Population ageing is reshaping societies worldwide, and the EMR is no exception. With longer life expectancies and declining birth rates, this region's proportion of older adults is growing rapidly, presenting unique challenges for health and social care systems.
A recent technical meeting report examined the feasibility of measuring unmet needs across different World Health Organization (WHO) regions through ongoing research commissioned by the WHO Kobe Centre for Health Development (WKC). This initiative aligns with WHO's global efforts to enhance data collection and address older adults' unmet health and social care needs. It is part of WHO's Universal Health Coverage (UHC) agenda and contributes to the Sustainable Development Goals (SDGs) by promoting equitable access to health services, especially for vulnerable populations.
In this blog, I focus on a study that examines unmet health and care needs among adults in the EMR region. The study was developed as part of a global initiative led by the WKC in collaboration with the WHO regional offices. The study adopts a mixed-method design, provides a review of the literature, examines extant data and gathers expert knowledge about ongoing relevant research in the region.
The study shows that, in spite of improvements in life expectancy across the region, healthy life expectancy often lags, leaving many older adults to live extended periods with poor health and unmet care needs. Noncommunicable diseases (NCDs) such as cardiovascular diseases, diabetes, and cancer are the primary causes of death among older adults in the EMR, yet access to adequate health care varies significantly. For example, the World Values Survey (WVS) provides data on the prevalence of unmet healthcare needs, revealing wide disparities across the region. According to the WVS, the prevalence of unmet healthcare needs ranges from 1% in Qatar to over 46% in Pakistan. However, the WVS is unreliable due to small and unrepresentative samples and the way in which the crude measure of unmet healthcare needs is assessed, as it is only based on one question.
Except for the WVS, there are scarce sources of information that can comprehensively capture the unmet health care needs of older adults in the EMR region. Beyond health care, social care needs—such as assistance with daily living— remain poorly understood due to insufficient data and standardisation across the region.
Out-of-pocket (OOP) health expenditure presents a significant barrier to UHC for older adults in the region. Many countries in the EMR rely heavily on OOP payments, which disproportionately affect vulnerable populations, including older people. For example, OOP expenditure constitutes over 77% of total health spending in Afghanistan, compared to just 6% in wealthier nations like Qatar. This financial burden often forces older adults to forgo necessary care or face catastrophic health expenditures that drive them further into poverty. Expanding UHC to include comprehensive coverage for older adults, particularly for long-term care and NCD management, is essential to reduce these inequities. Countries such as Tunisia and the Gulf Cooperation Council (GCC) states have implemented non-contributory health schemes to address these gaps, offering a model for regional adaptation.
The study highlights several factors driving unmet health and social care needs. Systemic issues like inadequate infrastructure and affordability challenges are compounded by external shocks, including conflicts and the COVID-19 pandemic. These crises have disproportionately affected fragile settings such as Occupied Palestinian Territory and Syria, further straining already limited resources. Sociocultural influences also play a role, with women and widows often experiencing more significant barriers to accessing care. Limited social contacts and the isolation faced by older adults, particularly in countries like Egypt, Jordan, and Saudi Arabia, are significantly lower compared to high-income countries in Europe. This lack of connection not only exacerbates health disparities but also delays the adoption of health innovations and reduces awareness of available services. Social connections, often overlooked in discussions on ageing, emerge as a key factor in improving health outcomes. Community-based initiatives to promote intergenerational support and reduce isolation could transform the lives of older adults, creating environments where they feel valued and connected. By addressing these social gaps, such interventions can play a pivotal role in enhancing public health outcomes and bridging disparities.
In the absence of localised surveys, country-level indicators can serve as proxies to estimate unmet needs. This approach involves utilising data such as life expectancy, disease burden, and economic metrics to infer the scale of health and social care gaps. For instance, indirect measures—such as rates of disability, chronic disease prevalence, and GDP per capita—can help model unmet needs. The report highlights that integrating these proxy indicators with available metrics, like the UHC service coverage index, provides a more comprehensive picture of care gaps. Additionally, adapting frameworks from regions with extensive data, combined with local socioeconomic context, can enhance the reliability of these estimates.
Addressing these challenges requires coordinated, multi-faceted approaches. Enhanced healthcare infrastructure is vital, particularly in rural and underserved areas. Investments in geriatric care training, integration of mental health services, and support for chronic disease management can bridge critical gaps in care delivery. Financial barriers must also be addressed through subsidies and innovative financing mechanisms to ensure that vulnerable populations, including refugees and low-income older adults, can access essential services. Furthermore, building resilience in health systems—to maintain service continuity during crises and address the needs of conflict-affected populations—is paramount.
The demographic shift underway in the EMR presents an opportunity to reimagine ageing as a period of potential growth and productivity rather than decline. By prioritising older adults' health and social care needs, policymakers, NGOs, and academic institutions can ensure that this growing demographic is supported to live with dignity and purpose. This report, supported by the WHO and part of a broader global initiative to strengthen data and address care gaps for older persons, can be seen as a call for action to align research, policy, and community action towards creating inclusive, equitable societies that value and care for their ageing populations.
References:
Technical meeting on strengthening data on the unmet care needs of older persons: meeting report, Kobe, Japan, 10-11 June 2024. Geneva: World Health Organization; 2024. Licence: CC BY-NC-SA 3.0 IGO.
About the author: Mohamed Ismail is an Affiliate Research Fellow at the Oxford Institute of Population Ageing. His research focuses on the ageing dynamics and estimating the cost of care, particularly in the Middle East and North Africa (MENA) region.
Opinions of the blogger is their own and not endorsed by the Institute
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