By Prof. Dr. Helmut Brand
Ageing and migration are two (demographic) phenomena that profoundly shape the policy arena across sectors and governments. Whilst the first is a long-term and slowly progressing development, the latter has picked up momentum in a nearly unprecedented manner, catching many by surprise. Together, both trends pose a significant threat to the confidence European citizens have in their respective national welfare systems. This has, in turn, shaken their trust in the European Union as an institution. A paradox – considering one trend may, in the end, significantly ease the real and perceived burdens the other poses on our health and social care systems.
Demographic change, ageing populations in particular, has been a public health concern for quite some time, and thus also a concern for policy makers.
This phenomenon is propelled forward by two main factors: Declining fertility and increased longevity. The EU’s population has aged by a rate of 2.5 years each decade. What you could term a side effects is that the old age dependency ratio is expected to change considerably. At the moment, there are four persons of working age for each person of retirement age and above. However, the ratio is expected to be less than 2:1 in 2050. Arguably, we have an economic problem.
Alongside the economic questions, we have a plethora of related issues, from the decreasing labour force to higher expenditure on pensions. Many are calling into question the sustainability of our health systems – both in terms of financial and human resources.
Who is going to care for all these elderly Europeans?
A 2015 global report on long term care (LCT) protection by the International Labour Organization pointed to the scale of the problem. It stated while European countries do fare better than Asian nations the absence of formal LCT workers means that 30% of those aged 65 or older are excluded from quality services with large variations between countries. When analysing the problem, we need to take note of informal caregiving. As more and more women take on the role of household bread winner, there is a heightened demand for help with domestic tasks. Can Europe rely on migration to help fill these gaps?
Migration – between EU countries and in from other countries around the world – provide an opportunity to rejuvenate the European workforce. One of the sectors that could benefit most is the care sector. In 2011 the proportion of migrants among the paid care work force was already as high as one in four in the UK and one in two in Italy.
Of course, there are a number of important considerations when integrating migrant workers into the care workforce, particularly refugees who have suffered trauma escaping from conflict zones like Syria and Iraq. Even though there is the so-called healthy migrant effect, at least some of the recently will face a number of issues. Providing the right time and care to address mental health issues such as stress and depression, and arrange comprehensive and appropriate language and cultural integration, needs awareness and commitment from all sides.
Certainly not everyone, whether refugee or not, is suited to work in the care sector, coming down to individual dispositions. And in some cultures taking care of the elderly is a typical occupation for women and results in a complication in places where the majority of refugees are men, as is the case in Germany. Last but not least, it is important to find a way to secure both quality of care and safeguarding the rights of the caregiver, especially in the informal sector.
To use the words of a European Commission report from 2011, “Europe’s future depends to a great extent on its capacity to tap the strong potential of the two fastest growing segments in its population: older people and immigrants”. With the recent refugee crisis, this statement acquires a whole new dimension. It would be naïve to maintain that the migrant crisis is the solution and not a challenge: but there are clear opportunities arising from it. They just need to be seized.
This will be one of the key points of discussion at this year’s European Health Forum Gastein (EHFG), 28-30 September. EHFG is one of the platforms that opens up dialogue across sectors and helps tackle topics precisely like the one outlined above, sharing best practices, lessons learned, and innovative thinking in health systems and policy. I hope to see you there.
Professor Helmut Brand, President of the European Health Forum Gastein (EHFG), Jean Monnet Professor of European Public Health and head of the Department of International Health at Maastricht University, The Netherlands. He serves on the European Advisory Committee on Health Research (EACHR) of WHO Europe and on the Expert Panel on “Investing in Health” (EXPH) for the European Commission.