The European Journal of Public Health Advance Access originally published online on July 13, 2005
The European Journal of Public Health 2005 15(4):335; doi:10.1093/eurpub/cki152
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Editorials |
Ageing societies—new priority for public health research?
Johannes Siegrist** Department of Medical Sociology, University of Duesseldorf, PO Box , D- Duesseldorf, Germany, tel. + , fax + , e-mail: siegrist{at}uni-duesseldorf.de
Population ageing, caused by longer life spans and low fertility rates, has changed the demographics in Europe and around the world. Older people not only are becoming a larger portion of the population, but also face a prolonged period of life in which a majority is relatively healthy, especially so in the ‘third age’ that ranges typically from the mid-50s to the early 80s. Nevertheless, ageing is associated with increased risks of chronic disease and impaired functioning. This fact results in challenges to health-care systems, prevention activities and social policy regulations. In this context, fresh evidence derived from public health research on the maintenance and promotion of health in older populations is clearly needed. But why should this research be given special priority? At least three reasons deserve attention.
The first reason concerns early retirement and its major determinants. Although large variations in workforce participation rates are observed between European countries, employment beyond age 55 years has fallen to a critically low level in recent years. In order to reverse this trend, it is important to intervene at the level of major determinants of early exit from the labour market. Recent research suggests that poor quality of work and employment is one such determinant, in addition to the financial incentives and pension schemes provided to employees. Poor quality of work is characterized by physically demanding, strenuous or risky jobs, and by jobs that are defined by low levels of control, autonomy and reward, including promotion prospects and job security.1,2 Being exposed to this type of jobs increases the risk of illness, work-related disability and the desire to leave one's job as early as possible.
A recent survey of populations aged 50+ years in 10 European countries, focusing on health, ageing and retirement, the SHARE project, demonstrated consistent associations of quality of work with measures of self-reported health.3 In the long-term, investments into health-promoting work not only increased the chances of better health in elderly employees, but also contributed to economic pay-off. In this process, innovative public health research that addresses the design, implementation and evaluation of such efforts plays an important role.
Socially productive activities after retirement are a second topic of potential relevance to the improvement of health and well-being among older people. On an epidemiological level, recent research demonstrated a link between productive activity and health and well-being. For instance, in a prospective cohort study in the USA it was found that social and productive activities, such as volunteering or providing help to family and friends, were independently associated with length of overall survival.4 Preliminary results from two large surveys in Europe support this notion. However, these studies underline the fact that these beneficial effects are contingent on the quality of productive engagement.3,5
As increases in longevity have been so rapid that modern society has not kept up, a mismatch has evolved between the strengths and capabilities of third-age populations and a shortage of productive and meaningful opportunities for these people to realize their potential. Although the individual may be willing to put forth effort, there are generally not sufficient opportunities to act in new social roles past retirement and to experience personal need fulfilment and its beneficial health effects. Exploring opportunities, motivations and effects of social productivity after retirement seems a further promising area of future public health research in this area.
Thirdly, social inequalities in health have been shown to persist into older age, although the social gradient of morbidity and mortality is steepest in midlife. For instance, a recent study of relative and absolute mortality inequalities related to education and housing tenure in 11 European populations documented consistent differences in survival of older men and women in all countries.6 The authors of this report concluded that the large number of excess deaths that occur among the lower socioeconomic groups of elderly populations are an important public health problem. Yet, current explanations of this excess morbidity and mortality are still fragmentary. Neither access to, nor quality of, health care or social selection provide a sufficient rationale. Rather, interactions of distinct socioeconomic, behavioural, psychosocial and genetic factors may contribute to the persistence of the social gradient in older age. Elucidating these interactions by interdisciplinary research efforts provides a challenging task of future public health research.
Johannes Siegrist is a co-investigator of the Survey of Health, Ageing and Retirement in Europe (SHARE) research network, funded by the European Commission.
References
1 Belkic KL, Landsbergis P, Schnall PL, Baker D. Is job strain a major source of cardiovascular disease risk? Scand J Work Environ Health 2004;30:85–128.[Web of Science][Medline]
2 Tsutsumi A, Kawakami N. A review of empirical studies on the model of effort-reward imbalance at work: reducing occupational stress by implementing a new theory. Soc Sci Med 2004;59:2335–59.[CrossRef][Web of Science][Medline]
3 Börsch-Supan A, Brugiavini A, Jürges H, et al. Health, ageing and retirement in Europe. First results of the Survey of Health, Ageing and Retirement in Europe. Mannheim: Research Institute of the Economics of Ageing.
4 Glass TA, Mendes de Leon C, Marottuli RA, Berkman LF. Population based study of social productive activities as predictors of survival among elderly Americans. BMJ 1999;319:78–483.
5 Marmot M, Banks J, Blundell R, et al. Health, wealth and lifestyles of the older population in England. London: The Institute for Fiscal Studies, 2002:2003.
6 Huisman M, Kunst AE, Anderson O, et al. Socio-economic inequalities in mortality among elderly people in 11 European populations. J Epidemiol Community Health 2004;45:468–75.
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