London School of Hygiene & Tropical Medicine

The concept of premature mortality needs to be either abandoned or redefined if it is not to discriminate against older people, according to a commentary piece published in the British Medical Journal.

One of the main health targets included in the United Nations Sustainable Development Goals (SDG) set out to reduce premature mortality from non-communicable diseases, such as cancer, heart disease and stroke, by a third by 2030. Premature mortality is defined by the World Health Organization (WHO) as deaths occurring among people aged 69 years or younger.

The article authors, from the University of East Anglia (UEA) and the London School of Hygiene & Tropical Medicine, argue that this definition sends out a clear statement to member states that health provision for younger groups must be prioritised at the expense of people aged 70 or over. They call on the WHO, the lead global agency on the issue, to rethink this definition so as not to discriminate against older people.

They maintain that this current use of premature mortality discourages research and data collection for older people, with an example being their exclusion from HIV targets. It also exacerbates and justifies the existing levels of age discrimination in health care and distracts from the major challenges that especially affect older people, such as palliative care.

The article's lead author Peter Lloyd-Sherlock, Professor of Social Policy and International development at UEA's School of International Development, said: "The implications for all countries, the UK included, is that resources allocated to conditions such as cancer, cardiovascular disease and dementia should be diverted from older people in order to comply with this global target.

"The World Health Organization cannot continue to take this unethical and discriminatory approach. The SDGs are the key reference point for global health over the next 15 years and must jettison this ageist approach."

Setting out their concerns and recommendations in the BMJ, Professor Lloyd-Sherlock and co-authors Professor Martin McKee and Professor Shah Ebrahim, from the London School of Hygiene & Tropical Medicine, say the premature mortality target 'sends a strong signal in favour of discriminating against older people'.

They add: "Since the 1990s key aspects of health policy have been framed by explicitly ageist principles…The prominent role given to premature mortality thresholds shows that ageism is becoming increasingly blatant. It is inconceivable that global targets would similarly discriminate against other groups, such as women or people with disabilities."

Proposing a less discriminatory approach, they conclude: "Engaging with ageism in health policy does not mean throwing the baby out with the bathwater. We still need mortality indicators…so long as they are interpreted with care. Additionally, policy-makers should explicitly assess how the choice of measure impacts on the priority given to each age group.

"Highly cost-effective health interventions exist for people of all ages. Improved surveillance increases the scope to capture the disease burden in older people…In 2015 WHO published a report on ageing and health, indicating that WHO itself is ready to jettison ageist concepts and champion a more ethical approach. It is important that such progress is not undermined by poorly considered global targets."

Publication

• Peter G Lloyd-Sherlock, Shah Ebrahim, Martin McKee and Martin James Prince. Institutionally ageist? Global health policy in the 21st century. British Medical Journal. DOI: 10.1136/bmj.i4514