly persons free access to health and medical services and assistance if needed with home help and personal care.

Part 3, “Countries Facing Rapid Population Aging in the Next Twenty to Thirty Years,” opens with Nana Apt (dean of academic affairs, Ashesi University in Ghana) discussing the policy challenges of human immunodeficiency virus/AIDS, urbanization and migration, and loss of traditional family supports, particularly for elderly African women. Sharad Gokhale, former president of the International Federation on Aging, promotes aging as a time for spiritual contemplation. Mohamed El-Banouby, professor in the Geriatric Medical Department at Ain Shams University in Cairo, Egypt, mentions how in nations such as Iran, Iraq, Lebanon, Palestine, Pakistan, and Syria, military spending dramatically consumes budgets for health and social services for elderly individuals. Vladamir Khavinson and Olga Mikhailova of the St Petersburg Institute of Bioregulation and Gerontology dissect the reasons for Russia's low average life expectancy (59 years), particularly the demolition of state-funded preventive measures after the 1990s. Enrique Vega of the Pan-American Health Organisation and the World Health Organization Regional Advisor on Aging and Health, details the implications of the Latin America and Caribbean Health, Well-Being and Aging study, which found, for example, that 26% of citizens older than 70 years had limitations in basic activities of daily living, including using the toilet, bathing and dressing, getting in and out of bed, eating, and controlling bodily functions.

Part 4, “Leaders in Research and Innovative Programs,” opens with George Martin (scientific director of the American Federation of Aging Research) and the late Joshua Lederberg (professor and president emeritus of molecular genetics and informatics at Rockefeller University) discussing the plasticity of intrinsic rates of aging, the accumulation of oxidatively altered proteins, lipids, DNA and RNA, the down-regulation of telomerase, and their skepticism about engineered enhancements of life spans. Thomas Perls and Dellara Terry review the New England Centenarian Study, of which they are codirectors.

In a powerful concluding chapter, William Novelli, chief executive officer of AARP (formerly American Association of Retired Persons), studies lessons from European countries in which the government covers approximately 80% of total heath expenses but at substantially less total gross domestic product and administration costs than in the United States. Similarly, he states that, in nations such as the United Kingdom and France, drug manufacturers have to provide evidence for the price the government pays them, or drug profit margins are negotiated. AARP is working to remove the US legislative prohibition of Medicare drug price negotiation, and it should be a bonus for potential readers that royalties from this valuable and well-organized book go to that sponsoring nonprofit foundation.