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Thursday, 31 May 2012

Census 2011 - Demographic planning for public health

The voluntary census of 2011 is beginning to trickle out its results.   Bookmark the home page for direct access to information as it is being released Census 2011 data

This weeks  released on age and sex contains two bits of information for future planning.  First and to noone’s surprise, the proportion of persons over the age of 65 is continuing to grow, having reached 14.8% of the population. Good news for geriatric specialities, but perhaps not as notable as it is being made to sound.  Consider the large countries with a seniors ratio that exceeds 20%, including Japan, Germany and Italy.  Sweden, Greece, Bulgaria, Austria, Portugal, Belgium, Finland, Spain – in fact most of Europe have proportions in the upper teens.   14.8% actually puts Canada 42nd of 230 countries globally. While some of the European countries may be economically challenged, and a portion of that caused by social programming – economic prosperity is not well related to the age structure of the population.  Enlightened countries look to the ageing population as an asset, not a liability. 

Subtly in the release of the data was the other hidden gem.  The baby boomerang generation (babies of the Baby boomers) are themselves having babies.  In fact the population aged 0-4 has gone up 11% in the past 5 years. What the census doesn’t capture is that the annual birth cohort after slowly decreasing for a couple of decades has continued to expand for the past 6-7 years.   Schools continue to see decreasing student populations and will do so for about the next 7 years, but school planners should be ramping up kindergarten opportunities and elementary schools in anticipation of the surge.  Not a tsunami of kids, but certainly growth can be anticipated. (of interest will be whether the recent recession has slowed family choices on having children or the number of children per family)

From a health system perspective, it is the perfect storm converging.  The seniors population in need of services continues to grow and will do so as the Baby boomers who are now just reaching retirement years begin to expect and need increased health services, and demand is placed on the two other groups that frequently utilize health services, the expanding child population and their new mothers.  

Baby boomers have come to know and expect ready access to health services, and an analysis by cohort demonstrate that a significant proportion of growth on health service utilization is based on expectation and not on need.

Of course, in our myopic health system planners may well review this from an absolute increase requirement of the things we are already doing.  Better clarity on defining expectations, training on health service utilization, self management, and diversification of providers can mitigate the absolute numbers needed,  but are rarely incorporated into planning models and sacred cows not to be touched politically.  Megalomaniac administrators and politicians may well look at the growth opportunities that absolute demand places on the system.  So,  regrettably, expect more of the same.   

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