Ms Leila Kostiainen: Innovations for an ageing society
One of the primary aims for people is to increase life expectancy, an aim which has been successful in the Nordic Countries. Life expectancy has increased with the passing years, as has the number of active years people enjoy. So it is paradoxical that the ageing of the population is seen as a major problem at the moment in Europe, said Ms Leila Kostiainen, State Secretary, at the 18th Nordic Congress of Gerontology on 28 May 2006.
The reason is understandable. When people live longer, there are more pensioners, which increases pension expenditure. The cost of health care for the elderly goes up too. That increases the pressure to raise taxation, which is particularly problematic since the working population is beginning to decrease. How are we going to manage?
This is the question we have thought about raising as the leading social, work and health policy theme during Finland’s EU Presidency. This issue is not a cause for concern to employment ministers alone or simply to social affairs ministers or to health ministers in particular. It is a shared future challenge for us all.
Taking up this challenge means resorting to many methods. Some of them have immediate effect; others offer a remedy only after many years. None of the methods should be ruled out simply because they do not bring immediate relief. Regrettably, even positive changes that are meant to be quick often come with a time-delay.
Ourmethods of dealing with the problem can be divided into three parts. First we have to try to mobilize a greater number of working age people into working life. One shared issue for all EU countries is the necessity to raise the retirement age. In other words, longer life expectancy should also mean a longer working life.
The second method is to increase the workforce. Workforce needs vary from country to country but, in general, workforce needs within the European Union call for open discussion on migration policies, family policies and reconciliation of work and family.
In the longer term, the birth rate has an effect on the work force, and the birth rate can be affected through family policies. By offering safe childcare alternatives, interest in larger families can be increased. In Finland, the aim has been to take the parent’s differing wishes regarding childcare into account by offering different alternatives. By European standards, the Finnish birth rate is at a reasonably good level.
The third method is to increase the efficiency of measures taken by society and improve productivity. The better we are at preventing problems and improving health, the lower the costs will be in the future. Promoting health is not purely a task for health policies. It is also the task of environment policies, housing, working conditions, city planning and construction. Consequently, we wish to introduce the idea of ‘health in all policies’.
The ageing and decreasing work force gives rise to concerns about increased productivity. Improving the productivity of social, health and other care services is a topical challenge in all the Nordic countries. Denmark is reforming its municipal structure so as to be more compact and effective. In Finland, the aim of renewal of the municipal and service structure is to guarantee sufficient and equitable welfare services for all inhabitants.
Today, care of the elderly requires substantial expertise and skills, as well as financial resources. Taking care of the vulnerable in our society is also a major responsibility of our service system. Good social protection is a basic pillar of modern society. Gerontology and geriatrics will play a more and more central role in the production of scientific information concerning the welfare of elderly people.
Our social security system is trying to maintain a balance between the individual’s rights and responsibilities by securing and promoting the population’s wellbeing in the changing environment. Principles on which elderly care is based comprise human dignity, equality, security, and opportunities for using and developing one’s own skills and capacities. Like the other Nordic countries, Finland is actively involved in the formulation of European social policy. The cornerstones of wellbeing for us all are maintenance of work ability and functional capacity, independent living and social inclusion. Therefore, the core issue for us representatives of the Nordic welfare states is to promote future welfare and wellbeing.
But does the day to day life of our elderly care stand closer scrutiny? Based on people’s everyday experiences, there has been talk for years about its shortcomings. There is heated debate about this issue in the media. Also our Parliament has recently questioned the promises of the Government Programme to improve the availability and quality of services for older people. We not only need more quantitative resources for elderly care but we should also enhance its quality. We should also adopt a more positive attitude towards ageing.
It is, however, important to note that older people are above all a resource and possibility for society and community – not a problem. Ageing should not be medicalised or stigmatised, although the rather superficial culture of our time stresses youth. The majority of our older people are well and can cope without outside help up to a high age. They also can provide support and protection for each other as well as for younger generations.
Ageing involves reduced functional capacity, and also the probability of illness increases. Medical care recommendations are mostly based on research on working-age population. Among older patients, affiliated diseases, sensitivity to side effects and assessment of life quality complicate the evaluation of treatment and care options compared to middle-aged patients. In Finland, the access to care has been improved by legislation for both older people and other population groups. The principle of guaranteed access to care has been applied for about a year. Professionals have also compiled uniform criteria for access to care with the aim of improving the equity of citizens in access to care.
The functional capacity of older people has improved over recent years.
In Finland, almost 90 per cent of those over 75 live in their own homes. This is one example of the success of our social and health policy. Geriatric rehabilitation projects have been supported systematically. Although gerontological research is well established in our countries, information about the actual functional capacity of older people is needed for future planning.
We also need more intensive co-operation between professionals working in the field of medicine and social and health care. On the other hand, we need more regional information on the co-ordination of services in order to be able to provide seamless services for clients. Research on ageing is at its best cross-scientific research.
An example of such collaboration in Finland we have developed a special programme, which will continue until 2009. The objective of this national programme is to promote the functional capacity and independent living of older people by means of physical activity that will enhance their muscular strength and sense of balance. This has been an excellent way of improving the co-operation between research and practice.
It is important to create structures that help disseminate and utilize researchinformation. Research seminars, networks, and electronic portals all deliver this dissemination of information.
Supporting the functional capacity of older people is a means of improving the quality of life, reducing service needs, and promoting empowered inclusion. This should include physical exercise, instruction in healthy nutrition, and the strengthening of social networks. All the people working with the elderly should be made aware of good solutions provided by technology for facilitating independent living. Risk management and injury prevention are an area in which evidence-based information is important.
We can be proud that research in evaluating changes in older people’s wellbeing and functional capacity has been started in Finland, Sweden and Norway. In Finland, the first information package was collected as a part of a welfare study in 2004, and the next is planned to be collected in 2008. As it will use the same internationally validated indicators as Norway and the WHO, in this way we shall be able to obtain comparisons for studying the conditions of older people in the Nordic countries.
These kinds of studies are always expensive but their funding should be secured, because through them it is possible to obtain very significant information.
I believe that by compiling the best practices from different sectors and by comparing the experiences of different member states, we will be able to cope with future challenges. It will not happen on its own and it requires systematic work at the national level, at the Nordic level and within the EU.
I believe the theme of this congress is most topical, and I hope that the discussions about our important joint challenge will give much food for thought.