Global aid for health leaves older adults out in the cold

May 01, 2017

Development assistance for health targets 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 most development assistance for health. Findings from the study, Vast Majority of Development Assistance for Health Funds Target Those Below Age Sixty, will be 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 publicly available 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 assistance 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.

"When we compared changes in development assistance for health and DALYs from 1990 to 2013 -- a period of epidemiological and demographic change during which the disease burden shifted toward older ages--we found that 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. For example, people younger than age five had $6.49 billion more assistance in 2013 than they had in 1990. The largest increases were for people 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 the assistance benefited people younger than age five 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.

"Our results revealed that development assistance for health is likely to target 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.
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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.

Columbia University's Mailman School of Public Health

Founded in 1922, Columbia University's Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health issues affecting New Yorkers, the nation and the world. The Mailman School is the third largest recipient of NIH grants among schools of public health. Its over 450 multi-disciplinary faculty members work in more than 100 countries around the world, addressing such issues as preventing infectious and chronic diseases, environmental health, maternal and child health, health policy, climate change & health, and public health preparedness. It is a leader in public health education with over 1,300 graduate students from more than 40 nations pursuing a variety of master's and doctoral degree programs. The Mailman School is also home to numerous world-renowned research centers including ICAP (formerly the International Center for AIDS Care and Treatment Programs) and the Center for Infection and Immunity. For more information, please visit http://www.mailman.columbia.edu.

Columbia University's Mailman School of Public Health

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