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The Global Gap In Health Care Dollars For Young And Old Is Huge

The United States spends a lot of money taking care of the health needs of old people.

In 2010, for example, each person 65 and older received $18,424 in health care services. That's five times more than the $3,628 in spending per child under 18, and three times more than the $6,125 per working-age adult, according to the Centers for Medicaid and Medicare Services.

"In the developed world, people live longer with very intense disease — and costly treatment," says Vegard Skirbekk, professor at Columbia University's Aging Center.

In the developing world, some countries are making great strides in life expectancy. People in poor countries lived an average of nine years longer in 2014 than in 1990, according to WHO statistics. And while illness can strike at any age, the longer people live, the greater their risk of getting one of the big three diseases of aging — cancer, heart disease and diabetes.

But in poor countries, the money for their treatment may not be there.

A new study in the journalHealth Affairs broke down the $36.4 billion spent on health assistance from development agencies and nonprofit donors to low- and middle-income countries. Ninety percent is spent on people under the age of 60. "The lion's share of assistance is going to children," says Joseph Dieleman, professor at the Institute for Health Metrics and Evaluation at the University of Washington, Seattle, and an author of the study.

"There has always been a preference in funding for younger age groups in the developing world," says Skirbekk, lead author of the study. "In 2013, assistance benefited people younger than five the most, with spending over three times more than any other age group." The money goes for maternal and newborn health, for childhood immunizations and to fight malaria and TB in children, among other things, the report says.

That effort has paid off. Deaths of children and adolescents have been cut nearly in half, from 14.2 million in 1990 to 7.3 million in 2015.

The preference for health-care funding for children and young people makes intuitive sense. Children are the future, and it's natural to want to protect them, says Dieleman: "The social norm is to want to prevent illness in young children."

In addition to wanting to protect children, wealthy nations have a self-interest in preventing the communicable diseases children and young adults in poor countries often get. Those diseases, like TB and malaria and new emerging infectious diseases, can spread in a country's population — and from one country to another.

Authors of the report suggested other reasons that health funding focuses on the young. "Children are seen as innocent. Whereas there's a perception that diseases of older age are an outcome of lifestyle choices," says Skirbekk. "Those kinds of attitudes are quite common."

Whether it's age discrimination or the attitude that diseases of the old are their own fault, the result is a gap in care of older people in the developing world.

"Older adults are the ones that increasingly need support," Skirbekk says.

And it's not just physical health. Some mental health conditions are increasingly common as people age — Alzheimer's, dementia, depression and anxiety, the report says. Yet, those mental health conditions receive only 0.3 percent of the development money the world provides to treat disease, according to the report.

The paper and its authors take no stand on the issue of age and disease. They don't conclude that it's right for donors and poor countries to continue to spend more health care money on children and working age adults — or that more money should be allocated for the diseases of old age.

But global citizens are weighing in. Since publication of the paper this month, the authors have heard from people with strong opinions. "We've gotten emails complaining that this is horrible, it's age discrimination," says Dieleman. "We've also gotten emails saying this is as it should be, it's important to take care of children."

"The question of what should the global community fund is a complicated one and not one we addressed in this paper," says Dieleman.

Skirbekk adds, "I hope our report will stimulate discussions on just that issue."

Your Turn: What's Your Stance On Health Care Spending In The Developing World?

Children get the largest share of any age group. Is that fair when people are living longer and facing diseases of aging? Tell us what you think. Submit your perspective in the tool below. Try to keep under 100 words. We'll feature some of the comments on Goats and Soda in a special #CuriousGoat post next week.

Our submission deadline has passed. Thanks for participating! Read some of the responses we received here.

Copyright 2021 NPR. To see more, visit https://www.npr.org.

Susan Brink