Opening Address to the 2nd International Conference On Healthy Ageing and Longevity
The Minister for Ageing, The Hon Julie Bishop MP, opens the 2nd International Conference On Healthy Ageing and Longevity at the Brisbane Convention Centre.
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18 March 2005
Good morning ladies and gentlemen. I acknowledge Dr Sidorenko, Professor Kidd, Mr Weller, delegates and guests.
My congratulations to John and the International Research Centre for Healthy Ageing and Longevity for staging this second symposium. It is a measure of its importance that it has attracted so many people, so many leaders in their field and from around the globe.
I welcome the opportunity to contribute a national, and perhaps a personal, perspective to the international picture that Dr Sidorenko has just drawn for us. He lauded Australia as being the first country to adopt the “society for all ages” concept as the fundamental principle of its ageing policy. and it is a strong conception.
As the United Nations has declared, it recognises the value that arises when “generations invest in one another and share in the fruits of that investment”. Australia adheres strongly to the “society for all ages” principle. We know that the demographic change ahead of us will touch every age group, every level in our society.
When the Australian Government looked at how to meet the challenges, and the opportunities, presented by our ageing population, it saw that an all-encompassing approach was a prerequisite.
The creation of the separate Ageing portfolio itself put the issue of the impact of our ageing population squarely on the national policy agenda.
The Australian Government commissioned critical analytical papers, such as the landmark Intergenerational Report, that looked at long-term fiscal issues involved with an ageing population, and the economic implications over the next 40 years, not just the next budget cycle. We have commissioned penetrating reviews of specific areas, like the cost of residential care and the delivery of community care.
As far as the broader issue of ageing is concerned, in 2001 we introduced the agenda-setting National Strategy for an Ageing Australia, which has acted as a stimulus and reference point for our current policies. Its remit was broad, ranging across all the areas of concern to us:
How is the nation to pay for the cost of care and infrastructure? What can we do to encourage saving and limit the growth of pensions? What will “retirement” look like in future? How do we get employers and employees to think about their needs, personal and organisational? How can we encourage people to adopt a whole of life approach to healthy ageing?
But let me pause here. I could spend the next 20 minutes describing in detail government achievements in this area. Instead, let me try to raise some general propositions.
It is a fact that governments tend to put in place policies and strategies in response to current scenarios. We preserve the status quo, preserve existing systems. So policies that seek to deal with the impact of the ageing population tend to focus on how we can limit the impact on current arrangements. This is self-evidently important and appropriate. But policies have tended to be based on a particular conception of older people, assuming that the next older generation will act in the same way, and have the same expectations, as the current older generation.
So, in terms of our policy agenda in ageing, let’s just consider who will be the next generation of old people. Just who are we planning for?
The Baby Boomer generation, that’s who. That generation of Australians born between 1946 and 1964.
The first of the Baby Boomers will turn 60, have their 60th birthday, next year. When we predict that the over 65 population will increase, from one in eight today, to one in four in 2040; and that the over 85 age cohort will become the fastest growing, it is the Baby Boomer generation making up those numbers. The oldest Boomers will be in their 90s, the youngest in their mid 70s in 2040, the next generation of old.
Now while we have economic modelling and can make budget assumptions and population predictions upon which to base our current policies, what I believe has been missing from much of the debate about our ageing population is a deeper appreciation of the values, aspirations and attitudes of the Baby Boomer generation, what will be our nation’s next older generation.
I hope this forum will take into account the likely expectations of the new ‘old’ and how they will want to age, given who they are.
To illustrate my point let me paint a picture. Let’s select a typical atypical member of the Baby Boomer generation. Let’s call her Mary. And let’s try to take the pulse of the next older generation though the eyes of Mary.
Let’s say Mary was born in Australia in 1946. Her parents, having experienced the deprivation of the Depression, arrived in Australia from war-torn Europe in early 1946, joining some half a million people who emigrated to Australia in the three years after World War II.
What more do we need to know about Mary? Her father was a tradesman, her mother stayed at home and looked after Mary and her siblings. They settled happily into, let’s say, suburban Melbourne.
Apart from family, what were the early influences? When Mary was 12, in 1958, the family bought a TV, the first in the street. So, from the beginning of her secondary school days, Mary and her friends became a generation of consumers – marketed to and advertised to - effectively all their lives.
Determined that she should have a better life than they, Mary’s parents encouraged her to go to university, one in six of her age group did so, but only if she studied for an arts degree, and only if she became a teacher.
So in 1964, at age 18, she went to the relatively new Monash University. A few months later she joined thousands of young people at Melbourne Town Hall, screaming and crying for a glimpse of the Beatles. She later became a lifelong devotee of The Rolling Stones, and so the rebellious streak emerged.
For political activism was a hallmark of the era; flower power, anti-Vietnam marches, protests. She grew up at a time of radical social change, with the emergence of social movements that re-configured attitudes across the globe: feminism, environmentalism, equal rights. She even voted Labor in the Federal election of 1972!
