May 01 2017

Global Aid for Health Leaves Older Adults Out in the Cold

Development assistance for health largely ignores older age groups, with 90 percent of the assistance going to people below the age of 60, according to a new study led by a researcher at the Robert N. Butler Columbia Aging Center, Mailman School of Public Health. Children below the age of 5 receive the mostdevelopment assistance for health. Findings from the study, “Vast Majority of Development Assistance for Health Funds Target Those Below Age Sixty,” are published online and in the May issue of the journal, Health Affairs.
 
Development assistance for health globally was $3.13 per person younger than age 60 in recipient countries, per DALY, defined as the sum of years lived with disability and years of life lost because of premature mortality. This is in contrast to $0.91 per person aged 60 and older. The gap was even higher at the extremes of the age distribution: People ages 70 and older received only $0.80 per DALY.
 
Funds earmarked for low- and middle-income countries to improve health have more than quadrupled since 1990, reaching $36.4 billion U.S. dollars in 2015.
 
The researchers used data from the Institute for Health Metrics and Evaluation’s Financing Global Health 2015 report and the Global Burden of Disease Study 2015. They examined 27 program areas that identified the cause of disease or the type of intervention targeted for the period 1990–2013. Country- and year-specific disability-adjusted life-years were calculated for each cause.
 
“Even during a period when the disease burden has shifted toward older ages,  assistance was directed increasingly to children,” said the study’s lead author, Vegard Skirbekk, PhD, of the Columbia Aging Center and professor of Population and Family Health at the Mailman School of Public Health.
 
Individuals younger than age 5 had $6.49 billion more assistance in 2013 than they had in 1990. The largest increases were for those ages 5–14 years. People in their twenties and thirties also received relatively large amounts of the spending for development assistance for health, some of it driven by HIV/AIDS funding.
 
In 2013, assistance benefited people younger than age 5 the most, with spending on this age group over three times more than any other age group. Many programs areas benefit this age group, especially assistance for child health, maternal and newborn health, and malaria. “Development assistance for health often targets diseases that occur early in life,” noted Skirbekk.
 
One driver for prioritizing younger over older populations may be that children are seen as representing the future. “Another idea is that younger people—especially children—should be given priority because they are more innocent, and that health risks and diseases that affect them are hardly due to behavior for which they could be held responsible,” observed Skirbekk.
 
Co-authors: Trygve Ottersen, Norwegian Institute of Public Health and Centre for Global Health, University of Oslo; Hannah Hamavid, Nafis Sadat, and Joseph L. Dieleman, Institute for Health Metrics and Evaluation, University of Washington.
 
The study was supported by the Robert N. Butler Columbia Aging Center at Columbia University, the Norwegian Institute of Public Health, and
Bill & Melinda Gates Foundation.