VOL. 67, NO. 3 - AAFI-AFICS, Geneva - UNOG

HEALTH
THE AAFI-AFICS INFORMATION SEMINAR ON LONG TERM CARE
24 January 2008
We are publishing in this issue of the Bulletin the opening remarks of Dr Halfdan Mahler and the reflections
of our colleague Angela Butler, both speeches having been very much in demand.
Opening remarks by Dr. Halfdan Mahler, former Director-General of WHO
When somebody called me over the telephone and said “you are coming to the opening of an AAFI-AFICS
seminar on long-term care ...”, I thought I was coming to sit down and I said : “yes, I’ll come”. I very quickly
found out that I had been a very feeble-minded Santa Klaus to believe that this was just an invitation to come
and have fun here, but I was supposed to perform, and say a few opening remarks. So here they are.
It is very fitting that AAFI-AFICS should have taken this initiative, not least because there is a very steep,
exponential increase in the need for long-term care; and this is not only in this privileged part of the world,
(be it in the super-duper privileged Geneva or in another part of Switzerland or in France), but it is really
everywhere. It is therefore particularly important that we should be properly informed about the options to us
here and elsewhere.
We cannot say that long-term care is something that just affects others because directly or indirectly it does
and will affect us all. I cannot help, Mr. Chairman, being a WHO person, but give you the definition of health
in that organization’s constitution because that is imminently relevant to long-term care. For WHO, “Health is
a state of complete physical, social and mental well-being and not merely the absence of disease or
infirmity”.
Before I left WHO, and that is more than 20 years ago, there was a strong move to add to that definition
“spiritual”; that is that health is also a state of “spiritual” well-being. Being the son of a priest, I am an atheist
but I was very much in favour of the idea of adding “spiritual”, because that is very important thing too and
has, in my opinion, nothing to do with religion. WHO has also recently given a definition of ageing: “a process
of optimising opportunities for health participation and security in order to enhance quality of life as people
age”.
Now, this is of course not a local problem but it is a global phenomenon. We tend to associate the
exponential need for long-term care services and support with the relatively rich industrialized countries.
Given my former WHO privileges, you will not be surprised if I frame some of my comments in a global
context. Also to see if there is something that we, in the so-called developed world, and more particularly in
the area surrounding Geneva, can learn from reflecting on long-term care in all regions of the world,
including reflecting in our conscience on facing the monstrous social economic inequities in the
contemporary world.
Here come some statistics which I shall make short to make sure they are not boring, but these are very
important demographic and epidemiological shifts and quite startling ones. By 2020, the percentage of the
population that will be more than 65 years old is quite extraordinary. For example, by 2020 in Switzerland
and in France more than 20% of the population will be 65 or more. There are similar examples across the
region. But, by 2050, it is estimated that the rest of the world will rapidly be catching up. By 2050, 23 % of
the population in China will be over 65 years, in Thailand over 21 %, etc. etc. And by then UK and France in
2050 will have a quarter of their populations over 65; staggering figures.
And at the same time, of course, medical science will continue to have made very great progress in warding
off diseases; but don’t let us forget that frailty is often the price of longevity. And hence the need for longterm
care everywhere. In 2003, WHO said that the need for long-term care in the developing world will rise
by as much as 400 % in the coming few decades – a 400 % increase in need; the United Nations World
Economic and Social Survey in 2007 says, I quote: “that the epidemiological transition from communicable to
non-communicable diseases has already taken place in developed countries… but it is now establishing
itself in very many developing countries”.
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