After working as a teacher for a few years, Mary married. Although it was the beginning of the so-called sexual revolution, during her early 20s and 30s she had three children. (Although some of her friends did things quite differently. While the pill was introduced in 1961 it wasn’t listed on the PBS until 1973.)
Mary and her husband bought their own home, invested in property and shares. A two-income family, because she returned to teaching after the children grew up. And as she approaches her 60th birthday next year, she has got a healthy superannuation package.
She is still married. Most of her friends are divorced. Mary’s parents, now in their 80s, look to Mary to care for them. Her siblings moved interstate years ago. As all her children have full time jobs Mary is called upon to care for the grandchildren, when she’s not called upon to care for her parents.
Part of her feels that she deserves to have it all. She’s somewhat self-centred. But part of her feels she has missed out. Who is she today?
Mary is better educated, more independent and wealthier than her parents, who are part of our current older generation. They still ration for a rainy day. Mary eats out, or takes it away. She is a of a generation the likes of which we’ve not seen before. Less accepting, less conforming, less trusting than any previous generations. A generation that will be very economically powerful. She is a social moderate, and increasingly an economic conservative. In so many ways the Boomers are disarmingly contradictory. She is, unlike her parents, a swinging voter.
The challenge for legislators at all levels, for policy makers, for social commentators, for researchers, for this conference, is to try to understand how Mary and her Baby Boomer generation, as the new ‘old’, will want to define the rest of their lives.
Given that they will live, on average, into their 80s and 90s, what are their expectations of quality of life? What personal responsibility will they take for it? Where and how do they intend to live? Who will care for them and who will pay? What will be their expectations of their children? What will be their expectations of government?
Let’s take health care. Advances in science and medical research and public health policies have meant that life expectancy for Australians is one of the highest in the world. Yet there has been a dramatic increase in chronic conditions in Mary’s generation. Heart disease, strokes, kidney disease, type II diabetes, musculoskeletal conditions. Many of these conditions are preventable or their onset can be delayed.
Today it has been estimated that the average 70 year old has four chronic conditions and consumes an average of 35 PBS scripts per year for those conditions. The cost of chronic disease in Australia is over 43 per cent of the total health care costs, or over $22 billion.
With well planned investment now into preventative efforts and serious lifestyle interventions for Mary’s age group and those older and younger, we could avoid much of the expense, let alone the disability and dependency, associated with chronic conditions.
Prevention is one of the few known ways to reduce demand for health and aged care services. And I believe that the best buy in public health today must be a combination of regular physical exercise and a healthy diet.
It is time for Baby Boomers to look to their longer-term health needs. They’ve got to stop smoking, drinking too much and eating bad food, and they have got to get active.
The prevalence of smoking tobacco is still too high. Notwithstanding massive Quit campaigns, there are still over three and a half million people in Australia who smoke,
with 19,000 deaths a year from smoking-related illness. Over 22 per cent of Australians aged between 40 and 49 years, and over 18 per cent of Australians aged 50 to 59, are still smoking.
Obesity is also a major problem for quality of life as overweight and obesity contribute to a range of chronic diseases, including type II diabetes, cardiovascular disease, arthritis, osteoporosis.
According to a paper published last month by the Australian Institute of Health and Welfare, the number of obese Australians aged 55 and older was approaching one million people, which represents more than one in five of all older Australians.
Some of the practical things that a community can do to encourage physical activity and lifestyle include creating footpaths, cycling tracks and swimming pools; addressing the concerns about unsafe neighbourhoods, removing barriers to daily exercise, encouraging social networks to get people out of home and activity back into our lifestyles.
GPs can make a real difference. Our doctors should be committed to prevention, as much as treating illness. In the Australian Government’s Focus on Prevention Package, funding was made available for GPs to assist their patients to find a healthy balance in their lifestyles by using a ‘Lifestyle Prescription’. This is authoritative written advice that is given to a patient recommending healthy behaviour change. Without resorting to medication, the doctor prescribes patients preventive actions to help them avoid or cope with chronic disease by making healthy lifestyle choices.
Prevention is the key. Any reduction in Australia’s health costs will depend upon how successfully we can create a health care system that actively encourages, motivates and enables preventative action by the users of, and providers within, the system.
While there are many programs and efforts already in place, let me speak about our current research efforts, which I believe will provide us with the road map for the future in terms of this whole of life approach to healthy ageing.
It will depend critically on conducting the right kinds of research today. In Ageing, a cornerstone of our efforts will be the Ageing Well, Ageing Productively research program. This program is designed to provide significant, long-term funding for the kinds of multi-disciplinary research which will bring about substantial improvements in the quality and delivery of health. We intend issuing a detailed call for research towards the middle of this year.
This program was initiated by the National Health and Medical Research Council in response to the research priorities which the government announced in 2002. The Council enlisted the cooperation of the Australian Research Council. To ensure that the right questions are asked, critical in any research, the councils are now finalising a period of intense consultation.
