Health and Long-Term Living: Trends and Best Practices in Europe

The ageing process, in Italy, is a fairly recent phenomenon. Indeed in the last century, life expectancy tripled and fertility plummeted. These phenomena caused a radical change within the age structure of the Italian population, with a real overturning of the age pyramid, whereas in the past the pyramid was characterised by a wide bottom and a narrow top, nowadays the same pyramid appears to have a narrow bottom and a wide top.
The current scenario is therefore characterised by a decreasing share of younger age groups in the overall population, and an increasing share of older age groups.
The current age structure evolution is an inevitable outcome of an effective birth and death control which determined a significant increase in the elderly population, throughout these past decades. This results in Italy being, by far, one of the oldest world countries.
It is self evident that population ageing poses major challenges to society, and, these challenges can only intensify in the coming years.
Accommodating policies to face up to the multiple impacts of population ageing are urgently needed and should be multidimensional: labour market, social and health care, housing, education, social protection and pension schemes.
Currently, in the Italian statistical system, a person is considered ‘aged’ if he or she is over 65. This definition is based on economic criteria, if we consider that 65 years old is the apparent ‘threshold’ for entry into the retirement system. All the demographic ratios, referred to ageing are built up taking this threshold into account.
The debate on the population ageing process is very relevant, because it involves several aspects related to people’s lives, in terms of both economic and social life, which deserves particular attention. With regard to the economic factors, this involves consequences on saving, consumption, investments, as well as on the present debate on the tax system and pension plans. With regard to the social factors, health assistance, family composition and life conditions are at stake.
The traditional political answer to the current demographic changes of the aged population mainly concerne the pension and the health systems. However, the path of the new policy on ageing, seems more oriented toward a merging with family and housing policy.
This phenomena is international and, most of all, is ‘irreversible’ as declared by the United Nations (2002). Because of this alleged characteristic, it becomes compulsory to consider another relevant aspect about ageing: the consciousness of the process (Cagiano de Azevedo, 2003).
The radical fertility reduction together with the mean age extension, are the result of diverse rational individual choices, which reflect a more important social and cultural revolution, characterising the western countries.
In this demographic scenario, Italy, because it has one of the lowest fertility rates in the world and one of the fastest increases of survival to the oldest age, gains an ‘eccentric’ position compared to the European average (Istat, 2002).
As a matter of fact, Italian fertility has always been characterized by the lowest level compared to the other European countries, both during the highest growth from the postwar period to the mid sixties, well known as ‘baby boom’, and the decline period which lasted thirty years, and which led to the historical minimum in 1995 and in recent years when it has been marked by a rather weak fertility increase.
With regards to length of life, demographic indicators clearly show that Italy has one of the highest life expectancy rates among European countries for both genders. These two phenomena have greatly modified the Italian age structure. For a better understanding of such phenomena, the following pyramid age comparing the population in 1951 and in 2006 has been produced.

Figure 1: Age pyramid of resident population, Italy, 1951 and 2006
Source: Census data (1951, de jure population) and Resident population by age, sex and marital status on 1st January 2006.

The pyramid base is smaller as regard the 1951’s one; if in 1951 the population between ‘0’ and ‘4’ years old was respectively 9,5% and 8,7%, for males and females, to the overall population by sex, in 2006 these percentages result halved, respectively 4,9% and 4,4%.
While in 1951, the so-called ‘elderly’ (65 years and over) population amounted to 8,2% of the total population, in 2006, 8,2% of the total population was represented by the over 76s. The median age, i.e the age that divides the population into two equal halves, may be used as an indicator of population ageing. Currently (2006) the median age is 42 in Italy compared to the 1951 level of 29; this means that, in the pyramid, 13 generations result ‘made young again’ between 29 and 42 years of age, passing from the older population to the younger population during the 55 years spent; and, considering that in 2020, the median age will reach the 47 years old mark, in the next 15 years 5 generations more will be made young again.

Table 1: Summary indicators of ageing1 in Italy, 1951, 2001, 2006 and 2020
(click to enlarge)
Source: Istat, Census data (1951 and 2001, de jure population), Resident population by age, sex and marital status on 1st January 2006 and National population projection by age and sex (2020).

Through the demographic indicators it is possible to notice the imbalance between young population and adults on the one hand, and between the young and old population on the other hand.
As they clearly show, the percentage of the old population results doubled in 55 years and they also show the longevity of the female population: indeed, in this sector of population, the percentage of the old population is more significant than that of the male population (+155% for females against +122% for males).
On the other hand, while a proportion of adults was only slightly unchanged, the indicators show a drop in the young population.
A summary indicator of ageing is provided by the so-called dependency ratio. Usually two dependency ratios are distinguished; the share of the young population (below age 15) relative to the potentially active population (of 15-64) indicates what may be labelled as the ‘green pressure’. The ‘grey pressure’ gives the share of the older (65 and over) population relative to the potentially active population. Taken together, the green and the grey pressures give the overall dependency ratio, as an indicator of population pressure.
Higher green pressure is usually associated with higher costs for education; while a high grey pressure is commonly associated with high costs for health care and pensions.
In Italy, the highest overall dependency ratio is caused by the fact that it has high share of older people, as confirmed, also, by the ageing ratio; in fact, comparing the overall dependency ratio with the one related only to the grey pressure, it comes as no surprise that the grey pressure is most dominant nowadays. On the contrary in 1951 the summary indicators showed a larger green pressure, a typical case of young and growing population; the dependency ratio related to the grey pressure increased from 12,5% in 1951 to 27,8% in 2006, and is destined to triple in 2020 (36,4%).
The ageing ratio, which is the best indicator of the demographic relation between the elderly and the young, shows a great imbalance destined to increase; in 2006 there were 139,9 elderly to one hundred young people.

Cinzia Castagnaro and Raimondo Cagiano de Azevedo: Department of Demography, University of Rome ‘La Sapienza’.
1 Ageing ratio: the ratio of the elderly (the grey pressure, those 65 years and over) to the young population (under 15 years of age).
Dependency ratio: the ratio of the economically dependent part of the population to the productive part: arbitrarily defined as the ratio of the elderly (the grey pressure, those 65 years and over) plus the young (the green pressure, those under 15 years of age) to the population in the ‘working’ ages (those 15-64 years of age).
Dependency ratio (only grey pressure): the ratio of the elderly (the grey pressure, those 65 years and over) to the population in the ‘working’ ages (those 15-64 years of age).

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