2. A Vital Investment

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• The Demographic Imperative
• More Sound Reasons to Invest in Healthy Aging

Canada's population is aging quickly. In fact, Canadians aged 65 and over will become more numerous than children under age 15 around the year 2015. This unprecedented demographic shift will have far-reaching social, economic and political impacts (Statistics Canada, 2005a).

The Demographic Imperative

In 2005, there were some 4 million Canadians over the age of 65. Due to the aging of the large baby boomer population, by 2031, there will be approximately 9 million Canadians aged 65 and over and they will account for 25 percent of the total population. This will be almost double the current proportion of 13 percent (Statistics Canada, 2005a).

Canada's older population is also aging. Between 1991 and 2001, the population aged 80 and over soared by 41 percent to 932,000. It is expected to increase an additional 43 percent from 2001 to 2011. By then, it will have surpassed an estimated 1.3 million (Statistics Canada, 2005a). Because women generally live longer than men, women dominate the senior population, especially after age 80.

More Sound Reasons to Invest in Healthy Aging

In addition to the demographic and political imperatives of an aging population, there are other important reasons to invest in healthy aging:

1. Seniors make a significant contribution to the richness of Canadian life and to the economy. Older people provide a wealth of experience, knowledge, continuity, support and love to younger generations. The unpaid work of seniors makes a major contribution to their families and communities. Some 69 percent of older Canadians provide one or more types of assistance to spouses, children, grandchildren, friends and neighbours (National Advisory Council on Aging (NACA), 2001). Many grandparents care for their grandchildren on a part- or full-time basis, and increasing numbers of Canadian grandparents are raising their grandchildren on their own (Statistics Canada, 2001a). As caregivers to spouses, family, friends and neighbours, seniors are a vital force in reducing health care and social service costs. Civil society programs benefit from the voluntary contributions of a large and growing number of retired seniors with valuable knowledge and skills. In addition, seniors are the largest per capita donors to charity (NACA, 2001).

Older Canadians also make an important contribution to the paid economy. More than 300,000 Canadians 65 or older were in the labour force in 2001 (Statistics Canada, 2001). As demographic shifts reduce the ratio between the proportion of employed and unemployed Canadians (i.e., children and retired people), governments and some employers are encouraging individuals to work longer. Remaining in the workforce and actively participating in civic affairs depends, in large part, on staying in good health.

2. Healthy aging can delay and minimize the severity of chronic diseases and disabilities in later life, thus saving health care costs and reducing long-term care needs (Laditka, 2001). Chronic diseases account for an enormous human and economic burden in Canada. The prevalence increases with age and is highest among older people in vulnerable communities (e.g., Aboriginal and economically disadvantaged groups) (Public Health Agency of Canada (PHAC), 2005a). Chronic diseases are responsible for 67 percent of total direct costs in healthcare and 60 percent of total indirect costs ($52 billion) as a result of early death, loss of productivity and foregone income (PHAC, 2005a).

At a population level, even small decreases in the key modifiable risk factors for chronic disease can have a large effect in preventing the transition from low to high risk (Rose, 1992). Practicing positive lifestyle behaviours can also help seniors manage chronic conditions, allowing them to live more years independently and in good health. For example, even modest rates of physical activity have been shown to stave off functional declines in people with osteoarthritis (Feinglass et al, 2005). Appropriate physical activity also helps with pain management (Arthritis Society, 2005).

Diagnosing, treating and managing chronic conditions are expensive. In 2003, seniors' health care needs accounted for more than 44 percent of all provincial government health spending, as well as 90 percent of expenditures in long-term care institutions (Canadian Institute for Health Information; Statistics Canada, 2005). These costs can be controlled and reduced when older people remain healthy enough to live in the community in a variety of supportive living arrangements. Experts believe that the health care costs of population aging will be manageable within the context of a growing economy-especially if the mental and physical problems due to chronic diseases and injuries can be prevented or delayed until the very end of life. This phenomenon, referred to as the "compression of morbidity" can be a direct outcome of healthy aging and its many benefits (World Health Organization (WHO), 2005).

3. The evidence compels us to build on existing opportunities, to put in place interventions that are known to be effective and to show leadership by supporting innovative approaches. Experience provides us with some models and successful interventions that can be replicated in different settings. In addition, there are opportunities to build on existing strategies in aging and healthy living that are already underway in most provincial/territorial, federal and local jurisdictions. Some of these promising practices and opportunities are explored in the chapters that follow and in the appendices to this report.

Canada's capacities in community-based research as well as new opportunities for collaborating with the World Health Organization provide opportunities to develop further knowledge and show leadership at provincial/territorial, national and international levels.

4. Canadians of all ages believe that efforts to enable seniors to remain healthy and independent are "the right thing to do". Established values such as independence and interdependence, social justice and respect for families with multiple generations help to define Canadian society. Further, as a signatory of the 2002 International Plan of Action on Ageing, Canada has made a clear commitment to "enhancing life-long physical and mental health and well-being, maintaining independent living and expanding the participation of older persons in society" (United Nations, 2002).

Investing in healthy aging is not an "either-or proposition" that sets up competition for resources between the young and old. Rather, it is part of a life course approach that seeks to improve well-being at various life stages by making strategic investments at different times and transitions related to age (e.g., childhood, entering school, adolescence, parenthood, menopause, older age, etc.).

Critical periods for both biological and social development include in utero, the first six years of life, the transition from school to the workforce, parenthood, retirement, menopause for women, role changes in older age, the onset of chronic illnesses or age-related declines, and the loss of family members and friends in later life. Policies that reduce inequalities protect and support vulnerable people at these critical times (Bartley et al, 1997).

It is never too late to invest in people's health. For example, with the assistance of interventions that are tailored to them, seniors who smoke can learn to quit and thus enjoy the immediate and long-term health benefits of a smoke-free lifestyle (Health Canada, 2002c). In addition, investments in an "age-friendly" environment usually benefit the old and young at the same time.

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