‘Ageing Well’ is also the focus of one of the five national research networks which the two councils are funding. The Ageing Well network is convened by Professor Hal Kendig of Sydney University, who I understand later today will talk about longitudinal findings on Predictors of Healthy Ageing. Over the next five years his research team will be looking at ways to foster multi-disciplinary research in ageing.
We have also made dementia the focus of much of our research activity. It is a worldwide concern, and not only in developed countries like Australia, where it has been identified as the leading cause of non-fatal disease burden. Its incidence will increase as our ageing population rises. Estimates released this week by Access Economics suggest that the total number of Australians with dementia will pass 200,000 this year. It estimates that new diagnoses will be running at the rate of 1000 a week, and forecasts that the number of people with dementia will pass 730,000 by mid-century.
The Australian Government already invests over $2.6 billion a year in dementia care and support programs, education and training. We have announced that dementia is a National Health Priority and have added a further $200 million in funding for research, education and dementia-specific community care packages. In fact I announced the first tranche of $52 million for research, and GP initiatives, and community awareness programs a couple of weeks ago. And earlier this week I announced further funding for the Living with Memory Loss program, which helps people with dementia remain in their communities.
A cohort of healthy active older Australians will impact upon our notions of work and retirement. With our ageing population, the government is seeking to enhance workforce participation amongst older workers, encouraging people to work longer if they can, beyond traditional retirement ages.
I fear the Boomer generation is unlikely to respond to that call unless work can be more flexible and better organised to take account of what they want to do with their time. How can it be better structured to fit in with the other activities they want to do? How does Mary hold down her teaching job, support her children by caring for the grandchildren as well as for her parents?
We need to redefine “retirement”. Our focus should not be on retirement age and when that begins, but on what can we do and what activities can be accommodated in our lives beyond traditional retirement age.
The challenge for employers is to better tailor or customise the final years of working life, at whatever age that might be. Work and retirement should merge into a transition phase with flexible hours, different work patterns, different jobs or levels of responsibility.
We need to put in place a more structured winding down phase, a gradual withdrawal. Work and retirement should be regarded as a continuum.
And what of aged care? Government spending on aged care has increased by over 120 per cent over the past nine years. Over $6.7 billion will be invested in aged care this year. Over the same period the over-70s population has increased by just 20 per cent. In terms of the projected increasing demand for care we have set out to build a system of care that was financially sustainable, that offered access to the right kind of care and support for those who needed it. We have made quality a given, and equity a fundamental. There are now numerous innovative models of care delivery. We are constantly searching for more effective ways of ensuring care is delivered at the right time and place and by the right people.
I believe it meets the needs and expectations of our current older generation. But given the assumed increase in demand, society must consider how to determine the respective rights and responsibilities of individuals, their families and the government in terms of who provides the care and who will pay. If that rate of government spending cannot continue, an effective doubling of the budget every nine years, what will the Boomers do about their aged care needs?
If Mary is any guide, the Boomers are likely to be averse to most forms of institutionalised care. And we should look closely at their expectations now. They are far more likely to demand more individualised and customised care, taking account of their particular needs and desires, rather than fitting into a more regulated, rigid system.
For future planning, the behaviours and attitudes, and the values that underpin them, of the Boomer generation are at least as important as economic considerations, GDP analysis, and budgetary limitations.
And if the new ‘old’ don’t see themselves in residential care, we must focus not only on community care, as the government has been doing, but on the built environment. Some people go into residential care, not because they can’t look after themselves, but because their housing is not appropriate or they are living in social isolation. We need to focus on integrating older people into the community so that they can continue to participate in their community. Urban and housing design needs to be flexible enough to meet people’s needs as they age. Technology opens up options for people to remain at home longer - ‘smart’ houses.
Also the use of online technology at home for security or health care or use of telemedicine by GPs. Boomers are keen users of technology.
So: if retirement is redefined and people take preventative health action and we focus our research efforts to build an evidence base on ageing, and housing and urban design is adapted, then we will be in good shape to meet the likely expectations for improved quality of life for individuals and communities.
But we must act now to avoid a generation of old people who retired too early, yet are living another 30 years, are physically inactive, with numerous chronic conditions leading to increased stress, depression and functional dependency. That scenario equals a downwards spiral in health status and quality of life, and an upwards spiral in health and aged care costs.
The Baby Boomer generation has the potential to rewrite the ageing agenda. Healthier, fitter, socially involved older people, emphasising quality of life and thus enabling a different focus for public spending, will offset the expected financial costs to our nation of an ageing population.
That is what our national ageing policy will embrace. That is why this forum is so important. It is time for us all to invest in research and analysis and encourage the type of debates and discussions I hope you will have over the next three days, about how we can change current structures and systems and beliefs to reflect the attitudes and values of the Baby Boomer generation.
We are the on the cusp of this transformation. In 20 years time the value of the investment will be realised, not just for Mary and her children, but for society as a whole – a society for all ages.