The good news is that Europe is ageing. In a little over half a century, the average life expectancy has gone from 66 to 75, and by 2050 is predicted to hit 82. This is not simply because people are not dying young, but because they are living to older ages than ever: the over 85s are the fastest growing demographic group on the continent. But for many, the good news is also bad news, because in many respects—notably pensions, social care and health provision—European societies are not prepared for this demographic shift. Lower fertility rates mean that the working age population is not keeping pace with the number of pensioners.

With regard to healthcare, while most respondents in a survey of more than 1,000 European medical professionals conducted for this study say that their national medical systems are adequately prepared to meet the age-related challenges of the next five years, the longer term is more worrying: 80% say that they are concerned about how they will be treated when they are old, and only 40% say that government policies to address
ageing are comprehensive and realistic.

This Economist Intelligence Unit study, supported by Pfizer, is based on that survey and backed by in-depth interviews with 22 healthcare experts and practitioners. It looks at the leading challenges presented by the ageing of societies—and the opportunities—and some of the steps countries will need to take in response. It revolves specifically around healthcare, but because it is unhelpful, if not impossible, to regard healthcare systems in isolation ("every minister is a health minister", as World Health Organization director-general Dr Margaret Chan points out), this report also seeks to address the broader, relevant ageing-related issues that will also have an impact on health. Its key findings include:

Everyone needs to take prevention seriously. An increasing body of evidence shows that ageing is not directly correlated with healthcare costs. Age is, however, a leading risk factor in a host of chronic diseases. An older population will therefore likely have a higher prevalence of not only individual chronic conditions but of people with more than one such disease. A crucial step toward reducing the future disease load, and therefore impact of ageing, is a greater focus on getting people to make lifestyle choices now that decrease the likelihood of chronic disease down the road. Survey respondents consider prevention to be the most cost-effective means to improve care for older people (cited by 49%). Increasing the emphasis on prevention, however, is far from simple. It will require change by individuals as much as health systems: 46% of medical professionals feel that their countries should prioritise making citizens responsible for their own health in order to meet primary and secondary care needs. Encouragingly, however, 60% feel that initiatives encouraging doctors to practise preventive care are effective, and almost the same number praise vaccination campaigns—a crucial weapon in the preventive health armoury.

Integrate health and social care better. Even with better prevention, the number of older people with chronic conditions will still inevitably increase. The key to managing this will be helping affected individuals to live healthy lives that are as independent as possible within the community. This will mean that societies have to address the increasingly blurred lines between traditional medical care and long-term or social care, but only 38% of respondents rate their countries as good or excellent in the provision of the latter. Currently, most countries treat the two types of care separately, with social care often difficult to obtain or means-tested. What Eva Topinková of Charles University, Prague says of the Czech Republic could describe much of Europe: "We have two ministries and two separate budgets, [but] social and medical needs in older people are intertwined, and very often people need both types of services at the same time." In our survey, medical professionals believe that the two areas requiring the most investment in their countries' primary and secondary care infrastructure are care in the home and nursing homes (both cited by 39%). This is not just a question of having better long-term care in isolation; it is also about providing integrated care across both systems for patients.

Train for the coming healthcare requirements, not those of the past. Ageing populations will not only affect general workforces—27% of respondents see a shortage of primary care workers as one of the top challenges facing their healthcare systems, and 20% say the same for secondary care workers. Worse still, the training of personnel is not geared for the evolving needs of healthcare systems, in particular the integrated care which older patients having more than one chronic condition require. Professor Oliver notes, "The core business of healthcare services now is about older people, but traditional training of doctors and nurses is still geared up to a world where it's all about young people." The difficulty in maintaining an adequate workforce makes a proper understanding of geriatric medicine by medical professionals all the more necessary.

Show ageism the door. After funding, survey respondents believe that negative attitudes toward older people constitute the leading barrier to the provision of better care (42%). Over half also say that older patients are less likely to have their complaints given full attention than younger ones. Ageism is a "huge problem" across Europe, according to Desmond O'Neill, president of the European Union Geriatric Medicine Society. "There is clear evidence that older people get less therapy and surgery," even where they would benefit as much as, or more than, younger individuals. This will have an impact on efforts to make healthcare systems fit for the challenges ahead. In our survey, 49% of respondents say that ageing is regarded as a threat to the viability of their countries' national healthcare systems, but 50% say it provides the opportunity for broader healthcare reforms which are needed anyway. To succeed, we need to focus on the opportunities instead of being overwhelmed by the threats, which means treating ageing as good news and older people as an asset, rather than the opposite.

Improving population health at older ages has the potential to deliver a boost to Europe's growth—by increasing older age participation in the workforce as well as by increasing the productivity and efficiency of healthcare. European initiatives such as the Active and Healthy Ageing Innovation Partnerships are a good start to achieving this goal, but given the diversity of European healthcare systems, it is unreasonable to expect that a comprehensive, co-ordinated, cross-border ageing strategy will ever be agreed.

Given the complexity of this topic, and of the diversity of healthcare systems and strategies within Europe, this report does not presume to present a blueprint for change. But the issues it discusses are things which policymakers need to know, and which should be central to their thinking. And, as this report will discuss, there are specific strategies that policymakers could adopt now to put citizens on a good footing to manage population ageing in a sustainable way. Population health interventions, for example—addressing the social determinants of health—can increase healthy life expectancy. Innovative technologies can help older people remain independent for longer. Health and social care providers can be encouraged to provide integrated patient-centred care, empowering patients to stay healthier. Healthcare professionals can be trained specifically in the needs of older people. Increasing pension ages is a political minefield, but it should lead to more flexible working patterns, keeping people healthier as they work longer. And while the current economic environment may be seen to compound long-term demographic challenges, it should also remind policymakers that there is a vital need to invest in the long-term sustainability of healthcare systems.